Prevalence and Correlates of HIV and Sexually Transmitted Infections among Female Sex Workers and Their Non-commercial Male Partners in Two Mexico-USA Border Cities

Abstract

Female sex workers (FSWs) acquire HIVand other sexually transmitted infections (STIs) through unprotected sex with commercial and non-commercial (intimate) male partners. Little research has focused on FSWs' intimate relationships, within which condom use is rare. We sought to determine the prevalence and correlates of HIV/STIs within FSWs' intimate relationships in Northern Mexico. From 2010 to 2011, we conducted a crosssectional survey of FSWs and their non-commercial male partners in Tijuana and Ciudad Juárez, Mexico. Eligible FSWs and their verified male partners were aged ≥18 years; FSWs reported lifetime use of heroin, cocaine, crack, or methamphetamine and recently exchanged sex (past month). Participants completed baseline questionnaires and testing for HIV, chlamydia, gonorrhea, and syphilis. We determined the prevalence and correlates of individuals' HIV/STI positivity using bivariate probit regression. Among 212 couples (n=424), prevalence of HIV was 2.6 % (n=11). Forty-two (9.9 %) tested positive for any HIV/STIs, which was more prevalent among women than men (12.7 % vs. 7.1 %, pG0.05). FSWs with regular sex work clients were less likely to test positive for HIV/STIs than those without regular clients. Similarly, male partners of FSWs who had regular clients were 9 % less likely to have HIV/STIs. Higher sexual decision-making power was protective against HIV/STIs for women. Men who recently used methamphetamine or reported perpetrating any conflict within steady relationships were more likely to test positive for HIV/STIs. Within FSWs' intimate relationships in two Mexican-US border cities, nearly one in ten partners tested positive for HIV/STIs. Couple-based prevention interventions should recognize how intimate relationship factors and social contexts influence HIV/STI vulnerability.

Rethinking risk: Gender and injection drug-related HIV risk among female sex workers and their non-commercial partners along the Mexico–U.S. border

“…As evidenced by our HIV/STI data in which women have higher prevalence compared to men (Robertson, et al, in press ), women in this context are clearly vulnerable to health harms despite higher levels of agency and autonomy as compared with women in more repressive sociocultural contexts. However, we argue that these risks are shaped by more complicated processes than what traditional gender norms would imply and that prevention programs must be sensitive to relationship characteristics as they are embedded within dynamic local realities.…”

“…Injection drug use was not associated with infection, but HIV/STI prevalence was higher among women than men (12.7%vs. 7.1%, p =0.05) (Robertson, et al in press ). A separate analysis found that the social and behavioral profiles of male partners who injected drugs were riskier than men who did not inject.…”

STI/HIV test result disclosure between female sex workers and their primary, non-commercial male partners in two Mexico-US border cities: a prospective study

“…To date, Proyecto Parejas findings suggest that STI/HIV prevalence may be lower among FSWs with primary, non-commercial male partners (HIV=3.8%, gonorrhoea=0.9%, chlamydia=7.5% and active syphilis=1.4%) than previously reported for FSWs overall, and even lower among their primary male partners (HIV=1.4%, gonorrhoea=1.4%, chlamydia=4.3% and active syphilis=1.4%) 14. However, elevated rates of STI/HIV-related risk behaviours were observed within this cohort 14.…”

“…However, elevated rates of STI/HIV-related risk behaviours were observed within this cohort 14. For example, at baseline, 64% of FSWs reported always having unprotected sex with their primary male partners (past month) 15.…”

Preventing HIV Transmission Among Partners of HIV-Positive Male Sex Workers in Mexico City: A Modeling Study

“…In general, elevated risk for HIV acquisition among male sex workers has been associated with multiple sexual partners and inconsistent condom use with clients (16–24). It has also been shown that among female sex workers’ non-commercial partners in two Mexican cities, nearly one in ten tested positive for HIV/STIs (25). …”