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Female sex workers (FSWs) experience elevated risk for HIV and sexually transmitted infections (STIs) through unprotected sex with male clients, yet the complexity of these commercial relationships remains understudied. From 2010 to 2011, we explored FSWs' conceptualizations of various client types and related risk behavior patterns using semistructured interviews with 46 FSWs in Tijuana and Ciudad Juarez, Mexico, where FSWs' HIV/STI prevalence is increasing. Our grounded theory analysis identified four types of commercial relationships: nonregular clients, regular clients and friends, clients who “fell in love” with FSWs, and long-term financial providers who often originated from the United States. As commercial relationships developed, clients' social and emotional connections to FSWs increased, rendering condom negotiation and maintaining professional boundaries more difficult. Drug abuse and poverty also influenced behaviors, particularly in Ciudad Juárez, where lucrative U.S. clients were increasingly scarce. While struggling to cultivate dependable relationships in a setting marked by historical sex tourism from a wealthier country, some FSWs ceased negotiating condom use. We discuss the need for HIV/STI research and prevention interventions to recognize the complexity within FSWs' commercial relationships and how behaviors (e.g., condom use) evolve as relationships develop through processes that are influenced by local sociopolitical contexts and binational income inequality. [ABSTRACT FROM PUBLISHER]

Nagpur is an industrial hub in Maharashtra, a state in Central India that has the second highest HIV prevalence in the country. Approximately 3000 brothel-based female sex workers (FSWs) are estimated to be working in Nagpur's Ganga-Jamuna red light district. The extent to which brothel madams, known as gharwalis, support HIV/STI prevention for FSWs has not been examined. The present study sought to identify personal, social, and behavioral characteristics of gharwalis in Nagpur as well as enhance our understanding of the gharwali's role in shaping the sexual practices of brothel-based FSWs. Thirty gharwalis participated in a survey that covered personal, social, behavioral, and environmental characteristics. Respondents ranged in age from 29 to 50 years (M = 38.9) and had worked as a gharwali for an average of 5.3 years; 80% had no formal education, 43% had never married, and 30% were divorced or separated, and 93% earned money from their own sex work. Gharwalis managed an average of 4.2 FSWs (range 2–10). Overall, gharwalis reported positive attitudes toward condoms, promoted use of condoms by their FSWs with clients, taught FSWs how to use condoms, knew where to obtain condoms for free, and required HIV testing for their FSWs; however, levels of HIV prevention knowledge were low. Gharwalis also reported providing a range of support services to FSWs who lived in their brothels, including shelter, protection from drunk and aggressive clients and police, emotional support, caring and love, and health care. These data suggest the feasibility of involving gharwalis in brothel-based HIV prevention programs. [ABSTRACT FROM PUBLISHER]

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. [ABSTRACT FROM PUBLISHER]

Due to stigma and the psychosocial repercussions of past trauma and abuse, survivors of sex trafficking may experience increased susceptibility to violence, revictimization, and various harmful health outcomes, including HIV infection. Given the paucity of research characterizing the experiences of formerly trafficked female sex workers (FSWs), we set out to describe and contextualize perceptions of HIV risk among women who have experienced past episodes of sex trafficking and who are currently engaged in sex work in Tijuana, Mexico. Based on semi-structured interviews and ethnographic fieldwork, we describe the following interrelated themes as influencing formerly trafficked FSWs' perceptions and experiences of HIV risk: economic vulnerability; susceptibility to violence; and psychological trauma. Our findings highlight the need for HIV prevention efforts to incorporate broader structural and social interventions aimed at reducing vulnerability to violence and human rights abuses among this population and improving their general economic, psychological, and social well-being. [ABSTRACT FROM AUTHOR]

The authors report the results of qualitative (n = 19) and quantitative (n = 545) interviews with young injection drug users (IDUs) in San Diego, California about their experiences using drugs in Tijuana, Mexico, and associated risks for HIV infection. Young IDUs who have ever traveled to Mexico (n = 365) used a variety of injection (54%) and noninjection (30%) drugs there and appear to be heavier users than those who have never traveled to Mexico. Sociocultural themes influencing drug use in Mexico included interactions among the purpose of travel, drug preference, and route of administration; familiarity with the border region; evolving relationships with the United States and Mexican drug markets; and the experience of crossing the U.S.–Mexico border. Interventions for IDUs in border regions need to be sensitive to the ethnicity, familiarity with the border region, and life history of participants, as well as differences in national policies that could influence drug use and risk for HIV on both sides of the border. [ABSTRACT FROM PUBLISHER]

