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Sex Work as a Mediator Between Female Gender and Incident HIV Infection Among People Who Inject Drugs in Tijuana, Mexico

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Abstract

We studied mechanisms driving gender differences in HIV incidence among 651 women and men who inject drugs (PWID) in Tijuana, Mexico, hypothesizing that sex work will mediate the association between female gender and HIV incidence. Of 43 HIV seroconversions occurring between 2011 and 2018, 8.8% were among females and 5.2% among males. HIV incidence density was significantly higher among females versus males (1.75 per 100 person years [PY], 95% CI 1.16–2.66, vs. 0.95 per 100 PY, 95% CI 0.62–1.47). Factors significantly associated with HIV seroconversion were: sex work (adjusted hazard ratio [aHR] = 2.25, 95% CI 1.05–4.80); methamphetamine injection (aHR = 2.30, 95% CI 1.12–4.73); and methamphetamine and heroin co-injection in the past six months (aHR = 2.26, 95% CI 1.23–4.15). In mediation analyses, sex work mediated a substantial proportion (84.3%) of the association between female gender and HIV incidence. Interventions should target female PWID who engage in sex work to reduce gender-related disparities in HIV incidence.

Resumen

Estudiamos los mecanismos que impulsan las diferencias de género en la incidencia del VIH entre 651 mujeres y hombres que se inyectan drogas (PQID) en Tijuana, México. Nuestra hipótesis es que el trabajo sexual puede ser una variable mediadora entre la asociación del género femenino y la incidencia del VIH. Entre 2011 y 2018 ocurrieron 43 seroconversiones de VIH: 8.8% fueron entre mujeres y 5.2% entre hombres. La densidad de incidencia del VIH fue significativamente mayor entre las mujeres en comparación con los hombres (1.75 por 100 personas años [PY], IC 95% = 1.16–2.66, vs. 0.95 por 100 PY, IC 95% = 0.62–1.47). Los factores con una asociación significativa con la seroconversión del VIH fueron: trabajo sexual (razón de riesgo ajustada [aHR]=2.25, IC 95% = 1.05–4.80); inyección de metanfetamina (aHR=2.30, IC 95% = 1.12–4.73); y la coinyección de metanfetamina y heroína en los últimos seis meses (aHR = 2.26, IC 95% = 1.23–4.15). En los análisis de mediación, el trabajo sexual medió una proporción sustancial (84.3%) de la asociación entre el género femenino y la incidencia del VIH. Intervenciones deben ser dirigidas a las mujeres PQID que participan en el trabajo sexual para reducir la incidencia del VIH relacionada con las disparidades de género.

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Abbreviations

PWID:

People who inject drugs

FSW:

Female sex workers

LMICs:

Low and middle-income countries

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Acknowledgements

The authors gratefully acknowledge the valuable contributions of all study participants and staff.

Funding

This study was funded by the National Institute on Drug Abuse (Grant Nos. R01DA031074, R37DA019829, T32 DA 23356-11).

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Authors and Affiliations

  1. School of Medicine, University of California, San Diego, La Jolla, USA

    Jennifer P. Jain, Daniela Abramovitz, Steffanie A. Strathdee, Patricia Gonzalez-Zuniga & Eileen V. Pitpitan

  2. School of Medicine, University of California, San Francisco, San Francisco, USA

    Jennifer P. Jain

  3. United States-Mexico Border Health Commission and El Colegio de la Frontera Norte, Tijuana, Mexico

    Gudelia Rangel

  4. El Colegio de La Frontera Norte, Tijuana, Mexico

    Gudelia Rangel

  5. School of Social Work, Columbia University, New York, United States

    Brooke S. West

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  1. Jennifer P. Jain
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Contributions

Conceived of the study design: JPJ, SS, EP, DA and BSW; Analyzed the data: JPJ and DA; Wrote the paper: JPJ, EP, and DA; Edited the paper: JPJ, EP, DA and SS; Oversaw data collection: SS, GR and PGZ.

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Correspondence to Jennifer P. Jain.

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Jain, J.P., Abramovitz, D., Strathdee, S.A. et al. Sex Work as a Mediator Between Female Gender and Incident HIV Infection Among People Who Inject Drugs in Tijuana, Mexico. AIDS Behav 24, 2720–2731 (2020). https://doi.org/10.1007/s10461-020-02828-y

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