title: Individual, interpersonal, and social-structural correlates of involuntary sex exchange among female sex workers in two Mexico-U.S. border cities.
abstract: 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.
authors.affiliation: *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.
authors.forename: Shira M
authors.initials: SM
authors.lastname: Goldenberg
authors.forename: Gudelia
authors.initials: G
authors.lastname: Rangel
authors.forename: Hugo
authors.initials: H
authors.lastname: Staines
authors.forename: Alicia
authors.initials: A
authors.lastname: Vera
authors.forename: Remedios
authors.initials: R
authors.lastname: Lozada
authors.forename: Lucie
authors.initials: L
authors.lastname: Nguyen
authors.forename: Jay G
authors.initials: JG
authors.lastname: Silverman
authors.forename: Steffanie A
authors.initials: SA
authors.lastname: Strathdee
mesh_terms: D000328:Adult; D000367:Age Factors; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D008800:Mexico / Q000453:epidemiology; D060386:Sex Workers; D012725:Sexual Behavior / Q000706:statistics & numerical data*; D012749:Sexually Transmitted Diseases / Q000453:epidemiology; D019966:Substance-Related Disorders / Q000150:complications*; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology