Sex Work Venue Disorder and HIV/STI Risk Among Female Sex Workers in Two México-US Border Cities: A Latent Class Analysis.

Research increasingly recognizes the importance of social and built environments in shaping health, including risks for and outcomes related to HIV and sexually transmitted infections (STI), but research on sex work venues is limited. We use latent class analysis to identify patterns of sex work venue characteristics and factors associated with class membership in two México-US border cities. Among 603 female sex workers (FSW), three classes of sex work venues were identified: low, medium, and high disorder venues, characterized by level of violence, policing and drug activity. In multivariable analysis, risk exposures and outcomes varied by class, suggesting the need for place-based interventions that are tailored to specific venue profiles and that promote FSW health and safety in the workplace.

Prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae infections in Tlaxcala, Mexico.

Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) are widely recognised as two prevalent sexually transmitted infections that can have detrimental effects on women's reproductive health. Previous research has concentrated on studying high-risk populations, resulting in limited epidemiological data regarding the general population. Therefore, the objective of this study was to estimate the prevalence of CT and NG among women attending public primary health care in Tlaxcala, Mexico. The study sample included 2,396 women already participating in the cervical cancer screening programme, from July to November 2014. After obtaining informed consent, the CT and NG tests were conducted on cervical samples, using a nucleic acid amplification test. We estimate the prevalence with 95% confidence intervals (CIs). Women who tested positive were promptly notified and provided with appropriate treatment. In our study population, CT and NG prevalences were 3.2 (95% CI: 2.6-4.0) and 0.01 (95% CI: 0.01-0.03), respectively. CT prevalence was higher in younger women (age < 40), although the results indicate a low prevalence; due to the potentially significant impact of CT and NG on women's health, we require adequate surveillance, and guaranteeing rapid referral to the correct treatment is a priority for the control of these diseases.

Políticas nacionales para el control del VIH y la evolución de la epidemia en México: un análisis de 1990 a 2017.

OBJETIVO: Analizar los cambios en la carga de la enfermedad del VIH de 1990-2017 y la influencia de las políticas y programas implementadas para su prevención y control. Material y métodos. Se elaboró una línea de tiempo de políticas e intervenciones en México; mediante modelos de regresión JoinPoint, se analizó su relación con los cambios ocurridos en las tendencias de la carga de la enfermedad del VIH. RESULTADOS: Los cambios en la carga de enfermedad se relacionan con la universalización del acceso a los medicamentos antirretrovirales (ARV), programas de atención integral y el combate al estigma y la discriminación. En el periodo analizado se observa descenso de la mortalidad relacionado con el acceso universal y gratuito a los ARV. La magnitud de los cambios tiende a ser mayor en los hombres que en las mujeres. CONCLUSIONES: Las políticas y programas implementados para tratar a las personas con VIH/Sida en México se integraron en estrategias cada vez más cohesionadas y eficaces.

Hepatitis C elimination among people who inject drugs in Mexico during the COVID-19 pandemic.

In 2019, Mexico was one of the first countries in Latin America to commit resources to achieve hepatitis C elimination by 2030. One year after this commitment, the global COVID-19 pandemic diverted attention to address immediate health needs to combat the spread of the disease. As a result, efforts to implement hepatitis C prevention and management programs were indefinitely postponed. Furthermore, populations at high risk of contracting the hepatitis C virus (HCV) and who bear the greatest burden of HCV national epidemic, including people who inject drugs and people who live with human immunodeficiency virus infection, remain exposed to extreme health disparities, which have potentially been exacerbated during the COVID-19 pandemic. In this article, we discuss the potential impact the COVID-19 pandemic has had on HCV elimination efforts in Mexico and the urgent need to resume them, since without these efforts, HCV elimination goals are likely not be achieved in the country by 2030.

