RESUMO
Impulsivity is a trait characteristic that is associated with sexual risk behavior. We examined correlates of impulsivity among 602 female sex workers (FSWs) enrolled in a sexual risk reduction intervention in Mexico (2016-2020). Impulsivity was positively associated with condomless sex with clients. Higher levels of impulsivity were associated with greater use of alcohol and heavy drugs, use of illicit drugs with clients, sexual/physical abuse history, and clinical depression. Global public health policy that supports free substance abuse treatment in combination with psychotherapeutic treatments (e.g. regulation management skills) and behavioral-focused therapy may help to reduce HIV/STI incidence in this vulnerable population.
Assuntos
Infecções por HIV , Profissionais do Sexo , Infecções Sexualmente Transmissíveis , Humanos , Feminino , Infecções Sexualmente Transmissíveis/epidemiologia , Infecções por HIV/epidemiologia , México/epidemiologia , Comportamento ImpulsivoRESUMO
Shame may increase HIV risk among stigmatized populations. The Personal Feelings Questionnaire-2 (PFQ-2) measures shame, but has not been validated in Spanish-speaking or nonclinical stigmatized populations disproportionately affected by HIV in resource-limited settings. We examined the psychometric properties of the Spanish-translated PFQ-2 shame subscale among female sex workers in two Mexico-U.S. border cities. From 2016 to 2017, 602 HIV-negative female sex workers in Tijuana and Ciudad Juarez participated in an efficacy trial evaluating a behavior change maintenance intervention. Interviewer-administered surveys collected information on shame (10-item PFQ-2 subscale), psychosocial factors, and sociodemographics. Item performance, confirmatory factor analysis, internal consistency, differential item functioning by city, and concurrent validity were assessed. Response options were collapsed to 3-point responses to improve item performance, and one misfit item was removed. The revised 9-item shame subscale supported a single construct and had good internal consistency (Cronbach's α = .86). Notable differential item functioning was found but resulted in a negligible effect on overall scores. Correlations between the revised shame subscale and guilt (r = .79, p < .01), depression (r = .69, p < .01), and emotional support (r = -.28, p < .01) supported concurrent validity. The revised PFQ-2 shame subscale showed good reliability and concurrent validity in our sample, and should be explored in other stigmatized populations.
Assuntos
Profissionais do Sexo , Feminino , Humanos , México , Psicometria , Reprodutibilidade dos Testes , Vergonha , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Efforts to increase HIV testing, diagnosis and care are critical to curbing HIV epidemics among cisgender men who have sex with men (MSM) and transgender women (TW) in low- and middle-income countries (LMIC). We compared the effectiveness of respondent-driven sampling (RDS) and venue-based sampling (VBS) for identifying previously undiagnosed HIV infection among MSM and TW in Tijuana, Mexico. METHODS: Between March 2015 and December 2018, we conducted RDS within the social networks of MSM and TW and VBS at venues frequented by MSM and TW to socialize and meet sexual partners. Those reached by RDS/VBS who reported at least 18 years of age, anal sex with MSM or TW, and no previous HIV diagnosis were eligible for HIV testing. RESULTS: Of those screened following recruitment via RDS (N = 1232; 98.6% MSM; 1.3% TW), 60.8% (749/1232) were eligible for HIV testing and 97.5% (730/749) were tested for HIV infection, which led to the identification of 36 newly diagnosed HIV infections (4.9%). Of those screened following recruitment via VBS (N = 2560; 95.2% MSM; 4.6% TW), 56.5% (1446/2560) were eligible for HIV testing and 92.8% (1342/1446) were tested for HIV infection, which led to the identification of 82 newly diagnosed HIV infections (6.1%). The proportion of new HIV diagnoses did not differ by recruitment method (ratio = 0.81, 95% confidence interval: 0.55 to 1.18). Compared to those recruited via RDS, those tested following recruitment via VBS were younger, more likely to identify as gay, and more likely to identify as TW. Compared to those recruited via VBS, those newly diagnosed with HIV infection following recruitment via RDS reported higher levels of internalized stigma and were more likely to report injection drug use and a history of deportation from the United States. CONCLUSIONS: Despite RDS and VBS being equally effective for identifying undiagnosed HIV infection, each recruitment method reached different subgroups of MSM and TW in Tijuana. Our findings suggest that there may be benefits to using both RDS and VBS to increase the identification of previously undiagnosed HIV infection and ultimately support HIV care engagement among MSM and TW in Mexico and other similar LMIC.
