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Structural Determinants of Client Perpetrated Violence Among Female Sex Workers in Two Mexico-U.S. Border Cities

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Abstract

Female sex workers (FSWs) are disproportionately affected by both HIV and gender-based violence, such as that perpetrated by clients (CPV). We used a structural determinants framework to assess correlates of physical or sexual CPV in the past 6 months among FSWs in the Mexico/U.S. border cities of Ciudad Juárez and Tijuana. Bivariate and multivariate logistic regression analysis identified individual, client, interpersonal, work environment and macrostructural factors associated with recent CPV. Among 496 FSWs, 5 % experienced recent CPV. Witnessing violence towards other FSWs in one’s neighborhood (aOR 5.6, 95 % CI 1.8–17.2), having a majority of foreign (aOR 3.5, 95 % CI 1.4–8.4) or substance using (aOR 4.0, 95 % CI 1.5–10.4) clients, and being a street worker (aOR 3.0, 95 % CI 1.1–7.7) were independently associated with recent CPV. Our findings underscore the vulnerability of FSWs and the need to design policies and interventions addressing macro-level influences on CPV rather than exclusively targeting individual behaviors.

Resumen

Las mujeres trabajadoras sexuales (MTS) se ven afectadas de manera desproporcionada por el VIH y la violencia de género, tal como la que reciben por parte de sus clientes. Utilizamos un marco con determinantes estructurales para evaluar los correlatos de la violencia física o sexual por parte de clientes en los últimos 6 meses en MTS en Ciudad Juárez y Tijuana, ciudades en la frontera entre México y Estados Unidos. Análisis de regresión logística bivariante y multivariante identificaron factores individuales, de los clientes, interpersonales, del entorno laboral y macroestructurales que están relacionados con el haber vivido la violencia por parte de clientes recientemente. De las 496 MTS, el 5 % experimentó violencia por parte de clientes recientemente. El ser testigo de la violencia contra otra MTS en su colonia (aOR 5.6, 95 % CI 1.8–17.2), el tener en su mayoría clientes extranjeros (aOR 3.5, 95 % CI 1.4–8.4) o que usan sustancias (aOR 4.0, 95 % CI 1.5–10.4) y el trabajar en la calle (aOR 3.0, 95 % CI 1.1–7.7) estuvieron relacionados de manera independiente con el haber vivido la violencia por parte de clientes recientemente. Nuestros hallazgos subrayan la vulnerabilidad de las MTS y la necesidad de diseñar políticas e intervenciones que aborden las influencias al nivel macro en la violencia por parte de los clientes en lugar de enfoque exclusivo en los comportamientos individuales.

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Acknowledgments

The authors respectfully acknowledge the participation of all the women in this study for making this work possible. We also thank the project coordinator, Kristen Meckel-Parker and the U.S.-Mexico bi-national study staff. Research reported in this publication was supported by the National Institute on Drug Abuse of the National Institutes of Health under award number R01DA029899. Dr. Strathdee is supported by a NIDA MERIT Award R37 DA019829. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Authors and Affiliations

  1. Division of Global Public Health, Department of Medicine, University of California, San Diego, 9500 Gilman Drive, MC-0507, La Jolla, San Diego, CA, 92093-0507, USA

    Erin E. Conners, Jay G. Silverman, Steffanie A. Strathdee & Kimberly C. Brouwer

  2. Joint Doctoral Program in Public Health, University of California San Diego and San Diego State University, San Diego, CA, USA

    Erin E. Conners

  3. Department of Psychiatry, University of California San Diego, San Diego, CA, USA

    Monica Ulibarri & Thomas L. Patterson

  4. Centro Nacional para la Prevención y el Control del VIH y el SIDA (CENSIDA), Mexico City, Mexico

    Carlos Magis-Rodriguez

  5. Facultad de Medicina, Universidad Autónoma de Ciudad Juárez, Ciudad Juárez, Mexico

    Hugo Staines-Orozco

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  1. Erin E. Conners
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  2. Jay G. Silverman
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  3. Monica Ulibarri
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  5. Steffanie A. Strathdee
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  6. Hugo Staines-Orozco
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  7. Thomas L. Patterson
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  8. Kimberly C. Brouwer
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Correspondence to Kimberly C. Brouwer.

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Conners, E.E., Silverman, J.G., Ulibarri, M. et al. Structural Determinants of Client Perpetrated Violence Among Female Sex Workers in Two Mexico-U.S. Border Cities. AIDS Behav 20, 215–224 (2016). https://doi.org/10.1007/s10461-015-1111-1

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  • DOI: https://doi.org/10.1007/s10461-015-1111-1

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