En 2019, México fue uno de los primeros países en Latinoamérica en comprometer recursos para eliminar la hepatitis C antes de 2030. Un año después de este compromiso, la pandemia mundial de COVID-19 desvió la atención hacia las necesidades inmediatas de salud para combatir la propagación de esta última. Como resultado, los esfuerzos para implementar programas de prevención y manejo de la hepatitis C se suspendieron indefinidamente. Asimismo, las poblaciones con alto riesgo de contraer el virus de la hepatitis C y que representan el mayor peso de la epidemia nacional, como las personas que se inyectan drogas y las personas que viven con infección por el virus de la inmunodeficia humana, permanecen expuestas a disparidades de salud extremas que potencialmente se han exacerbado durante la pandemia de COVID-19. En este artículo discutimos el impacto potencial que la pandemia de COVID-19 ha tenido sobre los esfuerzos de eliminación de la hepatitis C en México y la necesidad urgente de reanudarlos, ya que sin ellos los objetivos de eliminación no se alcanzarán en el país en 2030.

Type 1 Diabetes Care in Mexico: An Analysis of the RENACED-DT1 National Registry.

BACKGROUND: Information regarding diagnosis, treatment, and follow-up of patients with type 1 diabetes (PWT1D) in Mexico is limited. We developed an on-line platform Registro Nacional de Pacientes con Diabetes Tipo 1 (RENACED-DT1). OBJECTIVE: The objective of the study was to describe the characteristics and healthcare of PWT1D registered in RENACED-DT1. METHODS: Analyses of 965 PWT1D from July 2014 to January 2018 in different endocrinology clinics around Mexico. RESULTS: Sixty-one percent were female with median age of 21 years, age at diagnosis 11 years, and disease duration at inclusion 8.2 years. Treatment regimen was basal-bolus in 61% and insulin-pumps in 21% (mainly in the private sector); 33.3% with self-monitoring of blood-glucose (SMBG) ≥4 times/day. Mean HbA1c at last follow-up was 8.7 ± 2.1% (72±23 mmol/mol), 18% had HbA1c < 7% (53 mmol/mol), and 35% > 9% (75 mmol/mol). SMBG ≥ 4 times/day was associated with HbA1c < 7%. Time since diagnosis > 10 years, female sex, BMI ≥ 30 kg/m2, SMBG < 4 times/day, and any hypoglycemia were associated with microvascular complications (p < 0.05). CONCLUSIONS: Percentage of patients achieving HbA1c < 7% is low; increased blood glucose monitoring is associated with better glycemic control. The achievement of optimal glycemic control must be increased to reduce the incidence of chronic complications and improve quality of life in PWT1D.

A Mixed Methods Analysis of the Venue-Related Social and Structural Context of Drug Use During Sex Among Male Clients of Female Sex Workers in Tijuana, Mexico.

Drug use during sex increases risks for HIV acquisition. Male clients of female sex workers (FSW) represent both a key population at risk for HIV as well as a transmission bridge population. In Tijuana, Mexico, drug use is prevalent and there is a need to understand male clients' drug use during sex with FSW. Characteristics of sex work venues may confer higher risks for drug use, risky sex, and HIV/STI. It is essential to understand the venue-related social and structural factors associated with drug use during sex in order to inform HIV prevention interventions with male clients in this region. We used a Mixed-Methods Sequential Explanatory Design to conduct an enriched examination of drug use during sex among male clients of FSW in Tijuana. Findings from logistic regression analysis showed that drug use during sex was significantly correlated with police harassment (AOR = 4.06, p < .001) and methamphetamine use (AOR = 33.77, p < .001). In-depth interview data provided rich meaning behind and context around the quantitative associations. Social and structural interventions to reduce police harassment, methamphetamine use, and promote condom availability are needed to reduce risks for HIV among male clients of FSW in Tijuana.

Perceived barriers to pre-exposure prophylaxis use and the role of syndemic factors among female sex workers in the Mexico-United States border region: a latent class analysis.

