Drug-Using Male Clients of Female Sex Workers Who Report Being Paid for Sex: HIV/Sexually Transmitted Infection, Demographic, and Drug Use Correlates

Background: Research has focused on male clients of female sex workers (FSWs) and their risk for HIV/sexually transmitted infections (STIs). However, it is unclear whether the commercial sex behaviors of these men are limited to paying for sex or whether they may also be paid for sex themselves. Methods: We analyzed the interview data and HIV/STI test results from 170 drug-using male clients of FSWs in Tijuana, Mexico, to determine the extent to which these men report being paid for sex and the association with positive HIV/STI results. Results: More than one quarter of men reported having been paid for sex in the past 4 months. In a multivariate logistic regression model, reporting having been paid for sex was significantly associated with testing positive for any HIV/STI (adjusted odds ratio [AdjOR], 3.53; 95% confidence interval [CI], 1.33-9.35), being bisexual (AdjOR, 15.59; 95% CI, 4.81-50.53), injection drug use in the past 4 months (AdjOR, 2.65; 95% CI, 1.16-6.03), and cocaine use in the past 4 months (AdjOR, 2.93; 95% CI, 1.22-7.01). Conclusions: Findings suggest that drug-using male clients of FSWs may be characterized by unique risk profiles that require tailored HIV prevention interventions.