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Prior studies estimate HIV prevalence of 4% among injection drug users (IDUs), compared with 0.8% in the general population of Tijuana, Mexico. However, data on HIV prevalence and correlates among non-injecting drug users (NIDUs) are sparse. Individuals were recruited through street outreach for HIV testing and behavioural risk assessment interviews to estimate HIV prevalence and identify associated sexual risk behaviours among NIDUs in Tijuana. Descriptive statistics were used to characterise ‘low-risk’ NIDUs (drug users who were not commercial sex workers or men who have sex with men). Results showed that HIV prevalence was 3.7% among low-risk NIDUs. During the prior six months, 52% of NIDUs reported having >1 casual partner; 35% reported always using condoms with a casual partner; and 13% and 15%, respectively, reported giving or receiving something in exchange for sex. Women were significantly more likely than men to have unprotected sex with an IDU (p<0.01). Conclusions: The finding that HIV prevalence among NIDUs was similar to that of IDUs suggests that HIV transmission has occurred outside of traditional core groups in Tijuana. Broad interventions including HIV testing, condom promotion and sexual risk reduction should be offered to all drug users in Tijuana. [ABSTRACT FROM PUBLISHER]

Studies show high rates of psychiatric symptoms among methamphetamine users; however, little information exists regarding methamphetamine use and anxiety. This study investigated psychosocial and behavioral correlates of anxiety symptoms in a sample of 245 HIV-positive men having sex with men (MSM) who were enrolled in a sexual risk-reduction intervention. In a multiple regression analysis, anxiety symptoms were associated with homelessness, recent experience of HIV symptoms, injection drug use, lifetime sexual abuse, engaging in risky sexual behaviors, and seeking out partners at risky sexual venues when 'high' on methamphetamine. These findings can be used to inform and refine sexual risk-reduction interventions and substance-use treatment programs for HIV-positive methamphetamine-using MSM. [ABSTRACT FROM AUTHOR]

While many studies have examined correlates of trading sex for money, few have examined factors associated with exclusive trading of sex for drugs. We identified sociodernographic, behavioral, and psychological correlates of trading sex for methamphetamine in a sample of HIV-negative het-erosexual men and women who were enrolled in a sexual risk reduction intervention in San Diego, California. Of 342 participants, 26% overall (21% of males and 31% of females) reported trading sex for methamphetamine in the past two months. Multiple logistic regression analysis revealed that recently trading sex for methamphetamine was independently associated with being female, homeless, binging on niethamphetamine, sexual victimization in the past two months, engaging in anal sex 24 or more times in the past two months, and higher sexual compulsivity scores. Effective interventions for this high-risk population should consider gender-focused counseling for sexual abuse, motivational enhancement therapy, social-cognitive skills training, as well as enhanced access and utilization of social services, including drug treatment. [ABSTRACT FROM AUTHOR]

There is little information about HIV awareness or condom use among female sex workers (FSWs) in Afghanistan. The purpose of this cross-sectional study was to assess HIV awareness, knowledge, and condom use among FSWs in three Afghan cities. FSWs residing in Jalalabad, Kabul, and Mazar-i-Sharif were recruited through outreach programs and completed an interviewer-administered questionnaire and rapid tests for hepatitis B surface antigen, HIV, syphilis, and hepatitis C virus. Logistic regression identified factors associated with HIV awareness, comprehensive HIV knowledge (knowledge that HIV cannot be detected by sight, that condoms prevent HIV, and rejection of local misconceptions about HIV transmission), and consistent condom use (use with every sex act) with clients in the last six months. Of 520 participants, 76.9% had no formal education and 37.7% lived outside Afghanistan in the last five years. Nearly half (44.2%) were aware of HIV but, of these, only 17.4% (N=40) had comprehensive HIV knowledge. There were significant differences by site; FSWs in Jalalabad were more likely to be aware of HIV but FSWs in Kabul were more likely to have correct HIV knowledge and use condoms consistently with clients. Consistent client condom use was reported by 11.5% (N=60) and was independently associated with having more clients per month (AOR=1.99, 95% CI: 1.04-3.81). In conclusion, comprehensive HIV knowledge and consistent condom use with clients are low among Afghan FSWs in these cities. Efforts to reach this population should focus on relaying accurate information and expanding condom use with clients. [ABSTRACT FROM AUTHOR]

Male clients of female sex workers (FSWs) may act as a bridge to the general population contributing to the spread of HIV and other sexually transmitted infections (STIs) in the USA and Mexico. This study used cross-sectional data to identify psychosexual and social-cognitive factors associated with sexual risk behavior in a bi-national sample of 300 male clients of FSWs recruited in Tijuana, Mexico from June to October 2008. In a multiple regression analysis, the number of unprotected vaginal sex acts with FSWs was associated with higher sexual compulsivity scores, lower self-efficacy for condom use, greater use of illicit drugs, and more financial need. Behavioral interventions are urgently needed to assist clients of FSWs in reducing high-risk behaviors in an effort to prevent the spread of HIV/STIs in this high-risk population and their sexual partners. [ABSTRACT FROM AUTHOR]

Identifying psychosocial factors associated with sexual risk behavior among methamphetamine users is essential to enhancing HIV and sexually transmitted infection prevention. This study examined the relationship between positive and negative life events and sexual risk behavior in a sample of 100 HIV-negative, heterosexually identified, methamphetamine-using men and women. Negative life event categories included death of a significant other, negative health event involving self or significant other, and child custody or visitation issues. Categories of positive life events included birth or pregnancy involving self or significant other, a positive relationship event, and a positive life change. Multivariate analyses demonstrated that negative life events were positively associated with total number of unprotected sex acts, whereas positive life events were not associated with sexual risk taking. Also, amount of methamphetamine used did not moderate the relationship between life events and sexual risk behavior. These data support future research to identify underlying mechanisms that link negative life events to sexual risk taking in this high-risk population. [ABSTRACT FROM AUTHOR]