Female sex workers (FSWs) experience syndemic factors (e.g., polydrug use, hazardous alcohol consumption, client-perpetrated violence, depression, and sexually transmitted infections) that often heighten vulnerability to HIV and limit healthcare utilization. We hypothesized that syndemic factors will limit FSWs' uptake of pre-exposure prophylaxis (PrEP). From 2016 to 2017, 295 HIV-negative FSWs were enrolled in a behavioral HIV prevention trial in Tijuana and Ciudad Juarez, Mexico, underwent STI testing, and completed surveys on syndemic factors and perceived barriers to PrEP use. Syndemic scores (0-5) were calculated by summing syndemic factors. Latent class analysis (LCA) was used to identify homogeneous classes with respect to perceived barriers to PrEP use. We identified four classes: (1) perceived healthcare access barriers (8.3%), (2) perceived financial barriers (18.7%), (3) high level of perceived barriers (19.9%), and (4) low level of perceived barriers (53.0%) to PrEP use. Those experiencing three (adjusted odds ratio [aOR] = 3.63, 95% confidence interval [CI] = 1.24-10.67) and four or five (aOR = 6.30, 95% CI = 1.70-23.35) syndemic factors had a higher odds of membership in the class characterized by a high level of perceived barriers than in the class characterized by a low level of perceived barriers. Addressing syndemic factors may maximize PrEP's impact among FSWs along Mexico's northern border.

HIV-1 drug resistance before initiation or re-initiation of first-line ART in eight regions of Mexico: a sub-nationally representative survey.

BACKGROUND: HIV pretreatment drug resistance (PDR) to NNRTIs in persons initiating ART is increasing in Mexico. OBJECTIVES: To compare HIV PDR in eight sub-regions of Mexico. PATIENTS AND METHODS: A large PDR survey was implemented in Mexico (September 2017-March 2018) across eight sub-regions. All larger clinics (which provide ART to 90% of all initiators) were included, allocating sample size using the probability-proportional-to-size method. Both antiretroviral-naive and prior antiretroviral-exposed persons were included. HIV PDR levels were estimated from pol Sanger sequences obtained at a WHO-designated laboratory. RESULTS: A total of 2006 participants were enrolled from 74 clinics. PDR to NNRTIs was higher than to other drug classes (P < 0.0001), crossing the 10% threshold in the North-East, East, South-West and South-East. NNRTI PDR was higher in the South-West (P = 0.02), coinciding with the highest proportion of restarters in this sub-region (14%). We observed higher PDR prevalence to any drug in women compared with men (16.5% versus 12.2%, P = 0.04). After multivariable adjustment, higher NNRTI PDR remained significantly associated with previous antiretroviral exposure in the Centre-North, North-West, South-West and South-East [adjusted OR (aOR): 21, 5, 8 and 25, respectively; P < 0.05]. Genetic network analyses showed high assortativity by sub-region (P < 0.0001), with evidence of drug resistance mutation transmission within local clusters. CONCLUSIONS: Diversification of the public health response to HIV drug resistance based on sub-regional characteristics could be considered in Mexico. Higher NNRTI PDR levels were associated with poorer regions, suggesting opportunities to strengthen local HIV programmes. Price and licensing negotiations of drug regimens containing integrase inhibitors are warranted.

Where Is the Opioid Use Epidemic in Mexico? A Cautionary Tale for Policymakers South of the US-Mexico Border.

In North America, opioid use and its harms have increased in the United States and Canada over the past 2 decades. However, Mexico has yet to document patterns suggesting a higher level of opioid use or attendant harms.Historically, Mexico has been a country with low-level use of opioids, although heroin use has been documented. Low-level opioid use is likely attributable to structural, cultural, and individual factors. However, a range of dynamic factors may be converging to increase the use of opioids: legislative changes to opioid prescribing, national health insurance coverage of opioids, pressure from the pharmaceutical industry, changing demographics and disease burden, forced migration and its trauma, and an increase in the production and trafficking of heroin. In addition, harm-reduction services are scarce.Mexico may transition from a country of low opioid use to high opioid use but has the opportunity to respond effectively through a combination of targeted public health surveillance of high-risk groups, preparation of appropriate infrastructure to support evidence-based treatment, and interventions and policies to avoid a widespread opioid use epidemic.

Multidimensional Patterns of Sexual Risk Behavior and Psychiatric Disorders in Men with Substance Use Disorders.

