Globally, FSWs who inject drugs (FSW-IDUs) are important `bridge' populations that can transmit HIV/STIs to the general population; however, interventions to reduce both their injection and sexual risks are lacking. The overall goal of this epidemiologic study is to simultaneously reduce high risk sexual and injection behaviors among FSW-IDUs in two Mexico-U.S. border cities, among whom HIV prevalence has recently increased from 2% to 14%; 46% had at least one active STI.
Our specific aims are:
Aim 1) To evaluate the efficacy of a behavioral intervention to decrease sharing of syringes and injection paraphernalia among FSW-IDUs. We hypothesize that FSW-IDUs in the active experimental injection risk reduction condition will report: (a) less receptive and distributive needle sharing; (b) less sharing of injection paraphernalia; (c) obtaining syringes and injection paraphernalia from safer sources.
Aim 2) To evaluate efficacy of a behavioral intervention to increase condom use among FSW-IDUs in the context of ongoing drug use. We hypothesize that FSW-IDUs in the active experimental sexual risk reduction condition will: (a) report less unprotected vaginal and anal sex; (b) have fewer incident cases of specific STIs.
Aim 3) To evaluate the joint effects of these two behavioral interventions to increase condom use and reduce sharing of needles/injection paraphernalia among FSW- IDUs. We hypothesize that the joint effect of these interventions will generate greater risk reductions compared to either intervention alone.
Aim 4) To determine the extent to which theoretically-important components of our interventions (i.e., self-efficacy, outcome expectancies, attitudes, intentions) represent underlying mechanisms of change in primary outcomes (i.e., sexual and injection-related risk reductions).
Aim 5) To explore subgroup differences in the efficacy of a) the sexual risk reduction intervention and b) the injection risk reduction intervention based on background characteristics, contextual factors, social factors and intrapersonal factors. To meet these aims, we will recruit 600 HIV-negative FSW-IDUs (300 each in Tijuana and Cd. Juarez) and randomize women to one of three time-equivalent groups (Group 1: injection risk intervention and didactic safer sex education; Group 2: sexual risk intervention and didactic safer injection education; Group 3: Both active injection and sexual interventions). In each city, cluster randomization will be used to minimize contamination. All women receive free STI treatment and will be followed-up at 4, 8 and 12 months. Our design allows us to `unpack' the intervention to determine whether its components are just as effective in reducing injection and/or sexual risks, or if the more intensive conditions are needed to alter the epidemiology of HIV/STIs, thus having direct, tangible policy implications for Mexico and the US. Interventions that reduce HIV risks among FSW-IDUs may curtail the burgeoning HIV epidemic in the U.S-Mexico border region, and have applicability to other resource-poor countries.Globally, FSWs who inject drugs (FSW-IDUs) are important `bridge' populations that can transmit HIV/STIs to the general population; however, interventions to reduce both their injection and sexual risks are lacking. The overall goal of this epidemiologic study is to simultaneously reduce high risk sexual and injection behaviors among FSW-IDUs in two Mexico-U.S. border cities, among whom HIV prevalence has recently increased dramatically. To our knowledge, this is the first study of its kind to be tested in any country, findings from which have particular relevance to resource-constrained environments. ? ? ?

Agency
National Institute of Health (NIH)
Institute
National Institute on Drug Abuse (NIDA)
Type
Research Project (R01)
Project #
1R01DA023877-01A1
Application #
7418852
Study Section
Special Emphasis Panel (ZRG1-AARR-H (08))
Program Officer
Jenkins, Richard A
Project Start
2008-02-01
Project End
2013-01-31
Budget Start
2008-02-01
Budget End
2009-01-31
Support Year
1
Fiscal Year
2008
Total Cost
$598,645
Indirect Cost
Name
University of California San Diego
Department
Family Medicine
Type
Schools of Medicine
DUNS #
804355790
City
La Jolla
State
CA
Country
United States
Zip Code
92093
Jain, Jennifer P; Bristow, Claire C; Pines, Heather A et al. (2018) Factors in the HIV risk environment associated with bacterial vaginosis among HIV-negative female sex workers who inject drugs in the Mexico-United States border region. BMC Public Health 18:1032
Mehta, Sanjay R; Chaillon, Antoine; Gaines, Tommi L et al. (2018) Impact of Public Safety Policies on Human Immunodeficiency Virus Transmission Dynamics in Tijuana, Mexico. Clin Infect Dis 66:758-764
West, Brooke S; Abramovitz, Daniela; Staines, Hugo et al. (2016) Predictors of Injection Cessation and Relapse among Female Sex Workers who Inject Drugs in Two Mexican-US Border Cities. J Urban Health 93:141-54
Seidman, Dominika; Rusch, Melanie; Abramovitz, Daniela et al. (2016) Intravaginal practices among HIV-negative female sex workers along the US-Mexico border and their implications for emerging HIV prevention interventions. Int J Gynaecol Obstet 133:212-6
Smith, Laramie R; Patterson, Thomas L; Magis-Rodriguez, Carlos et al. (2016) Engagement in the HIV Care Continuum among Key Populations in Tijuana, Mexico. AIDS Behav 20:1017-25
Pitpitan, Eileen V; Patterson, Thomas L; Abramovitz, Daniela et al. (2016) Policing behaviors, safe injection self-efficacy, and intervening on injection risks: Moderated mediation results from a randomized trial. Health Psychol 35:87-91
Burgos, Jose L; Patterson, Thomas L; Graff-Zivin, Joshua S et al. (2016) Cost-Effectiveness of Combined Sexual and Injection Risk Reduction Interventions among Female Sex Workers Who Inject Drugs in Two Very Distinct Mexican Border Cities. PLoS One 11:e0147719
Mehta, Sanjay R; Wertheim, Joel O; Brouwer, Kimberly C et al. (2015) HIV Transmission Networks in the San Diego-Tijuana Border Region. EBioMedicine 2:1456-63
Gaines, Tommi L; Urada, Lianne A; Martinez, Gustavo et al. (2015) Short-term cessation of sex work and injection drug use: evidence from a recurrent event survival analysis. Addict Behav 45:63-9
Servin, Argentina E; Strathdee, Steffanie; Muñoz, Fatima A et al. (2015) Vulnerabilities faced by the children of sex workers in two Mexico-US border cities: a retrospective study on sexual violence, substance use and HIV risk. AIDS Care 27:1-5

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