title: 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.
abstract: Tijuana is situated on Mexico's northern border with the U.S., where sex work is quasi-legal. Whereas previous work has focused on the risk behaviors of female sex workers (FSWs), less is known about the risk behaviors of their male clients. Further, research has not examined structural factors as moderators of the association between substance use and condom use, including the contexts in which sex takes place. The purpose of the current study is to examine whether having sex with FSWs in a bar moderates the link between alcohol intoxication during sex and condom use. We recruited 375 male clients of FSWs in Tijuana, Mexico from San Diego, California and Tijuana. Using computer assisted interviewing, we surveyed participants on their alcohol use, condom use, and physical contexts of sex with FSWs in the past 4 months. Results showed that more frequent intoxication during sex with FSWs is associated with more unprotected sex, but only among clients having sex with FSWs in a bar context. Results point to potential reasons for inconsistent condom use with FSWs in this context, including lower risk perceptions of sex with FSWs in bars. Future research should examine structural factors that underlie clients' risk behavior in bars in order to inform structural-level HIV prevention interventions.
authors: Division of Global Public Health, Department of Medicine, University of California San Diego, School of Medicine, 9500 Gilman Drive, MC 0507, La Jolla, CA, 92093-0507, USA, epitpitan@ucsd.edu.
authors: Eileen V
authors: EV
authors: Pitpitan
authors: Karla D
authors: KD
authors: Wagner
authors: David
authors: D
authors: Goodman-Meza
authors: Shirley J
authors: SJ
authors: Semple
authors: Claudia
authors: C
authors: Chavarin
authors: Steffanie A
authors: SA
authors: Strathdee
authors: Thomas L
authors: TL
authors: Patterson
mesh_terms: D000328:Adult; D002140:California / Q000453:epidemiology; D017280:Condoms / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control* / Q000523:psychology; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008800:Mexico / Q000453:epidemiology; D012147:Restaurants / Q000706:statistics & numerical data*; D011477:Sex Work / Q000523:psychology / Q000706:statistics & numerical data; D060386:Sex Workers; D012725:Sexual Behavior / Q000523:psychology / Q000706:statistics & numerical data*; D012747:Sexual Partners / Q000523:psychology; D019966:Substance-Related Disorders / Q000453:epidemiology* / Q000523:psychology; D011795:Surveys and Questionnaires; D047568:Unsafe Sex / Q000706:statistics & numerical data*
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