Previous evidence links substance use disorders (SUD) to STI/HIV risk and suggests that comorbid psychiatric disorders increase the probability to engage in sexual risk behaviors. This study had two aims: (1) to identify subgroups based on sexual risk behavior using a person-centered approach in a sample of substance users and (2) to measure the association of psychiatric and SUD with subgroup membership. We assessed 402 male adults with SUD, reporting sexual intercourse in the previous 12 months using the HIV-Risk Behavior Scale and the Mini International Neuropsychiatric Interview. Latent class analysis was performed to determine multidimensional patterns of sexual risk behaviors and multinomial logistic regression was utilized to associate classes with disorders. The three-class model showed the best fit, and the classes were labeled: Relationship-Based (31.34% of the sample), Condom-Based (39.55%), and Multiple Risks (29.10%). Controlling for age and marital status, major depressive disorders, antisocial personality disorder, and any psychiatric disorder were associated with the Multiple Risks class. Results stress the importance of developing a personalized assessment and counseling for sexual risk behaviors in individuals with SUD, particularly when they endorse criteria for comorbid psychiatric disorders. Future studies should focus on evaluating differential response to preventive interventions.

[HIV mortality in sanitary districts of Mexico from 1990 to 2015]. / La mortalidad por VIH en las jurisdicciones sanitarias de México de 1990 a 2015.

OBJECTIVE: To analyze the distribution and trends of HIV mortality in the Sanitary Districts (JS) of Mexico. MATERIALS AND METHODS: To calculate crude and standardized mortality rates, official figures of deaths from Instituto Nacional de Estadística y Geografía and population estimates from Consejo Nacional de Población were used. Magnitude, distribution and trends of HIV mortality were analyzed, at the national level, by state and JS, using JoinPoint regression model. RESULTS: From 2008 to 2015, HIV mortality decreased by more than 20%. In the 25 JS with highest mortality, live 11% of the national population, but concentrated 28.6% of the total HIV death, with mortality rates two or more fold than national rate. CONCLUSIONS: We identified the 25 JS where actions to reduce HIV mortality in Mexico should be focused. For first time a health problem was analyzed in all JS of Mexico.

OBJETIVO: Analizar la distribución y tendencias de la mortalidad por VIH en las jurisdicciones sanitarias (JS) de México. MATERIAL Y MÉTODOS: Se calcularon las tasas estandarizadas de mortalidad utilizando las cifras oficiales de defunciones (Instituto Nacional de Estadística y Geografía) y estimaciones de población (Consejo Nacional de Población). Se analizó la magnitud, distribución y tendencias de la mortalidad por VIH a nivel nacional, por entidad federativa y JS utilizando el modelo de regresión JoinPoint. RESULTADOS: De 2008 a 2015, la mortalidad por VIH disminuyó más de 20%. En las 25 JS con mayor mortalidad por VIH reside 11% de la población nacional, pero concentra 28.6% de las muertes, con el doble o triple de la mortalidad nacional. CONCLUSIONES: Se identificaron las 25 JS en donde deben focalizarse las acciones para reducir la mortalidad por VIH. Por primera vez se analizó un problema de salud en todas las JS mexicanas.

Prevalence of HIV/STIs and correlates with municipal characteristics among female sex workers in 13 Mexican cities.

OBJECTIVE: To identify correlates of HIV/STI prevalence among 13 cities with varying sizes of female sex worker (FSW) populations and municipal characteristics in Mexico. MATERIALS AND METHODS: FSWs underwent interviews and testing for HIV, syphilis, gonorrhea and chlamydia. Logistic regression explored variations in HIV/STI prevalence. RESULTS: Among FSWs (n=1 092), prevalence across 13 sites was: HIV: 0.4% (range: 0%-1.4%): syphilis: 7.8% (range: 0%-17.2%); chlamydia: 15.3% (range: 5.7%-32.2%); gonorrhea:2.9% (range 0%-13.8%), and any HIV/STI: 23% (range: 9.9%- 46%). Municipalities with high human development scores and a lower municipal marginalization index had higher odds of combined HIV/STI prevalence. After controlling for sitespecific variability in municipal characteristics, greater risk of HIV/STIs was associated with lower education, having a spouse diagnosed or treated for an STI, unaffordability of condoms, and having non-Mexican clients. CONCLUSIONS: Prevalence of HIV/STIs varies across Mexican municipalities indicating the need for surveillance to identify hotspots for targeted resource allocation.

