Jesus Bucardo

Prevalence and Correlates of HIV Infection among Female Sex Workers in 2 Mexico—US Border Cities

BACKGROUND We examined human immunodeficiency virus (HIV) prevalence and correlates among female sex workers (FSWs) in Tijuana and Ciudad Juarez, 2 large cities on the Mexico-US border. METHODS FSWs aged > or =18 years underwent interviews and testing for HIV, syphilis, gonorrhea, and chlamydia. Logistic regression identified factors associated with HIV infection. RESULTS In 924 FSWs, the prevalence of HIV, gonorrhea, chlamydia, and syphilis titers > or =1:8 was 6%, 6.4%, 13%, and 14.2%, respectively. Factors independently associated with HIV were the injection of cocaine (odds ratio [OR], 2.96); the smoking, snorting, or inhalation of methamphetamine (OR, 3.32); and syphilis titers > or =1:8 (OR, 4.16). CONCLUSIONS Culturally appropriate interventions are needed to identify and treat ulcerative sexually transmitted infections and reduce HIV risks associated with stimulants among FSWs in the Mexico-US border region.

Trends in Production, Trafficking, and Consumption of Methamphetamine and Cocaine in Mexico

Over the past decade, Mexico has experienced a significant increase in trafficking of cocaine and trafficking and production of methamphetamine. An estimated 70% of United States cocaine originating in South America passes through the Central America–Mexico corridor. Mexico-based groups are now believed to control 70%–90% of methamphetamine production and distribution in the United States. Increased availability of these drugs at reduced prices has led to a parallel rise in local drug consumption. Methamphetamine abuse is now the primary reason for seeking drug abuse treatment in a number of cities, primarily in northwestern Mexico. Although cocaine and methamphetamine use have been linked with the sex trade and high-risk behaviors, such as shooting gallery attendance and unprotected sex in other settings, comparatively little is known about the risk behaviors associated with use of these drugs in Mexico, especially for methamphetamines. We review historical aspects and current trends in cocaine and methamphetamine production, trafficking, and consumption in Mexico, with special emphasis on the border cities of Ciudad Juarez and Tijuana. Additionally, we discuss the potential public health consequences of cocaine use and the recent increase in methamphetamine use, especially in regards to the spread of bloodborne and other infections, in an effort to inform appropriate public health interventions.

Comparison of Sexual and Drug Use Behaviors Between Female Sex Workers in Tijuana and Ciudad Juarez, Mexico

Female sex workers (FSWs) have been documented to have high rates of sexually transmitted diseases and HIV in many parts of the world. However, little work has been done to characterize the prevalence of these infections along the U.S.–Mexican border, where sexual tourism and culturally sanctioned sex work among nationals is widespread. The objective of this study was to compare differences in background characteristics, HIV risk behaviors, drug use, and sexually transmitted infection/HIV prevalence between FSWs who participated in a behavioral risk intervention in two U.S.–Mexican border cities. Baseline data were collected from March 2004 through September 2005. Data from 295 FSWs were compared between Tijuana and Ciudad (Cd.) Juarez. Among 155 FSWs in Tijuana and 140 in Cd. Juarez, HIV seroprevalence was 4.8% and 4.9%, respectively. FSWs in Cd. Juarez were more likely to test positive for active syphilis (31.3%) compared with Tijuana (11.8%) but did not differ in terms of the prevalence of gonorrhea and chlamydia. FSWs in both sites reported high levels of unprotected sex and use of drugs; however, FSWs in Cd. Juarez were more likely than those in Tijuana to ever have injected drugs (75% vs. 25%, p <.001). Heroin and cocaine use and injection drug use were significantly more common in Cd. Juarez, whereas methamphetamine use was more common in Tijuana. Injection of vitamins was common in both cities. Logistic regression analyses suggested that being younger, working in Cd. Juarez, and using heroin or cocaine were independently associated with active syphilis infection. In Tijuana, methamphetamine use was strongly associated with active syphilis infection. These preliminary results suggest that risk profiles for HIV/sexually transmitted infection among FSWs in these two Mexico–U.S. border cities differ, suggesting a need to tailor interventions to the specific needs in each city.

History of abuse and psychological distress symptoms among female sex workers in two Mexico-U.S. border cities.

This study examined histories of past emotional, physical, and sexual abuse as correlates of current psychological distress using data from 916 female sex workers (FSWs) who were enrolled in a safer-sex behavioral intervention in Tijuana and Ciudad (Cd.) Juarez, Mexico. We hypothesized that histories of abuse would be associated with higher symptom levels of depression and somatization and that social support would moderate the relationship. Nonparametric correlations and a series of hierarchical regression analyses revealed that all forms of past abuse predicted higher levels of depressive symptoms, and physical and sexual abuse were significantly associated with higher levels of somatic symptoms. Social support was also significantly associated with fewer symptoms of distress; however, it was not shown to moderate the relationship between abuse history and distress.

An HIV-Prevention Intervention for Sex Workers in Tijuana, Mexico: A Pilot Study

Female sex workers (FSW) are at high risk of acquiring sexually transmitted infections (STIs), including HIV, and putting their clients and other partners at risk for infection. There is considerable evidence that Social Cognitive Theory (SCT)–based interventions are effective in reducing high-risk sexual behavior among at-risk populations in the United States. However, no studies have been undertaken of such interventions with FSWs in Mexico, where high rates of STIs exist and where sex tourism attracts a large number of American clients. This article describes the development of a culturally relevant sexual risk reduction intervention based on SCT and Theory of Reasoned Action for FSWs in Mexico. The intervention was designed to promote consistent use of condoms with clients. Spanish-speaking counselors used motivational interviewing techniques and skill-building exercises to promote behavior change in a clinic-based sample of FSWs. The authors describe the intervention and provide pilot data that demonstrate the feasibility and benefits of this approach.

