1 Sex Work, High-Risk Sexual Behavior and Violence on the U.S. – Mexico Border Avelardo Valdez, Ph.D. Alice Cepeda, M.S. Office for Drug and Social Policy Research Graduate School of Social Work

2 Sponsored by the National Institutes of Health, National Institute on Drug Abuse (NIDA). (R24 DA 07234)

3 OTHER SUPPORT & ACKNOWLEDGEMENT Nuevo Laredo Servicios de Salud de Tamaulipas, Departmento de Investigacio Dr. Carlos Castro Medina Jefe de Jurisdicion Sanitaria No. V Dr. Ruben Jesus Roman Castillo Clinica y Hospital de Especialidades Nuevo Laredo, Tamaulipas Manlio Benavides Project Hope, Laredo Texas Alberto H. Colorado South Texas Council on Alcohol and Drug Abuse Ciudad Juarez Programa Companeros, AC Maria Elena Ramos Rodriguez Rebecca Ramos Apolonia Hernandez Salud de Estado de Chihuahua Jefe de la Jurisdiccion, Sanitaria No. 2 Jose Antonio Flores Barrientos

4 AIM OF RESEARCH The aim of the study was to explore the nature and extent of injecting drug use and high-risk sexual behavior and obtain an estimate of the total size of the sex worker population in Ciudad Juarez, Chihuahua. The data gathered here is vital to the development of appropriate and effective public health interventions to reduce the risk of transmissions of HIV, HCV and other sexually transmitted diseases among sex workers and their clients.

5 PROBLEM The intersection between high-risk sexual and injecting drug use networks on the U.S./Mexico border is thought to present a serious risk to the spread of HIV/AIDS, HBV, HCV and other infections in both the U.S. and Mexico. This study attempts to more clearly assess this relationship and its public health implications. Moreover, the study focuses on estimating the size of the total population of sex workers and clients.

6 U.S. - MEXICO BORDER CONTEXT Intense disparity in economic opportunity and resources Intense disparity in economic opportunity and resources Cities along border are major points of commerce Cities along border are major points of commerce Economic growth has been unequally distributed Economic growth has been unequally distributed Mexican border cities as staging areas for migration Mexican border cities as staging areas for migration Structural and Social Resources Infrastructure unable to support population growth Infrastructure unable to support population growth Three conditions are conducive to illegal commerce, contraband, drug trade, and prostitution Three conditions are conducive to illegal commerce, contraband, drug trade, and prostitution

7 METHODOLOGY This study combined multiple methods to identify and examine the “ hidden population” of sex workers. These methods included social mapping, ethnographic observations, and the administration of a life history interview and Childhood Trauma Questionnaire to 63 and 75 sex workers (male and female) in Nuevo Laredo and Ciudad Juarez, Mexico, respectively.

8 CIDUDAD JUAREZ, CHIHUAHUA Study was conducted in three geographic areas: Zona Centro: Downtown Area Zona la paz: Adjacent to the downtown area Zona Cervercerea: middle - class commercial area Approximately, 835 sex workers were identified in the zonas. (710 = female) (125 = male)

9 NUEVO LAREDO, TAMAULIPAS Study was conducted in two geographic areas: Zona Centro: Downtown Zona Rosa: Working class Neighborhood Approximately 1,308 sex workers were identified in these zonas. (1,046 = female) (262 = male)

10 DEMOGRAPHIC CHARACTERISTICS OF SEX WORKERS IN NUEVO LAREDO AND CIUDAD JUAREZ VariablePercentage Nuevo Laredo Ciudad Juarez (N = 63) (N = 75) Sex Male2915 Female7185 Average Age 2626 Marriage Status Single4137 Common Law 3633 Separated1016 Married77 Divorced77 With Children 4688 Average Number of Children 2.522.3 Average Number of Years in School 7.86.9

11 SEX WORKERS PLACE OF BIRTH AND CITY RAISED VariablePercentage BornRaised Nuevo Laredo Sample Nuevo Laredo 2530 Other City 7570 Ciudad Juarez Sample Ciudad Juarez 4859 Other City 5241

