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. Patterson1,2, M. Gallardo3, S. Goldenberg4, I. Artamonova4, S.J. Semple1, A. Robertson4, S.A. Strathdee4
1University 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.
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