RESUMO
OBJECTIVE: To describe intravaginal practices (IVPs) among female sex workers (FSWs) who inject drugs in two cities-Tijuana and Ciudad Juarez-on the border between the USA and Mexico. METHODS: Data for a secondary analysis were obtained from interviews conducted as part of a randomized controlled trial in FSWs who injected drugs between October 28, 2008, and May 31, 2010. Eligible individuals were aged at least 18years and reported sharing injection equipment and having unprotected sex with clients in the previous month. Descriptive statistics were used to assess frequency and type of IVPs. Logistic regression was used to assess correlates of IVPs. RESULTS: Among 529 FSWs who completed both surveys, 229 (43.3%) had performed IVPs in the previous 6months. Factors independently associated with IVPs were reporting any sexually transmitted infection in the previous 6months (adjusted odds ratio [aOR] 1.8, 95% confidence interval [CI] 1.1-3.1; P=0.03), three or more pregnancies (aOR 1.9, 95% CI 1.1-3.2; P=0.02), and having clients who became violent when proposing condom use (aOR 5.8, 95% CI 1.0-34.3; P=0.05), which are all factors related to inconsistent condom use. CONCLUSION: Screening for IVPs could help to identify FSW at increased risk of HIV, and facilitate conversations about specific risk-reduction methods.
Assuntos
Usuários de Drogas/estatística & dados numéricos , Infecções por HIV/prevenção & controle , Profissionais do Sexo/estatística & dados numéricos , Infecções Sexualmente Transmissíveis/prevenção & controle , Sexo sem Proteção/estatística & dados numéricos , Ducha Vaginal/estatística & dados numéricos , Adulto , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , México , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Fatores de Risco , Assunção de Riscos , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Although most people who inject drugs (PWID) in Tijuana, Mexico, primarily inject heroin, injection and non-injection use of methamphetamine and cocaine is common. We examined patterns of polydrug use among heroin injectors to inform prevention and treatment of drug use and its health and social consequences. METHODS: Participants were PWID residing in Tijuana, aged ≥18 years who reported heroin injection in the past six months and were recruited through respondent-driven sampling (n = 1,025). Latent class analysis was conducted to assign individuals to classes on a probabilistic basis, using four indicators of past six-month polydrug and polyroute use: cocaine injecting, cocaine smoking or snorting, methamphetamine injecting, and methamphetamine smoking or snorting. Latent class membership was regressed onto covariates in a multinomial logistic regression. RESULTS: Latent class analyses testing 1, 2, 3, and 4 classes were fit, with the 3-class solution fitting best. Class 1 was defined by predominantly heroin use (50.2%, n = 515); class 2 by methamphetamine and heroin use (43.7%, n = 448), and class 3 by methamphetamine, cocaine, and heroin use (6.0%, n = 62). Bivariate and multivariate analyses indicated a group of methamphetamine and cocaine users that exhibited higher-risk sexual practices and lower heroin injecting frequency, and a group of methamphetamine users who were younger and more likely to be female. CONCLUSIONS: Discrete subtypes of heroin PWID were identified based on methamphetamine and cocaine use patterns. These findings have identified subtypes of heroin injectors who require more tailored interventions to reduce the health and social harms of injecting drug use.
Assuntos
Usuários de Drogas/estatística & dados numéricos , Dependência de Heroína/epidemiologia , Abuso de Substâncias por Via Intravenosa/epidemiologia , Adulto , Cocaína/administração & dosagem , Feminino , Infecções por HIV/epidemiologia , Dependência de Heroína/classificação , Humanos , Modelos Logísticos , Masculino , Metanfetamina/administração & dosagem , México , Fatores de Risco , Assunção de Riscos , Distribuição por Sexo , Abuso de Substâncias por Via Intravenosa/classificação , Sexo sem Proteção/estatística & dados numéricos , Adulto JovemRESUMO
Injection drug-using men from the US and Mexico who purchase sex in Tijuana, Mexico are at risk for transmitting HIV to their contacts in both countries via syringe sharing. We used social network methods to understand whether place of residence (US vs. Mexico) moderated the effect of emotional closeness on syringe sharing. We interviewed 199 drug-using men who reported paying/trading for sex in Tijuana, Mexico using an epidemiological and social network survey and collected samples for HIV/STI testing. Seventy-two men reported using injection drugs with 272 network contacts. Emotional closeness was strongly associated with syringe sharing in relationship where the partner lives in the US, while the relationship between emotional closeness and syringe sharing was considerably less strong in dyads where the partner lives in Mexico. Efforts to reduce HIV risk behaviors in emotionally close relationships are needed, and could benefit from tailoring to the environmental context of the relationship.
