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Correlates of HIV, sexually transmitted infections, and associated high-risk behaviors among male clients of female sex workers in Tijuana, Mexico

Patterson, Thomas La,b; Goldenberg, Shirac; Gallardo, Manueld; Lozada, Remediosd; Semple, Shirley Je; Orozovich, Priscie; Abramovitz, Danielae; Strathdee, Steffanie Af

doi: 10.1097/QAD.0b013e32832f08a1
Epidemiology and social

Objectives: To determine sociodemographic and behavioral correlates of HIV infection among male clients of female sex workers (FSWs) in Tijuana.

Methods: Four hundred men aged 18 years or older who had paid or traded for sex with a FSW in Tijuana during the past 4 months were recruited in Tijuana's ‘zone of tolerance,’ where prostitution is practiced openly under a municipal permit system. Efforts were made to balance the sample between residents of the United States (San Diego County) and of Mexico (Tijuana). Participants underwent interviews and testing for HIV, syphilis, gonorrhea, and Chlamydia. Logistic regression identified correlates of HIV infection.

Results: Mean age was 36.6 years. One-quarter had injected drugs within the previous 4 months. Lifetime use of heroin, cocaine, and methamphetamine was 36, 50, and 64%, respectively. Men had frequented FSWs for an average of 11 years, visiting FSWs an average of 26 times last year. In the past 4 months, one-half reported having unprotected sex with a FSW; 46% reported being high fairly or very often when having sex with a FSW. Prevalence of HIV, syphilis, gonorrhea, and Chlamydia was 4, 2, 2.5, and 7.5%; 14.2% were positive for at least one infection. Factors independently associated with HIV infection were living in Mexico, ever using methamphetamine, living alone, and testing positive for syphilis.

Conclusion: Male clients of FSWs in Tijuana had a high sex and drug risk profile. Although sexually transmitted infection prevalence was lower than among FSWs, HIV prevalence was comparable suggesting the need for interventions among clients to prevent spread of HIV and sexually transmitted infections.

aDepartment of Psychiatry, University of California, USA

bMental Illness Research, Education, and Clinical Care Program (MIRECC), San Diego Veterans Administration Healthcare System, USA

cJoint Doctoral Program in Public Health, San Diego State University and University of California, San Diego, California, USA

dPatronato Pro-COMUSIDA, Tijuana, Mexico

eDepartment of Psychiatry, USA

fDivision of Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, California, USA.

Received 8 May, 2009

Revised 3 June, 2009

Accepted 4 June, 2009

Correspondence to Professor Thomas L. Patterson, PhD, Department of Psychiatry, University of California, 9500 Gilman Drive, La Jolla, CA 92093-0680, USA. Tel: +1 858 534 3354; fax: +1 858 534 7723; e-mail:

© 2009 Lippincott Williams & Wilkins, Inc.