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To gain insights into bridging behaviors and their correlates among male clients of female sex workers FSWs. Participants underwent interviews and testing for HIV, chlamydia, syphilis, and gonorrhea. Compared to other clients, bridgers were more likely to use drugs during sex with FSWs 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.
A series of linked bridges may begin with a male client or steady partner who infects an FSW, who then infects another male client, who in turn infects his wife or girlfriend. A few studies provide evidence for such sequences. In Thailand, Cambodia, and Myanmar, the generalization of HIV was driven primarily by clients of FSWs, whose social networks were the source of increased prevalence in the general community. In light of the potential importance of bridging behavior, this study aimed to estimate the frequency of bridging behavior among male clients and to gain insights into the correlates of that behavior.
Outreach workers contacted clients in bars, brothels, or on the street. Pre- and post-test counseling were provided, as were referrals for medical care for those testing positive. Participants were asked about socio-demographic factors and about the frequency of unprotected vaginal, oral, and anal sex over the past four months with FSWs and with their spouses or steady partners. Data were also gathered on recent illicit drug use and psychiatric diagnoses. Participants were given a finger-prick, and drops of blood were drawn for on-site rapid testing of both HIV and syphilis.
Participants receiving a positive rapid test for syphilis or a confirmed positive test for HIV were referred to local clinics for treatment. Those testing positive for chlamydia and gonorrhea were given free treatment at the study offices. Clients who did not have a spouse or steady partner during the last four months were excluded from these analyses. Differences between the two risk groups were assessed using Wilcoxon's rank-sum test for continuous covariates, Fisher's exact test for binary covariates, and chi-square test for categorical covariates with more than two categories.
Bridgers were defined as male clients who had unprotected vaginal or anal sex with both FSWs and their wives or steady partners in the previous four months. Non-bridgers were clients with wives or steady partners who had i unprotected sex with FSWs only, ii unprotected sex with their wives or steady partners only, or iii only protected sex with FSWs and with their wives or partners. Group differences were assessed using the above-referenced tests. In addition, univariate logistic regressions were performed to evaluate the associations between bridging behavior and demographic characteristics, psychosocial factors, sexual risk behaviors, and substance use variables.