OBJETIVO: Identificar correlaciones de la prevalencia de VIH / ITS entre 13 ciudades con diferentes tamaños de población de trabajadoras sexuales y características municipales en México. MATERIAL Y MÉTODOS: Las trabajadoras sexuales fueron entrevistadas y recibieron pruebas de VIH, sífilis, gonorrea y clamidia. La regresión logística exploró las variaciones en la prevalencia del VIH/ITS. RESULTADOS: Entre las trabajadoras sexuales (n = 1 092), la prevalencia en 13 sitios fue: VIH: 0.4% (rango: 0-1.4%): sífilis: 7.8% (rango: 0-17.2%); clamidia: 15.3% (rango: 5.7-32.2%); gonorrea: 2.9% (rango 0-13.8%) y cualquier VIH/ITS: 23% (rango: 9.9-46%). Los municipios con altos puntajes de desarrollo humano y menor índice de marginación municipal tuvieron una mayor probabilidad de prevalencia combinada de VIH/ITS. Después de controlar la variabilidad específica del sitio en las características municipales, el mayor riesgo de VIH / ITS se asoció con menor educación, tener un cónyuge diagnosticado o tratado para una ITS, imposibilidad de conseguir condones y tener clientes no mexicanos. CONCLUSIONES: La prevalencia de VIH/ITS varía entre losmunicipios mexicanos, lo que indica la necesidad de una vigilancia para identificar hotspots para la asignación selectiva.

Childhood Experiences of Sexual Violence, Pregnancy, and Marriage Associated With Child Sex Trafficking Among Female Sex Workers in Two US-Mexico Border Cities.

OBJECTIVES: To quantitatively assess the relationships of childhood experiences of marriage, pregnancy, and sexual violence with underage sex trafficking. METHODS: Cross-sectional survey data from a population-based sample of 603 female sex workers from Tijuana and Ciudad Juárez, Mexico, were collected in 2013 and 2014, and we analyzed the data to evaluate relationships between pregnancy, marriage, and sexual violence when younger than 16 years, and child sex trafficking. RESULTS: Adjusted odds of child sex trafficking among those who experienced pregnancy, marriage, and childhood sexual violence when younger than 16 years in combined models were 2.8 (95% confidence interval [CI] = 1.8, 4.3), 1.7 (95% CI = 0.99, 2.8), and 1.7 (95% CI = 1.01, 3.0), respectively, relative to others (n = 603). For 89.8%, 78.0%, and 97.0% of those who had an experience of pregnancy (n = 69), marriage (n = 50), or sexual violence (n = 33) when younger than 16 years, respectively, the experience occurred before or the same year as sex trafficking. CONCLUSIONS: These results provide empirical evidence of modifiable risk factors for child sex trafficking that could be integrated into the prevention efforts and protocols of health clinics and governmental agencies in Mexico currently working to reduce underage pregnancy, marriage, and sexual violence.

Uptake of a Partner Notification Model for HIV Among Men Who Have Sex With Men and Transgender Women in Tijuana, Mexico.

Undiagnosed HIV infection is common among men who have sex with men (MSM) and transgender women (TW) in Latin America. We examined uptake of a partner notification (PN) model among MSM and TW in Tijuana, Mexico. Forty-six HIV-positive MSM/TW enrolled as index patients, and reported 132 MSM/TW sexual partners for PN. Of notified partners (90/132), 39% declined eligibility screening or participation, 39% tested for HIV, and of those 28% were newly-diagnosed HIV-positive. Partners who were seen by the index patient more than once in the past 4 months and those who primarily had sex with the index patient in one of their homes were more likely to be notified via PN (76% vs. 50%; p = 0.01 and 86% vs. 64%, p = 0.02, respectively). Lower than expected PN uptake was associated with problems identifying index patients, obtaining reliable partner contact information, and engaging notified partners.

Vaginal washing and lubrication among female sex workers in the Mexico-US border region: implications for the development of vaginal PrEP for HIV prevention.

