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. 2020 May;32(5):557-566.
doi: 10.1080/09540121.2019.1626338. Epub 2019 Jun 4.

Perceived barriers to pre-exposure prophylaxis use and the role of syndemic factors among female sex workers in the Mexico-United States border region: a latent class analysis

Jennifer P Jain  1 , Steffanie A Strathdee  1 , Thomas L Patterson  2 , Shirley J Semple  2 , Alicia Harvey-Vera  1 , Carlos Magis-Rodríguez  3 , Gustavo Martinez  4 , Heather A Pines  1
Affiliations

Perceived barriers to pre-exposure prophylaxis use and the role of syndemic factors among female sex workers in the Mexico-United States border region: a latent class analysis

Jennifer P Jain et al. AIDS Care. 2020 May.

Abstract

Female sex workers (FSWs) experience syndemic factors (e.g., polydrug use, hazardous alcohol consumption, client-perpetrated violence, depression, and sexually transmitted infections) that often heighten vulnerability to HIV and limit healthcare utilization. We hypothesized that syndemic factors will limit FSWs' uptake of pre-exposure prophylaxis (PrEP). From 2016 to 2017, 295 HIV-negative FSWs were enrolled in a behavioral HIV prevention trial in Tijuana and Ciudad Juarez, Mexico, underwent STI testing, and completed surveys on syndemic factors and perceived barriers to PrEP use. Syndemic scores (0-5) were calculated by summing syndemic factors. Latent class analysis (LCA) was used to identify homogeneous classes with respect to perceived barriers to PrEP use. We identified four classes: (1) perceived healthcare access barriers (8.3%), (2) perceived financial barriers (18.7%), (3) high level of perceived barriers (19.9%), and (4) low level of perceived barriers (53.0%) to PrEP use. Those experiencing three (adjusted odds ratio [aOR] = 3.63, 95% confidence interval [CI] = 1.24-10.67) and four or five (aOR = 6.30, 95% CI = 1.70-23.35) syndemic factors had a higher odds of membership in the class characterized by a high level of perceived barriers than in the class characterized by a low level of perceived barriers. Addressing syndemic factors may maximize PrEP's impact among FSWs along Mexico's northern border.

Keywords: HIV; Mexico; female sex workers; latent class analysis; pre-exposure prophylaxis; syndemic theory.

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Figures

Figure 1.
Figure 1.. Item-response probabilities across classes of FSWs in Tijuana and Ciudad Juarez, Mexico with varying patterns of perceived barriers to PrEP use as identified via latent class analysis (N=295).
Identified classes consist of FSWs with a low-level of perceived barriers (diamond; 53.0%), a high level of perceived barriers (square; 19.9%), perceived financial barriers (triangle; 18.7%), and perceived health care access barriers (cross; 8.3%). Abbreviations: FSW=female sex workers; PrEP=pre-exposure prophylaxis.
See this image and copyright information in PMC

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