Assuntos
Usuários de Drogas/psicologia , Infecções por HIV/transmissão , Uso Comum de Agulhas e Seringas/psicologia , Características de Residência , Profissionais do Sexo , Parceiros Sexuais , Abuso de Substâncias por Via Intravenosa/psicologia , Seringas , Adulto , Infecções por HIV/epidemiologia , Humanos , Relações Interpessoais , Entrevistas como Assunto , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Uso Comum de Agulhas e Seringas/estatística & dados numéricos , Rede Social , Abuso de Substâncias por Via Intravenosa/complicações , Abuso de Substâncias por Via Intravenosa/epidemiologia , Inquéritos e Questionários , Estados Unidos/epidemiologiaRESUMO
Given that syphilis is associated with HIV infection among people who inject drugs (PWID), we examined syphilis incidence among PWID in Tijuana, Mexico. From 2006 to 2007, 940 PWID (142 women and 798 men) were recruited via respondent-driven sampling and followed for 18 months. At semi-annual visits, participants were tested for syphilis and completed surveys, which collected information on socio-demographics, sexual behaviours, substance use and injection behaviours. Poisson regression was used to estimate syphilis incidence rates (IRs), incidence rate ratios (IRRs) and 95% confidence intervals (CIs). Twenty-one participants acquired syphilis during follow-up (IR = 1.57 per 100 person-years, 95% CI: 1.02-2.41). In a multivariate analysis, syphilis incidence was higher among women (IRR = 3.90, 95% CI: 1.37-11.09), HIV-positive participants (IRR = 4.60, 95% CI: 1.58-13.39) and those who reported ever exchanging sex for drugs, money, or other goods (IRR = 2.74, 95% CI: 0.97-7.76), while syphilis incidence was lower among those living in Tijuana for a longer duration (IRR = 0.95 per year, 95% CI: 0.91-1.00) and those reporting at least daily injection drug use (past 6 months) (IRR = 0.22, 95% CI: 0.09-0.54). Our findings suggest interventions that address the destabilising conditions associated with migration and integrate sexual and drug-related risk reduction strategies may help reduce syphilis incidence among PWID along the Mexico-US border.
Assuntos
Usuários de Drogas/estatística & dados numéricos , Comportamento Sexual/estatística & dados numéricos , Abuso de Substâncias por Via Intravenosa/epidemiologia , Sífilis/epidemiologia , Feminino , Seguimentos , Infecções por HIV/epidemiologia , Infecções por HIV/transmissão , Humanos , Incidência , Modelos Logísticos , Masculino , México/epidemiologia , Análise Multivariada , Uso Comum de Agulhas e Seringas/estatística & dados numéricos , Fatores de Risco , Comportamento de Redução do Risco , Assunção de Riscos , Comportamento Sexual/psicologia , Abuso de Substâncias por Via Intravenosa/complicações , Inquéritos e Questionários , Sífilis/diagnóstico , Sífilis/transmissão , Sexo sem Proteção/estatística & dados numéricos , Adulto JovemRESUMO
AIMS: Risk environment factors may influence unprotected sex between female sex workers who are also injection drug users (FSW-IDUs) and their regular and non-regular clients differently. Our objective is to identify correlates of unprotected vaginal sex in the context of client type. METHODS: A cross-sectional survey of 583 FSW-IDUs in Tijuana and Ciudad Juarez, Mexico, was analyzed using negative binomial regression to determine physical, social, economic, and policy risk-environment factors that affect the frequency of unprotected sex with regular and non-regular clients. RESULTS: Median number of unprotected vaginal sex acts in the past month among FSW-IDUs and their regular and non-regular clients was 11 (IQR 3-30) and 13 (IQR 5-30), respectively. Correlates differed by site and client type and were most closely associated with the risk environment. In Tijuana, social factors (e.g., injecting drugs with clients) were independently associated with more unprotected sex. Factors independently associated with less unprotected sex across client type and site included social and economic risk environment factors (e.g., receiving more money for unprotected sex). In the policy risk environment, always having free access to condoms was independently associated with less unprotected sex among non-regular clients in Tijuana (Risk rate ratio = 0.64; 95% confidence interval 0.43-0.97). CONCLUSIONS: Primarily physical, social, and economic risk-environment factors were associated with unprotected vaginal sex between FSW-IDUs and both client types, suggesting potential avenues for intervention.
