Correlates of unprotected sex by client type among female sex workers that inject drugs in Tijuana and Ciudad Juarez, Mexico.

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.

History of abuse and psychological distress symptoms among female sex workers in two Mexico-U.S. border cities.

This study examined histories of past emotional, physical, and sexual abuse as correlates of current psychological distress using data from 916 female sex workers (FSWs) who were enrolled in a safer-sex behavioral intervention in Tijuana and Ciudad (Cd.) Juarez, Mexico. We hypothesized that histories of abuse would be associated with higher symptom levels of depression and somatization and that social support would moderate the relationship. Nonparametric correlations and a series of hierarchical regression analyses revealed that all forms of past abuse predicted higher levels of depressive symptoms, and physical and sexual abuse were significantly associated with higher levels of somatic symptoms. Social support was also significantly associated with fewer symptoms of distress; however, it was not shown to moderate the relationship between abuse history and distress.