behavioral intervention to reduce sexual and injection risks among female sex workers who also inject drugs in mexico

Conditions: HIV; HIV Infections

Summary: the investigators propose a highly efficient four-arm (factorial) trial to simultaneously test the efficacy of two behavioral interventions aimed at: * increasing condom use in the context of ongoing drug use and * decreasing needle and paraphernalia sharing among female sex workers who also inject drugs in two mexican-u.s. border cities: tijuana and ciudad juarez.

our specific aims are: * aim 1: to evaluate the efficacy of a behavioral intervention to decrease sharing of syringes and injection paraphernalia among fsw-idus. we hypothesize that fsw-idus in the active experimental injection risk reduction condition will report: (a) less receptive and distributive needle sharing; (b) less sharing of injection paraphernalia; (c) obtaining syringes and injection paraphernalia from safer sources. * aim 2: to evaluate the efficacy of a behavioral intervention to increase condom use among fsw-idus in the context of ongoing drug use. we hypothesize that fsw-idus in the active experimental sexual risk reduction condition will: (a) report less unprotected vaginal and anal sex; and (b) have fewer incident cases of specific stis. * aim 3: to evaluate the joint effects of these two behavioral interventions to increase condom use and reduce sharing of needles and syringes/injection paraphernalia among fsw-idus. we hypothesize that the joint effect of these interventions will generate greater risk reductions compared to either intervention alone. * aim 4: to determine the extent to which theoretically-important components of our interventions (i.e., self-efficacy, outcome expectancies, attitudes, intentions) represent underlying mechanisms of change in primary outcomes (i.e., sexual- and injection-related risk reductions). * aim 5: to explore subgroup differences in the efficacy of: a) the sexual risk reduction, and b) the injection risk reduction intervention based on background characteristics, contextual factors, social factors and intrapersonal factors.

Eligibility criteria:
inclusion criteria: * be biologically female * be at least 18 years old * report having exchanged sex for money, goods or drugs within the last month * report having injected drugs within the last month * report having unprotected vaginal or anal sex at least once in last 30 days * report sharing needles/syringes or other injection paraphernalia (i.e., cottons, cookers, water) at least once in the last month * live in tijuana, ciudad juarez or its suburbs, as determined through municipal boundaries in each city * test hiv-negative at baseline * agree to receive antibiotic treatment for chlamydia, gonorrhea, syphilis trichomonas vaginalis or bacterial vaginosis if they test positive at baseline. exclusion criteria: if women report: * consistent use of condoms for vaginal and anal sex with all male partners during the previous month * not being able to provide verification of injection drug use (i.e. track marks) * not sharing needles/syringes or paraphernalia at least once in the last month * being under 18 years of age * being male or transgender * being incapable of giving informed consent * planning to permanently move outside of the municipal boundaries of tijuana or ciudad juarez within the next year.

Keywords: hiv injection drug users female sex workers stis hiv seronegativity