Assuntos
Infecções por HIV/diagnóstico , Homossexualidade Masculina/estatística & dados numéricos , Programas de Rastreamento/métodos , Vigilância da População/métodos , Pessoas Transgênero/estatística & dados numéricos , Adolescente , Adulto , Feminino , Infecções por HIV/epidemiologia , Homossexualidade Masculina/psicologia , Humanos , Masculino , Programas de Rastreamento/estatística & dados numéricos , México/epidemiologia , Pessoa de Meia-Idade , Prevalência , Estudos de Amostragem , Comportamento Sexual , Inquéritos e Questionários , Pessoas Transgênero/psicologia , Adulto JovemRESUMO
OBJECTIVE To characterize recent HIV infections among newly diagnosed men who have sex with men and transgender women in Tijuana. METHODS Limiting Antigen (LAg)-Avidity testing was performed to detect recent HIV infection within a cohort of newly-diagnosed men who have sex with men and transgender women in Tijuana. Logistic regression was used to determine characteristics associated with recent infection. A partial transmission network was inferred using HIV-1 pol sequences. Tamura-Nei 93 genetic distances were measured between all pairs of sequences, and the network was constructed by inferring putative transmission links (genetic distances ≤ 1.5%). We assessed whether recent infection was associated with clustering within the inferred network. RESULTS Recent infection was detected in 11% (22/194) of newly-diagnosed participants. Out of the participants with sequence data, 60% (9/15) with recent infection clustered compared with 31% (43/139) with chronic infection. Two recent infections belonged to the same cluster. In adjusted analyses, recent infection was associated with years of residence in Tijuana (OR = 1.5; 95%CI 1.01-1.09), cocaine use (past month) (OR = 8.50; 95%CI 1.99-28.17), and ever experiencing sexual abuse (OR = 2.85; 95%CI 1.03-7.85). DISCUSSION A total of 11% of men newly diagnosed with HIV who have sex with men and transgender women in Tijuana were recently infected. The general lack of clustering between participants with recent infection suggests continued onward HIV transmission rather than an outbreak within a particular cluster.
Assuntos
Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Homossexualidade Masculina , Pessoas Transgênero , Brasil/epidemiologia , Feminino , Humanos , Masculino , Transtornos Relacionados ao Uso de Substâncias/epidemiologiaRESUMO
Mobile phone technology may help sustain reductions in HIV/STI transmission risk behaviors among female sex workers (FSWs). We examined the efficacy of a text messaging intervention designed to maintain behavioral improvements in safer sex practices among 602 FSWs in Tijuana and Ciudad Juarez, Mexico. We hypothesized that FSWs who received brief risk reduction counseling and theory-based safer sex maintenance text messages over a 24-month period would have fewer incident HIV/STIs and report greater maintenance of safer sex practices compared to FSWs who received counseling and texts on maintaining general health. Theory-based texts did not change the odds of becoming infected with HIV/STIs in either study site. However, they did lead to significant, sustained protected sex in Tijuana. Theory-based text messaging interventions may help sustain reductions in sexual risk behavior among FSWs.Trial Registration Clinical Trials.gov. Identifier: NCT02447484.
