Abstract
Although sex work and younger age increase HIV vulnerability, empirical data regarding the impacts of underage sex work are lacking. We explored associations between features of the risk environment, sex work, and drug use history, and underage sex work entry among 624 female sex workers (FSWs) in Tijuana and Ciudad Juarez, Mexico. Forty-one percent (n = 253) of women began sex work as minors, among whom HIV and any STI/HIV prevalence were 5.2 and 60.7%. Factors independently associated with increased odds of underage sex work were inhalants as the first drug used, forced first injection, number of drug treatment attempts, and recent receptive syringe sharing. Number of recent condom negotiation attempts with steady partners and depression as a reason for first injecting were negatively associated with underage entry. These results underscore the importance of efforts to prevent underage sex work and the wider factors contributing to HIV risk among vulnerable youth and underage FSWs.
Resumen
Aunque el trabajo sexual y una edad más joven aumentan la vulnerabilidad al VIH, aun faltan datos empíricos sobre los impactos del trabajo sexual en la minoría de edad. Exploramos las asociaciones entre las características del entorno de riesgo, antecedentes de trabajo sexual y consumo de drogas y la entrada al trabajo sexual como menor de edad entre 624 trabajadoras sexuales (TS) en Tijuana y Ciudad Juárez, México. El cuarenta y un por ciento (n = 253) de las mujeres comenzaron el trabajo sexual como menores de edad, en las cuales el VIH y cualquier otra prevalencia de ITS/VIH fueron 5.2 y 60.7% respectivamente. Los factores asociados independientemente con un aumento de la probabilidad de trabajo sexual durante la minoría de edad fueron: los inhalantes como primera droga consumida, primera inyección forzada, el numero de intentos de tratamiento de rehabilitación de drogas, y recibir jeringas recientemente compartidas. El número de intentos recientes para la negociación del condón con parejas estables y la depresión como una razón por la cual se inyectaron por la primera vez fueron negativamente asociadas con la entrada al trabajo sexual en la minoría de edad. Estos resultados subrayan la importancia de los esfuerzos para prevenir el trabajo sexual en la minoría de edad y factores más amplios que contribuyen al riesgo del VIH entre jóvenes vulnerables y TS que son menores de edad.
Similar content being viewed by others
References
Adams N. Anti-trafficking legislation: protection or deportation? Fem Rev. 2003;73:135–9.
Haley N, Leclerc P, Lemire N, Boivin J-F, Frappier J-Y, Claessens C. Prevalence of HIV infection and risk behaviours among Montreal street youth. Int J STD AIDS. 2000;11(4):241–7.
Anderson JE, Freese TE, Pennbridge JN. Sexual risk behavior and condom use among street youth in Hollywood. Fam Plann Perspect. 1994;26(1):22–5.
Clements K, Gleghorn A, Garcia D, Katz M, Marx R. A risk profile of street youth in northern California: implications for gender-specific human immunodeficiency virus prevention. J Adolesc Health. 1997;20(5):343–53.
Greenblatt M, Robertson MJ. Life-styles, adaptive strategies, and sexual behaviors of homeless adolescents. Psychiatr Serv. 1993;44(12):1177–80.
Kral AH, Molnar BE, Booth RE, Watters JK. Prevalence of sexual risk behaviour and substance use among runaway and homeless adolescents in San Francisco, Denver and New York City. Int J STD AIDS. 1997;8(2):109–17.
Kipke MD, O’Connor S, Palmer R, MacKenzie RG. Street youth in Los Angeles: profile of a group at high risk for human immunodeficiency virus infection. Arch Pediatr Adolesc Med. 1995;149(5):513–20.
Chettiar J, Shannon K, Wood E, Zhang R, Kerr T. Survival sex work involvement among street-involved youth who use drugs in a Canadian setting. J Public Health. 2010;32(3):322–7.
Shannon K, Kerr T, Allinott S, Chettiar J, Shoveller J, Tyndall MW. Social and structural violence and power relations in mitigating HIV risk of drug-using women in survival sex work. Soc Sci Med. 2008;66(4):911–21.
