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. 2011 Apr 25;6(4):e19048.
doi: 10.1371/journal.pone.0019048.

Social and structural factors associated with HIV infection among female sex workers who inject drugs in the Mexico-US border region

Steffanie A Strathdee  1 , Remedios Lozada, Gustavo Martinez, Alicia Vera, Melanie Rusch, Lucie Nguyen, Robin A Pollini, Felipe Uribe-Salas, Leo Beletsky, Thomas L Patterson
Affiliations

Social and structural factors associated with HIV infection among female sex workers who inject drugs in the Mexico-US border region

Steffanie A Strathdee et al. PLoS One. .

Abstract

Background: FSWs who inject drugs (FSW-IDUs) can acquire HIV through high risk sexual and injection behaviors. We studied correlates of HIV infection among FSW-IDUs in northern Mexico, where sex work is quasi-legal and syringes can be legally obtained without a prescription.

Methods: FSW-IDUs>18 years old who reported injecting drugs and recent unprotected sex with clients in Tijuana and Ciudad Juarez underwent surveys and HIV/STI testing. Logistic regression identified correlates of HIV infection.

Results: Of 620 FSW-IDUs, prevalence of HIV, gonorrhea, Chlamydia, trichomonas, syphilis titers ≥1:8, or any of these infections was 5.3%, 4%, 13%, 35%, 10% and 72%, respectively. Compared to other FSW-IDUs, HIV-positive women were more likely to: have syphilis titers ≥1:8 (36% vs. 9%, p<0.001), often/always inject drugs with clients (55% vs. 32%, p = 0.01), and experience confiscation of syringes by police (49% vs. 28%, p = 0.02). Factors independently associated with HIV infection were syphilis titers ≥1:8, often/always injecting with clients and police confiscation of syringes. Women who obtained syringes from NEPs (needle exchange programs) within the last month had lower odds of HIV infection associated with active syphilis, but among non-NEP attenders, the odds of HIV infection associated with active syphilis was significantly elevated.

Conclusions: Factors operating in both the micro-social environment (i.e., injecting drugs with clients) and policy environment (i.e., having syringes confiscated by police, attending NEPs) predominated as factors associated with risk of HIV infection, rather than individual-level risk behaviors. Interventions should target unjustified policing practices, clients' risk behaviors and HIV/STI prevention through NEPs.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Odds of HIV infection for IDUs with (○ ○ ○) and without (Δ Δ Δ) active syphilis by needle exchange attendance.
See this image and copyright information in PMC

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