RESUMO
In Tijuana, Mexico, sex work is regulated by the municipal government, through registration cards issued to female sex workers (FSWs) for an annual fee. Registration has been associated with decreased drug use and increase condom use and HIV testing. Previously, it was demonstrated that FSWs operating in bars were more likely than street-based FSWs to be registered. This implies that certain venues may be more accessible to local authorities for the enforcement of this type of programme. Taking a novel multilevel approach, we examined whether venue characteristics of bars reflecting greater organised management and visibility affect registration status of FSWs. In an analysis of venue-level characteristics, predictors of being registered were availability of free condoms at work and distance to the main sex strip; however, these were not independently associated after inclusion of FSWs' income, illicit drug use and history of HIV testing. Our findings suggest that sex work regulations may inadvertently exclude venues in which the more vulnerable and less visible FSWs, such as injection drug users and those with limited financial resources, are situated. Efforts to revise or reconsider sex work regulations to ensure that they best promote FSWs' health, human and labour rights are recommended.
Assuntos
Fidelidade a Diretrizes , Promoção da Saúde/legislação & jurisprudência , Sistema de Registros , Trabalho Sexual/legislação & jurisprudência , Local de Trabalho , Adulto , Preservativos/estatística & dados numéricos , Feminino , Regulamentação Governamental , Infecções por HIV/prevenção & controle , Humanos , Modelos Logísticos , México , Análise Multivariada , Estudos Retrospectivos , Infecções Sexualmente Transmissíveis/prevenção & controle , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Populações VulneráveisAssuntos
Características de Residência/estatística & dados numéricos , Profissionais do Sexo/estatística & dados numéricos , Infecções Sexualmente Transmissíveis/epidemiologia , Infecções por Chlamydia/epidemiologia , Gonorreia/epidemiologia , Infecções por HIV/epidemiologia , Humanos , México/epidemiologia , Estudos Soroepidemiológicos , Abuso de Substâncias por Via Intravenosa/epidemiologia , Sífilis/epidemiologiaRESUMO
The northwest border city of Tijuana is Mexico's fifth largest and is experiencing burgeoning drug use and human immunodeficiency virus (HIV) epidemics. Since local geography influences disease risk, we explored the spatial distribution of HIV among injection drug users (IDUs). From 2006-2007, 1056 IDUs were recruited using respondent-driven sampling, and then followed for eighteen months. Participants underwent semi-annual surveys, mapping, and testing for HIV, tuberculosis, and syphilis. Using Average Nearest Neighbor and Getis-Ord Gi* statistics, locations where participants lived, worked, bought and injected drugs were compared with HIV status and environmental and behavioral factors. Median age was thirty-seven years; 85 percent were male. Females had higher HIV prevalence than males (10.2 percent vs. 3.4 percent; p=0.001). HIV cases at baseline (n=47) most strongly clustered by drug injection sites (Z-Score -6.173; p < 0.001), with a 16 km2 hotspot near the Mexico/U.S. border, encompassing the red-light district. Spatial correlates of HIV included syphilis infection, female gender, younger age, increased hours on the street per day, and higher number of injection partners. Almost all HIV seroconverters injected within a 2.5 block radius of each other immediately prior to seroconversion. Only history of syphilis infection and female gender were strongly associated with HIV in the area where incident cases injected. Directional trends suggested a largely static epidemic until July-December 2008, when HIV spread to the southeast, possibly related to intensified violence and policing that spiked in the latter half of 2008. While clustering allows for targeting interventions, the dynamic nature of epidemics suggests the importance of mobile treatment and harm reduction programs.
