Female drug dealers have been a neglected population despite their potentially elevated risk for social, legal, family, and psychological health problems. This study examined correlates of drug-dealing behavior in a sample of 209 female methamphetamine users in San Diego, CA. Twenty-five percent of the sample reported dealing methamphetamine in the past 2 months. Women who dealt methamphetamine were significantly more likely than their nondealing counterparts to have started using illicit drugs before the age of 13 years (68 % versus 44.7 %, p = .003); to have been introduced to methamphetamine by a parent (15.1 % versus 5.8 %, p = .037); and to report currently using methamphetamine to stay awake (84.9 % versus 64.7 %, p = .004), enhance self-confidence (62.3 % versus 45.5 %, p = .025), and feel more attractive (54.7 % versus 38.5 %, p = .029). In a multivariate logistic regression, factors independently associated with methamphetamine dealing were: having a spouse or live-in partner (Adjusted Odds Ratio, AOR = 2.89), using methamphetamine with a broader range of types of person (AOR = 1.46), and reporting lower levels of emotional support (AOR = 0.57). These findings suggest that female methamphetamine dealers are in urgent need of access to substance use treatment, therapies to enhance self-worth and emotional support, and family-based substance use prevention interventions for dependent children and those at risk.
Methamphetamine; Dealers; Women; Emotional support; Self-concept
Male clients of female sex workers (FSWs) are at risk of HIV and other sexually transmitted infections (STIs). We conducted a two-arm randomized controlled trial to test the efficacy of a sexual risk reduction intervention for male clients of FSWs in Tijuana, Mexico.
Male clients of FSWs who were at least 18, were HIV-negative at baseline, and reported recent unprotected sex with FSWs were randomized to the Hombre Seguro sexual risk reduction intervention, or a time-attention didactic control condition. Each condition lasted approximately one hour. Participants underwent interviewer-administered surveys and testing for HIV and other STIs at baseline, and at 4, 8, and 12 month follow-ups. Combined HIV/STI incidence and unprotected vaginal and anal sex acts with FSWs were the primary outcomes.
A total of 400 participants were randomized to one of the two conditions. Analyses indicated that randomization was successful; there were no significant differences between the participants in the two conditions at baseline. Average follow-up was 84% across both conditions. This is the first study to test the efficacy of a sexual risk reduction intervention for male clients of FSWs using the rigor of a randomized controlled trial.
NCT01280838, Date of registration: January 19, 2011.
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 to 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.
While methamphetamine users report high rates of internalized or self-stigma, few studies have examined experiences of stigma (i.e., stigmatization by others) and its correlates.
This study identified correlates of stigma experiences in a sample of 438 HIV-positive men who have sex with men (MSM) who were enrolled in a sexual risk reduction intervention in San Diego, CA.
Approximately 96% of the sample reported experiences of stigma related to their use of methamphetamine. In multiple regression analysis, experiences of stigma were associated with binge use of methamphetamine, injection drug use, increased anger symptoms, reduced emotional support, and lifetime treatment for methamphetamine use.
These findings suggest that experiences of stigma are common among methamphetamine users and that interventions to address this type of stigma and its correlates may offer social, psychological, and health benefits to HIV-positive methamphetamine-using MSM.
Stigma experiences; Methamphetamine; Men who have sex with men; HIV
To gain insights into bridging behaviors and their correlates among male clients of female sex workers (FSWs).
Men aged ≥18 years who recently paid or traded for sex with FSWs were recruited in Tijuana in 2008–2009. Participants underwent interviews and testing for HIV, chlamydia, syphilis, and gonorrhea. Logistic regression compared “bridgers” (clients who had unprotected sex with FSWs and with a wife or steady partner) with men who did not.
Of 383 men, 134 (35%) had a steady partner. Half (n = 70) of those had unprotected sex with both FSWs and the steady partner. Prevalence of any STI or HIV was 16.5% among bridgers and 2.3% among non-bridgers. Compared to other clients, bridgers were more likely to use drugs during sex with FSWs (81.4% versus 46.9%, p < 0.0001), had higher sensation-seeking (p < 0.0001) and misogyny scores (p = 0.05), and were more likely to offer FSWs extra money for unprotected sex (34.4% versus 1.6%, p < 0.0001). Factors independently associated with bridging were: using drugs during sex with FSWs (adjusted odds ratio (AOR): 3.4, p = 0.007), sensation-seeking (AOR: 4.3 per unit increase, p = 0.05), and offering FSWs more money for unprotected sex (AOR: 24.5, p = 0.003).
