Female sex workers in Tijuana and Ciudad Juarez are at high risk of becoming infected with HIV. So are their clients, many of whom come from the U.S.
Researchers from UC San Diego say a brief counseling session can help reduce sex workers’ risky behavior. A new study tested this intervention in the two Mexican border cities.
In Tijuana’s red light district called La Zona Norte, you can find a sex worker anytime, even in the middle of the day.
Just ask Linda Sandoval, who's often standing on one of the street corners.
"You come right here, and you look for a girl. You get whatever you want, you do whatever you want, you know, for a little bit of money," Sandoval said.
The 29-year-old Linda Sandoval has been selling herself on the streets of Tijuana for more than a decade.
A dingy yellow hotel down a narrow alley charges $3 for 20 minutes in a room.
“You just stand here and you just wait for a client to get here, and take you to the room," Sandoval said.
She started as a stripper in local clubs when she was 13. She began shooting drugs shortly thereafter.
Sandoval said sex work is humiliating. Clients ask her to do things you couldn’t imagine.
"They use you, actually, they use you," the petite brunette said. "But you use drugs, and you want the money just quick, you know, you just want to get it fast, and you just want to get your dose. So it don’t matter what you have to do to get your dose."
And that includes having unprotected sex, or sharing dirty needles.
This kind of high-risk behavior takes its toll.
An estimated 6 percent of sex workers in Tijuana are infected with HIV. Twelve percent of sex workers who shoot drugs have the disease.
That’s 40 times higher than the HIV rate in Mexico as a whole.
Recently, researchers from UC San Diego and Mexico completed a study. It involved nearly 600 HIV-negative female sex workers in Tijuana and Ciudad Juarez.
The study tested whether a brief intervention could reduce risky behavior, and diminish the rate of new infections.
The women received a 30-minute counseling session on how to negotiate safe sex, and one on how to reduce risky injection practices.
Each session was either a lecture, or a more interactive format.
Every four months, women were tested for sexually transmitted diseases, including HIV and syphilis.
After one year, the data was analyzed.
Dr. Steffanie Strathdee, who heads up the division of global public health for UC San Diego's School of Medicine, directed the study. She said the results were dramatic.
"The interactive version of the safer sex intervention was associated with a 60 percent decrease in the rate of new HIV and STD infections," Strathdee said. "That was very significant, and that we saw consistently in both cities, Tijuana and Ciudad Juarez."
In Tijuana, researchers found women who received either version of the safe injection intervention did equally well. And both groups had lower rates of new infections than women in Ciudad Juarez.
Strathdee eventually figured out the reason for the discrepancy: Tijuana has a much more robust clean syringe exchange program than Ciudad Juarez.
"So the bottom line," Strathdee concluded, "is if you’re a city or a policy maker that’s making a decision on how to reduce injection risk for HIV, it’s much more important to have coverage of sterile syringes through either needle exchange or pharmacies, than it is to provide an intervention like this."
Clean syringes cost about 5 cents a piece. The half-hour interventions are inexpensive, too.
Some question the value of spending any money to prevent sex workers from becoming infected.
But UC San Diego assistant professor Jose Luis Burgos said it’s a sound investment.
"Eventually, many of them change their lives. So potentially they are going to have children," Burgos said. "They are going to have interactions with people from Tijuana, from Mexico, and the U.S. So I think that it’s an investment that makes sense, not only for Mexico but for both countries.”
Linda Sandoval hopes to get out of the sex trade soon. She’s met a guy she’d like to have a family with.
In the meantime, she said the interventions changed the way she does business. These days, she uses clean needles. And she insists that all of her clients wear condoms. Sandoval said most of them say yes.
"Let’s use a condom, you’re right, you know, I have a family, I have a wife, or whatever, or for myself. And some of them, they don’t care, and they’re like, alright, you don’t want to do it, I’ll find somebody else. I’m like, alright," she said smiling.
UC San Diego's Strathdee is presenting her study this week at the International AIDS Conference in Washington, DC.
