XVIII International AIDS Conference


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Deconstructing the HIV transmission bridge: which male clients are having unprotected sex with female sex workers and with their wives?

Presented by Thomas L. Patterson (United States).

T.L. Patterson1,2, M. Gallardo3, C. Anderson4, S.J. Semple1, S. Goldenberg4, 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: Studies of male clients of female sex workers (FSWs) are sparse. We studied clients having unprotected sex with FSWs and with their regular partners in order to gain insights into interventions focusing on bridging behaviors.
Methods: Men aged ≥18 years from the U.S. or Mexico who recently paid or traded for sex with FSWs were recruited in Tijuana's Zona Roja in 2008-2009. Participants underwent interviews and rapid testing for HIV and STIs. Logistic regression compared clients having unprotected sex with FSWs and their wives/steady partners (“bridgers”) with those who did not.
Results: Of 383 men, 134 (35.0%) had wives/steady partners; half (52.2%) of those men were bridgers. Prevalence of HIV and STIs was 2.3% and 16.5%, respectively. Median age was 36; 56.7% were from the U.S.; 84.3% were Hispanic; and median visits to FSWs last year was 8.5. Bridgers were more likely than other clients to report using drugs during sex with FSWs (81.4% vs. 46.9%, p< 0.0001) or that their FSW partners did (73.5% vs. 42.2%, p< 0.001). Bridgers also had higher sensation-seeking (p< 0.0001) and misogyny (p=0.01) scores, and offered FSWs more money for unprotected sex more often (34.4% vs. 1.6%, p< 0.0001). Factors independently associated with bridging were: using drugs during sex with FSWs (AdjOR: 3.4, p=0.007), sensation-seeking (AdjOR: 4.3 per one unit increase, p=0.01), and offering FSWs more money for unprotected sex (AdjOR: 24.5, p=0.003).
Conclusions: Bridgers place themselves and multiple sex partners at high risk of HIV/STIs. Sensation-seeking clients who use drugs during sex and coerce FSWs into unprotected sex may be more tolerant of risks that others find unacceptable, suggesting that they may be less responsive to standard risk-reduction interventions. Researchers should develop individual-level and structural interventions for FSWs' clients rather than rely on FSWs to change behaviors that may not be under their complete control.

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