Epidemiology of Sex Trafficking, Drug Use and HIV at the U.S.-Mexico Border

描述（由申请人提供）：在整个拉丁美洲，几乎没有关于性贩运的经验数据，联合国将性贩运定义为“强迫、胁迫、欺诈或强迫”。 以欺骗手段从事性工作、通过绑架进入或未满18岁从事这类工作。“最近的媒体报道证实，在美墨边境地区，贩卖妇女和女孩从事性工作以及贩毒集团参与这种形式的性剥削的情况正在增加，构成了一场重大的人权危机。此外，公共卫生研究所以前在南亚和东南亚的研究已经确定，通过贩运进入性工作会增加艾滋病毒/性传播感染的风险。虽然美墨边境地区性贩运的性质和背景可能与亚洲有很大不同（例如，非法药物的可能作用），我们的两国研究小组的研究发现，往往与FSW之间的贩运有关的因素（例如，在蒂华纳和华雷斯城，性交易（年轻、暴力）与艾滋病毒风险增加、非法药物使用和强迫注射药物使用有关，这表明性交易可能加剧了该地区对艾滋病毒的脆弱性。为了防止性贩运和减少被贩运妇女和女孩感染艾滋病毒的风险，需要提供以下数据：（a）性贩运是如何发生的，什么结构助长了这种犯罪;（B）受害者一旦被贩运，是否以及如何变得容易感染艾滋病毒。尽管该区域有明确和迫切的需要，但迄今尚未对这些问题进行研究。拟议的研究旨在描述两个主要边境城市（蒂华纳和华雷斯城）的性贩运性质，包括主要的结构性因素（例如，与贩毒集团活动、警察暴力、向北迁移、获得保健服务有关的问题），这些问题可能影响性贩运和贩运受害者的艾滋病毒风险。为了实现这一目标，我们建议与多个国家和州一级的系统关键信息提供者（SKI）协商，对来自蒂华纳和华雷斯城的800名FSW进行混合方法研究，以告知内容，确保相关性，并最大限度地提高我们工作的可接受性和传播性。据估计，这些城市中70%的FSW来自墨西哥其他州或中美洲和南美洲，这些地点为拉丁美洲研究这些问题提供了无与伦比的机会，并为制定急需的干预措施提供了信息。将与30名性交易（未成年人或强迫/胁迫性工作）筛查呈阳性的性工作者（每个城市15名）进行深入访谈。将通过自我报告调查和生物艾滋病毒/性传播感染检测，从800名FSW（每个城市400名）中收集数据。根据访谈、调查和实验室数据以及SKI咨询，将确定具体区域结构性干预目标并进行优先排序（即那些被发现与性贩运和被贩运的FSW中的艾滋病毒风险相关的重点结构因素），以防止性贩运并降低沿着美国的艾滋病毒风险。墨西哥边境。将在随后的R34应用中提出所指结构干预措施的开发和试点。

DESCRIPTION (provided by applicant): Across Latin America, virtually no empirical data exist on the subject of sex trafficking, defined by the United Nations as "forced, coerced, fraudulent or deceitful entry in to sex work, entry by abduction, or entry into such work under age 18." Recent media reports support that trafficking of women and girls into sex work, and drug cartel involvement in this form of sexual exploitation, is on the rise in the U.S. Mexico border region, constituting a major human rights crisis. Further, previous research by the PI in South and Southeast Asia has established that entry into sex work via trafficking confers elevated HIV/STI risk. Although the nature and context of sex trafficking in the US-Mexico border region likely differ significantly from that of Asia (e.g., the likely role of illicit drugs), research of our binational research team has found that factors often associated with trafficking among FSWs (e.g., young age, violence) relate to increased HIV risk, illicit drug use and forced injection drug use in Tijuana and Ciudad Juarez, suggesting that sex trafficking may be promoting vulnerability to HIV in this region. To both prevent sex trafficking and reduce risk for HIV among women and girls who have been trafficked, data is required a) on how sex trafficking is occurring and what structures facilitate this crime, and b) on whether and how victims, once trafficked, are made vulnerable to HIV. Despite the clear and urgent need in the region, no study of these issues has been conducted to date. The proposed study aims to describe the nature of sex trafficking in two major border cities (Tijuana and Ciudad Juarez) including major structural factors (e.g., those related to drug cartel activities, police violence, northward migration, access to health services) that may affect both sex trafficking and HIV risk among trafficking victims. To accomplish this, we propose to conduct a mixed-methods study of 800 FSWs from Tijuana and Ciudad Juarez in consultation with multiple national and state-level systems key informants (SKI) to inform the content, ensure the relevance, and maximize the acceptability and dissemination of our work. As an estimated 70% of FSWs in these cities originate from other Mexican states or Central and South America, these locations offer an unparalleled opportunity within Latin America to study these concerns, as well as to inform the development of much- needed interventions. In-depth interviews will be conducted with 30 FSWs (15 per city) screening positive for sex trafficking (minor or forced/coerced sex work entry). Data will be collected from 800 FSWs (400 per city) identified using venue-based sampling, via self-report survey and biologic HIV/STI testing. Based on interview, survey and laboratory data and SKI consultation, targets will be identified and prioritized for region-specific, structural interventins (i.e., those focused structural factors found to be associated with sex trafficking and HIV risk among trafficked FSWs) to prevent sex trafficking and reduce coincident HIV risk along the US.- Mexico border. Development and piloting of indicated structural interventions will be proposed within a subsequent R34 application.