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

doi:10.7448/ias.17.1.19218

Abstract

IntroductionThe 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.MethodsParticipants (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.ResultsParticipants’ 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.ConclusionsThe 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.

Highlights

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
We used a computer experiment to measure the optimal level of incentives by interviewing 1,745 men who have sex with men (MSM) and MSWs, and we found that at a rate of $288 a year, more than threequarters of the men would attend prevention talks, engage in testing for STIs and attempt to stay free of STIs
This article provides a strong rationale for the adaptation of an economic incentives intervention for male sex workers in the context of HIV and STI prevention

Summary

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. 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. No efforts in Mexico, have directly linked incentives for HIV and STI prevention, including regular STI medical check-ups and treatment, targeting populations at high risk. This novel approach shows promise in light of Mexico’s history of economic interventions to promote public health, and its concentrated HIV epidemic disproportionately affecting MSM.

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