AIDS and Behavior

, Volume 17, Issue 8, pp 2577–2587 | Cite as

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

  • Eileen V. Pitpitan
  • Karla D. Wagner
  • David Goodman-Meza
  • Shirley J. Semple
  • Claudia Chavarin
  • Steffanie A. Strathdee
  • Thomas L. Patterson
Original Paper


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.


HIV risk Male clients Female sex workers Alcohol use Risk environment Structural interventions 


Tijuana esta situada en la frontera de México con los Estados Unidos, donde el trabajo sexual es cuasi-legal. Mientras trabajos previos se han enfocado sobre las conductas de riesgo de trabajadoras sexuales (TS), menos se sabes sobre las conductas de riesgo de sus clientes masculinos. Mas aun, las investigaciones no han examinado a los factores estructurales como moderadores de la asociación entre el uso de sustancias y el uso del condón, incluyendo los contextos en el cual la relación sexual se da. El objetivo del presente estudio es de examinar si el tener sexo en con una TS en un bar modera la asociación entre la intoxicación con alcohol y el uso del condón. Reclutamos 375 clientes masculino de TS en Tijuana, México provenientes de San Diego, California y Tijuana. Utilizando entrevistas asistidas por computadora, encuestamos a los participantes en relación a su uso de alcohol, uso de condones y contextos físicos de su relación sexual con TS en los últimos cuatro meses. Los resultados demostraron que la intoxicación con alcohol con mayor frecuencia durante el sexo con TS esta asociado con mayor de sexo sin protección, pero solo dentro del contexto de aquellos clientes que tienen relaciones sexuales con TS dentro de un bar. Los resultados apuntan hacia las razones potenciales del uso inconsistente de condones con TS en este contexto, incluyendo menores percepciones de riesgos de tener relaciones sexuales con TS en bares. Investigaciones futuras deberán examinar los factores estructurales que subyacen las conductas de riesgo en bares para poder informar intervenciones de prevención de VIH a nivel estructural.

Palabras clave

Riesgo de VIH clientes masculinos trabajadoras sexuales uso de alcohol ambiente de riesgo intervenciones estructurales 


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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Eileen V. Pitpitan
    • 1
  • Karla D. Wagner
    • 1
  • David Goodman-Meza
    • 1
  • Shirley J. Semple
    • 1
  • Claudia Chavarin
    • 1
  • Steffanie A. Strathdee
    • 1
  • Thomas L. Patterson
    • 2
  1. 1.Division of Global Public Health, Department of MedicineUniversity of California San Diego, School of MedicineLa JollaUSA
  2. 2.Department of PsychiatryUniversity of California San DiegoLa JollaUSA

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