Addressing the Other Side: Study Explores Sexual Risk Behavior of Sex Work Clients in Tijuana
Male clients of female sex workers in Tijuana were the focus of a great study published in the journal AIDS last week. Researchers from both sides of the border interviewed and tested 400 men who they contacted inside the Zona Roja or zone of tolerance, an area where sex worker is allowed by the government. All the men had had sex with a female sex worker at least once in the previous four months. The men were interviewed and also offered free STD and HIV testing.
The majority of clients reported not using condoms and perhaps not surprisingly had high rate of HIV, about the same as the rate among female sex workers in the same city.
The study was conceptualized as the first step towards creating interventions for clients of female sex workers. It’s well documented that the major obstacle to condom use in sex worker-client interactions are clients, who often use financial or other forms of pressure or coercion to avoid using condoms. While some places have had success in reducing STD/HIV rates by working with sex workers to increase condom use, making a more significant impact requires that we get clients on board.
One of the things I appreciated about this study was how it highlights the need for research methods and interventions that are tailored to the people who are the focus of the work. It was also nice to see the researchers acknowledge that by having unprotected sex with sex workers, clients aren’t only transmitting STDs, including HIV to partners at home, they are transmitting it them to other sex workers.
Of course the really hard work is coming up with a way to get clients to start using condoms, and addressing why people knowingly put themselves and others at grave risk.
Reference:
Patterson, T.L., 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 Publish Ahead of Print July 10, 2009. Accessed July 12, 2009.
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While HIV prevention interventions targeting clients of sex workers is still new, exciting territory- projects do exist (though perhaps this is the first in Tijuana).
Most notably is the intervention as part of the Avahan program in India (see the psi.org.in link for more information). This project demonstrated population-level increases in consistent condom use AND has shown that behavior change is associated with exposure to the program.
In Vietnam, both FHI and PSI are working with male clients of sex workers.
In Russia, the NGO Stellit and Yale University have joined forces to do research with male sex partners of sex workers.
Hopefully, future research among male clients of sex workers can incorporate lessons learned from projects that came before.
Thanks for pointing those out. This isn’t my area so like most people who have half an ear to the ground I only hear about the punitive interventions like “john school” which, I imagine, have no impact at all.