'It's the devil you know or the devil you don't': structural drivers of HIV infection among female sex workers who inject drugs
S.A. Strathdee1, H. Staines-Orozco2, R. Lozada3, A. Vera1, G. Martinez2, R. Melanie1, L. Nguyen1, R.A. Pollini1, F. Uribe-Salas4, T.L. Patterson5
1University of California at San Diego, Medicine, La Jolla, United States, 2Universidad Autonoma de Ciudad Juarez, Medicine, Ciudad Juarez, Mexico, 3Prevencasa A.C., Tijuana, Mexico, 4El Colegio de la Frontera Norte, Tijuana, Mexico, 5University of California at San Diego, Psychiatry, La Jolla, United States
Background: FSWs who inject drugs (FSW-IDUs) may be vulnerable to HIV through high risk sexual and injection behaviors. We studied correlates of HIV infection among FSW-IDUs in northern Mexico, where sex work is quasi-legal and syringes can be legally purchased and carried without a prescription.
Methods: FSW-IDUs ≥18 years old who reported injecting drugs and recent unprotected sex with clients participated in an ongoing behavioral intervention in Tijuana and Ciudad Juarez. At baseline, participants underwent surveys and biological testing for HIV and other sexually transmitted infections (STIs). Logistic regression was used to identify correlates of HIV infection.
Results: To date, of 512 FSW-IDUs (269 from Tijuana, 243 from Ciudad Juarez), median age and duration in sex work were 33 and 11 years, respectively. Prevalence of HIV, gonorrhea, Chlamydia, trichomonas, bacterial vaginosis, syphilis titers ≥1:8, or any STI (including HIV) was 6.3%, 3.9%, 13.5%, 37.1%, 41.2%, 13.5% and 73.1%, respectively. Compared to other women, HIV-positive women were more likely to have syphilis titers ≥1:8 (40.0% vs. 11.6%, p< .001), report often/always injecting drugs with clients (56.3% vs. 31.3%, p=0.006), and report that police confiscated their syringes (50.0% vs. 28.2%, p=0.012) in exchange for not arresting them in the last 6 months. Factors independently associated with HIV infection were often/always injecting drugs with clients (AdjOR: 2.82; p=0.005) and police confiscation of syringes (AdjOR: 2.55; p=0.011).
Conclusions: Structural factors predominate as drivers of HIV infection among FSW-IDUs in these cities, indicating the need to intervene upon the HIV risk environment. Although the association between syringe confiscation and HIV infection may not be causal, the fact that HIV-positive women are more likely to have their syringes confiscated may increase their likelihood of syringe sharing. Interventions to address these unjustified arrests and address risk behaviors with clients should be pursued as strategies to reduce HIV risk.
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