Female sex workers (FSWs) acquire HIV and other sexually transmitted infections (STIs) through unprotected sex with commercial and non-commercial (intimate) male partners. Little research has focused on FSWs' intimate relationships, within which condom use is rare. We sought to determine the prevalence and correlates of HIV/STIs within FSWs' intimate relationships in Northern Mexico. From 2010 to 2011, we conducted a cross-sectional survey of FSWs and their non-commercial male partners in Tijuana and Ciudad Juárez, Mexico. Eligible FSWs and their verified male partners were aged ≥18 years; FSWs reported lifetime use of heroin, cocaine, crack, or methamphetamine and recently exchanged sex (past month). Participants completed baseline questionnaires and testing for HIV, chlamydia, gonorrhea, and syphilis. We determined the prevalence and correlates of individuals' HIV/STI positivity using bivariate probit regression. Among 212 couples (n = 424), prevalence of HIV was 2.6 % (n = 11). Forty-two (9.9 %) tested positive for any HIV/STIs, which was more prevalent among women than men (12.7 % vs. 7.1 %, p < 0.05). FSWs with regular sex work clients were less likely to test positive for HIV/STIs than those without regular clients. Similarly, male partners of FSWs who had regular clients were 9 % less likely to have HIV/STIs. Higher sexual decision-making power was protective against HIV/STIs for women. Men who recently used methamphetamine or reported perpetrating any conflict within steady relationships were more likely to test positive for HIV/STIs. Within FSWs' intimate relationships in two Mexican-US border cities, nearly one in ten partners tested positive for HIV/STIs. Couple-based prevention interventions should recognize how intimate relationship factors and social contexts influence HIV/STI vulnerability.
This is a preview of subscription content,to check access.
Access this article
Similar content being viewed by others
Baral S, Beyrer C, Muessig K, et al. Burden of HIV among female sex workers in low-income and middle-income countries: a systematic review and meta-analysis. Lancet Infect Dis. 2012; 12(7): 538–549.
Foss AM, Hossain M, Vickerman PT, Watts CH. A systematic review of published evidence on intervention impact on condom use in sub-Saharan Africa and Asia. Sex Transm Infect. 2007; 83(7): 510–516.
Patterson TL, Mausbach B, Lozada R, et al. Efficacy of a brief behavioral intervention to promote condom use among female sex workers in Tijuana and Ciudad Juarez, Mexico. Am J Public Health. 2008; 98(11): 2051–2057.
Wariki WM, Ota E, Mori R, Koyanagi A, Hori N, Shibuya K. Behavioral interventions to reduce the transmission of HIV infection among sex workers and their clients in low- and middle-income countries. Cochrane Database Syst Rev. 2012; 2, CD005272.
Leonard L, Ndiaye I, Kapadia A, et al. HIV prevention among male clients of female sex workers in Kaolack, Senegal: results of a peer education program. AIDS Educ Prev. 2000; 12(1): 21–37.
Lowndes CM, Alary M, Labbe AC, et al. Interventions among male clients of female sex workers in Benin, West Africa: an essential component of targeted HIV preventive interventions. Sex Transm Infect. 2007; 83(7): 577–581.
Deering KN, Bhattacharjee P, Bradley J, et al. Condom use within non-commercial partnerships of female sex workers in southern India. BMC Public Health. 2011; 11(Suppl 6): S11.
Kerrigan D, Ellen JM, Moreno L, et al. Environmental-structural factors significantly associated with consistent condom use among female sex workers in the Dominican Republic. AIDS. 2003; 17(3): 415–423.
Lowndes CM, Alary M, Gnintoungbe CA, et al. Management of sexually transmitted diseases and HIV prevention in men at high risk: targeting clients and non-paying sexual partners of female sex workers in Benin. AIDS. 2000; 14(16): 2523–2534.
Mills S, Benjarattanaporn P, Bennett A, et al. HIV risk behavioral surveillance in Bangkok, Thailand: sexual behavior trends among eight population groups. AIDS. 1997; 11(Suppl 1): S43–51.
Murray L, Moreno L, Rosario S, Ellen J, Sweat M, Kerrigan D. The role of relationship intimacy in consistent condom use among female sex workers and their regular paying partners in the Dominican Republic. AIDS Behav. 2007; 11(3): 463–470.
Bryant J, Brener L, Hull P, Treloar C. Needle sharing in regular sexual relationships: an examination of serodiscordance, drug using practices, and the gendered character of injecting. Drug Alcohol Depend. 2010; 107(2): 182–187.