BACKGROUND: To assess the potential acceptability and inform the development of behaviorally-congruent vaginal douche- or gel-based HIV pre-exposure prophylaxis (PrEP) products, we examined vaginal washing and lubrication practices among female sex workers (FSWs) in Tijuana and Ciudad Juarez, two northern Mexico cities bordering the United States (US). METHODS: Two hundred and ninety-five HIV-negative FSWs (145 Tijuana; 150 Ciudad Juarez) enrolled in a behavioral HIV prevention intervention trial completed surveys assessing vaginal washing and lubrication practices, as well as motivators and barriers to performing each practice. Logistic regression was used to identify potential predictors of each practice in the past month. RESULTS: In the past month, vaginal washing was performed by 56 and 22% of FSWs in Tijuana and Ciudad Juarez (p <  0.0001), respectively, while vaginal lubrication was performed by 64 and 45% of FSWs in Tijuana and Ciudad Juarez (p = 0.001), respectively. Vaginal washing was positively associated with living in Tijuana (adjusted odds ratio [AOR] = 4.35, 95% confidence interval [CI]: 2.60-7.30), older age (AOR = 1.04 per year, 95% CI: 1.01-1.06), and vaginal lubrication (AOR = 2.99, 95% CI: 1.67-5.35), while it was negatively associated with being born in the same state as the study site (AOR = 0.50, 95% CI: 0.31-0.82), earning a monthly income ≥3500 pesos (AOR = 0.53, 95% CI: 0.28-1.00), and hazardous alcohol consumption (AOR = 0.56, 95% CI: 0.33-0.95). Vaginal lubrication was positively associated with living in Tijuana (AOR = 2.21, 95% CI: 1.37-3.54) and vaginal washing (AOR = 2.91, 95% CI: 1.64-5.18), while it was negatively associated with being born in the same state as the study site (AOR = 0.47, 95% CI: 0.29-0.75). CONCLUSIONS: The moderate and high prevalence of vaginal washing and lubrication, respectively, suggest behaviorally-congruent, multi-purpose, vaginal douche- and gel-based PrEP products that simultaneously address FSWs' needs and prevent HIV infection may be acceptable to many FSWs along the Mexico-US border. Future product development and implementation should also consider the link between vaginal washing and lubrication to ensure existing practices do not undermine vaginal PrEP product effectiveness. TRIAL REGISTRATION: ClincialTrials.gov ( NCT02447484 ).

Comparing risk environments for HIV among people who inject drugs from three cities in Northern Mexico.

BACKGROUND: A large body of research has investigated the rise of injection drug use and HIV transmission in Tijuana and Ciudad Juarez (CJ). However, little is known about the dynamics of injecting in Hermosillo. This study compares drug-related behaviors and risk environment for HIV of people who inject drugs (PWID) across Tijuana, CJ, and Hermosillo to identify factors that could explain differences in HIV prevalence. METHODS: Data from Tijuana belong to a prospective study (El Cuete IV). Data from Hermosillo and Ciudad Juarez belong to a cross-sectional study. Both studies collected data in places where PWID spend time. All participants completed quantitative behavioral and serological testing for HIV. Datasets were merged using only comparable variables. Descriptive statistics tests were used to compare sociodemographic and behavioral characteristics of people who inject drugs PWID sampled in each city. A logistic regression model was built to identify factors independently associated with the likelihood of reporting receptive syringe sharing in the past 6 months. RESULTS: A total of 1494 PWID provided data between March 2011 and May 2012. HIV prevalence differed significantly between participants in Tijuana (4.2%), CJ (7.7%), and Hermosillo (5.2%; p < 0.05). PWID from Hermosillo reported better living conditions, less frequency of drug injection, and lower prevalence of syringe sharing (p < 0.01). PWID from CJ reported a higher prevalence of syringe sharing and confiscation by police (p < 0.01). In a multivariable logistic regression model, living in Hermosillo compared to Tijuana (adjusted odds ratio [AOR] = 0.42, 95% confidence interval [CI] 0.29-0.61) and being female (AOR = 0.61, 95% CI 0.45-0.83) were protective against syringe sharing. Having used crystal meth (AOR = 1.62, 95% CI 1.24-2.13, p = 0.001), having experienced syringe confiscation by police in the last 6 months (AOR = 1.78, 95% CI 1.34-2.40), and lower perception of syringe availability (AOR = 2.15, 95% CI 1.59-2.91) were significantly associated with syringe sharing (p < 0.05). CONCLUSIONS: Differences in HIV prevalence across cities reflect mainly differences in risk environments experienced by PWID, shaped by police practices, access to injection equipment, and dynamics of drug markets. Findings highlight the importance of ensuring sterile syringe availability through harm reduction services and a human rights approach to drug harms in northern Mexico and to generate better understanding of local dynamics and contexts of drug use for designing proper harm reduction programs.

