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

Abstract

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.

Association of gender-based violence with sexual and drug-related HIV risk among female sex workers who use drugs in Kazakhstan

“…Studies also show that WESW who are unhoused, younger, experience economic hardship, food insecurity, and use drugs are more vulnerable to violence. 18,33,34 consistent with findings from this study. This emphasizes the need for structural interventions to support stable housing, food security and substance use treatment, in parallel with HIV and violence prevention interventions.…”

Mental health and adherence to antiretroviral therapy among Mexican people living with HIV during the COVID-19 pandemic

“…This is consistent with the fact that women, during the pandemic, have reported more mental health problems and difficulties in maintaining adequate ART adherence during the pandemic [ 52 , 56 , 57 ]. Besides, being female has been recognized as a psychosocial vulnerability factor, both in the general population [ 58 ] and in PLWH [ 39 , 59 ]. On the other hand, patients with previous vulnerability in this study presented greater problems of anxiety, depression, and substance use, consistent with other studies reporting a greater likelihood of emotional symptoms in patients with a history of mood disorder [ 48 , 55 ].…”

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

“…However, our previous study found that this measure of economic hardship was associated with expected demographic and HIV risk variables, including older age, not being married, violence, and sexual risk behaviors for HIV. 42 Since women report engaging in a variety of risk behaviors in order to make more money, future studies may want to consider measuring economic hardship among FSW by asking about specific behaviors that may be connected to the urgency of their work (e.g. substance use to work longer hours, substance use with clients to make more money) women may engage in when attempting to improve their financial situation.…”