Effects of government registration on unprotected sex amongst female sex workers in Tijuana; Mexico.

BACKGROUND Sex work is partially regulated in Tijuana, but little is known of its health effects. A recent behavioural intervention amongst female sex workers (FSWs) decreased incidence of HIV/STIs by 40%. We evaluated effects of sex worker regulation on condom use amongst FSWs randomized to this intervention. METHODS FSWs aged ≥18 years who reported unprotected sex with ≥1 client in the last 2 months and whether they were registered with Tijuanas Municipal Health Department underwent a brief, theory-based behavioural intervention to increase condom use. At baseline and 6 months, women underwent interviews and testing for HIV, syphilis, Chlamydia trachomatis and Neisseria gonorrhoeae. Negative binomial regression was used to determine the effect of registration on numbers of unprotected sex acts and cumulative HIV/STI incidence. RESULTS Of 187 women, 83 (44%) were registered. Lack of registration was associated with higher rates of unprotected sex (rate ratio: 1.7, 95% CI: 1.2-2.3), compared to FSWs who were registered, after controlling for potential confounders. CONCLUSIONS Registration predicted increased condom use amongst FSWs enrolled in a behavioural intervention. Public health programmes designed to improve condom use amongst FSWs may benefit from understanding the impact of existing regulation systems on HIV risk behaviours.

The Relationship between Functional Capacity and Community Responsibilities in Middle-aged and Older Latinos of Mexican Origin with Chronic Psychosis

The purpose of this study was to examine the relationship between scores on the UCSD Performance-based Skills Assessment (UPSA), a performance-based measure of functional capacity, and level of patient community responsibilities (i.e., work for pay; volunteer work; attend school; household duties) in a Latino sample. Participants were 58 middle-aged and older Latinos of Mexican origin (mean age=48.8 years) with a diagnosis of schizophrenia or schizoaffective disorder. We conducted an analysis of covariance (ANCOVA), controlling for age, symptoms of psychosis, and participant language, to determine if greater participation in community responsibilities was associated with higher functional capacity, as measured by the UPSA. Results indicated significant group differences in UPSA scores (F=5.11, df=2, 51; p=.009), with patients reporting only a single community responsibility having significantly higher UPSA scores than those reporting zero community responsibilities (p=.016) and those reporting two responsibilities scoring significantly higher than those reporting zero community responsibility (p=.008). There were no differences found between those reporting one and those reporting two community responsibilities (p=.256). In contrast, no group differences were observed on the Dementia Rating Scale, a global measure of cognitive functioning (F=2.14, df=2, 51; p=.128). These results provide initial support for the validity of the UPSA in Latino patients of Mexican origin, and suggest that improvement in functional capacity (i.e., UPSA scores) may be associated with increased capacity for greater community involvement in this population.

Evaluation of a Culturally Tailored Skills Intervention for Latinos with Persistent Psychotic Disorders.

Fifty-nine Latino participants diagnosed with persistent psychotic disorders were assigned to either a culturally tailored skills-training intervention (n = 21), an equivalent non tailored intervention (n = 15), or a community-based support group (n = 23). Participants completed a number of skills-based performance assessments (e.g., UCSD performance-based skills assessment; UPSA) and a well-being measure prior to and immediately posttreatment. Compared with those in the nontailored intervention, participants receiving the tailored intervention showed significant improvement in several outcomes. These results indicate that Latino individuals with persistent psychotic disorders benefit from interventions that consider cultural values and mores.

LANGUAGE, ACCULTURATION, AND FUNCTIONAL CAPACITY ASSESSMENT IN SCHIZOPHRENIA

The effects of language and acculturation on measurement of functional capacity in schizophrenia are not yet fully understood. We assessed functional capacity using the UCSD Performance-Based Skills Assessment (UPSA), Social Skills Performance Assessment (SSPA), and Medication Management Ability Assessment (MMAA) in Englishspeaking (n=210) and monolingual Spanish-speaking (n=29) individuals with schizophrenia-spectrum disorders. The two groups did not differ on age, severity of positive, negative, and depressive symptoms, of Global Assessment of Functioning scores. However, the Spanish-speaking sample had less education, later age of onset of psychosis, lower Dementia Rating Scale scores, and lower dosages of antipsychotics; they were also more likely to be female, to have schizoaffective disorder (vs. schizophrenia), and to be married. The Spanish-speaking group performed better than did English speakers on theMMAA, butworse on the UPSA. The groups did not differ on the SSPA. In a multiple hierarchical regression controlling for group differences, DRS score (p<.001) and language (p=.008) predicted UPSA performance (R=.74). Within the Spanish-speaking sample, higher levels of education and acculturationwere both associatedwith better UPSA performance (rs=.61, .78, ps<.001), but did not explain variance in UPSA performance beyond that accounted for by DRS performance. These results suggest that measurement of functional skills can be strongly affected by language of test administration. Although acculturation is associated with functional capacity among monolingual Spanish-speakers with schizophrenia, it does not predict performance once cognitive performance is considered.