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

描述：性交易和吸毒的高比率，以及这两者的交集，加剧了与美国接壤的墨西哥最大城市提华纳的艾滋病毒传播。恶劣的社会经济条件是提华纳以及其他地方开展性工作的主要驱动力。上一首 国际和平研究所在南亚的研究表明，经济债务不仅在妇女启动性交易方面意义重大，而且还与FSW中艾滋病毒/性传播感染风险的增加有关。她的工作表明，绝大多数FSW报告了非正式债务类型(80%)，这些债务降低了妇女与客户谈判避孕套的能力，增加了艾滋病毒风险。美墨边境地区的债务性质可能与南亚地区有很大不同。在提华纳，高水平的移民以及广泛的毒品使用可能会对妇女的债务类型产生影响，这些债务可能是增加艾滋病毒风险的最有影响力的债务类型。债务也可能影响女性与毒品有关的艾滋病毒风险。根据与妇女地位委员会在提华纳的初步访谈，妇女地位委员会之间的债务是以服务义务的形式报告的(例如，在其他情况下，更正式地称为债务束缚)，妇女被期望从事性工作，以此来偿还向她们提供金钱、药物或其他需求的人(例如，与移徙、提供住房和食物有关的费用)。我们假设，提华纳的这些非正式类型的债务和义务耗尽了妇女在性工作中的中介机构，降低了与管理者和客户的谈判能力，减少了避孕套的使用，增加了GBV受害者，并减少了吸毒期间的谈判能力。在这方面，需要更多的工作来确定FSW之间的多种债务类型，以及这些债务对艾滋病毒危险行为的影响程度。因此，拟议的研究旨在：1)确定和定义多种类型的债务(包括服务义务)，以及2)检查债务、吸毒、性交易和提华纳妇女艾滋病风险之间的相互关系。为了实现这一点，我们建议在提华纳对400名FSW进行一项混合方法研究。对报告吸毒(n=25)和非吸毒(n=25)的负债妇女进行的生活史访谈将提供与债务、吸毒和性工作参与有关的描述性情景，以及这些对艾滋病毒风险的影响。还将通过自我报告调查和生物艾滋病毒/性传播感染检测，从使用基于场地的采样确定的400个FSW收集定量数据。这些发现将为纵向研究提供指导，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-以及这些因素对FSW中艾滋病毒风险的贡献。调查结果对于提供关于减少债务战略的初步方向(例如，减少货币债务以及改变促进债务的社会结构)也将至关重要，以减少该区域妇女中的艾滋病毒风险。鉴于越来越多的数据表明，在全球妇女高危人群中促进经济福祉是一项有效的艾滋病毒预防战略，这种调查尤其重要。

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.