RESUMO
BACKGROUND: FSWs who inject drugs (FSW-IDUs) can acquire HIV through high risk sexual and injection behaviors. We studied correlates of HIV infection among FSW-IDUs in northern Mexico, where sex work is quasi-legal and syringes can be legally obtained without a prescription. METHODS: FSW-IDUs>18 years old who reported injecting drugs and recent unprotected sex with clients in Tijuana and Ciudad Juarez underwent surveys and HIV/STI testing. Logistic regression identified correlates of HIV infection. RESULTS: Of 620 FSW-IDUs, prevalence of HIV, gonorrhea, Chlamydia, trichomonas, syphilis titers ≥1:8, or any of these infections was 5.3%, 4%, 13%, 35%, 10% and 72%, respectively. Compared to other FSW-IDUs, HIV-positive women were more likely to: have syphilis titers ≥1:8 (36% vs. 9%, p<0.001), often/always inject drugs with clients (55% vs. 32%, pâ=â0.01), and experience confiscation of syringes by police (49% vs. 28%, pâ=â0.02). Factors independently associated with HIV infection were syphilis titers ≥1:8, often/always injecting with clients and police confiscation of syringes. Women who obtained syringes from NEPs (needle exchange programs) within the last month had lower odds of HIV infection associated with active syphilis, but among non-NEP attenders, the odds of HIV infection associated with active syphilis was significantly elevated. CONCLUSIONS: Factors operating in both the micro-social environment (i.e., injecting drugs with clients) and policy environment (i.e., having syringes confiscated by police, attending NEPs) predominated as factors associated with risk of HIV infection, rather than individual-level risk behaviors. Interventions should target unjustified policing practices, clients' risk behaviors and HIV/STI prevention through NEPs.
Assuntos
Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Trabalho Sexual/estatística & dados numéricos , Abuso de Substâncias por Via Intravenosa/complicações , Abuso de Substâncias por Via Intravenosa/epidemiologia , Adulto , Comportamento , Demografia , Meio Ambiente , Feminino , Humanos , México/epidemiologia , Programas de Troca de Agulhas , Razão de Chances , Fatores Socioeconômicos , Sífilis/complicações , Estados Unidos/epidemiologiaRESUMO
Pasa la Voz (spread the word) is a human immunodeficiency virus (HIV) prevention methodology inspired by respondent-driven sampling (RDS) that uses social networks to access hard-to-reach populations. As field testing showed the approach to be efficacious among at-risk women in West Texas and Southern New Mexico, we set out to evaluate the methodology in a Mexican context. A local community organization, Programa Compañeros, first implemented a traditional one-on-one outreach strategy using promotoras (outreach workers) in Ciudad Juarez, Mexico, from September 2005 to January 2006. This was followed by implementation of Pasa la Voz from February 2006 to January 2007. The percentage of women agreeing to be tested increased from 11.9% to 49.9%, and staff time declined from 22.70 hours to 3.68 hours per HIV test, comparing the one-on-one with the Pasa la Voz methodology, respectively. Pasa la Voz was successful at imparting a cost-savings prevention education program with significant increases in the number of at-risk women being tested for HIV.
Assuntos
Relações Comunidade-Instituição , Infecções por HIV/prevenção & controle , Educação em Saúde/métodos , Apoio Social , Sorodiagnóstico da AIDS , Agentes Comunitários de Saúde , Feminino , Infecções por HIV/diagnóstico , Humanos , México , New Mexico , Aceitação pelo Paciente de Cuidados de Saúde , Avaliação de Programas e Projetos de Saúde , Texas , MigrantesRESUMO
BACKGROUND: Sex work is regulated in the Zona Roja (red light district) in Tijuana, Mexico, where HIV and sexually transmitted disease (STD) prevalence is high among female sex workers (FSWs). We examined the spatial distribution of STDs by work venue among FSWs in Tijuana. METHODS: FSWs aged 18 years and older who reported unprotected sex with ≥ 1 client in the past 2 months underwent testing for HIV, syphilis, gonorrhea, and Chlamydia. HIV/STDs were mapped by venue (i.e., bar, hotel) and Getis-Ord Gi statistics were used to identify geographic hotspots. High-risk venues were then identified using a standardized STD ratio (high risk defined as a ratio ≥ 1.25). Logistic regression was used to assess correlates of working at a high risk venue. RESULTS: Of 474 FSWs, 176 (36.4%) had at least 1 bacterial sexually transmitted infection (STI); 36 (7.6%) were HIV-positive. Within the Zona Roja, 1 venue was identified as a geographic "hotspot," with a higher than expected number of HIV/STD-positive FSW (P < 0.05) as compared to neighboring venues. Using the STD ratio definition, 11 venues were identified as high-risk; FSWs working in these locations had higher education, were more likely to report always using drugs with sex, and having mostly US clients. They were less likely to be registered FSWs or to live at their work venue. CONCLUSIONS: A relatively few number of sex work venues accounted for a large proportion of the HIV/STI burden among FSWs in Tijuana. Structural interventions that focus on sex work venues could help increase STI diagnosis, prevention, and treatment among FSWs in Tijuana.
