Correlates of unprotected sex with male clients among female sex workers in 13 Mexican cities

Glob Public Health. 2017 Dec;12(12):1538-1552. doi: 10.1080/17441692.2016.1206603. Epub 2016 Jul 14.


This study examined correlates of unprotected vaginal and anal sex (UVA) with male clients among female sex workers (FSWs). Baseline data were gathered from 1089 FSWs recruited from 13 cities across Mexico enrolled in an evidence-based sexual risk reduction intervention. We used generalised estimating equations (GEE) to predict total UVA while controlling for the nested structure of the data. Total UVA with clients in the past month was examined in relation to selected sociodemographic, substance-use, and micro- and macro-environmental factors. A greater number of UVA acts was associated with three micro-level environmental factors (i.e. never getting condoms for free, unaffordability of condoms, greater number of clients per month), and three macro-level environmental factors (i.e. lower health and higher education indices, greater population size of city). These findings suggest the development of social and structural approaches to HIV prevention for FSWs in Mexico, including modification of venue-based policies that pressure FSWs to maximise client volume, changes to the work environment that promote availability and affordability of condoms, and improved population health. Moreover, our findings call for the development of context-specific HIV interventions that take into account variations in the sexual risk behaviours and HIV risk environments of FSWs throughout Mexico.

Keywords: Female sex workers; Mexico; sex work environment; sexual risk behaviour; substance use.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Cities*
  • Condoms / statistics & numerical data
  • Female
  • Humans
  • Interviews as Topic
  • Male
  • Mexico
  • Middle Aged
  • Models, Statistical
  • Qualitative Research
  • Sex Workers*
  • Sexual Partners
  • Sexually Transmitted Diseases / prevention & control
  • Substance-Related Disorders
  • Surveys and Questionnaires
  • Unsafe Sex* / statistics & numerical data
  • Young Adult