Substance use, economic vulnerability, and HIV/STI risk among female sex workers in Mexico.

BACKGROUND: Economic hardship (e.g., difficulty to pay for basic needs) has been associated with increased HIV/STI risk among female sex workers (FSW), and may be exacerbated by high levels of substance use. Few studies have assessed the intersection of economic hardship, substance use, and HIV/STI risk among FSW. METHODS: Quantitative data were collected via questionnaires among 469 FSW residing in Tijuana and Ciudad Juarez, Mexico. Using logistic regression, we assessed the role of economic hardship on the association between substance use (past 30-days alcohol use, drug use, or injection drugs use with clients, and past 6-months drug use) and testing positive for an STI (also an indicator of HIV risk). RESULTS: Drug use in the preceding six months was significantly associated with testing positive for an STI (AOR = 1.8, CI: 1.1 = 2.9, p = .02); no difference in this association was found by whether women reported economic hardship. Past 30-day drug use with clients was associated with STI infection, but only among those who did not report economic hardship (AOR = 1.5, 95% CI: 1.1-1.9, p < .01). CONCLUSIONS: Findings suggest that economic hardship influences the association between substance use and increased risk for HIV/STI among FSW; however, these associations may be more complex than previously hypothesized.

Economic vulnerability, violence, and sexual risk factors for HIV among female sex workers in Tijuana, Mexico.

Economic vulnerability is often reported to underlie involvement in sex work among female sex workers (FSW), but may also create urgency in women's work, limiting women's negotiating power with clients and in turn, increasing their vulnerability for violence and HIV. This study assessed economic vulnerability in relation to violence and sexual risk behaviors for HIV among a sample of FSW in Tijuana, Mexico. FSW at least 18 years of age were recruited through venue-based sampling for a survey (n = 228) and in-depth interviews (n = 50) to investigate HIV risk factors in this region. Using crude and adjusted logistic regression models, we assessed lack of financial support from others as well as reports of financial hardship separately in relation to experiencing sexual violence (e.g. by clients, police, relationship partners, in the past 6 months), physical violence (past 6 months), STI diagnosis, and inconsistent condom use (past 30 days). Qualitative interviews (n = 50), conducted with a subsample of the survey participants, were also examined for related themes. FSW who reported no financial support were more likely to report sexual violence (OR = 2.1; 95% CI:1.1-4.2). FSW who reported financial hardship were more likely to experience sexual violence (OR = 1.9; 95% CI:1.1-3.6) and physical violence (OR = 1.9; 95% CI:1.1-3.6), as well as to report past 30-day inconsistent condom use (OR = 2.4; 95%CI: 1.3-4.6) and to test positive for an STI (OR = 1.9; 95% CI:1.1-3.4). Qualitative data substantiated these findings. Findings suggest that interventions to improve economic well-being may be useful to prevent the intersecting concerns of violence and HIV among FSW.

Economic Vulnerability among Girls at Risk for Adolescent Pregnancy: Qualitative Findings among a Clinic Sample of Girls Residing in the U.S.-Mexico Border Region.

