Intravaginal practices among HIV‐negative female sex workers along the US–Mexico border and their implications for emerging HIV prevention interventions

Abstract

Objective To describe intravaginal practices (IVPs) among female sex workers (FSWs) who inject drugs in two cities—Tijuana and Ciudad Juarez—on the border between the USA and Mexico. Methods Data for a secondary analysis were obtained from interviews conducted as part of a randomized controlled trial in FSWs who injected drugs between October 28, 2008, and May 31, 2010. Eligible individuals were aged at least 18 years and reported sharing injection equipment and having unprotected sex with clients in the previous month. Descriptive statistics were used to assess frequency and type of IVPs. Logistic regression was used to assess correlates of IVPs. Results Among 529 FSWs who completed both surveys, 229 (43.3%) had performed IVPs in the previous 6 months. Factors independently associated with IVPs were reporting any sexually transmitted infection in the previous 6 months (adjusted odds ratio [aOR] 1.8, 95% confidence interval [CI] 1.1–3.1; P=0.03), three or more pregnancies (aOR 1.9, 95% CI 1.1–3.2; P=0.02), and having clients who became violent when proposing condom use (aOR 5.8, 95% CI 1.0–34.3; P=0.05), which are all factors related to inconsistent condom use. Conclusion Screening for IVPs could help to identify FSW at increased risk of HIV, and facilitate conversations about specific risk-reduction methods.

Vaginal washing and lubrication among female sex workers in the Mexico-US border region: implications for the development of vaginal PrEP for HIV prevention

“…It is important to note that our results differ in several ways from those reported by a previous study that examined intravaginal practices among FSWs in Tijuana and Ciudad Juarez [ 28 ]. In contrast to FSWs included in our study, in the previous study, a greater proportion of FSWs in Ciudad Juarez (53%) than in Tijuana (33%) reported performing intravaginal practices in the past 6 months [ 28 ].…”

“…It is important to note that our results differ in several ways from those reported by a previous study that examined intravaginal practices among FSWs in Tijuana and Ciudad Juarez [ 28 ]. In contrast to FSWs included in our study, in the previous study, a greater proportion of FSWs in Ciudad Juarez (53%) than in Tijuana (33%) reported performing intravaginal practices in the past 6 months [ 28 ]. Furthermore, while data on the use of commercial solutions were not reported by the previous study, unlike our findings with respect to the use of non-commercial solutions for vaginal washing, the previous study found that use of homemade solutions for intravaginal practices was higher in Ciudad Juarez (79%) than in Tijuana (30%) [ 28 ].…”

“…In contrast to FSWs included in our study, in the previous study, a greater proportion of FSWs in Ciudad Juarez (53%) than in Tijuana (33%) reported performing intravaginal practices in the past 6 months [ 28 ]. Furthermore, while data on the use of commercial solutions were not reported by the previous study, unlike our findings with respect to the use of non-commercial solutions for vaginal washing, the previous study found that use of homemade solutions for intravaginal practices was higher in Ciudad Juarez (79%) than in Tijuana (30%) [ 28 ]. While these discrepancies may reflect variation in norms affecting FSWs’ vaginal washing and lubrication practices both across and within settings over time, they may also be explained by a number of important differences between the present and previous studies.…”

“…Potential predictors significantly associated with vaginal washing or lubrication practices in bivariate analyses ( p -value< 0.05) were further examined in multivariable models. In previous research, age, education, number of previous pregnancies, number of clients, condom use with clients, HIV testing, and history of STIs have been associated with FSWs’ intravaginal practices [ 24 , 27 , 28 , 30 ]. Based on this research, directed acyclic graphs (DAGs) [ 53 ] were constructed to depict known or plausible relationships between the potential predictors and the outcomes.…”

“…High rates of gonorrhea (6%), chlamydia (13%), and syphilis (14%) have also been documented among FSWs in the border region [ 44 ]. In a survey conducted with FSWs who inject drugs in Tijuana and Ciudad Juarez between 2008 and 2010, 53% of FSWs in Ciudad Juarez and 33% of FSWs in Tijuana reported performing intravaginal practices in the past 6 months most commonly to clean (65%) or treat vaginal symptoms (64%) [ 28 ]. While that work established the prevalence of intravaginal practices among FSWs in the region, practice-specific data on vaginal washing and vaginal lubrication were not collected.…”