Spina M, Tirelli U. Condom use in female sex workers in Italy. Am J Public Health. 1999; 89(1): 108.
Voeten HA, Egesah OB, Varkevisser CM, Habbema JD. Female sex workers and unsafe sex in urban and rural Nyanza, Kenya: regular partners may contribute more to HIV transmission than clients. Trop Med Int Health. 2007; 12(2): 174–182.
Walden VM, Mwangulube K, Makhumula-Nkhoma P. Measuring the impact of a behaviour change intervention for commercial sex workers and their potential clients in Malawi. Health Educ Res. 1999; 14(4): 545–554.
Wang C, Hawes SE, Gaye A, et al. HIV prevalence, previous HIV testing, and condom use with clients and regular partners among Senegalese commercial sex workers. Sex Transm Infect. 2007; 83(7): 534–540.
Wong ML, Lubek I, Dy BC, Pen S, Kros S, Chhit M. Social and behavioural factors associated with condom use among direct sex workers in Siem Reap, Cambodia. Sex Transm Infect. 2003; 79(2): 163–165.
El-Bassel N, Terlikbaeva A, Pinkham S. HIV and women who use drugs: double neglect, double risk. Lancet. 2010; 376(9738): 312–314.
El-Bassel N, Wechsberg WM. Couple-based behavioral HIV interventions: placing HIV risk-reduction responsibility and agency on the female and male dyad. Couple Fam Psychol: Res Pract. 2012; 1(2): 94–105.
El-Bassel N, Wechsberg WM, Shaw SA. Dual HIV risk and vulnerabilities among women who use or inject drugs: no single prevention strategy is the answer. Curr Opin HIV AIDS. 2012; 7(4): 326–331.
Misovich SJ, Fisher JD, Fisher WA. Close relationships and elevated HIV risk behavior: evidence and possible underlying psychological processes. Rev Gen Psychol. 1997; 1(1): 72–107.
Pequegnat W, Bray JH. HIV/STD prevention interventions for couples and families: a review and introduction to the special issue. Couple Fam Psychol: Res Pract. 2012; 1(2): 79–93.
Strathdee SA, Magis-Rodriguez C. Mexico's evolving HIV epidemic. JAMA. 2008; 300(5): 571–573.
Sirotin N, Strathdee SA, Lozada R, et al. A comparison of registered and unregistered female sex workers in Tijuana, Mexico. Public Health Rep. 2010; 125(Suppl 4): 101–109.
Sirotin N, Strathdee SA, Lozada R, et al. Effects of government registration on unprotected sex amongst female sex workers in Tijuana; Mexico. Int J Drug Policy. 2010; 21(6): 466–470.
Patterson TL, Semple SJ, Staines H, et al. Prevalence and correlates of HIV infection among female sex workers in 2 Mexico-US border cities. J Infect Dis. 2008; 197(5): 728–732.
Brouwer KC, Case P, Ramos R, et al. Trends in production, trafficking, and consumption of methamphetamine and cocaine in Mexico. Subst Use Misuse. 2006; 41(5): 707–727.
Munoz FA, Pollini RA, Zuniga ML, et al. Condom access: associations with consistent condom use among female sex workers in two northern border cities of Mexico. AIDS Educ Prev. 2010; 22(5): 455–465.
Strathdee SA, Lozada R, Martinez G, et al. Social and structural factors associated with HIV infection among female sex workers who inject drugs in the Mexico-US border region. PLoS One. 2011; 6(4): e19048.
Ojeda VD, Strathdee SA, Lozada R, et al. Associations between migrant status and sexually transmitted infections among female sex workers in Tijuana, Mexico. Sex Transm Infect. 2009; 85(6): 420–426.
Ulibarri MD, Strathdee SA, Lozada R, et al. Condom use among female sex workers and their non-commercial partners: effects of a sexual risk intervention in two Mexican cities. Int J STD AIDS. 2012; 23(4): 229–234.
Strathdee SA, Lozada R, Staines-Orozco H, et al. No effect of a sexual risk intervention on condom use with female sex workers and their regular partners in two Mexico-US border cities [abstract presented April 19, 2009]. Annual Meeting of the International Harm Reduction Association 2009; Liverpool, United Kingdom.