Sensation-seeking clients who use drugs during sex and coerce FSWs into unprotected sex may be less responsive to standard risk reduction interventions. Interventions are needed that target clients rather than rely on FSWs to change behaviors that may not be under their control.
male clients; bridging behavior; female sex workers; HIV transmission; prevention; Mexico
To examine efficacy of a brief behavioral intervention to promote condom use among female sex workers (FSWs) in two Mexico-U.S. border cities.
924 FSWs aged ≥18 years without known HIV infection living in Tijuana and Ciudad Juarez having recent unprotected sex with clients were randomized to a 30 minute behavioral intervention integrating motivational interviewing and principles of behavior change, or a didactic control condition. At baseline and six months, women underwent interviews and testing for HIV, syphilis, gonorrhea and chlamydia.
Comparing intervention versus control groups, we observed a 40% decline in cumulative STI incidence (p=0.049). Incidence density for the intervention vs. control was 13.8 vs 24.92 per 100 person years (py) for STIs combined (p=0.034), and 0 vs. 2.01 per 100 py for HIV (p<0.001), with concomitant increases in total numbers and percentages of protected sex acts and decreases in total numbers of unprotected sex acts with clients (p<0.05).
This brief behavioral intervention shows promise in reducing HIV/STI risk behaviors among FSWs in two Mexican-U.S border cities, and may be transferable to other resource-constrained settings.
sex work; prostitute; HIV; sexually transmitted infections; condoms; Mexico
Retrospective reports of children’s relationships with their parents have been associated with increased risk for depressive symptoms in adulthood. This study examined four dimensions of the current mother-child relationship (affection, criticism, over-involvement, conflict) in relation to depressive symptoms in a sample of 270 HIV-positive men who have sex with men (MSM). Depressive symptoms were positively associated with overt conflict or disagreement with mothers and perceived over-involvement by mothers, and inversely related to frequency of contact with mothers. These findings suggest that clinicians who treat HIV-positive methamphetamine-using MSM with depressive symptoms should evaluate issues in the mother-son relationship and consider family-based therapies as an adjunct to treatment.
depressive symptoms; methamphetamine; men who have sex with men; HIV; maternal relationship
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 sociodemographic, behavioral, and psychological correlates of trading sex for methamphetamine in a sample of HIV-negative heterosexual 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 methamphetamine, 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.
sex trading; methamphetamine; heterosexual; sexual risk behavior
Although rates of methamphetamine use continue to increase throughout the United States, little is known about the individuals who sell methamphetamine at the street level. This exploratory study examined the prevalence and correlates of drug-dealing behavior in a sample of 404 heterosexually-identified methamphetamine users who were participants in a sexual risk reduction intervention in San Diego, CA. Twenty-nine percent of participants (N = 116) reported “dealing” methamphetamine in the past two months. In a multivariate logistic regression, methamphetamine dealing was associated with being male (OR = 1.99; 95% CI 1.16 – 3.39), younger age (OR = 1.87 per year; 95% CI 1.10 – 3.17), more frequent use of methamphetamine (OR = 2.69; 95% CI 1.59 – 4.57), injecting methamphetamine (OR = 3.10; 95% CI 1.79 – 5.37), and higher hostility scores (OR = 1.07 per unit increase; 95% CI 1.01 – 1.13). These characteristics, particularly intensity of drug use and hostility, may be associated with greater resistance to drug treatment and lower success in treatment programs.
Studies of implementation of efficacious human immunodeficiency virus (HIV) prevention interventions are rare, especially in resource-poor settings, but important, because they have the potential to increase the impact of interventions by improving uptake and sustainability. Few studies have focused on provider and organizational factors that may influence uptake and fidelity to core intervention components. Using a hybrid design, we will study the implementation of an efficacious intervention to reduce sexually transmitted infections (STIs) among female sex workers (FSWs) in 12 cities across Mexico. Our protocol will test a ‘train-the-trainer’ implementation model for transporting the Mujer Segura (Healthy Woman) intervention into community-based organizations (CBOs).