Despite increasing prevalence of HIV among U.S. Latinos, participation in HIV clinical trials is low. Barriers to HIV clinical trial participation in U.S. Latinos are not well understood. Using in-depth, semistructured interviews with HIV care providers serving HIV-positive Latinos and focus groups with HIV-positive Mexican-origin Latinos, we assessed cross-cultural barriers (e.g., stigma and linguistic) to HIV clinical trials in San Diego, California, bordering Mexico. Cross-cultural barriers were explored using grounded theory analytical techniques. Patient-provider concordance on the nature of HIV-related stigma, linguistic barriers, the impact of U.S.-Mexico border on Latino patients and participation in clinical trials were found. Providers described care access challenges faced by patients of Mexican-origin, particularly in light of immigration and U.S. border policy. HIV-related stigma and communication barriers among Latinos remain important obstacles to clinical trials participation and care access in the United States. [ABSTRACT FROM AUTHOR]

The present study examined the applicability of the Social Ecological Model for explaining condom use in a sample of female sex workers (FSWs) (N=435) participating in a behavioral intervention to increase condom use in Tijuana, Mexico. Using a multigroup path analysis, we compared women who work in bar settings (n=233) to those who worked on the street (n=202) with regard to an individual factor (self-efficacy), an interpersonal factor (client financial incentives), and a structural factor (condom access). Competing models showed differential impacts of these factors in the two venue-based groups. Having access to condoms was associated with greater self-efficacy and less unprotected sex in women who worked in bars. Among street-based FSWs, having clients offer monetary incentives for unprotected sex was related to greater unprotected sex, while having access to condoms was not. Understanding the contextual factors associated with condom use among subgroups of FSWs has important implications for the development of HIV prevention interventions. [ABSTRACT FROM AUTHOR]

This study describes factors associated with methamphetamine initiation in a racially diverse sample of 340 methamphetamine-using, HIV-positive gay and bisexual men. A factor analysis was conducted on reasons for initiation, and four factors were identified: to party, to cope, for energy, and to improve self-esteem. Methamphetamine to party accounted for more than one-third of the variance in the factor analysis. Methamphetamine to cope captured almost 9% of the variance, methamphetamine for energy accounted for approximately 8% of the variance, and methamphetamine for self-esteem accounted for approximately 7% of the variance. Regression analyses revealed differential associations between methamphetamine-initiation factors and HIV-risk behaviors. Methamphetamine for self-esteem predicted binge methamphetamine use, while methamphetamine to cope was associated with injecting methamphetamine. Using methamphetamine for energy was associated with number of illicit drugs-used and using methamphetamine to party was associated with having a greater number of sexually transmitted infections. These findings suggest that methamphetamine initiation among gay and bisexual men is multifaceted, which could have implications for intervention development. [ABSTRACT FROM AUTHOR]

The purpose of this study was to test a version of the Theory of Planned Behavior (TPB) for predicting safe sex behavior in a sample of 228 HIV-negative heterosexual methamphetamine users. We hypothesized that, in addition to TPB constructs, participants' amount of methamphetamine use and desire to stop unsafe sex behaviors would predict intentions to engage in safer sex behaviors. In turn, we predicted that safer sex intentions would be positively correlated with participants' percentage of protected sex. Hierarchical linear regression indicated that 48% of the total variance in safer sex intentions was predicted by our model, with less negative attitudes toward safer sex, greater normative beliefs, greater control beliefs, less methamphetamine use, less intent to have sex, and greater desire to stop unsafe sex emerging as significant predictors of greater safer sex intentions. Safer sex intentions were positively associated with future percent protected sex (p<0.05). These findings suggest that, among heterosexual methamphetamine users, the TPB is an excellent model for predicting safer sex practices in this population, as are some additional factors (e.g., methamphetamine use). Effective interventions for increasing safer sex practices in methamphetamine user will likely include constructs from this model with augmentations to help reduce methamphetamine use. [ABSTRACT FROM AUTHOR]

Injecting drug users (IDU) in Bangladesh are at the early stages of an HIV epidemic. To understand the dynamics of the HIV epidemic, male IDU (n = 561) were recruited from the needle/syringe exchange program in Dhaka in 2002, who underwent a risk-behavior survey and were tested for HIV, syphilis, hepatitis C, and hepatitis B. Correlates of HIV infection were determined by conducting bivariate and multiple regression analyses. The median age of the IDU was 35 years, 39.6% had no formal education, approximately half were married and/or living with their regular sex partner and 26% were currently homeless. The median age at first injection was 29 years. HIV was detected in 5.9% of the IDU and homelessness was the only factor independently associated with HIV (OR = 5.5). Urgent measures must be undertaken to prevent escalation of the HIV epidemic. The study's limitations are noted. [ABSTRACT FROM AUTHOR]

Copyright of Culture, Health & Sexuality is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)