Ulibarri MD, Strathdee SA, Lozada R, et al. Intimate partner violence among female sex workers in two Mexico-U.S. border cities: partner characteristics and HIV risk-behaviors as correlates of abuse. Psychol Trauma. 2010; 2(4): 318–325.
Ulibarri MD, Strathdee SA, Patterson TL. Sexual and drug use behaviors associated with HIV and other sexually transmitted infections among female sex workers in the Mexico-US border region. Curr Opin Psychiatr. 2010; 23(3): 215–220.
Syvertsen JL, Robertson AM, Abramovitz D, et al. Study protocol for the recruitment of female sex workers and their non-commercial partners into couple-based HIV research. BMC Public Health. 2012; 12(136): 1–16.
Sherman SG, Latkin CA. Intimate relationship characteristics associated with condom use among drug users and their sex partners: a multilevel analysis. Drug Alcohol Depend. 2001; 64(1): 97–104.
Johnson HA, Zabriskie RB, Hill B. The contribution of couple leisure involvement, leisure time, and leisure satisfaction to marital satisfaction. Marriage Fam Rev. 2006; 40(1): 69–91.
Pulerwitz J, Gortmaker SL, De Jong W. Measuring sexual relationship power in HIV/STD research. Sex Roles. 2000; 42(7): 637–660.
Straus MA, Douglas EM. A short form of the revised conflict tactics scales, and typologies for severity and mutuality. Violence Vict. 2004; 19(5): 507–520.
Kenny DA, Kashy DA, Cook WL. Dyadic Data Analysis. New York, NY: Gilford; 2006.
UNAIDS. Consensus indicators are needed for concurrency. Lancet. 2010; 375(9715): 621–622.
Greenland S. Modeling and variable selection in epidemiologic analysis. Am J Public Health. 1989; 79(3): 340–349.
Akaike H. A new look at the statistical model identification. IEEE Trans Autom Control. 1974; 19(6): 716.
Cleland CM, Des Jarlais DC, Perlis TE, Stimson G, Poznyak V. HIV risk behaviors among female IDUs in developing and transitional countries. BMC Public Health. 2007; 7(1): 271.
Patterson TL, Goldenberg S, Gallardo M, et al. Correlates of HIV, sexually transmitted infections, and associated high-risk behaviors among male clients of female sex workers in Tijuana, Mexico. AIDS. 2009; 23(13): 1765–1771.
Robertson AM, Syvertsen JL, Amaro H, et al. Can't buy my love: a typology of female sex workers' commercial relationships in the Mexico-U.S. border region. J Sex Res. May 9 2013.
Robertson AM, Syvertsen JL, Rangel MG, et al. Concurrent sexual partnerships among female sex workers and their non-commercial male partners in Tijuana and Ciudad Juarez, Mexico. Sex Transm Infect. 2013; 89(4): 330–332.
Coates TJ, Richter L, Caceres C. Behavioural strategies to reduce HIV transmission: how to make them work better. Lancet. 2008; 372(9639): 669–684.
Morris M. Barking up the wrong evidence tree. Comment on Lurie & Rosenthal, “Concurrent partnerships as a driver of the HIV epidemic in sub-Saharan Africa? The evidence is limited. AIDS Behav. 2010; 14(1): 31–33. discussion 34–37.
Amaro H. Love, sex, and power. Considering women's realities in HIV prevention. Am Psychol. 1995; 50(6): 437–447.
Jana S, Basu I, Rotheram-Borus MJ, Newman PA. The Sonagachi project: a sustainable community intervention program. AIDS Educ Prev. 2004; 16(5): 405–414.
Kerrigan D, Moreno L, Rosario S, et al. Environmental-structural interventions to reduce HIV/STI risk among female sex workers in the Dominican Republic. Am J Public Health. 2006; 96(1): 120–125.
Halli SS, Ramesh BM, O’Neil J, Moses S, Blanchard JF. The role of collectives in STI and HIV/AIDS prevention among female sex workers in Karnataka, India. AIDS Care. 2006; 18(7): 739–749.
Wingood GM, DiClemente RJ. Application of the theory of gender and power to examine HIV-related exposures, risk factors, and effective interventions for women. Health Educ Behav. 2000; 27(5): 539–565.
Pulerwitz J, Amaro H, De Jong W, Gortmaker SL, Rudd R. Relationship power, condom use and HIV risk among women in the USA. AIDS Care. 2002; 14(6): 789–800.
Connell R. Gender, health and theory: conceptualizing the issue, in local and world perspective. Soc Sci Med. Jun 29 2011.
