Perceived barriers to pre-exposure prophylaxis use and the role of syndemic factors among female sex workers in the Mexico-United States border region: a latent class analysis

ABSTRACT

Female sex workers (FSWs) experience syndemic factors (e.g., polydrug use, hazardous alcohol consumption, client-perpetrated violence, depression, and sexually transmitted infections) that often heighten vulnerability to HIV and limit healthcare utilization. We hypothesized that syndemic factors will limit FSWs’ uptake of pre-exposure prophylaxis (PrEP). From 2016 to 2017, 295 HIV-negative FSWs were enrolled in a behavioral HIV prevention trial in Tijuana and Ciudad Juarez, Mexico, underwent STI testing, and completed surveys on syndemic factors and perceived barriers to PrEP use. Syndemic scores (0–5) were calculated by summing syndemic factors. Latent class analysis (LCA) was used to identify homogeneous classes with respect to perceived barriers to PrEP use. We identified four classes: (1) perceived healthcare access barriers (8.3%), (2) perceived financial barriers (18.7%), (3) high level of perceived barriers (19.9%), and (4) low level of perceived barriers (53.0%) to PrEP use. Those experiencing three (adjusted odds ratio [aOR] = 3.63, 95% confidence interval [CI] = 1.24–10.67) and four or five (aOR = 6.30, 95% CI = 1.70–23.35) syndemic factors had a higher odds of membership in the class characterized by a high level of perceived barriers than in the class characterized by a low level of perceived barriers. Addressing syndemic factors may maximize PrEP’s impact among FSWs along Mexico’s northern border.

KEYWORDS:

• HIV
• pre-exposure prophylaxis
• latent class analysis
• syndemic theory
• female sex workers
• Mexico

Disclosure statement

The authors have no conflicts of interest to declare.

ORCID

Jennifer P. Jain http://orcid.org/0000-0002-6339-1649

Steffanie A. Strathdee http://orcid.org/0000-0002-7724-691X

Thomas L. Patterson http://orcid.org/0000-0003-2311-6164

Alicia Harvey-Vera http://orcid.org/0000-0002-8708-8169

Carlos Magis-Rodríguez http://orcid.org/0000-0001-5481-1253

Heather A. Pines http://orcid.org/0000-0002-7173-1981

Additional information

Funding

This work was supported by the National Institute on Drug Abuse (T32 DA023356; R01 DA039071; K01 DA040543) and the University of California, San Diego, Center for AIDS Research (CFAR), an NIH-funded program (P30 AI036214), which is supported by the following NIH Institutes and Centers: NIAID, NCI, NIMH, NIDA, NICHD, NHLBI, NIA, NIGMS, and NIDDK.