Stoltz J, Shannon K, Kerr T, Zhang R, Montaner JS, Wood E. Associations between childhood maltreatment and sex work in a cohort of drug-using youth. Soc Sci Med. 2007;65(6):1214–21.
Weber A, Boivin J-F, Blais L, Haley N, Roy É. HIV risk profile and prostitution among female street youths. J Urban Health. 2002;79(4):525–35.
Miller CL, Spittal PM, LaLiberte N, et al. Females experiencing sexual and drug vulnerabilities are at elevated risk for HIV infection among youth who use injection drugs. JAIDS. 2002;30(3):335–41.
Silverman J, Decker MR, Gupta J, Maheshwari A, Willis BM, Raj A. HIV prevalence and predictors of infection in sex-trafficked Nepalese girls and women. JAMA. 2007;298(5):536–42.
Shannon K, Bright V, Gibson K, Tyndall MW. Sexual and drug-related vulnerabilities for HIV infection among women engaged in survival sex work in Vancouver, Canada. Can J Public Health. 2007;98(6):465–9.
El-Bassel N, Witte S, Wada T, Gilbert L, Wallace J. Correlates of partner violence among female street-based sex workers: substance abuse, history of childhood abuse, and HIV risks. AIDS Patient Care STDs. 2001;15(1):41–51.
Edlin BR, Irwin KL, Faruque S, et al. Intersecting epidemics–crack cocaine use and HIV infection among inner-city young adults. New Engl J Med. 1994;331(21):1422–7.
Gleghorn AA, Marx R, Vittinghoff E, Katz MH. Association between drug use patterns and HIV risks among homeless, runaway, and street youth in Northern California. Drug Alcohol Depend. 1998;51(3):219–27.
Shannon K, Kerr T, Marshall B, et al. Survival sex work involvement as a primary risk factor for hepatitis C virus acquisition in drug-using youths in a Canadian setting. Arch Pediatr Adolesc Med. 2010;164(1):61–5.
Goldenberg S, Gallardo Cruz M, Strathdee S, Nguyen L, Semple S, Patterson T. Correlates of unprotected sex with female sex workers among male clients in Tijuana, Mexico. Sex Transm Dis. 2010;37(5):319–25.
Widom CS, Kuhns JB. Childhood victimization and subsequent risk for promiscuity, prostitution, and teenage pregnancy: a prospective study. Am J Public Health. 1996;86(11):1607–15.
Bagley C, Young L. Juvenile prostitution and child sexual abuse: a controlled study. C J Commun Ment Health. 1987;6(1):5–26.
McClanahan SF, McClelland GM, Abram KM, Teplin LA. Pathways into prostitution among female jail detainees and their implications for mental health services. Psychiatr Serv. 1999;50(12):1606–13.
Simons RL, Whitbeck LB. Sexual abuse as a precursor to prostitution and victimization among adolescent and adult homeless women. J Fam Issues. 1991;12(3):361–79.
Zierler S, Feingold L, Laufer D, Velentgas P, Kantrowitz-Gordon I, Mayer K. Adult survivors of childhood sexual abuse and subsequent risk of HIV infection. Am J Public Health. 1991;81(5):572–5.
Polusny MA, Follette VM. Long-term correlates of child sexual abuse: theory and review of the empirical literature. App Prev Psychol. 1995;4(3):143–66.
Follette VM, Polusny MA, Bechtle AE, Naugle AE. Cumulative trauma: the impact of child sexual abuse, adult sexual assault, and spouse abuse. J Trauma Stress. 1996;9(1):25–35.
Wyatt GE, Guthrie D, Notgrass CM. Differential effects of women’s child sexual abuse and subsequent sexual revictimization. J Consult Clin Psychol. 1992;60(2):167–73.
Wyatt GE, Newcomb MD, Riederle MH. Sexual abuse and consensual sex: women’s developmental patterns and outcomes. University of Virginia: Sage; 1993.
