Economic Debt, Drug Use, and HIV Risk among Sex Workers in Tijuana, Mexico

墨西哥蒂华纳性工作者的经济债务、吸毒和艾滋病毒风险

• 批准号: 8926376
• 负责人: Elizabeth Ann Reed
• 金额: $ 15.27万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-15 至 2017-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8926376
• 关键词: AIDS prevention; Address; Affect; Asia; Biological; Child; Cities; Client; Data; Data Collection; Development; Drug abuse; Drug usage; Economic Factors; Economics; Female; Food; Gender; Goals; HIV; HIV risk; HIV/STD; Health; Housing; India; Industry; Influentials; Interview; Investigation; Longitudinal Studies; Measurement; Mediation; Methods; Mexican; Mexico; Nature; Needle Sharing; Needles; Outcome; Parents; Patient Self-Report; Personal Satisfaction; Pharmaceutical Preparations; Police; Population; Prevalence; Prevention program; Prevention strategy; Reporting; Research; Risk; Risk Behaviors; Risk Factors; Safety; Sampling; Secure; Services; Social Change; Source; Structure; Surveys; System; Testing; Unsafe Sex; Victimization; Violence; Woman; Work; Working Women; base; condoms; cost; high risk; life history; male; migration; non-drug; sex; sexual violence; social; socioeconomics

DESCRIPTION: High rates of sex trade and drug use, and the intersection of these, exacerbate the spread of HIV in Tijuana, the largest Mexican city bordering the US. Poor socioeconomic conditions are the primary driver of sex work initiation in Tijuana, as well as elsewhere. Previous research by the PI in South Asia has established that economic debt is not only significant in terms of women's initiating sex trade, but is also associated with elevated HIV/STI risk among FSW. Her work indicated that the vast majority of FSW reported informal types of debt (80%) and that this debt reduced women's condom negotiating power with clients, increasing HIV risk. The nature of debt in the US-Mexico border region likely differs significantly from that of South Asia. In Tijuana, high levels of migration as well as widespread drug use likely have an influence on the types of debts women have that may be most influential in increasing HIV risk. Debt may affect women's drug-related HIV risk as well. Based on preliminary interviews with FSW in Tijuana, debts among FSW have been reported in the form of service obligation (e.g. referred to more formally as debt-bondage in other contexts), where women are expected to work in sex work as a way to repay someone who has provided them with money, drugs, or other needs (e.g. costs associated with migration, provision of housing and food). We hypothesize that these informal types of debts and obligation in Tijuana deplete women's agency in sex work, decreasing negotiating power with managers and clients, reducing condom use, increasing GBV victimization and reducing negotiating power during drug use. More work is needed to define the multiple types of debts among FSW in this context and the extent to which these influence HIV risk behaviors. Thus, the proposed study aims: 1) to identify and define the multiple types of debt (including service obligations), and 2) to examine the interrelations between debt, drug use, sex trade, and HIV risk among FSW in Tijuana. To accomplish this, we propose to conduct a mixed-methods study of 400 FSW in Tijuana. Life history interviews with FSW in debt who report drug use (n=25) and non-drug use (n=25) will provide descriptive scenarios related to debt, drug use, and sex work involvement, as well as the implications of these on HIV risk. Quantitative data will also be collected from 400 FSW identified using venue-based sampling, via self-report survey and biologic HIV/STI testing. Findings will inform longitudinal studies to better understand the temporal and interrelated dynamics of debt, drug use, and sex work - and contribution of these to HIV risk among FSW. Findings will also be critical to provide initial direction on debt reduction strategies (e.g. reducing monetary debt as well as to change the social structures that promote debts) to reduce HIV risk among FSW in this region. Such investigation is especially important, given increasing data indicating that promoting economic well-being is an effective HIV prevention strategy among high-risk populations of women globally.

描述：性贸易和吸毒的高率，以及这些交汇处，加剧了艾滋病毒在蒂华纳（Tijuana）的传播，蒂华纳（Tijuana）是与美国接壤的最大墨西哥城市。社会经济状况差是蒂华纳和其他地方的性工作启动的主要驱动力。以前的 PI在南亚的研究确定，经济债务不仅在妇女开始性贸易方面具有重要意义，而且还与FSW中的HIV/STI风险升高有关。她的工作表明，大多数FSW报告了非正式债务类型（80％），而这一债务减少了妇女的避孕套与客户谈判权力，从而增加了艾滋病毒的风险。美墨边境地区债务的性质可能与南亚有很大不同。在蒂华纳（Tijuana），高水平的移民以及广泛的毒品使用可能会影响妇女所拥有的债务类型，这些债务可能对增加艾滋病毒风险最大。债务也可能影响妇女与毒品有关的艾滋病毒风险。根据对蒂华纳（Tijuana）的FSW进行初步访谈，已经以服务义务的形式报告了FSW之间的债务（例如，在其他情况下，更正式地称为债务 - 债务），在其他情况下，妇女有望在性工作中工作，作为一种偿还提供金钱，毒品或其他需求的人（例如，其他需求或其他需求的成本）（例如，与迁移，食品和食品相关的成本）。我们假设蒂华纳的这些非正式债务和义务耗尽了性工作中的妇女代理，从而减少了与经理和客户的谈判权力，减少了避孕套的使用，增加了GBV受害者并减少了在吸毒期间的谈判权力。在这种情况下，还需要更多的工作来定义FSW之间多种类型的债务，以及这些影响艾滋病毒风险行为的程度。因此，拟议的研究目的是：1）确定和定义多种类型的债务（包括服务义务），以及2）检查蒂华纳FSW中FSW中债务，毒品使用，性交易和HIV风险之间的相互关系。为此，我们建议在蒂华纳进行400 FSW的混合方法研究。人生历史访谈与报告药物使用（n = 25）和非药物使用（n = 25）的债务访谈将提供与债务，毒品使用和性工作参与有关的描述性情况，以及这些对HIV风险的影响。定量数据还将通过自我报告调查和生物HIV/STI测试来从使用基于场所的采样的400 FSW收集。调查结果将为纵向研究提供信息，以更好地了解债务，吸毒和性工作的时间和相互关联的动态 - 以及这些对FSW中HIV风险的贡献。调查结果对于提供减少债务策略的初始指导（例如减少货币债务以及改变促进债务的社会结构）以降低该地区FSW中的HIV风险。鉴于越来越多的数据表明，促进经济福祉是全球高风险妇女人群中有效的艾滋病毒预防策略，因此这种调查尤其重要。

项目成果

Non-barrier contraceptive use and relation to condom use behaviour by partner type among female sex workers in Andhra Pradesh, India.

印度安得拉邦女性性工作者按伴侣类型划分的无障碍避孕药具使用情况以及与安全套使用行为的关系。

• DOI: 10.1136/jfprhc-2014-100918
• 发表时间: 2017
• 期刊: The journal of family planning and reproductive health care
• 作者: Reed,Elizabeth;Erausquin,JenniferToller;Biradavolu,Monica;Servin,ArgentinaE;Blankenship,KimM
• 通讯作者: Blankenship,KimM

Social Network Clustering of Sexual Violence Experienced by Adolescent Girls.

青春期女孩遭受性暴力的社交网络聚集。

• DOI: 10.1093/aje/kwx154
• 发表时间: 2017
• 期刊: American journal of epidemiology
• 影响因子: 5
• 作者: Shakya,HollyB;Fariss,ChristopherJ;Ojeda,Christopher;Raj,Anita;Reed,Elizabeth
• 通讯作者: Reed,Elizabeth