Staudt KA. Violence and Activism at the Border: Gender, Fear, and Everyday Life in Ciudad Juárez. 1st ed. Austin, TX: University of Texas Press; 2008.
Syvertsen JL, Robertson AM, Rolon ML, et al. “Eyes that don't see, heart that doesn’t feel:” coping with sex work in an intimate relationship context along the Mexico-U.S. border and the implications for HIV prevention. Soc Sci Med. 2014; 8:1–8.
Burton J, Darbes LA, Operario D. Couples-focused behavioral interventions for prevention of HIV: systematic review of the state of evidence. AIDS Behav. 2010; 14(1): 1–10.
El-Bassel N, Gilbert L, Witte S, Wu E, Hunt T, Remien RH. Couple-based HIV prevention in the United States: advantages, gaps, and future directions. J Acquir Immune Defic Syndr. 2010; 55(Suppl 2): S98–101.
El-Bassel N, Witte SS, Gilbert L, et al. HIV prevention for intimate couples: a relationship-based model. Fam Syst Health. 2001; 19(4): 379–395.
Case P, Ramos R, Brouwer KC, et al. At the borders, on the edge: use of injected methamphetamine in Tijuana and Ciudad Juarez, Mexico. J Immigr Minor Health. 2008; 10(1): 23–33.
Corsi KF, Booth RE. HIV sex risk behaviors among heterosexual methamphetamine users: literature review from 2000 to present. Curr Drug Abuse Rev. 2008; 1(3): 292–296.
Loza O, Strathdee SA, Martinez GA, et al. Risk factors associated with chlamydia and gonorrhoea infection among female sex workers in two Mexico-USA border cities. Int J STD AIDS. 2010; 21(7): 460–465.
Rosenthal D, Oanh TTK. Listening to female sex workers in Vietnam: influences on safe-sex practices with clients and partners. Sex Health. 2006; 3(1): 21.
Syvertsen JL, Robertson AM, Palinkas LA, Rangel MG, Martinez G, Strathdee SA. ‘Where sex ends and emotions begin’: love and HIV risk among female sex workers and their intimate, non-commercial partners along the Mexico-US border. Cult Health Sex. 2013; 15(5): 540–554.
Castaneda X, Ortiz V, Allen B, Garcia C, Hernandez-Avila M. Sex masks: the double life of female commercial sex workers in Mexico City. Cult Med Psychiatry. 1996; 20(2): 229–247.
Shannon K, Kerr T, Allinott S, Chettiar J, Shoveller J, Tyndall MW. Social and structural violence and power relations in mitigating HIV risk of drug-using women in survival sex work. Soc Sci Med. 2008; 66(4): 911–921.
Pivnick A. HIV infection and the meaning of condoms. Cult Med Psychiatry. 1993; 17(4): 431–453.
Sobo EJ. Inner-city women and AIDS: the psycho-social benefits of unsafe sex. Cult Med Psychiatry. 1993; 17(4): 455–485.
Cusick L, Rhodes T. Sustaining sexual safety in relationships: HIV positive people and their sexual partners. Cult Health Sex. 2000; 2(4): 473–487.
Warr DJ, Pyett PM. Difficult relations: sex work, love and intimacy. Sociol Health Illn. 1999; 21(3): 290–309.
Rhodes T, Cusick L. Love and intimacy in relationship risk management: HIV positive people and their sexual partners. Sociol Health Illn. 2000; 22(1): 1–26.
Rhodes T, Cusick L. Accounting for unprotected sex: stories of agency and acceptability. Soc Sci Med. 2002; 55(2): 211–226.
Rhodes T, Quirk A. Drug users' sexual relationships and the social organisation of risk: the sexual relationship as a site of risk management. Soc Sci Med. 1998; 46(2): 157–169.
Funding for this study was provided by the National Institutes of Health (NIH) grants R01DA027772, R36DA032376, T32AI007384, T32DA023356, and K01DA026307; the NIH had no further role in study design; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication. We thank the project staff and participants without whom this research would not be possible.
About this article
Cite this article
Robertson, A.M., Syvertsen, J.L., Ulibarri, M.D. et al. Prevalence and Correlates of HIV and Sexually Transmitted Infections among Female Sex Workers and Their Non-commercial Male Partners in Two Mexico-USA Border Cities. J Urban Health 91, 752–767 (2014). https://doi.org/10.1007/s11524-013-9855-2