Pitpitan, E.V., Wagner, K.D., Goodman-Meza, D., et al. AIDS and Behavior (May 2013), E-publication ahead of print.
The authors assessed the interaction between alcohol use during sex and the physical setting to examine condom use with female sex workers (FSWs) among male clients in Tijuana, Mexico. They focused on whether having sex at a bar determines the association between alcohol or drug use during sex and sexual risk behavior. Of 375 male clients (191 from Tijuana, 184 from San Diego) recruited from September 2012 to March 2013, 14 percent reported having sex with a FSW in a bar in the past four months and were less likely to live in the United States and more likely to be married. Among these clients, more frequent intoxication with alcohol during sex was associated with more unprotected sex. This association was not found among clients who did not report having sex with FSWs at a bar. Clients who reported having sex with a FSW in a bar indicated various reasons for inconsistent condom use, such as unavailability of condoms, belief that the FSW did not have sexually transmitted infections, and withdrawal before ejaculation. The authors recommended an integrated approach entailing structural- and individual-level HIV prevention interventions, e.g., targeting sex work venues and clients’ HIV knowledge and risk perceptions.