title: Correlates of unprotected sex with female sex workers among male clients in Tijuana, Mexico.
abstract: BACKGROUND
  Tijuana, situated adjacent to San Diego, CA on the US-Mexico border, is experiencing an emerging HIV epidemic, with prevalence among female sex workers (FSWs) having risen in recent years from <1% to 6%. Comparable data on FSWs' clients are lacking. We explored correlates of unprotected sex with FSWs among male clients in Tijuana.
  
  
  METHODS
  In 2008, males from San Diego (N = 189) and Tijuana (N = 211) aged 18 or older who had paid or traded for sex with a FSW in Tijuana during the past 4 months were recruited in Tijuana's red light district. Participants underwent psychosocial interviews, and were tested for HIV, syphilis (Treponema pallidum), gonorrhea (Neisseria gonorrhoeae), and Chlamydia (Chlamydia trachomatis).
  
  
  RESULTS
  Of 394 men, median age was 36 years, 42.1% were married, and 39.3% were unemployed. Ethnic composition was 13.2% white, 79.4% Hispanic, and 7.4% black or other. Half (50.3%) reported unprotected vaginal or anal sex with FSWs in Tijuana in the past 4 months. High proportions reported using drugs during sex (66%), and 36% reported frequenting the same FSW. Factors independently associated with unprotected sex with FSWs were using drugs during sex, visiting the same FSW, being married, and being unemployed.
  
  
  CONCLUSIONS
  FSWs' clients represent a sexually transmitted infections/HIV transmission "bridge" through unprotected sex with FSWs, wives, and other partners. Tailored interventions to promote consistent condom use are needed for clients, especially within the context of drug use and ongoing relations with particular FSWs.
authors.affiliation: Department of Medicine, University of California, San Diego, La Jolla, USA.
authors.forename: Shira M
authors.initials: SM
authors.lastname: Goldenberg
authors.forename: Manuel
authors.initials: M
authors.lastname: Gallardo Cruz
authors.forename: Steffanie A
authors.initials: SA
authors.lastname: Strathdee
authors.forename: Lucie
authors.initials: L
authors.lastname: Nguyen
authors.forename: Shirley J
authors.initials: SJ
authors.lastname: Semple
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Patterson
mesh_terms: D000293:Adolescent; D000328:Adult; D003625:Data Collection; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000635:transmission*; D006801:Humans; D007407:Interviews as Topic; D016015:Logistic Models; D008297:Male; D008800:Mexico / Q000453:epidemiology; D012309:Risk-Taking; D011477:Sex Work / Q000706:statistics & numerical data*; D012749:Sexually Transmitted Diseases / Q000453:epidemiology / Q000635:transmission*; D012959:Socioeconomic Factors; D019966:Substance-Related Disorders / Q000150:complications / Q000453:epidemiology; D047568:Unsafe Sex / Q000706:statistics & numerical data*; D055815:Young Adult