An exploration of contextual factors that influence HIV risk in female sex workers in Mexico: The Social Ecological Model applied to HIV risk behaviors

Abstract

The present study examined the applicability of the Social Ecological Model for explaining condom use in a sample of female sex workers (FSWs) (N=435) participating in a behavioral intervention to increase condom use in Tijuana, Mexico. Using a multigroup path analysis, we compared women who work in bar settings (n=233) to those who worked on the street (n=202) with regard to an individual factor (self-efficacy), an interpersonal factor (client financial incentives), and a structural factor (condom access). Competing models showed differential impacts of these factors in the two venue-based groups. Having access to condoms was associated with greater self-efficacy and less unprotected sex in women who worked in bars. Among street-based FSWs, having clients offer monetary incentives for unprotected sex was related to greater unprotected sex, while having access to condoms was not. Understanding the contextual factors associated with condom use among subgroups of FSWs has important implications for the development of HIV prevention interventions.

Keywords:

• sex workers
• condom use
• Mexico
• HIV risk
• Social Ecological Model

Acknowledgements

The intervention study on which this article based was funded by the National Institutes of Mental Health, grant no. R01 MH65849 (“Behavioral intervention for high-risk women in Mexico,” T.L. Patterson, P.I.). Dr. Larios’ doctoral studies were partly funded by a minority fellowship from the American Psychological Association. Dr. Strathdee's work with FSW drug users in Tijuana is funded by National Institute of Drug Abuse, grant no. ROI DA023877.