Assuntos
Infecções por HIV , Profissionais do Sexo , Infecções Sexualmente Transmissíveis , Envio de Mensagens de Texto , Feminino , Infecções por HIV/prevenção & controle , Humanos , México , Comportamento de Redução do Risco , Infecções Sexualmente Transmissíveis/prevenção & controleRESUMO
BACKGROUND: Stigma toward sexual and gender minorities is an important structural driver of HIV epidemics among men who have sex with men (MSM) and transgender women (TW) globally. Sex-seeking websites and apps are popular among MSM and TW. Interventions delivered via Web-based sex-seeking platforms may be particularly effective for engaging MSM and TW in HIV prevention and treatment services in settings with widespread stigma toward these vulnerable populations. OBJECTIVE: To assess the potential utility of this approach, the objectives of our study were to determine the prevalence of Web-based sex seeking and examine the effect of factors that shape or are influenced by stigma toward sexual and gender minorities on Web-based sex seeking among MSM and TW in Tijuana, Mexico. METHODS: From 2015 to 2018, 529 MSM and 32 TW were recruited through venue-based and respondent-driven sampling. Interviewer-administered surveys collected information on Web-based sex seeking (past 4 months) and factors that shape or are influenced by stigma toward sexual and gender minorities (among MSM and TW: traditional machismo, internalized stigma related to same-sex sexual behavior or gender identity, and outness related to same-sex sexual behavior or gender identity; among MSM only: sexual orientation and history of discrimination related to same-sex sexual behavior). A total of 5 separate multivariable logistic regression models were used to examine the effect of each stigma measure on Web-based sex seeking. RESULTS: A total of 29.4% (165/561) of our sample reported seeking sex partners on the Web. Web-based sex seeking was negatively associated with greater endorsement of traditional machismo values (adjusted odds ratio [AOR] 0.36, 95% CI 0.19 to 0.69) and greater levels of internalized stigma (AOR 0.96, 95% CI 0.94 to 0.99). Web-based sex seeking was positively associated with identifying as gay (AOR 2.13, 95% CI 1.36 to 3.33), greater outness (AOR 1.17, 95% CI 1.06 to 1.28), and a history of discrimination (AOR 1.83, 95% CI 1.08 to 3.08). CONCLUSIONS: Web-based sex-seeking is relatively common among MSM and TW in Tijuana, suggesting that it may be feasible to leverage Web-based sex-seeking platforms to engage these vulnerable populations in HIV prevention and treatment services. However, HIV interventions delivered through Web-based sex-seeking platforms may have limited reach among those most affected by stigma toward sexual and gender minorities (ie, those who express greater endorsement of traditional machismo values, greater levels of internalized stigma, lesser outness, and nongay identification), given that within our sample they were least likely to seek sex on the Web.
Assuntos
Homossexualidade Masculina/psicologia , Internet/estatística & dados numéricos , Comportamento Sexual/estatística & dados numéricos , Estigma Social , Pessoas Transgênero/psicologia , Adulto , Estudos Transversais , Feminino , Homossexualidade Masculina/estatística & dados numéricos , Humanos , Masculino , México , Pessoa de Meia-Idade , Pessoas Transgênero/estatística & dados numéricosRESUMO
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.
Assuntos
Transtornos Relacionados ao Uso de Álcool/epidemiologia , Infecções por HIV/prevenção & controle , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Profilaxia Pré-Exposição , Profissionais do Sexo/psicologia , Adulto , Transtornos Relacionados ao Uso de Álcool/complicações , Feminino , Infecções por HIV/epidemiologia , Acessibilidade aos Serviços de Saúde , Humanos , Análise de Classes Latentes , México/epidemiologia , Prevalência , Profissionais do Sexo/estatística & dados numéricos , Sindemia , Estados UnidosRESUMO
Stressors that arise in parenting are likely to have an adverse impact on the psychological well-being of female sex workers (FSWs), particularly in low- to middle-income countries (LMIC). This study examined the association between maternal role strain and depressive symptoms among 426 FSW mothers with dependent-age children (aged < 18 years) in Tijuana and Cd. Juarez, Mexico (2016-2017). Four dimensions of maternal role strain (e.g., child emotional and behavioral problems) were examined in relation to maternal depressive symptoms. We also investigated whether the relationship between maternal role strain and depressive symptoms was modified by venue of sex work. Compared to indoor/establishment-based FSWs, street-based FSWs reported significantly more child-related financial strain. In multiple regression analysis, having more depressive symptoms was associated with identifying as a street-based FSW, greater use of drugs, lower emotional support, more child-related financial strain and more emotional and behavioral problems in children. A significant interaction was identified such that the association between maternal role strain and depressive symptoms was stronger for indoor/establishment-based compared to street-based FSWs. These findings suggest the need to address parenting strain and type of sex work venue in the development of counseling programs to improve the mental health of FSWs in LMIC.
