UC San Diego

Background: Sex trafficking is a human rights abuse that carries particularly negative health and social consequences, including HIV and sexually transmitted infections (STIs). While HIV/STI infection and sex trafficking have been linked in Asia, the context of these associations and their applicability in Mexico is poorly understood.

Aims: Aims of this dissertation were to (1) Critically review evidence linking mobility, trafficking, and HIV vulnerability in Mexico and Central America; (2) Explore associations between features of the risk environment, sex work and drug use history, and underage sex work among female sex workers (FSWs) in Tijuana and Cd. Juarez, Mexico; and (3) Describe and "unpack" sex trafficking and its relationship to HIV/STI vulnerability among formerly trafficked FSWs in Tijuana.

Methods: This study employed qualitative and quantitative methods to investigate sex trafficking, mobility and HIV vulnerability. In Chapter 2, a critical review of the epidemiology and context of HIV vulnerability among mobile populations in Central America and Mexico was conducted. Chapter 3 draws upon questionnaires and HIV/STI testing among FSWs (n=624) in Tijuana and Cd. Juarez. In Chapter 4, in-depth interviews were conducted with formerly trafficked FSWs in Tijuana (n=31).

Results: Chapter 2 found that among mobile groups in Central America and Mexico, social isolation, socio-economic impacts of displacement, gender inequalities, and stigma/discrimination strongly shape HIV/STI risk. In Chapter 3, underage sex work entry was positively associated with inhalants as the first drug used, forced first injection, number of drug treatment attempts, and recent receptive syringe-sharing. Number of recent condom negotiation attempts with steady partners and depression as a reason for first injecting were negatively associated with underage entry into sex work. In Chapter 4, sex trafficking was linked to elevated HIV/STI vulnerability through gender-based violence, economic vulnerability, migration, and stigma.

Conclusions: These findings contribute to a foundation of knowledge to advocate for strategies to reduce sex trafficking and HIV. Multi-level, intersectoral interventions to prevent sex trafficking and HIV infection are needed for vulnerable youths, migrants, and FSWs in Mexico-U.S. border cities; recommended components include strengthening the response to gender-based violence, peer-delivered prevention, and the provision of shelter, food, job placements, and psychological support.