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

Abstract

IntroductionThe 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.MethodsParticipants (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.ResultsParticipants’ 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.ConclusionsThe 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.

The Relationship Between Psychological Temporal Perspective and HIV/STI Risk Behaviors Among Male Sex Workers in Mexico City

“…MSWs are at high risk of STI/HIV acquisition and further transmission (Baral et al, 2015), particularly because of the market inducements for higher risk: They get paid higher prices for unprotected sex (Arunachalam & Shah, 2012; Galárraga et al, 2014a). The extant evidence has shown that MSWs engage in risky sexual behavior motivated by the additional premium(higher payment) they receive for having sex without condom; and that they are a subgroup of the population that, in general, may be focused on living the present day without considering the potentially deleterious future consequences of having unsafe sex with a client—a scenario in which they could be infected with HIV.…”

“…Nevertheless, the epidemic is disproportionately concentrated among men who have sex with men(MSM) who had an HIV prevalence of 17% in 2011 (Bautista-Arredondo, Colchero, Romero, Conde-Gonzalez, & Sosa-Rubi, 2013). This prevalence is higher among specific MSM subgroups such as transvestite, transgender, and transsexual (TTT) with a prevalence of around 19.8% (Colchero et al, 2015; Infante, Sosa-Rubí, & Cuadra, 2009), and male sex workers (MSWs) with a prevalence above 30%(Galárraga et al, 2014a). Much of the literature has focused on examining the relationship between sexual risk behaviors among MSM and HIV and/or other sexually transmitted infections(STI).…”

“…A specific subset of the MSM population, young men who have sex with men (YMSM), has been the focus of a growing body of research (Beidas, Birkett, Newcomb, & Mustanski, 2012; Chamberlain, Mena, Geter, &Crosby, 2016; Crosby, Mena, &Geter, 2016; Guo, Zhang, Wang, Chen, & Zheng, 2016; Hoenigl, Chaillon, Morris, & Little, 2016; Lee, Kim, Woo, Yoon, &Choi, 2016; Maksut, Eaton, Siembida, Driffin, &Baldwin, 2016). Yet research that seeks to understand the unique vulnerabilities of young male sex workers trying to understand their time perceptions remains limited (Galárraga et al, 2014a; Infante et al, 2009). In response to this public health need and taking into account the fact that MSWs have the highest HIV prevalence rates (Galárraga et al, 2014a), our study analyzes the relationship between a psychological temporal perspective and HIV/STI risk behaviors among MSWs.…”

“…Yet research that seeks to understand the unique vulnerabilities of young male sex workers trying to understand their time perceptions remains limited (Galárraga et al, 2014a; Infante et al, 2009). In response to this public health need and taking into account the fact that MSWs have the highest HIV prevalence rates (Galárraga et al, 2014a), our study analyzes the relationship between a psychological temporal perspective and HIV/STI risk behaviors among MSWs.…”

Evaluation of HIV, STI and CD4 results among voluntary attendees at the HIV/AIDS program of Mexico City

“…3,4 A control trial study performed among male sex workers found, at baseline, a HIV prevalence of 38%. 5 Most current studies of HIV frequencies among female sex workers in Northern Mexico have fluctuated between 4.8 and 10.9% and intravenous drug use was significantly associated to that HIV prevalences. [6][7][8][9] Nevertheless, no HIV prevalence study have been done among people who requested Voluntary Counseling and Testing in the HIV/AIDS preventive programs in Mexico.…”