1. 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
- Author
-
Jain, Jennifer P, Strathdee, Steffanie A, Patterson, Thomas L, Semple, Shirley J, Harvey-Vera, Alicia, Magis-Rodríguez, Carlos, Martinez, Gustavo, and Pines, Heather A
- Subjects
Public Health ,Health Sciences ,Clinical Trials and Supportive Activities ,Violence Research ,HIV/AIDS ,Infectious Diseases ,Substance Misuse ,Clinical Research ,Prevention ,Infection ,Good Health and Well Being ,Peace ,Justice and Strong Institutions ,Adult ,Alcohol-Related Disorders ,Female ,HIV Infections ,Health Services Accessibility ,Humans ,Latent Class Analysis ,Mexico ,Patient Acceptance of Health Care ,Pre-Exposure Prophylaxis ,Prevalence ,Sex Workers ,Syndemic ,United States ,HIV ,pre-exposure prophylaxis ,latent class analysis ,syndemic theory ,female sex workers ,Public Health and Health Services ,Psychology ,Public health ,Sociology ,Clinical and health psychology - 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.
- Published
- 2020