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

描述(申请人提供)：在整个拉丁美洲，几乎没有经验性交易的数据，联合国将其定义为“强迫、强迫、欺诈性或 欺骗性工作、诱拐或未满18周岁从事此类工作。“最近的媒体报道支持，在美国墨西哥边境地区，贩卖妇女和女孩进行性工作，以及参与这种形式的性剥削的贩毒集团正在增加，构成了一场重大的人权危机。此外，PI之前在南亚和东南亚进行的研究已经证实，通过人口贩运进入性工作会增加艾滋病毒/性传播感染的风险。尽管美国-墨西哥边境地区的性贩运的性质和背景可能与亚洲有很大不同(例如，非法毒品的可能作用)，但我们的两国研究团队的研究发现，与性工作者贩运有关的因素(例如，年轻、暴力)往往与提华纳和华雷斯艾滋病毒风险增加、非法药物使用和强制注射毒品使用有关，这表明性贩运可能会增加该地区对艾滋病毒的易感性。为了防止性贩运和减少被贩运的妇女和女孩感染艾滋病毒的风险，需要a)关于性贩运是如何发生的以及哪些结构为这种犯罪提供便利的数据，以及b)受害者一旦被贩运是否以及如何容易感染艾滋病毒。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(提华纳和华雷斯)的性贩运的性质，包括可能影响贩运受害者的性贩运和艾滋病毒风险的主要结构性因素(例如，与贩毒集团活动、警察暴力、北迁、获得保健服务有关的因素)。为此，我们建议对提华纳和华雷斯的800名FSWs进行混合方法研究，与多个国家和州一级的关键信息系统(SKI)协商，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70%的FSWs来自墨西哥其他州或中南美洲，这些地点提供了拉丁美洲无与伦比的机会来研究这些关切，并为制定急需的干预措施提供信息。将对30名性服务工作者(每个城市15名)进行深入访谈，筛查性交易呈阳性(轻微或强迫/强迫进入性工作)。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名暗娼(每个城市400名)中收集数据，采用基于场地的抽样。根据访谈、调查和实验室数据以及滑雪咨询，将确定针对特定地区的结构性干预(即那些被发现与被贩卖的性工作者的性交易和艾滋病毒风险相关的重点结构性因素)的目标并确定优先顺序，以防止性交易，并降低美国-墨西哥边境沿线同时发生的艾滋病毒风险。指定的结构性干预措施的开发和试点将在随后的R34应用中提出。 公共卫生相关性：拟议的研究旨在描述美国-墨西哥两个主要边境城市(提华纳和华雷斯)的性贩运的性质，包括可能影响贩运受害者的性贩运和艾滋病毒风险的主要结构性因素(例如，与贩毒集团活动有关的因素)。为此，我们建议对提华纳和华雷斯的800名FSWs进行混合方法研究，与多个国家和州一级的关键信息系统(SKI)协商，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。方法包括：a)对30名暗娼(每个城市15名)进行深入访谈，筛查性交易呈阳性(轻微或强迫/强迫进入性工作)；b)对800名暗娼(每个城市400名)进行调查和艾滋病毒检测；c)确定针对区域的结构性干预目标并确定其优先次序。

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. PUBLIC HEALTH RELEVANCE: The proposed study aims to describe the nature of sex trafficking in two major U.S.-Mexico border cities (Tijuana and Ciudad Juarez) including major structural factors (e.g., those related to drug cartel activities) that may affect both sex trafficing 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. Methods include a) in-depth interviews with 30 FSWs (15 per city) screening positive for sex trafficking (minor or forced/coerced sex work entry); b) survey and HIV testing of 800 FSWs (400 per city) identified via venue-based sampling; and c) identification and prioritization of targets for region-specific, structural interventions.