Are men's misogynistic attitudes associated with poor mental health and substance use behaviors? An exploratory study of men in Tijuana, Mexico.

Men's misogynistic attitudes (i.e., dislike or contempt for women) have been shown to be associated with men's perpetration of physical/sexual violence against women and poor health outcomes for women. However, these attitudes have rarely been examined for their influence on men's own health. This paper examines the socio-demographic, substance use, and mental health correlates of misogynistic attitudes among a binational sample of men (n=400) in Tijuana, Mexico with high-risk substance use and sexual behaviors. We used a 6-item scale to measure misogynistic attitudes (α = .72), which was developed specifically for this context. We used descriptive statistics to describe our sample population and the extent to which they hold misogynistic attitudes. Then, using misogynistic attitudes as our dependent variable, we conducted bivariate linear regression and multivariable linear regression to examine the relationship between these attitudes and socio-demographic characteristics, substance use behaviors (i.e., use of alcohol, marijuana, heroin, methamphetamines, cocaine), and mental health (i.e., depression, self-esteem). In the multivariable model, we found significant relationships between misogynistic attitudes and education level (t = -4.34, p < 0.01), heroin use in the past 4 months (t = 2.50, p = 0.01), and depressive symptoms (t = 3.37, p < 0.01). These findings suggest that misogynistic attitudes are linked to poor health outcomes for men and future research needs to further explore the temporality of these relationships and identify strategies for reducing men's misogynistic attitudes with the ultimate aim of improving the health and well-being of both women and men.

Dissonant health transition in the states of Mexico, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.

BACKGROUND: Child and maternal health outcomes have notably improved in Mexico since 1990, whereas rising adult mortality rates defy traditional epidemiological transition models in which decreased death rates occur across all ages. These trends suggest Mexico is experiencing a more complex, dissonant health transition than historically observed. Enduring inequalities between states further emphasise the need for more detailed health assessments over time. The Global Burden of Diseases, Injuries, and Risk Factors Study 2013 (GBD 2013) provides the comprehensive, comparable framework through which such national and subnational analyses can occur. This study offers a state-level quantification of disease burden and risk factor attribution in Mexico for the first time. METHODS: We extracted data from GBD 2013 to assess mortality, causes of death, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) in Mexico and its 32 states, along with eight comparator countries in the Americas. States were grouped by Marginalisation Index scores to compare subnational burden along a socioeconomic dimension. We split extracted data by state and applied GBD methods to generate estimates of burden, and attributable burden due to behavioural, metabolic, and environmental or occupational risks. We present results for 306 causes, 2337 sequelae, and 79 risk factors. FINDINGS: From 1990 to 2013, life expectancy from birth in Mexico increased by 3·4 years (95% uncertainty interval 3·1-3·8), from 72·1 years (71·8-72·3) to 75·5 years (75·3-75·7), and these gains were more pronounced in states with high marginalisation. Nationally, age-standardised death rates fell 13·3% (11·9-14·6%) since 1990, but state-level reductions for all-cause mortality varied and gaps between life expectancy and years lived in full health, as measured by HALE, widened in several states. Progress in women's life expectancy exceeded that of men, in whom negligible improvements were observed since 2000. For many states, this trend corresponded with rising YLL rates from interpersonal violence and chronic kidney disease. Nationally, age-standardised YLL rates for diarrhoeal diseases and protein-energy malnutrition markedly decreased, ranking Mexico well above comparator countries. However, amid Mexico's progress against communicable diseases, chronic kidney disease burden rapidly climbed, with age-standardised YLL and DALY rates increasing more than 130% by 2013. For women, DALY rates from breast cancer also increased since 1990, rising 12·1% (4·6-23·1%). In 2013, the leading five causes of DALYs were diabetes, ischaemic heart disease, chronic kidney disease, low back and neck pain, and depressive disorders; the latter three were not among the leading five causes in 1990, further underscoring Mexico's rapid epidemiological transition. Leading risk factors for disease burden in 1990, such as undernutrition, were replaced by high fasting plasma glucose and high body-mass index by 2013. Attributable burden due to dietary risks also increased, accounting for more than 10% of DALYs in 2013. INTERPRETATION: Mexico achieved sizeable reductions in burden due to several causes, such as diarrhoeal diseases, and risks factors, such as undernutrition and poor sanitation, which were mainly associated with maternal and child health interventions. Yet rising adult mortality rates from chronic kidney disease, diabetes, cirrhosis, and, since 2000, interpersonal violence drove deteriorating health outcomes, particularly in men. Although state inequalities from communicable diseases narrowed over time, non-communicable diseases and injury burdens varied markedly at local levels. The dissonance with which Mexico and its 32 states are experiencing epidemiological transitions might strain health-system responsiveness and performance, which stresses the importance of timely, evidence-informed health policies and programmes linked to the health needs of each state. FUNDING: Bill & Melinda Gates Foundation, Instituto Nacional de Salud Pública.

