Argentina E. Servin

Vulnerabilities faced by the children of sex workers in two Mexico–US border cities: a retrospective study on sexual violence, substance use and HIV risk

Most studies of female sex workers (FSWs) conducted in the Mexico–US border region have focused on individual HIV risk, centered on sexual behaviors and substance abuse patterns. Little attention has been drawn to the reality that sex workers are often parents whose children potentially face vulnerabilities unique to their family situation. The objective of the present study was to identify the vulnerabilities faced by the children of FSWs in two Mexican–US border cities. From 2008 to 2010, 628 FSW-injection drug users underwent interviewer-administered surveys and HIV/STI testing. Approximately one in five participants (20%) reported having a parent involved in sex work and majority referred it was their mother (88%). Close to one-third of participants (31%) reported first injecting drugs <18 years of age, and 33% reported they began working regularly as a prostitute <18 years of age. First drinking alcohol <18 years old (AOR = 1.87, 95%CI: 1.13–3.08), lifetime cocaine use (AOR = 1.76, 95%CI: 1.09–2.84), ever being forced or coerced into non-consensual sex as a minor (<18 years of age; AOR = 1.54, 95%CI: 1.01–2.35), and injecting drugs with used syringes in the prior month (AOR = 1.63, 95%CI: 1.07–2.49) were the factors associated with having had a parent involved in sex work. These findings begin to lay the groundwork for understanding the potential vulnerabilities faced by the children of sex workers. Understanding these potential needs is necessary for creating relevant, evidence-based interventions focused on supporting these women.

A binational comparison of HIV provider attitudes towards the use of complementary and alternative medicine among HIV-positive Latino patients receiving care in the US-Mexico border region.

Use of complementary and alternative medicine (CAM) is common among Latinos living with HIV in the United States (US)–Mexico border region. Health providers may vary in their approach to communicating acceptance or non acceptance of CAM use, which can undermine patient confidence in disclosing CAM use. Patient–provider communication about CAM is important because certain types of CAM can affect antiretroviral therapy (ART) adherence. We undertook the present binational study to understand US and Mexican provider beliefs, and perceptions surrounding CAM use among Latino patients, and to learn if and how CAM communication occurs. Between July and December 2010, we conducted in-depth, qualitative interviews in Tijuana and San Diego. Analysis procedures drew upon principles of Grounded Theory. The sample was comprised of 19 HIV-health care providers, including 7 women and 12 men. Emerging CAM-related themes were: Providers perceptions, attitudes and knowledge about CAM; CAM types and modalities; and patient–provider CAM communication. Many clinicians were uncomfortable supporting CAM use with their patients. San Diego providers reported more frequent instances of CAM use among Latino patients than Tijuana providers. Providers from both cities reported that patients infrequently disclose CAM use and almost half do not routinely ask patients about CAM practices. Most of the providers acknowledged that they lack information about CAM, and are concerned about the drug interaction as well as the effects of CAM on adherence. Our findings have important implications for understanding provider communication surrounding CAM use in a highly transnational population and context. Because CAM use may undermine ART adherence and is highly prevalent among Latinos, provider communication about CAM is critical to improved health outcomes among HIV-positive Latinos. Considering the significant growth of US Latinos, especially in the US–Mexico border region, assessment of Mexican and US provider training and communication needs surrounding Latino patient CAM use is warranted.

Choosing sides: HIV health care practices among shared populations of HIV-positive Latinos living near the US-Mexico border.

Background: We compared HIV-positive patients receiving care in the border cities of San Diego, United States, with Tijuana, Mexico. Methods: Participants were HIV-positive Latinos (n = 233) receiving antiretroviral therapy (ART) from San Diego–Tijuana clinics (2009-2010). Logistic regression identified correlates of receiving HIV care in San Diego versus Tijuana. Results: Those with their most recent HIV visit in San Diego (59%) were more likely to be older, have at least a high school education, and were less likely to have been deported than those with last visits in Tijuana. Despite reporting better patient–provider relationships and less HIV-related stigma than those with visits in Tijuana, San Diego patients were twice as likely to make unsupervised changes in their ART regimen. Conclusions: We observed poorer relative adherence among HIV-positive Latinos receiving care in San Diego, despite reports of good clinical relationships. Further study is needed to ascertain underlying reasons to avoid ART-related resistance.