We have partnered with Mexican Foundation for Family Planning (Mexfam), a non-governmental organization that has CBOs throughout Mexico. At each CBO, trained ethnographers will survey CBO staff on characteristics of their organization and on their attitudes toward their CBO and toward the implementation of evidence-based interventions (EBIs). Then, after CBO staff recruit a sample of 80 eligible FSWs and deliver a standard-care, didactic intervention to 40 women randomly selected from that pool, a Mexfam staff person will be trained in the Mujer Segura intervention and will then train other counselors to deliver Mujer Segura to the 40 remaining participating FSWs. FSW participants will receive a baseline behavioral assessment and be tested for HIV and STIs (syphilis, gonorrhea, and chlamydia); they will be reassessed at six months post-intervention to measure for possible intervention effects. At the same time, both qualitative and quantitative data will be collected on the implementation process, including measures of counselors’ fidelity to the intervention model. After data collection at each CBO is complete, the relative efficacy of the Mujer Segura intervention will be analyzed, and across CBOs, correlations will be examined between individual and organizational provider characteristics and intervention efficacy.
This cooperative, bi-national research study will provide critical insights into barriers and facilitating factors associated with implementing interventions in CBOs using the ‘train the trainer’ model. Our work builds on similar scale-up strategies that have been effective in the United States. This study has the potential to increase our knowledge of the generalizability of such strategies across health issues, national contexts, and organizational contexts.
Implementation; Dissemination; HIV; Evidence-based intervention; Female sex workers
Drug assertiveness skills have been demonstrated effective in reducing substance use behaviors among patients with alcohol- or heroin-use disorders. This study examined the association between drug assertiveness and methamphetamine use, psychological factors, and sexual risk behaviors in a sample of 250 HIV-positive men who have sex with men (MSM) enrolled in a safer sex intervention in San Diego, CA. Less assertiveness in turning down drugs was associated with greater frequency and larger amounts of methamphetamine use, lower self-esteem, higher scores on a measure of sexual sensation-seeking, and greater attendance at risky sexual venues. These data suggest that drug assertiveness training should be incorporated into drug abuse treatment programs and other risk reduction interventions for methamphetamine users.
drug assertiveness behavior; methamphetamine; sexual risk behavior; men who have sex with men; HIV-positive
Substance use has been identified as a risk factor for elevated levels of obsessive–compulsive disorder (OCD). This study examined methamphetamine use and sexual risk behaviors as correlates of OCD in a sample of 245 HIV-positive men having sex with men (MSM) in San Diego, CA. In a logistic regression analysis, OCD was associated with greater frequency of methamphetamine use, more depressive symptoms, seeking out risky venues and risky sexual partners when “high” on methamphetamine, and reporting fewer sex acts in the past 2 months. These data suggest the need for increased awareness and understanding of the role that OCD may play in the drug use behaviors and risky sexual practices of methamphetamine users.
Obsessive–compulsive disorder; Methamphetamine; Sexual risk behavior; Men who have sex with men; HIV
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.
anxiety symptoms; methamphetamine; men who have sex with men; sexual risk behavior; HIV
Previous research among drug-using men who have sex with men (MSM) indicates that trading sex for methamphetamine may be common.
This study identified background characteristics, substance use variables, contextual factors, and sexual risk behaviors associated with trading sex for methamphetamine in a sample of HIV-positive MSM. Baseline data were gathered from 155 participants who were enrolled in a sexual risk-reduction intervention. Logistic regression was used to compare MSM who traded sex for methamphetamine with men who did not.
Forty-three percent of the sample reported trading sex for methamphetamine in the past 2 months. Trading sex for methamphetamine was associated with being a binge user, homelessness, having an income of less than $20,000 per year, being less assertive at turning down drugs, engaging in more anal sex without a condom, and seeking out risky sex partners when high on methamphetamine.
Conclusions and Scientific Significance
These data suggest that the trading of sex for methamphetamine may be a primary source of new HIV infections within and outside of the MSM community, necessitating targeted interventions with this vulnerable subgroup.
methamphetamine; trading sex; men who have sex with men; sexual risk behavior
Although men who have sex with men (MSM) are disproportionately affected by HIV/AIDS in Mexico, data on current risk behaviors in this population are lacking. This study investigated the prevalence and correlates of unprotected anal intercourse (UAI) in a sample of 260 MSM in Tijuana, Mexico.
In June 2010, men attending a gay pride celebration were invited to complete a sexual risk survey. Men who reported UAI with a male partner in the past year were compared with men who reported only protected anal sex during the same period.