Surratt H, Inciardi J, Kurtz S, Kiley M. Sex work and drug use in a subculture of violence. Crime Delinq. 2004;50(1):43–59.
Sanders T, Campbell R. Designing out vulnerability, building in respect: violence, safety and sex work policy. Br J Sociol. 2007;58(1):1–19.
Kurtz SP, Surratt HL, Inciardi JA, Kiley MC. Sex work and “date” violence. Violence Against Women. 2004;10(4):357–85.
Lowman J. Violence and the outlaw status of (street) prostitution in Canada. Violence Against Women. 2000;6(9):987–1011.
Pauw I, Brener L. ‘You are just whores—you can’t be raped’: barriers to safer sex practices among women street sex workers in Cape Town. Cult Health Sex. 2003;5(6):465–81.
US State Department: Trafficking in Persons Report. Human Rights Reports. Available at: http://www.state.gov/g/tip/rls/tiprpt/2010/ (2010).Accessed on May 12, 2011.
Bucardo J, Semple SJ, Fraga-Vallejo M, Davila W, Patterson TL. A qualitative exploration of female sex work in Tijuana, Mexico. Arch Sex Behav. 2004;33(4):343–51.
Strathdee SA, Lozada R, Semple SJ, et al. Characteristics of female sex workers with US clients in two Mexico—US border cities. Sex Transm Dis. 2008;35(3):263–8.
Strathdee SA, Magis-Rodriguez C. Mexico’s evolving HIV epidemic. JAMA. 2008;300(5):571–3.
US Department of State: Bureau of Democracy, Human Rights, and Labor. Country Reports on Human Rights Practices: Mexico. Human Rights Reports. Available at: www.state.gov/g/drl/rls/hrrpt/2005/62736.htm (2005) Accessed April 6, 2011.
Magis-Rodriguez C, Brouwer KC, Morales S, et al. HIV prevalence and correlates of receptive needle sharing among injection drug users in the Mexican-U.S. border city of Tijuana. J Psychoactive Drugs. 2005;37(3):333–9.
Cravioto P. La magnitud y naturaleza del problema de la heroína en Ciudad Juárez, Chihuahua (Doctorado en Ciencias de la Salud). México, DF: Universidad Nacional Autónoma de México; 1999.
Strathdee SA, Lozada R, Martinez G, et al. Social and structural factors associated with HIV infection among female sex workers who inject drugs in the Mexico-US border region. PLoS One. 2011;6(4):e19048. doi:10.1371/journal.pone.0019048.
Loza O, Strathdee SA, Lozada R, et al. Correlates of early versus later initiation into sex work in two Mexico-U.S. border cities. J Adolesc Health. 2010;46(1):37–44.
Patterson TL, Semple SJ, Staines H, et al. Prevalence and correlates of HIV infection among female sex workers in 2 Mexico-US border cities. J Infect Dis. 2008;197(5):728–32.
Patterson TL, Semple SJ, Fraga M, et al. Comparison of sexual and drug use behaviors between female sex workers in Tijuana and Ciudad Juarez, Mexico. Subst Use Misuse. 2006;41(10):1535–49.
Strathdee SA, Philbin MM, Semple SJ, et al. Correlates of injection drug use among female sex workers in two Mexico-US border cities. Drug Alcohol Depend. 2008;92(1–3):132–40.
Rhodes T, Singer M, Bourgois P, Friedman SR, Strathdee SA. The social structural production of HIV risk among injecting drug users. Soc Sci Med. 2005;61(5):1026–44.
Rhodes T. The ‘risk environment’: a framework for understanding and reducing drug-related harm. Int J Drug Policy. 2002;13(2):85–94.
Bronfenbrenner U. The ecology of human development. Cambridge: Harvard University Press; 1979.
Rhodes T. Risk environments and drug harms: a social science for harm reduction approach. Int J Drug Policy. 2009;20(3):193–201.
McMichael AJ. Prisoners of the proximate: loosening the constraints on epidemiology in an age of change. Am J Epidemiol. 1999;149(10):887–97.
