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Motherhood and Risk for Human Immunodeficiency Virus/Sexually Transmitted Infections Among Female Sex Workers in the Mexico-US Border Region

Servin, Argentina E. MD, MPH*; Reed, Elizabeth ScD; Brouwer, Kimberly C. PhD; Magis-Rodriguez, Carlos MPH, MD, PhD§; Boyce, Sabrina MPH; Strathdee, Steffanie A. PhD*; Silverman, Jay G. PhD

doi: 10.1097/OLQ.0000000000000634
Original Studies

Background: Globally, female sex workers (FSWs) have been identified as a high-risk group for human immunodeficiency virus (HIV) and sexually transmitted infections (STIs). However, as women of reproductive age, FSWs also have children. Few studies have investigated if financial responsibilities associated with motherhood increase women’s vulnerability to HIV and STIs among FSWs.

Methods: From March 2013 to March 2014, 603 FSWs aged ≥18 years were recruited from Tijuana and Ciudad Juarez (Mexico) to participate in a study assessing HIV/STI risk environments.

Results: Findings from logistic regression models indicate that FSWs who reported motherhood were more likely to report (in the past 30 days): a higher client volume (>30 clients) (adjusted odds ratio [AOR], 1.91; 95% confidence interval [CI], 1.27–2.87) and always using alcohol right before or during sex with clients in the past 30 days (AOR, 1.77; 95% CI, 1.19–2.61). In contrast, they were more likely to report consistent condom use for vaginal or anal sex with clients (AOR, 1.68; 95% CI, 1.10–2.55), less likely to report using drugs right before or during sex with clients (AOR, 0.38; 95% CI, 0.26–0.56) and less likely to have tested positive for STIs at baseline (AOR, 0.63; 95% CI, 0.43–0.91).

Conclusions: These results provide a glimpse of the complex relationship between motherhood and women who are sex workers. Understanding the convergence of motherhood and sex work and how this can influence a woman’s decision when engaging in sex work and affect her health is essential to designing effective programs addressing reduce risk for HIV and STIs among FSWs in this region and elsewhere.

Motherhood was associated with both protective and higher risk behaviors for human immunodeficiency virus/sexually transmitted infections risk and infection among female sex workers in 2 Mexico-US border cities.

From the *Division of Global Public Health, Department of Medicine, University of California; †Division of Health Promotion and Behavioral Science, San Diego State University, ‡Division of Epidemiology, Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA.; §National Center for the Prevention and Control of HIV/AIDS, Ministry of Health of Mexico, Mexico; and ¶Center on Gender Equity and Health, Department of Medicine, University of California, San Diego, La Jolla, CA

Conflict of interest and sources of funding: none declared.

Correspondence: Argentina E. Servin, MD, MPH, Division of Global Public Health, Department of Medicine, University of California, San Diego, Centralized Research Services Facility, 9500 Gilman Drive, MC 0507 La Jolla, CA 92093-0507. E-mail:

Received for publication October 10, 2016, and accepted March 30, 2017.

© Copyright 2017 American Sexually Transmitted Diseases Association