Assuntos
Depressão/epidemiologia , Mães/psicologia , Trabalho Sexual/psicologia , Profissionais do Sexo/psicologia , Adolescente , Adulto , Feminino , Humanos , Saúde Mental/estatística & dados numéricos , México/epidemiologia , Pessoa de Meia-Idade , Adulto JovemRESUMO
Understanding the relationship between cognitive and behavioral processes and long-term behavior change is critical to developing behavior change maintenance interventions. We examined the relationship between cognitive and behavioral safer sex maintenance strategies and condomless vaginal/anal sex with clients among female sex workers (FSWs) in Mexico. We hypothesized a moderating effect of hazardous alcohol use, such that the relationship between the use of safer sex maintenance strategies and condomless sex would be weaker among FSWs who meet criteria for hazardous alcohol consumption. Data were gathered from 602 FSWs enrolled in a sexual risk reduction intervention with a text messaging maintenance component. Seven cognitive and behavioral strategies purported to be critical in sustaining long-term behavior change were measured (e.g., maintenance self-efficacy). The relationship between FSWs' use of safer sex maintenance strategies and condomless vaginal/anal sex with clients was moderated by hazardous alcohol consumption. The association was weaker among FSWs who met criteria for hazardous alcohol consumption. Among FSWs who met criteria for hazardous alcohol consumption, maintenance self-efficacy was associated with fewer condomless sex acts with clients (b = -0.35, p < .001). Among FSWs who did not meet criteria for hazardous alcohol consumption, recovery self-efficacy (b = -0.21, p < .05) and self-monitoring (b = -0.34, p < .001) were associated with fewer acts of condomless sex. Results indicate the importance of examining the multidimensional nature of safer sex maintenance strategies and of exploring subgroup differences in their associations with behavioral outcomes. Interventions that address safer sex maintenance strategies in the context of alcohol treatment should be developed for this subgroup of FSWs.
Assuntos
Alcoolismo/psicologia , Preservativos , Comportamento de Redução do Risco , Sexo Seguro/estatística & dados numéricos , Profissionais do Sexo/estatística & dados numéricos , Adulto , Feminino , Humanos , México , Autoeficácia , Profissionais do Sexo/psicologia , Comportamento Sexual/psicologia , Envio de Mensagens de TextoRESUMO
ABSTRACT OBJECTIVE To characterize recent HIV infections among newly diagnosed men who have sex with men and transgender women in Tijuana. METHODS Limiting Antigen (LAg)-Avidity testing was performed to detect recent HIV infection within a cohort of newly-diagnosed men who have sex with men and transgender women in Tijuana. Logistic regression was used to determine characteristics associated with recent infection. A partial transmission network was inferred using HIV-1 pol sequences. Tamura-Nei 93 genetic distances were measured between all pairs of sequences, and the network was constructed by inferring putative transmission links (genetic distances ≤ 1.5%). We assessed whether recent infection was associated with clustering within the inferred network. RESULTS Recent infection was detected in 11% (22/194) of newly-diagnosed participants. Out of the participants with sequence data, 60% (9/15) with recent infection clustered compared with 31% (43/139) with chronic infection. Two recent infections belonged to the same cluster. In adjusted analyses, recent infection was associated with years of residence in Tijuana (OR = 1.5; 95%CI 1.01-1.09), cocaine use (past month) (OR = 8.50; 95%CI 1.99-28.17), and ever experiencing sexual abuse (OR = 2.85; 95%CI 1.03-7.85). DISCUSSION A total of 11% of men newly diagnosed with HIV who have sex with men and transgender women in Tijuana were recently infected. The general lack of clustering between participants with recent infection suggests continued onward HIV transmission rather than an outbreak within a particular cluster.