Monica D. Ulibarri

History of abuse and psychological distress symptoms among female sex workers in two Mexico-U.S. border cities.

This study examined histories of past emotional, physical, and sexual abuse as correlates of current psychological distress using data from 916 female sex workers (FSWs) who were enrolled in a safer-sex behavioral intervention in Tijuana and Ciudad (Cd.) Juarez, Mexico. We hypothesized that histories of abuse would be associated with higher symptom levels of depression and somatization and that social support would moderate the relationship. Nonparametric correlations and a series of hierarchical regression analyses revealed that all forms of past abuse predicted higher levels of depressive symptoms, and physical and sexual abuse were significantly associated with higher levels of somatic symptoms. Social support was also significantly associated with fewer symptoms of distress; however, it was not shown to moderate the relationship between abuse history and distress.

Condom use among female sex workers and their non-commercial partners: effects of a sexual risk intervention in two Mexican cities.

The purpose of this study was to examine whether a brief behavioural intervention promoting condom use among female sex workers (FSWs) and their clients had the added benefit of increasing condom use among FSWs and their steady, non-commercial partners (e.g. husbands, boyfriends). Participants were 362 FSWs, aged ≥18 years, living in Tijuana or Ciudad Juarez, Mexico, who received a behavioural intervention to promote condom use with clients. Repeated-measures negative binomial regression was used to assess FSWs’ condom use with steady partners versus clients across time. Results showed that FSWs engaged in unprotected sex with steady partners more than with their clients, and that the intervention changed FSWs’ condom use with clients but not their steady partners. HIV-prevention interventions for FSWs should promote consistent condom use across partner type. Targeting couples rather than individuals may also be necessary.

“Amar te Duele” (“Love Hurts”): Sexual Relationship Power, Intimate Partner Violence, Depression Symptoms and HIV Risk Among Female Sex Workers Who Use Drugs and Their Non-commercial, Steady Partners in Mexico

A significant body of research among female sex workers (FSWs) has focused on individual-level HIV risk factors. Comparatively little is known about their non-commercial, steady partners who may heavily influence their behavior and HIV risk. This cross-sectional study of 214 FSWs who use drugs and their male steady partners aged ≥18 in two Mexico-U.S. border cities utilized a path-analytic model for dyadic data based upon the Actor-Partner Interdependence Model to examine relationships between sexual relationship power, intimate partner violence (IPV), depression symptoms, and unprotected sex. FSWs’ relationship power, IPV perpetration and victimization were significantly associated with unprotected sex within the relationship. Male partners’ depression symptoms were significantly associated with unprotected sex within the relationship. Future HIV prevention interventions for FSWs and their male partners should address issues of sexual relationship power, IPV, and mental health both individually and in the context of their relationship.ResumenUna cantidad significativa de investigación con mujeres trabajadoras sexuales (MTS) se ha enfocado en factores de riesgo de VIH a nivel individual. A manera comparativa, muy poco se conoce sobre sus parejas estables, no comerciales quienes pueden influenciar considerablemente su comportamiento y riesgo de VIH. Este estudio transversal de 214 MTS y sus parejas masculinas estables mayores de 18 años en dos ciudades fronterizas de México-EUA empleó un modelo de cadenas causales analítico para datos duales basados en el Modelo de Interdependencia Actor-Pareja para examinar relaciones entre poder de relación sexual, violencia intima de la pareja (VIP), depresión y sexo sin protección. La relación de poder y consumación de VIP en las MTS estaban significativamente asociadas con el sexo sin protección en la relación. Los síntomas de depresión de las parejas masculinas estaban significativamente asociados con relaciones sexuales sin protección en la pareja. Las intervenciones futuras de prevención de VIH para MTS y sus parejas masculinas deberían abordar aspectos tales como poder en la relación sexual, VIP, y salud mental tanto a nivel individual como en el contexto de su relación

Sexual Relationship Power as a Mediator Between Dating Violence and Sexually Transmitted Infections Among College Women

This study examined relationship power as a possible mediator of the relationship between dating violence and sexually transmitted infections (STIs). The proposed mediation model was based on the theory of gender and power as well as previous research on intimate partner violence and STI risk. Survey results from a sample of 290 single, undergraduate women indicated that 85% experienced at least one form of dating violence victimization in the past year, 5.9% tested positive for an STI, and 5.2% received treatment for an STI. Results revealed that women with lower levels of sexual relationship power had higher rates of dating violence victimization and STIs; also, sexual relationship power partially mediated the relationship between dating violence victimization and STIs. Future dating violence and STI-prevention interventions targeting young women may want to use an empowerment approach to decrease their likelihood of dating violence victimization and STI risk.

Prevalence and characteristics of abuse experiences and depression symptoms among injection drug-using female sex workers in Mexico

This mixed methods study examined the prevalence and characteristics of physical and sexual abuse and depression symptoms among 624 injection drug-using female sex workers (FSW-IDUs) in Tijuana and Ciudad Juarez, Mexico; a subset of 47 from Tijuana also underwent qualitative interviews. Linear regressions identified correlates of current depression symptoms. In the interviews, FSW-IDUs identified drug use as a method of coping with the trauma they experienced from abuse that occurred before and after age 18 and during the course of sex work. In a multivariate linear regression model, two factors—ever experiencing forced sex and forced sex in the context of sex work—were significantly associated with higher levels of depression symptoms. Our findings suggest the need for integrated mental health and drug abuse services for FSW-IDUs addressing history of trauma as well as for further research on violence revictimization in the context of sex work in Mexico.

