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.

National Institute of Health (NIH)
National Institute on Drug Abuse (NIDA)
Research Project (R01)
Project #
Application #
Study Section
Special Emphasis Panel (ZRG1-AARR-F (08))
Program Officer
Jenkins, Richard A
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
University of California San Diego
Schools of Medicine
La Jolla
United States
Zip Code
Fleming, Paul J; Patterson, Thomas L; Chavarin, Claudia V et al. (2018) Are men's misogynistic attitudes associated with poor mental health and substance use behaviors? An exploratory study of men in Tijuana, Mexico. Psychol Men Masc 19:314-318
Fleming, Paul J; Patterson, Thomas L; Chavarin, Claudia V et al. (2017) Behavioral and Psychosocial Correlates of HIV Testing Among Male Clients of Female Sex Workers in Tijuana, Mexico. AIDS Behav 21:2322-2331
Semple, Shirley J; Strathdee, Steffanie A; Pitpitan, Eileen V et al. (2015) Behavioral and psychosocial correlates of anal sex among male clients of female sex workers in Tijuana, Mexico. Arch Sex Behav 44:1025-33
Wagner, Karla D; Pitpitan, Eileen V; Valente, Thomas W et al. (2015) Place of Residence Moderates the Relationship Between Emotional Closeness and Syringe Sharing Among Injection Drug Using Clients of Sex Workers in the US-Mexico Border Region. AIDS Behav 19:987-95
Pitpitan, Eileen V; Goodman-Meza, David; Burgos, Jose Luis et al. (2015) Prevalence and correlates of HIV among men who have sex with men in Tijuana, Mexico. J Int AIDS Soc 18:19304
Pitpitan, Eileen V; Strathdee, Steffanie A; Semple, Shirley J et al. (2015) Perceived stigma of purchasing sex among Latino and non-Latino male clients of female sex workers in Tijuana, Mexico. J Immigr Minor Health 17:172-80
Pitpitan, Eileen V; Strathdee, Steffanie A; Semple, Shirley J et al. (2015) Buffering Syndemic Effects in a Sexual Risk-Reduction Intervention for Male Clients of Female Sex Workers: Results From a Randomized Controlled Trial. Am J Public Health 105:1866-71
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
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

Showing the most recent 10 out of 21 publications