Open AccessThe disproportionate burden of HIV and STIs among male sex workers in Mexico City and the rationale for economic incentives to reduce risks
Author(s) -
Galárraga Omar,
SosaRubí Sandra G,
González Andrea,
BadialHernández Florentino,
CondeGlez Carlos J,
JuárezFigueroa Luis,
BautistaArredondo Sergio,
Kuo Caroline,
Operario Don,
Mayer Kenneth H
Publication year - 2014
Publication title -
journal of the international aids society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.724
H-Index - 62
ISSN - 1758-2652
DOI - 10.7448/ias.17.1.19218
Subject(s) - medicine , incentive , men who have sex with men , syphilis , chlamydia , sex work , transactional sex , demography , randomized controlled trial , environmental health , sex workers , human immunodeficiency virus (hiv) , family medicine , population , immunology , surgery , economics , research methodology , microeconomics , sociology
Introduction The objective of this article is to present the rationale and baseline results for a randomized controlled pilot trial using economic incentives to reduce HIV and sexually transmitted infection (STI) risk among male sex workers (MSWs) in Mexico City. Methods Participants ( n =267) were tested and treated for STIs (chlamydia, gonorrhoea, syphilis and HIV) and viral hepatitis (hepatitis B and C), received HIV and STI prevention education and were randomized into four groups: (1) control, (2) medium conditional incentive ($50/six months), (3) high conditional incentive ($75/six months) and (4) unconditional incentive ($50/six months). In the conditional arms, incentives were contingent upon testing free of new curable STIs (chlamydia, gonorrhoea and syphilis) at follow‐up assessments. Results Participants’ mean age was 25 years; 8% were homeless or lived in a shelter, 16% were unemployed and 21% lived in Mexico City less than 5 years. At baseline, 38% were living with HIV, and 32% tested positive for viral hepatitis or at least one STI (other than HIV). Participants had a mean of five male clients in the previous week; 18% reported condomless sex with their last client. For 37%, sex work was their main occupation and was conducted mainly on the streets (51%) or in bars/discotheques (24%) and hotels (24%). The average price for a sex transaction was $25 with a 35% higher payment for condomless sex. Conclusions The findings suggest that economic incentives are a relevant approach for HIV prevention among MSWs, given the market‐based inducements for unprotected sex. This type of targeted intervention seems to be justified and should continue to be explored in the context of combination prevention efforts.