Correlates of condomless anal sex among men who have sex with men (MSM) in Tijuana, Mexico: The role of public sex venues

<div><p>Condomless anal sex between male partners is the primary risk factor for HIV transmission among men who have sex with men (MSM). Correlates of condomless anal sex have been well-studied in developed countries, but they have received less attention in lower-to-middle income countries (LMIC), where MSM are often subject to stigma, discrimination, intolerance, and even the criminalization of same sex behavior. In Mexico, a LMIC where traditional views on homosexuality are common, HIV prevalence among MSM is high (16.9%), yet little research has been conducted on the correlates of condomless anal sex in this high-risk population. The present study examined correlates of condomless anal sex among 201 MSM recruited in Tijuana, Mexico, with a focus on the role of public sex venues in relation to sexual risk behavior. Eligibility requirements were: biologically male, 18 years of age or older, resident of Tijuana, and self-reported anal or oral sex with a male partner in the past year. Participants completed an interviewer-administered, demographic and psychosocial survey, and were tested for HIV and syphilis. A hierarchical multiple linear regression model was tested to identify correlates of condomless anal sex. Thirty-eight percent of participants (<i>N =</i> 76) reported condomless anal sex with a male partner in the past 2 months. Higher levels of condomless anal sex were associated with higher levels of depressive symptoms, greater sexual compulsivity, and more frequent seeking out of sex partners in a public venue in the past 2 months. In view of these findings, we recommend the development of multi-level, “combination” interventions, which in the Mexican context should include enhanced condom promotion and distribution, improved availability and access to mental health treatment and counseling services, and expanded HIV/STI testing in public venues.</p></div

Cost-effectiveness acceptability curve for the combined interactive safer sex/Safer injection intervention for Ciudad Juarez.

<p>Cost-effectiveness acceptability curve for the combined interactive safer sex/Safer injection intervention for Ciudad Juarez.</p

Reductions in HIV/STI Incidence and Sharing of Injection Equipment among Female Sex Workers Who Inject Drugs: Results from a Randomized Controlled Trial

<div><p>Background</p><p>We evaluated brief combination interventions to simultaneously reduce sexual and injection risks among female sex workers who inject drugs (FSW-IDUs) in Tijuana and Ciudad Juarez, Mexico during 2008–2010, when harm reduction coverage was expanding rapidly in Tijuana, but less so in Juarez.</p><p>Methods</p><p>FSW-IDUs ≥18 years reporting sharing injection equipment and unprotected sex with clients within the last month participated in a randomized factorial trial comparing four brief, single-session conditions combining either an interactive or didactic version of a sexual risk intervention to promote safer sex in the context of drug use, and an injection risk intervention to reduce sharing of needles/injection paraphernalia. Women underwent quarterly interviews and testing for HIV, syphilis, gonorrhea, <i>Chlamydia</i> and <i>Trichomonas,</i> blinding interviewers and assessors to assignment. Poisson regression with robust variance estimation and repeated measures ordinal logistic regression examined effects on combined HIV/STI incidence and receptive needle sharing frequency.</p><p>Findings</p><p>Of 584 initially HIV-negative FSW-IDUs, retention was ≥90%. After 12 months, HIV/STI incidence decreased >50% in the interactive vs. didactic sex intervention (Tijuana:AdjRR:0.38,95% CI:0.16–0.89; Juarez: AdjRR:0.44,95% CI:0.19–0.99). In Juarez, women receiving interactive vs. didactic injection risk interventions decreased receptive needle-sharing by 85% vs. 71%, respectively (p = 0.04); in Tijuana, receptive needle sharing declined by 95%, but was similar in active versus didactic groups. Tijuana women reported significant increases in access to syringes and condoms, but Juarez women did not.</p><p>Interpretation</p><p>After 12 months in both cities, the interactive sexual risk intervention significantly reduced HIV/STI incidence. Expanding free access to sterile syringes coupled with brief, didactic education on safer injection was necessary and sufficient for achieving robust, sustained injection risk reductions in Tijuana. In the absence of expanding syringe access in Juarez, the injection risk intervention achieved significant, albeit more modest reductions, suggesting that community-level interventions incorporating harm reduction are more powerful than individual-level interventions.</p><p>Trial Registration</p><p>clinicaltrials.gov <a href="http://www.clinicaltrials.gov/ct2/show/NCT00840658?term=NCT00840658&rank=1" target="_blank">NCT00840658</a></p></div

Descriptive Statistics of Participants by Intervention Group at Baseline, by Study Site (n = 584).

<p>Descriptive Statistics of Participants by Intervention Group at Baseline, by Study Site (n = 584).</p

Number of condomless anal sex acts with male partners in the past 2 months regressed on personal and social characteristics (Step 1), substance use factors (Step 2), psychological risk factors (Step 3) and venues used to meet sex partners (Step 4) among men who have sex with men in Tijuana, Mexico (<i>N</i> = 197)^a.

<p>Number of condomless anal sex acts with male partners in the past 2 months regressed on personal and social characteristics (Step 1), substance use factors (Step 2), psychological risk factors (Step 3) and venues used to meet sex partners (Step 4) among men who have sex with men in Tijuana, Mexico (<i>N</i> = 197)<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0186814#t002fn006" target="_blank">^a</a>.</p

Baseline characteristics of men who have sex with men (MSM) in Tijuana, Mexico (<i>N =</i> 201).

<p>Baseline characteristics of men who have sex with men (MSM) in Tijuana, Mexico (<i>N =</i> 201).</p

Intervention effect on 12 months HIV/any STI incidence rate: Ciudad Juarez^*.

<p>Intervention effect on 12 months HIV/any STI incidence rate: Ciudad Juarez^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0065812#nt109" target="_blank">*</a>}.</p

Cost-effectiveness acceptability curve for the combined interactive safer sex/ didactic safer injection intervention in Cd. Juarez.

<p>Cost-effectiveness acceptability curve for the combined interactive safer sex/ didactic safer injection intervention in Cd. Juarez.</p

Costs associated with the Mujer Mas Segura intervention.

<p>Costs associated with the Mujer Mas Segura intervention.</p

Mujer Mas Segura trial Design of 2x2 Factorial Trial to Simultaneously Evaluate Injection and Sexual Risk Reduction Interventions¹.

<p>¹Adapted from Strathdee PloS ONE 2013.</p