Background: In the U.S., research to identify the risk factors explaining high rates of adolescent pregnancy disproportionately affecting racial/ethnic minorities, including Latinas, have largely focused on social and cultural factors that influence girls' pregnancy intentions and decisions regarding the use of contraception, as well as girls' sexual and reproductive decision-making control in relationships. However, economic factors may play a role in increasing girls' risk for adolescent pregnancy as well. Disproportionately high rates of adolescent pregnancy occur in areas of concentrated poverty, with higher rates among ethnic minorities. This qualitative study used a descriptive, exploratory design with a content analysis approach (1) to describe economic vulnerability in girls' lives and (2) to identify potential ways in which economic vulnerability may influence risk factors for adolescent pregnancy among adolescent females at high risk for pregnancy recruited from a health clinic by the U.S.-Mexico border in California. Methods: Qualitative in-depth interviews were conducted among 21 girls reporting risk factors for pregnancy (including a previous pregnancy, experiences of dating violence, or having ever been diagnosed with an STI) and who were seeking sexual/reproductive health services at a clinic near the U.S.-Mexico border in California. Participants were asked about their family life, economic stressors, characteristics of intimate partner relationships, and future education/career aspirations. Interviews were analyzed using content analysis to identify common themes related to economic vulnerability and risk for pregnancy. Results: Female participants were 17 years of age on average, most (72%) were Latina, and over half (60%) were in a relationship. Participants reported a high level of economic vulnerability at home, which they felt compromised their welfare, negatively affected expectations for future educational goals, and promoted financial dependence for basic needs (e.g., food) on male partners. The latter often compromised girls' decision-making control with relationship partners over contraceptive use and pregnancy timing. Conclusions: Study findings suggest that economic vulnerability: (a) supports economic reliance on male partners, with implications for male partner control over pregnancy decisions and (b) hinders girls' expectations for future educational opportunities, which may reduce girls' prioritization to delay pregnancy.

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.

Substance Use among Female Sex Workers in Two US-Mexico Border Cities: Associations with Age of Entry.

BACKGROUND: Research has documented consistent associations between entry into sex work as a minor and sexual HIV risk. However, previous studies have not examined whether substance use and related HIV risk are elevated among those who enter sex work under age 18. METHODS: Quantitative data were collected via time-location sampling of 603 female sex workers (FSWs) ages 18 years and older residing in two Mexico-US border cities. Age of entry into sex work (categorized as 15 years or younger, 16-17 years, or 18 years and older) was assessed as a predictor of substance use (forced and voluntary) within the first month post-entry and recent (past 30 days) substance use with clients. RESULTS: Compared to those who entered as adults, participants who entered sex work at age 15 or younger were significantly more likely to report drug use (AOR = 5.2, CI = 2.9-8.9) and forced drug use within the first 30 days of entry (AOR= 6.0, CI = 1.9-18.9), as well as past month drug use with clients (AOR= 3.4, CI = 1.9-5.8). Similar results were found among participants who entered sex work at age 16-17. CONCLUSIONS: Increased risk of recent substance use with clients indicates continuing elevated risk for those entering sex work at these early ages. Early and forced substance use at entry may underlie the elevated risk of HIV infection consistently observed among this population.

Intimate Partner Violence Among Female Sex Workers and Their Noncommercial Male Partners in Mexico: A Mixed-Methods Study.

Utilizing mixed methods, we examined intimate partner violence (IPV) behaviors among 428 female sex workers (FSWs) who use drugs and their noncommercial male partners in Tijuana and Ciudad Juarez, Mexico. Half of all participants reported perpetrating and experiencing at least one type of IPV behavior in the past year. In interviews, drug use emerged as an important theme associated with IPV behaviors, and we found men and women differed in their motivations for engaging in IPV behaviors. Findings highlight how gender and power are interlinked with and may exacerbate drug use and IPV behaviors among marginalized populations.

"He invited me and didn't ask anything in return" Migration and Mobility as Vulnerabilities for Sexual Exploitation among Female Adolescents in Mexico.

Although human trafficking is recognized as a major human rights violation, there is limited evidence regarding the vulnerabilities that contribute to female adolescents' risk of being forced or coerced into the sex trade. Vulnerabilities such as gender-based violence, economic and social inequalities have been shown to shape the risk of sexual exploitation among adolescents. In-depth interviews (n=18) with current sex workers who reported being deceived or forced into the sex trade as adolescents (<17 years old) were analysed to explore their experiences of migration and mobility in Mexico. Driven by socio-economic and vulnerabilities in home communities, adolescents often engaged in internal migration and mobility to other Mexican communities and states. Migration and mobility further predisposed them to social isolation, economic hardship and abuse, which were used as tools to trick them into the sex trade. Policies that support safer migration for adolescents in origin, transit, and destination communities are needed.