Prevalence of Sexually Abusive Experiences in Childhood and Adolescence Among a Community Sample of Latinas: A Descriptive Study

This study examined the prevalence, severity, and circumstances of self-reported sexually coercive and abusive experiences in childhood and adolescence in a community sample of Latina women (N = 204) ages 18 to 34 years. Results from structured phone interviews indicated that 35% of the women reported experiencing some form of sexual abuse, 31% of the reported perpetrators were family members, and 52% were boyfriends, friends, or acquaintances. Of those who reported an abusive experience, 44% had not disclosed the abuse to anyone; for those who did disclose, 74% reported feeling supported. Findings highlight the importance of including peer and dating-partner abuse in the assessment of CSA and the necessity for outreach to Latina women who may have never disclosed their experiences of abuse.

Methamphetamine use, attitudes about condoms, and sexual risk behavior among HIV-positive men who have sex with men.

This study examined attitudes about condoms as a moderator of the relationship between methamphetamine use and sexual risk behavior in a sample of 297 HIV-positive, methamphetamine-using men who have sex with men (MSM). To test for a moderating effect of attitudes towards condoms, an interaction term was included in multiple regression analysis along with age, income, negative condom attitudes, frequency of methamphetamine use, and Beck depression score. A post hoc analysis was conducted to determine the relations between methamphetamine use and unprotected sex for persons with more vs. less negative attitudes toward condoms. These analyses indicated that when individuals had more negative attitudes toward condoms, the relation between methamphetamine frequency and unprotected sex was significant, while among participants with less negative attitudes toward condoms, no significant association was found. Addressing methamphetamine-using MSM’s attitudes about condoms can serve as a form of harm reduction for those who are not yet ready or willing to discontinue methamphetamine use.

Adverse pregnancy outcomes and sexual violence among female sex workers who inject drugs on the United States-Mexico border

This study examines the prevalence of miscarriage/stillbirth among female sex workers who inject drugs (FSW-IDUs) and measures its associations with physical and sexual violence. Baseline data from 582 FSW-IDUs enrolled in an HIV intervention study in Tijuana and Ciudad Juárez, Mexico were used for current analyses. 30% of participants had experienced at least one miscarriage/stillbirth, 51% had experienced sexual violence, and 49% had experienced physical violence. History of miscarriage/stillbirth was associated with sexual violence (adjusted odds ratio [aOR] = 1.7, p = .02) but not physical violence. Additional reproductive risks associated with miscarriage/stillbirth included high numbers of male clients in the previous month (aOR = 1.1 per 30 clients, p = 0.04), history of abortion (aOR = 3.7, p < .001), and higher number of pregnancies (aOR = 1.4 per additional pregnancy, p < .001). Programs and research with this population should integrate reproductive health and consider gender-based violence.

Associations between Mental Health, Substance Use, and Sexual Abuse Experiences among Latinas

This study examined self-reported sexually abusive experiences in childhood and adulthood as correlates of current drug use, alcohol abuse, and depression and posttraumatic stress disorder (PTSD) symptoms. Participants were 204 Latina women 18-34 years old. RESULTS indicated significant relationships between history of sexual abuse (regardless of age of occurrence), depression symptoms, PTSD symptoms, alcohol abuse, and drug use. When examined separately, childhood sexual abuse was associated with symptoms of depression, PTSD, and substance use but not alcohol abuse behaviors. Experiencing sexual abuse in adulthood was associated with symptoms of depression, alcohol abuse behaviors, and substance use but not PTSD symptoms. Structural equation modeling showed that substance use partially mediated the relationship between sexual abuse and mental health outcomes. These findings suggest mental health and substance use services should incorporate treatment for trauma, which may be the root of comorbid mental health and substance use issues. Language: enThis study examined self-reported sexually abusive experiences in childhood and adulthood as correlates of current drug use, alcohol abuse, and depression and posttraumatic stress disorder (PTSD) symptoms. Participants were 204 Latina women 18–34 years old. Results indicated significant relationships between history of sexual abuse (regardless of age of occurrence), depression symptoms, PTSD symptoms, alcohol abuse, and drug use. When examined separately, childhood sexual abuse was associated with symptoms of depression, PTSD, and substance use but not alcohol abuse behaviors. Experiencing sexual abuse in adulthood was associated with symptoms of depression, alcohol abuse behaviors, and substance use but not PTSD symptoms. Structural equation modeling showed that substance use partially mediated the relationship between sexual abuse and mental health outcomes. These findings suggest mental health and substance use services should incorporate treatment for trauma, which may be the root of comorbid mental health and substance use issues.

Prevalence and Correlates of Client-Perpetrated Abuse Among Female Sex Workers in Two Mexico–U.S. Border Cities

History of abuse has been associated with greater HIV risk among women. This study examined client-perpetrated abuse among female sex workers (FSWs) in two Mexico–U.S. border cities where HIV prevalence is rising. Among 924 FSWs, prevalence of client-perpetrated abuse was 31%. In multivariate logistic regression models, intimate partner violence (IPV), psychological distress, and having drug-using clients were associated with experiencing client-perpetrated abuse. FSWs along the Mexico–U.S. border report frequently experiencing abuse from both clients and intimate partners, which may have serious mental health consequences. Our findings suggest the need for screening and gender-based violence prevention services for Mexican FSWs.