Incidence and predictors of HIV and sexually transmitted infections among high risk couples in Northern Mexico:

a prospective, multilevel study

Angela M Robertson, Gudelia Rangel, Gustavo Martinez, Monica D Ulibarri, Jennifer L Syvertsen, Samuel A Bazzi,

Scott Roesch, Heather A Pines, and Steffanie A Strathdee

IAS 2014, Melbourne, Australia

Funding: National Institutes of Health (NIH) grants R01 DA027772, R36 DA032376, T32 AI007384, T32 DA023356, K01 DA026307, and P30 AI060354-10 . Contact: sstrathdee@ucsd.edu

Setting: Mexico-U.S. border

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Sex work is socially tolerated and quasi legal in many Mexican border cities; high HIV/STI risk among sex workers/clients

Cohort of Sex Workers & Intimate Partners• Proyecto Parejas: prospective mixed methods study of HIV/STIs

among 214 sex workers & their 214 intimate male partners (n=428) in Tijuana & Ciudad Juarez, Mexico – Most couples always had unprotected sex together; condoms used for sex work– Heavy current drug use (62% heroin, 54% stimulants, 62% injected any drugs)

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Findings Highlight Social/Economic Contexts of Risk

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Time-varying predictors of new STIs (w/o HIV):• Recent stimulant use

(meth, crack, cocaine) increases women’s risk (aOR: 2.13; CI: 1.07–4.28)

• Women having regular sex work clients decreased their male partners’ risk (aOR: 0.38; CI: 0.14–1.03)

Female Sex Workers

Intimate Male Partners

Incidence of all STIs among FSWs than their male partners

• Women who reported physically assaulting partners also had decreased risk (aOR: 0.44; CI: 0.22–0.86)

More research is needed to understand how conflict and sex work earnings impact couples’ risk

• Couple interventions to promote communication and reduce conflict are needed

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CONCLUSIONS Interventions that increase empowerment of sex workers (i.e., choice of clients, ability to avoid violence) may reduce their own HIV/STI incidence and that of their intimate male partners.

THANK YOU!

Acknowledgements: Proyecto Parejas study participants & staff; NIH grants R01DA027772, R36DA032376, T32AI007384,

T32DA023356, K01 DA026307, and P30 AI060354-10

Contact: Steffanie A Strathdee, PhD: sstrathdee@ucsd.edu

Photos: O Loza, A Robertson, J Syvertsen, C Bava