Pearce N, McKinlay JB. Back to the future in epidemiology and public health. J Clin Epidemiol. 1998;51(8):643–6.
Agar M. The story of crack: towards a theory of illicit drug trends. Addict Res Theory. 2003;11(1):3–29.
Strathdee SA, Hallett TB, Bobrova N, et al. HIV and risk environment for injecting drug users: the past, present, and future. Lancet. 2010;376(9737):268–84.
Tempalski B, McQuie H. Drugscapes and the role of place and space in injection drug use-related HIV risk environments. Int J Drug Policy. 2009;20(1):4–13.
Kerrigan D, Ellen JA, Moreno L, et al. Environmental-structural factors significantly associated with consistent condom use among female sex workers in the Dominican Republic. Aids. 2003;17(3):415–23.
Shannon K, Rusch M, Shoveller J, Alexson D, Gibson K, Tyndall MW. Mapping violence and policing as an environmental-structural barrier to health service and syringe availability among substance-using women in street-level sex work. Int J Drug Policy. 2008;19(2):140–7.
Kerrigan D, Moreno L, Rosario S, et al. Environmental-structural interventions to reduce HIV/STI risk among female sex workers in the Dominican Republic. Am J Public Health. 2006;96(1):120–5.
Skeldon R, HIV USEA. Population mobility and HIV vulnerability in South East Asia: an assessment and analysis: UNDP South East Asia HIV & Development Project; 2000.
Coffee M, Lurie MN, Garnett GP. Modelling the impact of migration on the HIV epidemic in South Africa. AIDS. 2007;21(3):343–50.
McMahon J, Tortu S, Pouget E, Hamid R, Neaigus A. Contextual determinants of condom use among female sex exchangers in East Harlem, NYC: an event analysis. AIDS Behav. 2006;10(6):731–41.
Goldenberg SM, Strathdee SA, Gallardo M, Rhodes T, Wagner KD, Patterson TL. “Over here, it’s just drugs, women and all the madness”: the HIV risk environment of clients of female sex workers in Tijuana, Mexico. Soc Sci Med. 2011;72(7):1185–92.
Dandona R, Dandona L, Gutierrez J, et al. High risk of HIV in non-brothel based female sex workers in India. BMC Public Health. 2005;5(1):87.
Larios SE, Lozada R, Strathdee SA, et al. An exploration of contextual factors that influence HIV risk in female sex workers in Mexico: the Social Ecological Model applied to HIV risk behaviors. AIDS Care. 2009;21(10):1335–42.
Harcourt C, Donovan B. The many faces of sex work. Sex Transm Infect. 2005;81(3):201–6.
Weitzer R. Sociology of sex work. Ann Rev Sociol. 2009;35:213–34.
Church S, Henderson M, Barnard M, Hart G. Violence by clients towards female prostitutes in different work settings: questionnaire survey. BMJ. 2001;322(7285):524.
Scambler G, Paoli F. Health work, female sex workers and HIV/AIDS: global and local dimensions of stigma and deviance as barriers to effective interventions. Soc Sci Med. 2008;66(8):1848–62.
Rhodes T, Donoghoe M, Hunter G, Soteri A, Stimson GV. Sexual behaviour of drug injectors in London: implications for HIV transmission and HIV prevention. Addiction. 1994;89(9):1085–96.
Rhodes T, Platt L, Judd A, et al. Hepatitis C virus infection, HIV co-infection, and associated risk among injecting drug users in Togliatti, Russia. Int J STD AIDS. 2005;16(11):749–54.
Poudel P, Carryer J. Girl-trafficking, HIV/AIDS, and the position of women in Nepal. Gend Dev. 2000;8(2):74–9.
Silverman J, Decker M, Gupta J, Maheshwari A, Patel V, Raj A. HIV prevalence and predictors among rescued sex-trafficked women and girls in Mumbai, India. JAIDS. 2006;43(5):588–93.
Archibold R. Massacre in Tijuana Recalls Worst Era. The New York Times. Accessed 26 Oct 2010.
