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Randomized Controlled Trial
. 2014 Nov 14;17(1):19218.
doi: 10.7448/IAS.17.1.19218. eCollection 2014.

The disproportionate burden of HIV and STIs among male sex workers in Mexico City and the rationale for economic incentives to reduce risks

Omar Galárraga  1 , Sandra G Sosa-Rubí  2 , Andrea González  3 , Florentino Badial-Hernández  3 , Carlos J Conde-Glez  2 , Luis Juárez-Figueroa  3 , Sergio Bautista-Arredondo  2 , Caroline Kuo  4 , Don Operario  5 , Kenneth H Mayer  6
Affiliations
Randomized Controlled Trial

The disproportionate burden of HIV and STIs among male sex workers in Mexico City and the rationale for economic incentives to reduce risks

Omar Galárraga et al. J Int AIDS Soc. .

Abstract

Introduction: The objective of this article is to present the rationale and baseline results for a randomized controlled pilot trial using economic incentives to reduce HIV and sexually transmitted infection (STI) risk among male sex workers (MSWs) in Mexico City.

Methods: Participants (n=267) were tested and treated for STIs (chlamydia, gonorrhoea, syphilis and HIV) and viral hepatitis (hepatitis B and C), received HIV and STI prevention education and were randomized into four groups: (1) control, (2) medium conditional incentive ($50/six months), (3) high conditional incentive ($75/six months) and (4) unconditional incentive ($50/six months). In the conditional arms, incentives were contingent upon testing free of new curable STIs (chlamydia, gonorrhoea and syphilis) at follow-up assessments.

Results: Participants' mean age was 25 years; 8% were homeless or lived in a shelter, 16% were unemployed and 21% lived in Mexico City less than 5 years. At baseline, 38% were living with HIV, and 32% tested positive for viral hepatitis or at least one STI (other than HIV). Participants had a mean of five male clients in the previous week; 18% reported condomless sex with their last client. For 37%, sex work was their main occupation and was conducted mainly on the streets (51%) or in bars/discotheques (24%) and hotels (24%). The average price for a sex transaction was $25 with a 35% higher payment for condomless sex.

Conclusions: The findings suggest that economic incentives are a relevant approach for HIV prevention among MSWs, given the market-based inducements for unprotected sex. This type of targeted intervention seems to be justified and should continue to be explored in the context of combination prevention efforts.

Keywords: HIV/STI prevention; Mexico; compensating differential; conditional cash transfer; conditional economic incentives; male sex workers; men who have sex with men; risk premium.

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