Motherhood and Risk for Human Immunodeficiency Virus/Sexually Transmitted Infections Among Female Sex Workers in the Mexico-US Border Region.

BACKGROUND: Globally, female sex workers (FSWs) have been identified as a high-risk group for human immunodeficiency virus (HIV) and sexually transmitted infections (STIs). However, as women of reproductive age, FSWs also have children. Few studies have investigated if financial responsibilities associated with motherhood increase women's vulnerability to HIV and STIs among FSWs. METHODS: From March 2013 to March 2014, 603 FSWs aged ≥18 years were recruited from Tijuana and Ciudad Juarez (Mexico) to participate in a study assessing HIV/STI risk environments. RESULTS: Findings from logistic regression models indicate that FSWs who reported motherhood were more likely to report (in the past 30 days): a higher client volume (>30 clients) (adjusted odds ratio [AOR], 1.91; 95% confidence interval [CI], 1.27-2.87) and always using alcohol right before or during sex with clients in the past 30 days (AOR, 1.77; 95% CI, 1.19-2.61). In contrast, they were more likely to report consistent condom use for vaginal or anal sex with clients (AOR, 1.68; 95% CI, 1.10-2.55), less likely to report using drugs right before or during sex with clients (AOR, 0.38; 95% CI, 0.26-0.56) and less likely to have tested positive for STIs at baseline (AOR, 0.63; 95% CI, 0.43-0.91). CONCLUSIONS: These results provide a glimpse of the complex relationship between motherhood and women who are sex workers. Understanding the convergence of motherhood and sex work and how this can influence a woman's decision when engaging in sex work and affect her health is essential to designing effective programs addressing reduce risk for HIV and STIs among FSWs in this region and elsewhere.

Behavioral and Psychosocial Correlates of HIV Testing Among Male Clients of Female Sex Workers in Tijuana, Mexico.

We use data collected from a sample of 400 male clients of female sex workers (FSW) to examine their HIV testing behavior. We present frequencies of HIV testing and used bivariate and multivariable analyses to assess its socio-demographic, behavioral, and psychosocial correlates. We found that the majority (55 %) of male clients of FSW in Tijuana, Mexico had never had an HIV test and the prevalence of HIV testing within the past year was low (9 %). In multivariable analyses, significant correlates of having ever tested for HIV were higher age, higher HIV knowledge score, lower sexual compulsiveness score, lower misogynistic attitudes score, having a condom break during sex with a FSW, and higher frequency of sex with a FSW while she was high. Our findings represent an important starting point for developing effective interventions to address the need to promote HIV testing among this population.