Correlates of unprotected sex with male clients among female sex workers in 13 Mexican cities

ABSTRACT

This study examined correlates of unprotected vaginal and anal sex (UVA) with male clients among female sex workers (FSWs). Baseline data were gathered from 1089 FSWs recruited from 13 cities across Mexico enrolled in an evidence-based sexual risk reduction intervention. We used generalised estimating equations (GEE) to predict total UVA while controlling for the nested structure of the data. Total UVA with clients in the past month was examined in relation to selected sociodemographic, substance-use, and micro- and macro-environmental factors. A greater number of UVA acts was associated with three micro-level environmental factors (i.e. never getting condoms for free, unaffordability of condoms, greater number of clients per month), and three macro-level environmental factors (i.e. lower health and higher education indices, greater population size of city). These findings suggest the development of social and structural approaches to HIV prevention for FSWs in Mexico, including modification of venue-based policies that pressure FSWs to maximise client volume, changes to the work environment that promote availability and affordability of condoms, and improved population health. Moreover, our findings call for the development of context-specific HIV interventions that take into account variations in the sexual risk behaviours and HIV risk environments of FSWs throughout Mexico.

KEYWORDS:

• Female sex workers
• Mexico
• sex work environment
• sexual risk behaviour
• substance use

Acknowledgments

The authors would like to thank the administration and field staff of Mexfam for their participation in the study, and Brian R. Kelly for his assistance with editing the manuscript.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

The hybrid type-2 implementation study whose data were used for these analyses was supported by the National Institute of Mental Health [grant number R01 MH087054-01A1]. Support was also provided by the National Institute on Drug Abuse under a Career Development Award [grant number K01 DA036447-01].