XVIII International AIDS Conference

Abstract

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“Over here, it's just drugs, women, and all the madness”: the HIV risk environment of clients of female sex workers in Tijuana

S. Goldenberg1,2, S. Strathdee1, M. Gallardo3, T. Rhodes4, K. Wagner1, T. Patterson5

1University of California, San Diego, Global Public Health, San Diego, United States, 2San Diego State University/University of California, San Diego, Joint Doctoral Program in Public Health, San Diego, United States, 3Patronato Pro-COMUSIDA, Tijuana, Mexico, 4London School of Hygiene and Tropical Medicine, University of London, Centre for Research on Drugs and Health Behaviour, London, United Kingdom, 5University of California, San Diego, Department of Psychiatry, San Diego, United States

Background: Tijuana - located on the Mexico-U.S. border - is experiencing an emerging HIV epidemic, especially among female sex workers (FSWs) and their clients. Little data is available on contextual factors influencing HIV risks among FSWs' clients, who represent a potential HIV transmission bridge.
Methods: Using in-depth qualitative interviews (n=30) conducted in 2008 in Tijuana's regulated Zona Roja (red light district), we describe the HIV risk environment of FSWs' clients. Codes were inductively derived and analyzed using the HIV “risk environment” framework.
Results: Clients identified the following aspects of their HIV risk environment as associated with frequent and sometimes unprotected sex with FSWs: (1) Social isolation and a search for intimacy, which were often linked to deportation from the U.S.; (2) Risky behaviors and lifestyles attributed to the Zona Roja as a risky place; (3) Established social relationships between FSWs and clients; and (4) Economic roles embedded within the neighborhood's sex and drug trades (e.g., jaladores (middlemen), drug dealers). Clients' risks appeared deeply embedded in local context, characterized by the interplay of structural forces and individual agency. For example, some jaladores attributed an increased likelihood of unprotected sex with FSWs to their economic roles, while others described their occupation as protective (e.g., by knowing the extent of unprotected sex between FSWs and clients).
Conclusions: Client-focused interventions have the potential to address the role that clients play in negotiating safer sex, complementing interventions among FSWs. Our findings suggest the need for tailored interventions that (1) harness the potential of existing coping strategies and protective behaviors among clients, and (2) address the circumstances contributing to risks at multiple levels (i.e., structural; individual) and across sectors. Suggestions for prevention programs include providing social, economic, and health services to deportees; jalador-led peer education and condom distribution; and interventions that stress consistent condom use within established FSW-client relationships.


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