Wright MW. From protests to politics: sex work, women’s worth, and Ciudad Juarez modernity. Ann Assoc Am Geogr. 2004;94(2):369–86.
Livingston J. Murder in Juárez: gender, sexual violence, and the global assembly line. Frontiers: J Women Stud. 2004;25(1):59–76.
Katsulis Y, Lopez V, Durfee A, Robillard A. Female sex workers and the social context of workplace violence in Tijuana, Mexico. Med Anthropol Q. 2010;24(3):344–62.
Cohen S. Ominous convergence: sex trafficking, prostitution and international family planning. Guttmacher Rep Public Policy. 2005;8(1):12–4.
Risley A. Sex trafficking: the “other” crisis in Mexico? Latin Am. 2010;54(1):99–117.
Katsulis Y. Agents or victims? Youth sex workers on the US-Mexico border. Wagadu. 2010;8:115–43.
Ramos R, Ferreira-Pinto JB, Brouwer KC, et al. A tale of two cities: social and environmental influences shaping risk factors and protective behaviors in two Mexico-US border cities. Health Place. 2009;15(4):999–1005.
Maxwell JC, Cravioto P, Galván F, Ramírez MC, Wallisch Ls, Spence RT. Drug use and risk of HIV/AIDS on the Mexico-USA border: a comparison of treatment admissions in both countries. Drug Alcohol Depend. 2006;82(S1):S85–93.
Thuy NT, Nhung VT, Thuc NV, Lien TX, Khiem HB. HIV infection and risk factors among female sex workers in southern Vietnam. AIDS. 1998;12(4):425–32.
Rhodes T, Simi M, Baroš S, Platt L, Žiki B. Police violence and sexual risk among female and transvestite sex workers in Serbia: qualitative study. BMJ. 2008;337(a811):560–3.
Benjamini Y, Hochberg Y. Controlling the false discovery rate: a practical and powerful approach to multiple testing. J R Stat Soc Series B Stat Methodol. 1995;57(1):289–300.
McCullagh P, Nelder JA. Generalized linear models. New York: Chapman & Hall/CRC; 1989.
Dean CB. Overdispersion. In: Armitage P, Colton T, editors. Encyclopedia of biostatistics. Chichester: John Wiley & Sons; 1998, p. 3226–32.
Stokes ME, Davis CS, Koch GG. Categorical data analysis using the SAS system. Cary: SAS publishing; 2000.
Potterat JJ, Rothenberg RB, Muth SQ, Darrow WW, Phillips-Plummer L. Pathways to prostitution: the chronology of sexual and drug abuse milestones. J Sex Res. 1998;35(4):333–40.
Goldenberg SM BI, Rolon ML, Collins S, et al. Estudio exploratorio de la asociación entre trata sexual y vulnerabilidad a la infección por VIH en la frontera México-Estados Unidos [An exploratory study of the relationship between sex trafficking and HIV vulnerability along the Mexico-US border]. XII Congreso Nacional sobre VIH/SIDA y otras ITS, Villahermosa, Mexico. Accessed 27–29 July 2011.
Medina-Mora ME, Real T. Epidemiology of inhalant use. Curr Opin Psychiatr. 2008;21(3):247–55.
Syvertsen J, Pollini RA, Lozada R, Vera A, Rangel G, Strathdee SA. Managing la malilla: exploring drug treatment experiences among injection drug users in Tijuana, Mexico, and their implications for drug law reform. Int J Drug Policy. 2010;21(6):459–65.
Brannigan A, Van Brunschot EG. Youthful prostitution and child sexual trauma. Int J Law Psychiatry. 1997;20(3):337–54.
Sarang A, Rhodes T, Platt L, et al. Drug injecting and syringe use in the HIV risk environment of Russian penitentiary institutions: qualitative study. Addiction. 2006;101(12):1787–96.
Latkin C, Mandell W, Vlahov D, Oziemkowska M, Celentano D. People and places: behavioral settings and personal network characteristics as correlates of needle sharing. JAIDS. 1996;13(3):273.