Mean age of participants was 29.7; 54% had a high school diploma or less; and 43% were unemployed. In the past year, 55% had been tested for HIV, 21% reported using illicit drugs before or during sex, and 94% had sex only with men. Overall, 50% reported having UAI with another male in the past year. Factors independently associated with UAI in the past year were unemployment (AOR = 1.87), attending adult movie theaters (AOR = 2.21), using illicit drugs before or during sex (AOR = 2.43), and not having a recent HIV test (AOR = 1.85).
Interventions to promote HIV testing and condom use among men who have sex with men may want to consider venue-specific approaches, as well as focus on drug-use issues in the context of unsafe sex.
Men who have sex with men; HIV risk behaviors; Unprotected anal intercourse; Mexico
In 2008, 400 males ≥ 18 years old who paid or traded for sex with a female sex worker (FSW) in Tijuana, Mexico, in the past 4 months completed surveys and HIV/STI testing; 30 also completed qualitative interviews. To analyze environmental HIV vulnerability among male clients of FSWs in Tijuana, Mexico, we used mixed methods to investigate correlates of clients who met FSWs in nightlife venues and clients’ perspectives on venue-based risks. Logistic regression identified micro-level correlates of meeting FSWs in nightlife venues, which were triangulated with clients’ narratives regarding macro-level influences. In a multivariate model, offering increased pay for unprotected sex and binge drinking were micro-level factors that were independently associated with meeting FSWs in nightlife venues versus other places. In qualitative interviews, clients characterized nightlife venues as high risk due to the following macro-level features: social norms dictating heavy alcohol consumption; economic exploitation by establishment owners; and poor enforcement of sex work regulations in nightlife venues. Structural interventions in nightlife venues are needed to address venue-based risks.
sex work; risk environment; clients; venues; structural factors; HIV
This study examined attitudes about condoms as a moderator of the relationship between methamphetamine use and sexual risk behavior in a sample of 297 HIV-positive, methamphetamine-using men who have sex with men (MSM). To test for a moderating effect of attitudes towards condoms, an interaction term was included in multiple regression analysis along with age, income, negative condom attitudes, frequency of methamphetamine use, and Beck depression score. A post hoc analysis was conducted to determine the relations between methamphetamine use and unprotected sex for persons with more vs. less negative attitudes toward condoms. These analyses indicated that when individuals had more negative attitudes toward condoms, the relation between methamphetamine frequency and unprotected sex was significant, while among participants with less negative attitudes toward condoms, no significant association was found. Addressing methamphetamine-using MSM's attitudes about condoms can serve as a form of harm reduction for those who are not yet ready or willing to discontinue methamphetamine use.
Methamphetamine; Attitudes; Condoms; Sexual risk; Men who have sex with men
Identifying psychosocial factors associated with sexual risk behavior among methamphetamine users is essential to enhancing HIV/STI prevention. Our 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/visitation issues. Categories of positive life events included: birth or pregnancy involving self or significant other; positive relationship event; and 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.
Tijuana, situated adjacent to San Diego, CA on the US-Mexico border, is experiencing an emerging HIV epidemic, with prevalence among female sex workers (FSWs) having risen in recent years from <1% to 6%. Comparable data on FSWs’ clients are lacking. We explored correlates of unprotected sex with FSWs among male clients in Tijuana.
In 2008, males from San Diego (N=189) and Tijuana (N=211) aged 18 or older who had paid or traded for sex with a FSW in Tijuana during the past 4 months were recruited in Tijuana’s red light district. Participants underwent psychosocial interviews and were tested for HIV, syphilis (Treponema pallidum), gonorrhea (Neisseria gonorrhoeae), and Chlamydia (Chlamydia trachomatis).
Of 394 men, median age was 36 years, 42.1% were married, and 39.3% were unemployed. Ethnic composition was 13.2% white, 79.4% Hispanic and 7.4% black or other. Half (50.3%) reported unprotected vaginal or anal sex with FSWs in Tijuana in the past 4 months. High proportions reported using drugs during sex (66%), and 36% reported frequenting the same FSW. Factors independently associated with unprotected sex with FSWs were using drugs during sex, visiting the same FSW, being married, and being unemployed.