Assuntos
Infecções Sexualmente Transmissíveis/epidemiologia , Sexo sem Proteção , Adulto , Infecções por Chlamydia/epidemiologia , Feminino , Gonorreia/epidemiologia , Infecções por HIV/epidemiologia , Humanos , México/epidemiologia , Prevalência , Fatores de Risco , Assunção de Riscos , Trabalho Sexual , Sífilis/epidemiologia , População Urbana , Local de TrabalhoRESUMO
AIMS: To identify correlates of active syphilis infection among female sex workers (FSWs) in Tijuana and Ciudad Juarez. DESIGN: Cross-sectional analyses of baseline interview data. Correlates of active syphilis (antibody titers >1 : 8) were identified by logistic regression. Setting Tijuana and Ciudad Juarez, two Mexican cities on the US border that are situated on major drug trafficking routes and where prostitution is quasi-legal. PARTICIPANTS: A total of 914 FSWs aged > or =18 years without known human immunodeficiency virus (HIV) infection who had had recent unprotected sex with clients. MEASUREMENTS: Baseline interviews and testing for syphilis antibody using Treponema pallidum particle agglutination (TPPA) and rapid plasma reagin (RPR) tests. FINDINGS: Median age and duration in sex work were 32 and 4 years, respectively. Overall, 18.0% had ever injected drugs, 14.2% often or always used illegal drugs before or during sex in the past month, 31.4% had clients in the last 6 months who injected drugs, and 68.6% reported having clients from the United States. Prevalence of HIV and active syphilis were 5.9% and 10.3%, respectively. Factors independently associated with active syphilis included injecting drugs (AOR: 2.39; 95% CI: 1.40, 4.08), using illegal drugs before or during sex (AOR: 2.06; 95% CI: 1.16, 3.65) and having any US clients (AOR: 2.85; 95% CI: 1.43, 5.70). CONCLUSIONS: Among female sex workers in Tijuana and Ciudad Juarez, drug-using behaviors were associated more closely with active syphilis than were sexual behaviors, suggesting the possibility of parenteral transmission of T. pallidum. Syphilis eradication programs should consider distributing sterile syringes to drug injectors and assisting FSWs with safer-sex negotiation in the context of drug use.
Assuntos
Infecções por HIV/epidemiologia , Uso Comum de Agulhas e Seringas/estatística & dados numéricos , Trabalho Sexual/estatística & dados numéricos , Abuso de Substâncias por Via Intravenosa/epidemiologia , Sífilis/epidemiologia , Sorodiagnóstico da AIDS , Adolescente , Adulto , Preservativos/estatística & dados numéricos , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Masculino , México/epidemiologia , Fatores de Risco , Sífilis/transmissão , Sorodiagnóstico da Sífilis , Estados Unidos/etnologia , Sexo sem Proteção , Saúde da MulherRESUMO
Tijuana is situated on the Mexico-USA border adjacent to San Diego, CA, on a major drug trafficking route. Increased methamphetamine trafficking in recent years has created a local consumption market. We examined factors associated with methamphetamine use and routes of administration by gender among injection drug users (IDUs). From 2006-2007, IDUs > or =18 years old in Tijuana were recruited using respondent-driven sampling, interviewed, and tested for HIV, syphilis, and TB. Logistic regression was used to assess associations with methamphetamine use (past 6 months), stratified by gender. Among 1,056 participants, methamphetamine use was more commonly reported among females compared to males (80% vs. 68%, p < 0.01), particularly, methamphetamine smoking (57% vs. 34%; p < 0.01). Among females (N = 158), being aged >35 years (AOR, 0.2; 95% CI, 0.1-0.6) was associated with methamphetamine use. Among males (N = 898), being aged >35 years (AOR, 0.5; 95% CI, 0.3-0.6), homeless (AOR, 1.4 (0.9-2.2)), and ever reporting sex with another male (MSM; AOR, 1.9; 95% CI, 1.4-2.7) were associated with methamphetamine use. Among males, a history of MSM was associated with injection, while sex trade and >2 casual sex partners were associated with multiple routes of administration. HIV was higher among both males and females reporting injection as the only route of methamphetamine administration. Methamphetamine use is highly prevalent among IDUs in Tijuana, especially among females. Routes of administration differed by gender and subgroup which has important implications for tailoring harm reduction interventions and drug abuse treatment.