Rhodes T, Davis M, Judd A. Hepatitis C and its risk management among drug injectors in London: renewing harm reduction in the context of uncertainty. Addiction. 2004;99(5):621–33.
Barnard MA. Needle sharing in context: patterns of sharing among men and women injectors and HIV risks. Addiction. 1993;88(6):805–12.
Samuel M, Doherty P, Bulterys M, Jenison S. Association between heroin use, needle sharing and tattoos received in prison with hepatitis B and C positivity among street-recruited injecting drug users in New Mexico, USA. Epidemiol Infect. 2001;127(3):475–84.
Hurley SF, Jolley DJ, Kaldor JM. Effectiveness of needle-exchange programmes for prevention of HIV infection. Lancet. 1997;349(9068):1797–800.
Des Jarlais DC, Marmor M, Friedmann P, et al. HIV incidence among injection drug users in New York City, 1992–1997: evidence for a declining epidemic. A J Public Health. 2000;90(3):352–6.
Watters JK, Estilo MJ, Clark GL, Lorvick J. Syringe and needle exchange as HIV/AIDS prevention for injection drug users. JAMA. 1994;271(2):115–20.
Magis-Rodriguez C, Lemp G, Hernandez MT, Sanchez MA, Estrada F, Bravo-Garcia E. Going North: Mexican migrants and their vulnerability to HIV. J Acquir Immune Defic Syndr. 2009;51(1):21–5.
Frohlich KL, Potvin L. The inequality paradox: the population approach and vulnerable populations. Am J Public Health. 2008;98(2):216–21.
Farmer P. On suffering and structural violence: a view from below. Race/Ethnicity: Multidisciplinary Global Perspectives. 2010;3(1):11–28.
Singer MC, Erickson PI, Badiane L, et al. Syndemics, sex and the city: understanding sexually transmitted diseases in social and cultural context. Soc Sci Med. 2006;63(8):2010–21.
Singer M. A dose of drugs, a touch of violence, a case of AIDS: conceptualizing the Sava Syndemic. Free Inq in Creat Sociol. 1996;24:99–110.
Centers for Disease Control and Prevention. Syndemics Prevention Network. Available at: http://www.cdc.gov/syndemics/definition.htm (2008). Accessed 12, Apr 2011.
Singer M, Clair S. Syndemics and public health: reconceptualizing disease in bio social context. Med Anthropol Q. 2003;17(4):423–41.
Dickson-Gomez J. Structural factors influencing patterns of drug selling and use and HIV risk in the San Salvador metropolitan area. Med Anthropol Q. 2010;24(2):157–81.
US Department of State, Bureau of Democracy, Human Rights, and Labor. Country Reports on Human Rights Practices: Mexico. Available at: http://www.state.gov/g/drl/rls/hrrpt/2009/wha/136119.htm (2009). Accessed 6 Apr 2011.
Sabido M, Giardina F, Hernandez G, et al. The UALE project: decline in the incidence of HIV and sexually transmitted infections and increase in the use of condoms among sex workers in Guatemala. J Acquir Immune Defic Syndr. 2009;51(1):35–41.
Goldenberg SM, Strathdee SA, Gallardo M, et al. How important are venue-based HIV risks among male clients of female sex workers? A mixed methods analysis of the risk environment in nightlife venues in Tijuana, Mexico. Health Place. 2011;17(3):748–56.
Acknowledgments
The authors thank our study participants and staff from Prevencasa, A.C. for their participation, time, and effort. This study was supported by the National Institutes of Health (NIDA R01 DA023877). Goldenberg is supported by doctoral awards from the Canada-U.S. Fulbright program and the Canadian Institutes of Health Research. The authors also thank Dr. Thomas Novotny from San Diego State University for reviewing this manuscript.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Goldenberg, S.M., Rangel, G., Vera, A. et al. Exploring the Impact of Underage Sex Work Among Female Sex Workers in Two Mexico–US Border Cities. AIDS Behav 16, 969–981 (2012). https://doi.org/10.1007/s10461-011-0063-3
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10461-011-0063-3