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The Eye of the Storm: Female Sex Workers with American Clients in 2 Mexico-US Border Cities
Steffanie Strathdee*1, R Lozada2, H Staines3, M Fraga4, P Orozovich1, M Pu1, A de la Torre5, H Amaro6, C Magis-Rodriguez7, and T Patterson1
1Univ of California, San Diego, US; 2State Publ Hlth Svcs Inst, Tijuana, Mexico; 3Univ Autonoma de Ciudad Juarez, Mexico; 4Univ Autonoma de Baja California, Tijuana, Mexico; 5Univ of California, Davis, US; 6Northeastern Univ, Boston, MA, US; and 7Natl Ctr for the Prevention and Control of AIDS, Mexico City, Mexico
Background: HIV prevalence is increasing in Tijuana and Ciudad Juarez,
which border San Diego, California,
and El Paso, Texas, respectively. Since prostitution is
quasi-legal in both Mexican cities, both are sex tourist destinations. To help
inform prevention efforts in both countries, we studied characteristics of
female sex workers who reported having American clients.
Methods: Between September 2004 and March 2006, female
sex workers aged >18 years reporting unprotected sex with clients within the
last month were enrolled in a behavioral intervention study in both cities.
Participants underwent antibody testing for HIV and sexually transmitted
infections (STI). Logistic regression was used to identify factors associated
with reporting >1 American male clients.
Results: We enrolled 924 female sex workers in Tijuana (n = 474)
and in Ciudad Juarez
(n = 450); 78% and 59% reported having
American clients (p <0.001).
Median age and median duration of sex work was 34 and 4 years, respectively;
95% had children. Prevalence of HIV, infectious syphilis (titer ≥1:8),
gonorrhea, Chlamydia, and any STI was
6%, 14%, 6%, 13%, and 27%, respectively. Compared with other female sex workers,
those with American clients were more likely to have infectious syphilis (16% vs 10%, p = 0.008),
gonorrhea (8% vs 2%, p <0.001), or any STI including HIV (30% vs
20%, p = 0.002). Female sex workers
with American clients were paid more to have sex without condoms (mean $30 vs $20 p <0.001),
more likely to have injected drugs in the last month (16% vs
5%, p <0.001), and use drugs
before or during sex (38% vs 20%, p <0.001) compared with other female
sex workers. Factors independently associated with having American clients
were: living in Tijuana (adjusted OR = 2.2),
being younger (adjusted OR = 0.96 per year), speaking English (adjustsed OR = 3.2), being paid >$30 for sex without
condoms (adjusted OR = 1.8), having >250 clients in the last 6 months (adjusted
OR = 1.6), infectious syphilis (adjusted OR = 1.8), and injecting drugs within the
last month (adjusted OR = 2.2).
Conclusions: In these 2 Mexico-US border cities, female sex
workers reporting having American clients were more likely to have current STI
and to engage in risk behaviors that place themselves, their clients, and
possibly the general population at risk for HIV/STI. Intensified binational prevention efforts involving both female sex
workers and their clients are urgently needed, especially in Tijuana.
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