Sexual violence and HIV infection associated with adolescent vs adult entry into the sex trade in Mexico

This sampling of sex workers in Mexico investigated entry in the sex trade as an adolescent vs as an adult and risk for human immunodeficiency virus infection and sexual violence. Adolescents migrating from Central America and Mexico to the United States are at risk for being trafficked into the sex industry in Mexico’s northern border cities. Research from other regions indicates that those entering the sex trade as adolescents (vs as adults) are more likely to experience sexual violence and human immunodeficiency virus (HIV) risk during initiation to the sex trade and to become infected with HIV. Language: en

Healthcare provider perspectives on barriers to HIV-care access and utilisation among Latinos living with HIV in the US-Mexico border

Latinos living with HIV residing in the US-Mexico border region frequently seek care on both sides of the border. Given this fact, a border health perspective to understanding barriers to care is imperative to improve patient health outcomes. This qualitative study describes and compares experiences and perceptions of Mexican and US HIV care providers regarding barriers to HIV care access for Latino patients living in the US-Mexico border region. In 2010, we conducted in-depth qualitative interviews with HIV care providers in Tijuana (n = 10) and San Diego (n = 9). We identified important similarities and differences between Mexican and US healthcare provider perspectives on HIV care access and barriers to service utilisation. Similarities included the fact that HIV-positive Latino patients struggle with access to ART medication, mental health illness, substance abuse and HIV-related stigma. Differences included Mexican provider perceptions of medication shortages and US providers feeling that insurance gaps influenced medication access. Differences and similarities have important implications for cross-border efforts to coordinate health services for patients who seek care in both countries.

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

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.

Non-barrier contraceptive use and relation to condom use behaviour by partner type among female sex workers in Andhra Pradesh, India.

Objective The study assessed non-barrier contraceptive use among female sex workers (FSW) in Andhra Pradesh, India and relation to inconsistent condom use among commercial and non-commercial male sexual partners. Methods FSW at least 18 years of age (n=2338) were recruited through respondent-driven sampling for an HIV risk survey. Analysis was restricted to women of childbearing age (n=2197). Crude and adjusted logistic regression models were used to assess non-barrier contraceptive use and relation to inconsistent condom use with husbands or regular male partners (i.e. non-clients), regular clients and occasional clients. Results Non-barrier methods of contraception included contraceptive pills (3.8%) and sterilisation (68.4%). In logistic regression models adjusted for relevant demographics, FSW using contraceptive pills were more likely to report inconsistent condom use with a regular client (past week) [adjusted odds ratio (AOR) 2.2, 95% confidence interval (CI) 1.2–4.0] and with an occasional client (past week) (AOR 2.6, 95% CI 1.6–5.3), as well as accepting more money for sex without a condom (past 30 days) (AOR 2.5, 95% CI 1.5–4.3). No significant associations were found between pill use and inconsistent condom use among womens non-client partners, potentially related to small sample sizes within these subgroups. Reporting sterilisation, which was more common among FSW who were older in age, was not associated with inconsistent condom use with client or non-client sexual partners. Conclusions Findings document potential unmet need for modern, spacing contraceptives (i.e. pill, intrauterine device), but also indicate the importance for family planning services, particularly those promoting modern contraceptive methods to be provided alongside HIV prevention among FSW in Andhra Pradesh, India.

Childhood Experiences of Sexual Violence, Pregnancy, and Marriage Associated With Child Sex Trafficking Among Female Sex Workers in Two US–Mexico Border Cities

Objectives To quantitatively assess the relationships of childhood experiences of marriage, pregnancy, and sexual violence with underage sex trafficking. Methods Cross-sectional survey data from a population-based sample of 603 female sex workers from Tijuana and Ciudad Juárez, Mexico, were collected in 2013 and 2014, and we analyzed the data to evaluate relationships between pregnancy, marriage, and sexual violence when younger than 16 years, and child sex trafficking. Results Adjusted odds of child sex trafficking among those who experienced pregnancy, marriage, and childhood sexual violence when younger than 16 years in combined models were 2.8 (95% confidence interval [CI] = 1.8, 4.3), 1.7 (95% CI = 0.99, 2.8), and 1.7 (95% CI = 1.01, 3.0), respectively, relative to others (n = 603). For 89.8%, 78.0%, and 97.0% of those who had an experience of pregnancy (n = 69), marriage (n = 50), or sexual violence (n = 33) when younger than 16 years, respectively, the experience occurred before or the same year as sex trafficking. Conclusions These results provide empirical evidence of modifiable risk factors for child sex trafficking that could be integrated into the prevention efforts and protocols of health clinics and governmental agencies in Mexico currently working to reduce underage pregnancy, marriage, and sexual violence.