Effects of government registration on unprotected sex amongst female sex workers in Tijuana; Mexico.
BACKGROUND
Sex work is partially regulated in Tijuana, but little is known of its health effects. A recent behavioural intervention amongst female sex workers (FSWs) decreased incidence of HIV/STIs by 40%. We evaluated effects of sex worker regulation on condom use amongst FSWs randomized to this intervention.


METHODS
FSWs aged ≥18 years who reported unprotected sex with ≥1 client in the last 2 months and whether they were registered with Tijuana's Municipal Health Department underwent a brief, theory-based behavioural intervention to increase condom use. At baseline and 6 months, women underwent interviews and testing for HIV, syphilis, Chlamydia trachomatis and Neisseria gonorrhoeae. Negative binomial regression was used to determine the effect of registration on numbers of unprotected sex acts and cumulative HIV/STI incidence.


RESULTS
Of 187 women, 83 (44%) were registered. Lack of registration was associated with higher rates of unprotected sex (rate ratio: 1.7, 95% CI: 1.2-2.3), compared to FSWs who were registered, after controlling for potential confounders.


CONCLUSIONS
Registration predicted increased condom use amongst FSWs enrolled in a behavioural intervention. Public health programmes designed to improve condom use amongst FSWs may benefit from understanding the impact of existing regulation systems on HIV risk behaviours.
Department of Medicine, Montefiore Medical Center - Albert Einstein College of Medicine, New York, NY, USA.
Nicole
N
Sirotin
Steffanie A
SA
Strathdee
Remedios
R
Lozada
Daniela
D
Abramovitz
Shirley J
SJ
Semple
Jesús
J
Bucardo
Thomas L
TL
Patterson
D000328:Adult; D017280:Condoms / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007406:Interview, Psychological; D008800:Mexico; D009042:Motivation; D011446:Prospective Studies; D011634:Public Health / Q000331:legislation & jurisprudence; D012044:Regression Analysis; D012309:Risk-Taking; D011477:Sex Work / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D012725:Sexual Behavior / Q000523:psychology / Q000706:statistics & numerical data; D012749:Sexually Transmitted Diseases / Q000453:epidemiology / Q000517:prevention & control*; D047568:Unsafe Sex / Q000517:prevention & control* / Q000706:statistics & numerical data