title: Prevalence and Correlates of Client-Perpetrated Violence against Female Sex Workers in 13 Mexican Cities.
abstract: BACKGROUND
  Globally, client-perpetrated violence against female sex workers (FSWs) has been associated with multiple health-related harms, including high-risk sexual behavior and increased exposure to HIV/STIs. This study examined correlates of client-perpetrated sexual, physical, and economic violence (e.g., robbery) against FSWs in 13 cities throughout Mexico.
  
  
  METHODS
  FSWs (N = 1,089) who were enrolled in a brief, evidence-based, sexual risk reduction intervention for FSWs (Mujer Segura) were interviewed about their work context, including experiences of violence perpetrated by clients, sexual risk and substance use practices, financial need, and social supports. Three broad categories of factors (sociodemographic, work context, behavioral and social characteristics of FSWs) were examined as correlates of sexual, physical, and economic violence.
  
  
  RESULTS
  The prevalence of different types of client-perpetrated violence against FSWs in the past 6 months was: sexual (11.7%), physical (11.8%), economic (16.9%), and any violence (22.6%). Greater financial need, self-identification as a street worker, and lower perceived emotional support were independently associated with all three types of violence. Alcohol use before or during sex with clients in the past month was associated with physical and sexual violence. Using drugs before or during sex with clients, injection drug use in the past month, and population size of city were associated with sexual violence only, and FSWs' alcohol use score (AUDIT-C) was associated with economic violence only.
  
  
  CONCLUSIONS
  Correlates of client-perpetrated violence encompassed sociodemographic, work context, and behavioral and social factors, suggesting that approaches to violence prevention for FSWs must be multi-dimensional. Prevention could involve teaching FSWs strategies for risk avoidance in the workplace (e.g., avoiding use of alcohol with clients), enhancement of FSWs' community-based supports, development of interventions that deliver an anti-violence curriculum to clients, and programs to address FSWs' financial need by increasing their economic opportunities outside of the sex trade.
authors.affiliation: Department of Psychiatry, University of California San Diego, La Jolla, California, 92093-0680, United States of America.
authors.forename: Shirley J
authors.initials: SJ
authors.lastname: Semple
authors.affiliation: Department of Psychiatry, University of California San Diego, La Jolla, California, 92093-0680, United States of America.
authors.forename: Jamila K
authors.initials: JK
authors.lastname: Stockman
authors.affiliation: Division of Global Public Health, Department of Medicine, University of California San Diego, La Jolla, California, 92093-0507, United States of America.
authors.forename: Eileen V
authors.initials: EV
authors.lastname: Pitpitan
authors.affiliation: Division of Global Public Health, Department of Medicine, University of California San Diego, La Jolla, California, 92093-0507, United States of America.
authors.forename: Steffanie A
authors.initials: SA
authors.lastname: Strathdee
authors.affiliation: Department of Psychiatry, University of California San Diego, La Jolla, California, 92093-0680, United States of America.
authors.forename: Claudia V
authors.initials: CV
authors.lastname: Chavarin
authors.affiliation: Evaluation and Research Department, Mexican Foundation for Family Planning (Mexfam), Distrito Federal, 14000, Mexico.
authors.forename: Doroteo V
authors.initials: DV
authors.lastname: Mendoza
authors.affiliation: Department of Psychiatry, University of California San Diego, La Jolla, California, 92093-0680, United States of America.
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Aarons
authors.affiliation: Department of Psychiatry, University of California San Diego, La Jolla, California, 92093-0680, United States of America.
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Patterson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002947:Cities; D003376:Counseling; D003625:Data Collection; D005260:Female; D006801:Humans; D008800:Mexico / Q000453:epidemiology; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D040242:Risk Reduction Behavior; D012742:Sex Offenses / Q000517:prevention & control / Q000706:statistics & numerical data*; D011477:Sex Work / Q000706:statistics & numerical data*; D060386:Sex Workers / Q000523:psychology* / Q000706:statistics & numerical data*; D012725:Sexual Behavior; D012749:Sexually Transmitted Diseases / Q000453:epidemiology; D014754:Violence / Q000517:prevention & control / Q000706:statistics & numerical data*; D055815:Young Adult