Interventions designed to reduce STI/HIV risk have mostly failed to consider clients of FSWs, who may act as a 'bridge'to the general population. Our recent survey of U.S and Mexican clients seeking FSWs in Tijuana revealed a startling HIV prevalence rate of 4.1%. Based on qualitative and quantitative interviews with clients from Tijuana Mexico and the U.S. we developed a theory-based intervention (Hombre Seguro) that uses Motivational Interviewing, active participation, and problem solving to increase clients'use of condoms with FSWs. We now propose an RCT to test the efficacy of this one- hour intervention in Tijuana which will enroll 400 HIV-negative men (200 residents of San Diego County;200 Tijuana residents) who report having unprotected sex with FSWs in the past 4 months. Our theory-based participatory intervention will be evaluated in comparison with a time and information equivalent didactic control condition. Participants will be recruited in Tijuana where they will undergo a baseline CAPI-administered interview, STI testing (HIV, syphilis, gonorrhea, Chlamydia), and intervention counseling with follow-up interviews at 4, 8, and 12 months post-baseline conducted in either Tijuana or San Diego. Our study aims are to: 1) evaluate the efficacy of Hombre Seguro to increase condom use of clients with FSWs;2) determine if the intervention is as efficacious among U.S. versus Mexican clients;3) determine the extent to which theoretically-based components of our intervention (e.g., self-efficacy) represent underlying mechanisms of change in primary outcomes (e.g., lower HIV/STI incidence);and 4) explore subgroup differences in efficacy of the intervention based on background characteristics (e.g., age), contextual factors (e.g., substance use before/during sex), psychosexual factors (e.g., social-sexual effectiveness), and psychosocial factors (e.g., social network influence). Our primary analytic approach will utilize a generalized linear mixed models (GLMM) approach to repeated measures analysis. This bi-national study will contribute significantly to HIV prevention research by addressing the role of male clients in the escalating HIV epidemics in Tijuana and San Diego, and could have application to other settings where HIV prevalence is high among FSWs and their clients.

Public Health Relevance

Behavioral interventions designed to reduce risk of HIV and sexually transmitted infections (STIs) have mostly failed to consider clients of female sex workers (FSWs), who may act as a "bridge" to the general population. This study proposes to test a brief, one-hour counseling intervention with male clients in Tijuana, Mexico, to reduce their rates of unprotected sex (i.e., sex without a condom) with FSWs as well as their rates of infection with HIV and STIs. Finding an effective intervention for this population is important given the rising rates of HIV infection in Tijuana (as documented in earlier studies) and the large numbers of people crossing the border in both directions, many of them specifically to purchase sex from FSWs in Tijuana.

Agency
National Institute of Health (NIH)
Institute
National Institute on Drug Abuse (NIDA)
Type
Research Project (R01)
Project #
3R01DA029008-04S1
Application #
8634323
Study Section
Program Officer
Jenkins, Richard A
Project Start
2013-03-01
Project End
2015-02-28
Budget Start
2013-03-01
Budget End
2014-02-28
Support Year
4
Fiscal Year
2013
Total Cost
$96,100
Indirect Cost
$34,100
Name
University of California San Diego
Department
Psychiatry
Type
Schools of Medicine
DUNS #
804355790
City
La Jolla
State
CA
Country
United States
Zip Code
92093
Goodman-Meza, David; Pitpitan, Eileen V; Semple, Shirley J et al. (2014) Hazardous drinking and HIV-risk-related behavior among male clients of female sex workers in Tijuana, Mexico. Am J Addict 23:502-9
Pitpitan, Eileen V; Chavarin, Claudia V; Semple, Shirley J et al. (2014) Hombre Seguro (Safe Men): a sexual risk reduction intervention for male clients of female sex workers. BMC Public Health 14:475
Volkmann, Tyson; Wagner, Karla D; Strathdee, Steffanie A et al. (2014) Correlates of self-efficacy for condom use among male clients of female sex workers in Tijuana, Mexico. Arch Sex Behav 43:719-27
Wagner, Karla D; Pitpitan, Eileen V; Chavarin, Claudia V et al. (2013) Drug-using male clients of female sex workers who report being paid for sex: HIV/sexually transmitted infection, demographic, and drug use correlates. Sex Transm Dis 40:619-23
Pitpitan, Eileen V; Wagner, Karla D; Goodman-Meza, David et al. (2013) Context matters: the moderating role of bar context in the association between substance use during sex and condom use among male clients of female sex workers in Tijuana, Mexico. AIDS Behav 17:2577-87
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Goldenberg, Shira M; Strathdee, Steffanie A; Gallardo, Manuel et al. (2011) How important are venue-based HIV risks among male clients of female sex workers? A mixed methods analysis of the risk environment in nightlife venues in Tijuana, Mexico. Health Place 17:748-56
Goldenberg, Shira M; Strathdee, Steffanie A; Gallardo, Manuel et al. (2011) "Over here, it's just drugs, women and all the madness": The HIV risk environment of clients of female sex workers in Tijuana, Mexico. Soc Sci Med 72:1185-92
Goldenberg, Shira M; Gallardo Cruz, Manuel; Strathdee, Steffanie A et al. (2010) Correlates of unprotected sex with female sex workers among male clients in Tijuana, Mexico. Sex Transm Dis 37:319-24
Patterson, Thomas L; Goldenberg, Shira; Gallardo, Manuel et al. (2009) Correlates of HIV, sexually transmitted infections, and associated high-risk behaviors among male clients of female sex workers in Tijuana, Mexico. AIDS 23:1765-71

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