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Correlates of Unprotected Sex With Female Sex Workers Among Male Clients in Tijuana, Mexico

Goldenberg, Shira M. MSC*†; Gallardo Cruz, Manuel MD; Strathdee, Steffanie A. PHD*; Nguyen, Lucie MS*; Semple, Shirley J. PHD§¶; Patterson, Thomas L. PHD§¶

Sexually Transmitted Diseases: May 2010 - Volume 37 - Issue 5 - p 319-324
doi: 10.1097/OLQ.0b013e3181c5334f
Original Study

Background: Tijuana, situated adjacent to San Diego, CA on the US-Mexico border, is experiencing an emerging HIV epidemic, with prevalence among female sex workers (FSWs) having risen in recent years from <1% to 6%. Comparable data on FSWs' clients are lacking. We explored correlates of unprotected sex with FSWs among male clients in Tijuana.

Methods: In 2008, males from San Diego (N = 189) and Tijuana (N = 211) aged 18 or older 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. Participants underwent psychosocial interviews, and were tested for HIV, syphilis (Treponema pallidum), gonorrhea (Neisseria gonorrhoeae), and Chlamydia (Chlamydia trachomatis).

Results: Of 394 men, median age was 36 years, 42.1% were married, and 39.3% were unemployed. Ethnic composition was 13.2% white, 79.4% Hispanic, and 7.4% black or other. Half (50.3%) reported unprotected vaginal or anal sex with FSWs in Tijuana in the past 4 months. High proportions reported using drugs during sex (66%), and 36% reported frequenting the same FSW. Factors independently associated with unprotected sex with FSWs were using drugs during sex, visiting the same FSW, being married, and being unemployed.

Conclusions: FSWs' clients represent a sexually transmitted infections/HIV transmission “bridge” through unprotected sex with FSWs, wives, and other partners. Tailored interventions to promote consistent condom use are needed for clients, especially within the context of drug use and ongoing relations with particular FSWs.

A study in Tijuana, Mexico found that male clients of female sex workers represent a transmission “bridge” for sexually transmitted infections/HIV through frequent unprotected sex with female sex workers, spouses, and other partners.

From the *Division of Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, CA; †Joint Doctoral Program in Public Health, San Diego State University and University of California San Diego, San Diego, CA; ‡Instituto de Servicios Estatales de Salud Pública, Baja California, Mexico; §Department of Psychiatry, University of California, San Diego, La Jolla, CA; and ¶MIRECC, VA Medical Center, San Diego, CA

Supported by the UCSD Center for AIDS Research with funds from NIH P30AI036214 and an administrative supplement to NIH R01DA23877–01A1S1.

The content is the responsibility solely of the authors and does not necessarily represent the official views of the National Institute of Allergy and Infectious Diseases, the National Institute on Drug Abuse, or the National Institutes of Health.

Correspondence: Thomas L. Patterson, PhD, University of California, San Diego, Dept. of Psychiatry 0680, 9500 Gilman Drive, La Jolla, CA 92093–0680. E-mail:

Received for publication June 18, 2009, and accepted October 8, 2009.

© Copyright 2010 American Sexually Transmitted Diseases Association