location: how important are venue-based HIV risks among clients of female sex
S. Goldenberg1,2, S. Strathdee1, L. Nguyen1, M. Gallardo3, S. Semple4, T. Patterson4
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, 4University of California, San Diego, Department of Psychiatry, San Diego, United States
Background: Tijuana, Mexico, is
experiencing an emerging HIV epidemic. Sex work regulations in Tijuana's red
light district require female sex workers(FSWs) to undergo routine STI/HIV testing to maintain a
permit. Clients meet FSWs predominantly in bars/clubs and on the street. We
used a mixed methods approach to study venue-based HIV risks among FSWs'
Methods: In 2008, 400 males ≥ 18 years
old who paid/traded for sex with a FSW in Tijuana in the past 4 months completed surveys and
HIV/STI testing. A sub-sample (n=30) completed qualitative interviews. Logistic
regression compared the risk profile of clients who meet FSWs in bars/clubs
versus those who meet FSWs elsewhere; findings were triangulated with clients' qualitative
descriptions of venue-based HIV risks.
Results: Of 399 clients, 75.4% recently met a FSW at a
bar/club and the remainder met FSWs only in other venues (e.g., street). Clients
who met FSWs in bars were more likely to report recent unprotected sex with a
FSW (55.1% vs. 35.1%), a wife/steady partner (40.9% vs. 28.6%), offering higher
pay for unprotected sex (19.6% vs. 8.2%), and binge drinking (44.9% vs. 17.3%).
Clients who met FSWs at bars were more likely than their counterparts to report
offering FSWs more money for unprotected sex (AOR: 2.65, p=0.02), binge
drinking (AOR: 4.13, p< 0.0001), and more years of education (AOR: 1.14, p=0.0004).
Clients described the following bar-based risks: (1) Heavy alcohol consumption impairs
judgment; (2) Bar-based FSWs accept higher pay for unprotected sex; and (3) Unprotected
sex is more likely with bar-based FSWs, who experience less regulatory
enforcement than street-based FSWs.
Conclusions: By identifying venue-based risks and grounding
these in clients' perspectives, we used mixed methods to identify and develop
an understanding of promising intervention targets. Bar-based strategies to
increase condom use should address alcohol use and clients' offers of increased
pay for unprotected sex.
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