Department of Psychiatry, University of California-San Diego, La Jolla, CA 92093, USA.
J Acquir Immune Defic Syndr. 2012 Aug 1;60(4):414-20. doi: 10.1097/QAI.0b013e31825693f2.
To gain insights into bridging behaviors and their correlates among male clients of female sex workers (FSWs).
Men aged ≥18 years who recently paid or traded for sex with FSWs were recruited in Tijuana in 2008-2009. Participants underwent interviews and testing for HIV, chlamydia, syphilis, and gonorrhea. Logistic regression compared "bridgers" (clients who had unprotected sex with FSWs and with a wife or steady partner) with men who did not.
Of 383 men, 134 (35%) had a steady partner. Half (n = 70) of those had unprotected sex with both FSWs and the steady partner. Prevalence of any sexually transmitted infection or HIV was 16.5% among bridgers and 2.3% among nonbridgers. Compared with other clients, bridgers were more likely to use drugs during sex with FSWs (81.4% versus 46.9%, P < 0.0001), had higher sensation-seeking (P < 0.0001) and misogyny scores (P = 0.05) and were more likely to offer FSWs extra money for unprotected sex (34.4% versus 1.6%, P < 0.0001). Factors independently associated with bridging were as follows: using drugs during sex with FSWs [adjusted odds ratio (AOR): 3.4, P = 0.007], sensation seeking (AOR: 4.3 per unit increase, P = 0.05), and offering FSWs more money for unprotected sex (AOR: 24.5, P = 0.003).
Sensation-seeking clients who use drugs during sex and coerce FSWs into unprotected sex may be less responsive to standard risk reduction interventions. Interventions are needed that target clients rather than rely on FSWs to change behaviors that may not be under their control.
了解性工作者（FSW）男性客户的中介行为及其相关因素。
2008-2009 年在提华纳招募了年龄≥18 岁、最近与 FSW 发生过有偿或交易性行为的男性参与者。参与者接受了 HIV、衣原体、梅毒和淋病的检测。采用逻辑回归比较了“中介者”（与 FSW 和妻子或稳定伴侣发生过无保护性行为的客户）与未发生无保护性行为的男性。
在 383 名男性中，有 134 名（35%）有稳定的伴侣。其中一半（n = 70）与 FSW 和稳定伴侣都发生了无保护性行为。中介者和非中介者的任何性传播感染或 HIV 患病率分别为 16.5%和 2.3%。与其他客户相比，中介者在与 FSW 发生性行为时更有可能使用毒品（81.4%比 46.9%，P < 0.0001），有更高的感觉寻求（P < 0.0001）和厌女症评分（P = 0.05），并更有可能为 FSW 提供额外的无保护性行为报酬（34.4%比 1.6%，P < 0.0001）。与中介行为独立相关的因素如下：与 FSW 发生性行为时使用毒品（调整后的优势比 [AOR]：3.4，P = 0.007）、感觉寻求（AOR：每增加一个单位增加 4.3，P = 0.05），以及为 FSW 提供更多无保护性行为的报酬（AOR：24.5，P = 0.003）。
在性行为中使用毒品且胁迫 FSW 发生无保护性行为的寻求刺激的客户可能对标准的风险降低干预措施反应不敏感。需要针对客户的干预措施，而不是依赖 FSW 来改变可能不受其控制的行为。
