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The disproportionate burden of HIV and STIs among male sex workers in Mexico City and the rationale for economic incentives to reduce risks

Omar Galárraga, Sandra G Sosa-Rubi, Andrea González, Florentino Badial-Hernández, Carlos J Conde-Glez, Luis Juárez-Figueroa, Sergio Bautista-Arredondo, Caroline Kuo, Don Operario, Kenneth H Mayer

Abstract


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.

Keywords: male sex workers; men who have sex with men; conditional cash transfer; conditional economic incentives; HIV/STI prevention; risk premium; compensating differential; Mexico.

(Published: 14 November 2014)

Ciation: Galárraga O et al. Journal of the International AIDS Society 2014, 17:19218

http://www.jiasociety.org/index.php/jias/article/view/19218 | http://dx.doi.org/10.7448/IAS.17.1.19218




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