Abstract

Sex under the influence: HIV risks among male clients frequenting female sex workers in Tijuana, Mexico when one or both partners are high during sex

T.L. Patterson^1,2, M. Gallardo³, S. Goldenberg⁴, I. Artamonova⁴, S.J. Semple¹, A. Robertson⁴, S.A. Strathdee<sup>4

1</sup>University of California San Diego, Psychiatry, La Jolla, United States, ²Veterans' Affairs Medical Center, La Jolla, United States, ³CAPASITS (Centros Ambulatorios de Prevención y Atención en SIDA e ITS), Tijuana, Mexico, ⁴University of California, San Diego, Division of Global Public Health, Medicine, La Jolla, United States

Background: Tijuana, adjacent to San Diego, CA on the US-Mexico border, is experiencing emerging epidemics of HIV and drug use. HIV prevalence among female sex workers (FSWs) and male clients is 6% and 4%, respectively. We explored HIV risks associated with commercial sex transactions in Tijuana when one or both partners were high.
Methods: In 2008, males aged >=18 years who had paid or traded for sex with a FSW in Tijuana during the past 4 months were recruited in Tijuana's red light district. Men underwent interviews and rapid testing for HIV, syphilis, gonorrhea, and Chlamydia. Using multinomial logistic regression, HIV risk patterns were assessed among three groups: when both, either or neither the client and the FSW were high on drugs during sex.
Results: Of 387 men (53% from Mexico; 47% from the U.S), median age was 37, 80% were Hispanic, and 43% were married/common-law. Most (52%) reported that both they and the FSW were high during sex; 20% reported that either was. Compared to those where neither was high, men reporting that both parties were high were more likely to be bisexual (AdjOR: 3.1; 95%CI: 1.01-9.44) and to have unprotected sex (AdjOR: 3.34; 95%CI: 1.89-5.89), higher sensation-seeking scores (p=0.005), lower self-esteem scores (p=0.001), and more friends who visited FSWs (p=0.05). None of these variables differed significantly between those reporting that either party was high during sex compared to parties where neither was high.
Conclusions: A high percentage of commercial sex transactions in Tijuana occurs when one or both partners are high on drugs, a situation that is closely associated with unprotected sex. Harm reduction interventions should be developed to promote safer sex negotiation in the context of sexual transactions and accompanying drug use. Ensuring that at least one partner abstains from drug use appears to confer some protection from risk.