title: Buffering Syndemic Effects in a Sexual Risk-Reduction Intervention for Male Clients of Female Sex Workers: Results From a Randomized Controlled Trial.
abstract: OBJECTIVE
  We sought to test the efficacy of a sexual risk intervention for male clients of female sex workers (FSWs) and examine whether efficacy was moderated by syndemic risk.
  
  
  METHODS
  From 2010 to 2014, we conducted a 2-arm randomized controlled trial (60-minute, theory-based, safer sex intervention versus a didactic time-equivalent attention control) that included 400 male clients of FSWs on the US-Mexico border with follow-up at 4, 8, and 12 months. We measured 5 syndemic risk factors, including substance use and depression. Primary outcomes were sexually transmitted infections incidence and total unprotected sex with FSWs.
  
  
  RESULTS
  Although participants in both groups became safer, there was no significant difference in behavior change between groups. However, baseline syndemic risk moderated intervention efficacy. At baseline, there was a positive association between syndemic risk and unprotected sex. Then at 12 months, longitudinal analyses showed the association depended on intervention participation (B = -0.71; 95% confidence interval [CI] = -1.22, -0.20; P = .007). Among control participants there still existed this modest association (B = 0.36; 95% CI = -0.49, 1.22; P = .09); among intervention participants there was a significant negative association (B = -0.35; 95% CI = -0.63, -0.06; P = .02).
  
  
  CONCLUSIONS
  A brief intervention might attenuate syndemic risks among clients of FSWs. Other populations experiencing syndemic problems may also benefit from such programs.
authors.affiliation: Eileen V. Pitpitan, Steffanie A. Strathdee, Shirley J. Semple, and Claudia V. Chavarin are with the Division of Global Public Health, Department of Medicine, University of California San Diego. Carlos Magis-Rodriguez is with the Centro Nacional para la Prevención y Control del VIH/SIDA (CENSIDA; National Center for HIV/AIDS Prevention and Control), Ministry of Health, Mexico. Thomas L. Patterson is with the Department of Psychiatry, University of California San Diego.
authors.forename: Eileen V
authors.initials: EV
authors.lastname: Pitpitan
authors.affiliation: Eileen V. Pitpitan, Steffanie A. Strathdee, Shirley J. Semple, and Claudia V. Chavarin are with the Division of Global Public Health, Department of Medicine, University of California San Diego. Carlos Magis-Rodriguez is with the Centro Nacional para la Prevención y Control del VIH/SIDA (CENSIDA; National Center for HIV/AIDS Prevention and Control), Ministry of Health, Mexico. Thomas L. Patterson is with the Department of Psychiatry, University of California San Diego.
authors.forename: Steffanie A
authors.initials: SA
authors.lastname: Strathdee
authors.affiliation: Eileen V. Pitpitan, Steffanie A. Strathdee, Shirley J. Semple, and Claudia V. Chavarin are with the Division of Global Public Health, Department of Medicine, University of California San Diego. Carlos Magis-Rodriguez is with the Centro Nacional para la Prevención y Control del VIH/SIDA (CENSIDA; National Center for HIV/AIDS Prevention and Control), Ministry of Health, Mexico. Thomas L. Patterson is with the Department of Psychiatry, University of California San Diego.
authors.forename: Shirley J
authors.initials: SJ
authors.lastname: Semple
authors.affiliation: Eileen V. Pitpitan, Steffanie A. Strathdee, Shirley J. Semple, and Claudia V. Chavarin are with the Division of Global Public Health, Department of Medicine, University of California San Diego. Carlos Magis-Rodriguez is with the Centro Nacional para la Prevención y Control del VIH/SIDA (CENSIDA; National Center for HIV/AIDS Prevention and Control), Ministry of Health, Mexico. Thomas L. Patterson is with the Department of Psychiatry, University of California San Diego.
authors.forename: Claudia V
authors.initials: CV
authors.lastname: Chavarin
authors.affiliation: Eileen V. Pitpitan, Steffanie A. Strathdee, Shirley J. Semple, and Claudia V. Chavarin are with the Division of Global Public Health, Department of Medicine, University of California San Diego. Carlos Magis-Rodriguez is with the Centro Nacional para la Prevención y Control del VIH/SIDA (CENSIDA; National Center for HIV/AIDS Prevention and Control), Ministry of Health, Mexico. Thomas L. Patterson is with the Department of Psychiatry, University of California San Diego.
authors.forename: Carlos
authors.initials: C
authors.lastname: Magis-Rodriguez
authors.affiliation: Eileen V. Pitpitan, Steffanie A. Strathdee, Shirley J. Semple, and Claudia V. Chavarin are with the Division of Global Public Health, Department of Medicine, University of California San Diego. Carlos Magis-Rodriguez is with the Centro Nacional para la Prevención y Control del VIH/SIDA (CENSIDA; National Center for HIV/AIDS Prevention and Control), Ministry of Health, Mexico. Thomas L. Patterson is with the Department of Psychiatry, University of California San Diego.
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Patterson
mesh_terms: D000328:Adult; D003710:Demography; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008800:Mexico / Q000453:epidemiology; D012307:Risk Factors; D040242:Risk Reduction Behavior; D021841:Safe Sex; D011477:Sex Work; D012749:Sexually Transmitted Diseases / Q000453:epidemiology / Q000517:prevention & control*