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Individual, Interpersonal, and Social-Structural Correlates of Involuntary Sex Exchange Among Female Sex Workers in Two Mexico–U.S. Border Cities

Goldenberg, Shira M. PhD*; Rangel, Gudelia PhD; Staines, Hugo MD; Vera, Alicia MPH*; Lozada, Remedios MD§; Nguyen, Lucie MS*; Silverman, Jay G. PhD*; Strathdee, Steffanie A. PhD*

JAIDS Journal of Acquired Immune Deficiency Syndromes: August 15th, 2013 - Volume 63 - Issue 5 - p 639–646
doi: 10.1097/QAI.0b013e318296de71
Epidemiology and Prevention

Background: To investigate individual, interpersonal, and social-structural factors associated with involuntary sex exchange among female sex workers (FSWs) along the Mexico–U.S. border.

Methods: In 2010 to 2011, 214 FSWs from Tijuana (n = 106) and Ciudad Juarez (n = 108) aged ≥ 18 years who reported lifetime use of heroin, cocaine, crack, or methamphetamine, having a stable partner, and having sold/traded sex in the past month completed quantitative surveys and HIV/sexually transmitted infection testing. Logistic regression was used to identify correlates of involuntary sex exchange among FSWs.

Results: Of 214 FSWs, 31 (14.5%) reported involuntary sex exchange These women were younger at sex industry entry [adjusted odds ratio (AOR): 0.84/1-year increase, 95% confidence interval (CI): 0.72 to 0.97] and were significantly more likely to service clients whom they perceived to be HIV/sexually transmitted infection-infected (AOR: 12.41, 95% CI: 3.15 to 48.91). In addition, they were more likely to have clients who used drugs (AOR: 7.88, 95% CI: 1.52 to 41.00), report poor working conditions (AOR: 3.27, 95% CI: 1.03 to 10.31), and report a history of rape (AOR: 4.46, 95% CI: 1.43 to 13.91).

Conclusions: Involuntary sex exchange is disproportionate among FSWs who begin to exchange sex at a younger age, and these women experience elevated risk of violence and HIV/STIs related to their clients’ behaviors and their working conditions. These data suggest the critical need for evidence-based approaches to preventing sexual exploitation of women and girls and to reducing harm among current sex workers. Multilevel interventions for all females who exchange sex and their clients that target interpersonal and social-structural risks (eg, measures to improve safety and reduce exploitation within the workplace) are needed.

*Division of Global Public Health, Department of Medicine University of California, San Diego, CA;

Departamento de Estudios de Poblacion, El Colegio de la Frontera Norte, Tijuana, Mexico;

Faculty of Medicine, Universidad Autonoma de Ciudad Juarez, Ciudad Juarez, Mexico; and

§Pro-COMUSIDA, Tijuana, Mexico.

Correspondence to: Steffanie A. Strathdee, PhD, Division of Global Public Health, University of California, 9500 Gilman Drive—MC 0507, San Diego, CA 92093-0507 (e-mail:

Supported by the National Institutes of Health Grant NIDAR01 DA027772 Dr. Goldenberg is supported by a Fellowship from the Canadian Institutes of Health Research.

Presented at the XIX International AIDS Conference, July 26, 2012, Washington, DC [Citation: Goldenberg S, Rangel G, Staines H, Vera A, Lozada R, Nguyen L, Silverman J, Strathdee SA. Correlates of sex trafficking among female sex workers in two Mexico-U.S. border cities. XIX International AIDS Conference, Washington, DC, July 26, 2012].

The authors have no conflicts of interest to disclose.

Received January 30, 2013

Accepted April 10, 2013

© 2013 by Lippincott Williams & Wilkins