The overall goal of this study is to study the context and epidemiology of HIV, STIs and associated risk behaviors among high risk female sex workers (FSWs) and their non-commercial male partners in two Mexico- US border cities. Preliminary data collected by our binational team over the past 5 years suggest that FSWs'non-commercial partners may be significant drivers of HIV/STI acquisition and/or their re-infection, which is supported by literature in other countries. FSWs in our setting are more than twice as likely to engage in unprotected sex with their main non-commercial partner;half of these partners have concurrent partnerships and one third are IDUs. The proposed study of FSW-partner pairs (dyads) builds on our existing research infrastructure in Tijuana and Cd. Juarez to meet the following aims:
Aim 1 : To examine the a) context and b) patterns of high risk sexual and substance using behaviors among high risk FSWs and their main non- commercial male partners, both within and outside of the partnerships, using a mixed-methods approach;
Aim 2 : To determine prevalence of HIV and specific STIs (i.e., syphilis, gonorrhea, Chlamydia, HSV-2) and associated correlates at the individual and partner level;
Aim 3 : To prospectively identify predictors of STI incidence and their attributable risks at the individual and partner level;
Aim 4 : To determine the feasibility of conducting a behavioral intervention trial among high risk FSWs and their main non-commercial male partner at the a) partner level and b) individual level, using mixed methods. To meet these aims, we will recruit 100 FSW-partner dyads in both Tijuana and Cd. Juarez (i.e., 200 couples), who will undergo interviews and HIV/STI testing at baseline and follow-up for 24 months to address both clinical and behavioral outcomes (Aims 2 and 3). A subset (25 couples per city) will undergo in-depth interviews at baseline and once during follow-up to refine the quantitative survey, and inform a mixed methods analysis to address Aims 1 and 4. Using qualitative and quantitative methods, we will assess each partner's interest in participating in a subsequent intervention, attrition and partnership dissolution, and potential barriers to interventions such as intimate partner violence (Aim 4). To our knowledge, the proposed study is the first prospective evaluation of FSWs and their non-commercial partners. Our binational research team is uniquely positioned to conduct this study, which will inform the response to the growing HIV crisis on the Mexico-US border and efforts to curtail HIV transmission among FSWs and their partners in other resource-constrained settings.

Public Health Relevance

The proposed study of FSW-partner pairs in Tijuana and Ciudad Juarez will meet the following aims:
Aim 1 : To examine the a) social context and b) patterns of high risk sexual and substance using behaviors among high risk FSWs and their main non-commercial male partners, both within and outside of the partnerships, using a mixed-methods approach;
Aim 2 : To determine prevalence of HIV and specific STIs (i.e., syphilis, gonorrhea, Chlamydia, HSV-2) and associated correlates at the individual and partner level;
Aim 3 : To prospectively identify predictors of STI incidence and their attributable risks at the individual and partner level;
Aim 4 : To determine the feasibility of conducting a behavioral intervention trial among high risk FSWs and their main non-commercial male partner at the a) partner level and b) individual level, using mixed methods.

Agency
National Institute of Health (NIH)
Institute
National Institute on Drug Abuse (NIDA)
Type
Research Project (R01)
Project #
3R01DA027772-02S1
Application #
8101465
Study Section
Special Emphasis Panel (ZRG1-AARR-F (02))
Program Officer
Hartsock, Peter
Project Start
2009-08-01
Project End
2014-04-30
Budget Start
2010-09-01
Budget End
2011-04-30
Support Year
2
Fiscal Year
2010
Total Cost
$71,843
Indirect Cost
Name
University of California San Diego
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
804355790
City
La Jolla
State
CA
Country
United States
Zip Code
92093
Ulibarri, Monica D; Salazar, Marissa; Syvertsen, Jennifer L et al. (2018) Intimate Partner Violence Among Female Sex Workers and Their Noncommercial Male Partners in Mexico: A Mixed-Methods Study. Violence Against Women :1077801218794302
Mittal, María Luisa; Bazzi, Angela Robertson; Rangel, María Gudelia et al. (2018) 'He's not my pimp': toward an understanding of intimate male partner involvement in female sex work at the Mexico-US border. Cult Health Sex 20:961-975
Wagner, Karla D; Syvertsen, Jennifer L; Verdugo, Silvia R et al. (2018) A mixed methods study of the social support networks of female sex workers and their primary noncommercial male partners in Tijuana, Mexico. J Mix Methods Res 12:437-457
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
Syvertsen, Jennifer L; Bazzi, Angela Robertson; Mittal, María Luisa (2017) Hope Amidst Horror: Documenting the Effects of the ""War On Drugs"" Among Female Sex Workers and Their Intimate Partners in Tijuana, Mexico. Med Anthropol 36:566-583
Palinkas, Lawrence A; Bazzi, Angela Robertson; Syvertsen, Jennifer L et al. (2016) Measuring Current Drug Use in Female Sex Workers and Their Noncommercial Male Partners in Mexico: Concordance Between Data Collected From Surveys Versus Semi-Structured Interviews. Subst Use Misuse 51:23-33
Bazzi, Angela R; Syvertsen, Jennifer L; Rolón, María Luisa et al. (2016) Social and Structural Challenges to Drug Cessation Among Couples in Northern Mexico: Implications for Drug Treatment in Underserved Communities. J Subst Abuse Treat 61:26-33
Tracas, Ashley; Bazzi, Angela Robertson; Artamonova, Irina et al. (2016) Changes in Condom Use Over Time Among Female Sex Workers and Their Male Noncommercial Partners and Clients. AIDS Educ Prev 28:312-24
Pines, Heather A; Patterson, Thomas L; Rangel, Gudelia et al. (2015) STI/HIV test result disclosure between female sex workers and their primary, non-commercial male partners in two Mexico-US border cities: a prospective study. Sex Transm Infect 91:207-13
Bazzi, Angela Robertson; Rangel, Gudelia; Martinez, Gustavo et al. (2015) Incidence and Predictors of HIV and Sexually Transmitted Infections Among Female Sex Workers and Their Intimate Male Partners in Northern Mexico: A Longitudinal, Multilevel Study. Am J Epidemiol 181:723-31

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