FSWs’ clients represent an STI/HIV transmission “bridge” through unprotected sex with FSWs, wives and other partners. Tailored interventions to promote consistent condom use are needed for clients, especially within the context of drug use and ongoing relations with particular FSWs.
sex work; clients; sexual behavior; sexually transmitted infections; HIV; prostitution
Methamphetamine (MA) use has been found to be associated with increased risk of HIV and sexually transmitted infections (STI) among men having sex with men, but it is unknown whether those who inject MA are at greater risk for these infections than those who administer MA by other routes. Furthermore, comparable data from heterosexual MA users are lacking. We investigated whether the HIV and STI risks of male and female heterosexual MA users who inject MA differ from those of comparable users who do not inject. Between 2001 and 2005, we interviewed 452 HIV-negative men and women aged 18 and older who had recently used MA and engaged in unprotected sex. Their mean age was 36.6 years; 68% were male; ethnicity was 49.4% Caucasian, 26.8% African-American, and 12.8% Hispanic. Logistic regression identified factors associated with injecting MA. Compared to non-IDU, IDU were more likely to: be Caucasian; be homeless; have used MA for a longer period and used more grams of MA in the last 30 days; have a history of felony conviction; and report a recent STI. HIV and STI prevention interventions should be tailored according to MA users’ method of administration.
depression; injection drug use; methamphetamine; motivations; polydrug; sexually transmitted infections
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 STIs. These findings suggest that methamphetamine initiation among gay and bisexual men is multifaceted, which could have implications for intervention development.
methamphetamine; initiation; sexual risk; men who have sex with men
This study examined the association between sexual risk behavior and co-administration of methamphetamine with other drugs in a sample of 341 HIV-positive MSM. Those who reported methamphetamine co-administration in the past two months (65%) reported significantly more unprotected anal and oral sex and a greater number of casual, anonymous, and paid sex partners in this timeframe compared to men who used methamphetamine alone. Two primary patterns of co-administration were identified: 1) drug combinations motivated by sexual performance and enhancement (e.g., methamphetamine, poppers, sildenafil) and 2) “party drug” combinations (e.g., methamphetamine, GHB, ketamine). Implications for further research and possible applications to risk-reduction interventions are discussed.
Methamphetamine; polydrug use; sexual risk; men who have sex with men; HIV-positive
This study examined demographic characteristics, sexual risk behaviors, sexual beliefs, and substance use patterns in HIV-positive, methamphetamine-using men who have sex with both men and women (MSMW) (n = 50) as compared to men who have sex with men only (MSM) (n = 150). Separate logistic regressions were conducted to predict group membership. In the final model, of 12 variables, eight were independently associated with group membership. Factors independently associated with MSMW were acquiring HIV through injection drug use, being an injection drug user, using hallucinogens, using crack, being less likely to have sex at a bathhouse, being less likely to be the receptive partner when high on methamphetamine, having greater intentions to use condoms for oral sex, and having more negative attitudes about HIV disclosure. These results suggest that, among HIV-positive methamphetamine users, MSMW differ significantly from MSM in terms of their HIV risk behaviors. Studies of gay men and HIV often also include bisexual men, grouping them all together as MSM, which may obscure important differences between MSMW and MSM. It is important that future studies consider MSM and MSMW separately in order to expand our knowledge about differential HIV prevention needs for both groups. This study showed that there were important differences in primary and secondary prevention needs of MSM and MSMW. These findings have implications for both primary and secondary HIV prevention among these high-risk populations.
Men who have sex with men and women; Men who have sex with men; Bisexual; HIV; Methamphetamine; Injection drug use
This study identified sociodemographic factors, drug using practices, sexual behaviors, and motivational factors associated with binge (a period of uninterrupted) methamphetamine (MA) use among heterosexual MA users.
Sample and Method
The FASTLANE study provided cross-sectional data collected by audio-CASI between June 2001 and August 2004 from 451 HIV-negative MA users in San Diego, CA USA who had engaged in unprotected sex and used MA in the previous two months.
The study sample was 67.8% male, 49.4% Caucasian, 26.8% African-American, and 12.8% Hispanic with a mean age of 36.6 years; 183 (40.5%) reported binge use in the past 2 months. Compared with non-binge users, binge users of MA were more likely to report risky drug use and sex behaviors and differed in motivations to initiate and currently use MA. The final logistic regression model for binge use included more days of MA use in the last month, ever treated for MA use, injection drug use, higher Beck Depression Inventory score, “experimentation” as a motivation for initiating MA use, and engaging in sex marathons while high on MA. HIV prevention efforts should differentiate and address these differences in motivations for MA use and the associated HIV-risk sex and drug use behaviors as key targets for effective intervention.
methamphetamine; binge; drug use; motivations; intensity
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 multi-group 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.
sex workers; condom use; Mexico; HIV risk; Social Ecological Model