12 WORKING PATTERNS AMONG SEX WORKER SAMPLES VariablePercentage Nuevo Laredo Ciudad Juarez Days Worked in Last Month 2020 Clients in Prior Week 86 Clients in Busiest Night 43 Clients in Slowest Night 11 Engaged in Sex with in Last Year Tourist9165 Truck Drivers 7640 Injecting Drug Users 5128 Casual Sex Partner (not client or primary sex partner 5628

13 FREQUENCY OF NEVER EVER USING CONDOMS WITH CLIENTS AMONG SEX WORKER SAMPLES Variable Percentage Nuevo Laredo Ciudad Juarez Vaginal Sex 2620 Anal Sex 5518 Oral Sex 4748

14 SELECTED CHARACTERISTICS OF DRUG USE

15 FREQUENCY OF DRUG USE AT WORK

16 INJECTING DRUG USE BEHAVIOR VariablePercentage Nuevo Laredo Ciudad Juarez Injected Illegal Drugs 2121 Injected with a syringe after someone else injected with it someone else injected with it or that someone else may have used or that someone else may have used3125 Obtain needle from Pharmacy9294 Friends/Relatives86 Injected legal substance (lifetime) 6152

17 VIOLENT EXPERIENCE DURING SEX WORK VariablePercentage Nuevo Laredo Ciudad Juarez Report of Violent Experience 5268 Average Incidence in Previous 30 Days 31 Clients Were Involved 5351 Other Sex Workers Were Involved 255 Police Were Involved 165 Bar Owners or Employees Were Involved 64

18 VIOLENCE NARRATIVES Un cliente aquí en el bar. Era uno de Laredo, Texas como de 45 años. Andaba muy tomado. Me pidió que me sentara con él y me quería estar manoseando. Yo le dije no, y se enojó. Me quiso morder el busto y yo le pegué con una botella. El “Vela” me lo quitó de encima y lo hecharon para afuera. Casi por lo regular es eso el problema o cuando no quieren pagar la cuenta. Se “arma”. A client here at the bar. He was from Laredo, Texas approximately 45 years old. He was really drunk. He asked me to sit with him and he was touching me. I told him, “no” and he got mad. He tried to bite my breast and I hit him with a bottle. The security guard took him off me and threw him out. Usually, these are the problems I have or else its because they don’t want to pay.

19 Fué con un cliente aquí en el bar. Un drogadícto que viene mucho aquí, “El Chilango le apodan”. Estabamos tomando y drogandonos. Nos fuimos al hotel de la vuelta. “El Guayabitos” (queda una cuadra y media). Se puso bien loco, le revolvió de todo pastas, alcohol, coca, (es bien loco). Me empezó a gritar y a golpear. Quería que yo le diera dinero para comprar mas drogas. Yo ya no traía. (Yo también andaba loqueando.) Me pegó bien fuerte. El señor del hotel le habló a los policías. Casi siempre tengo estos problemas a consecuencia de las drogas. La hago muy seguido. Los hombres con los que me meto también. Este cliente del problema es un hombre de como unos 32 años, muy alto, delgado, moreno. Está tatuado (tiene varios tatuajes en todo el cuerpo). Vive en el parque o en la plaza. Trabaja de patero aquí en el puente o roba. Cada rato está en la carcel. It was with a client at the bar. A drug addict who comes here a lot and who they call “El Chilango”. We were drinking and getting high. We went to the hotel around the corner called “El Guayabitos” (a block and a half away). He got really crazy, he mixed everything, pills, alcohol, coke. He began to yell at me and hitting me. He wanted me to give him money so he could buy more drugs. I didn’t have any (I was also high). He hit me really hard. The hotel owner called the police. I always have these problems because of the drugs. I do them very often. Its also because of the men I am involved with. This client is a man of about 32 years, tall, thin, and dark. He has a tattoo (a couple all over his body). He lives in the park or in the plaza. He works on the bridge selling stuff or else he robs. He is always in jail.

20 Fue un cliente que no queria usar el condon. Parecia que andaba drogado porque se violento mucho. Tuve que pedir ayuda a los encargados de seguridad. El cliente era un hombre de tipo Veracruzano y fue en los cuartos que tienen para ocuparse. It was with a client who did not want to use a condom. It seemed that he was high because he got violent. I had to ask for help from the security guards. The client looked like he was from Veracruz and it happened in the rooms they (bar owners) rent out.

21 Un joven de 21 anos que era cliente. Fue y me saco de la barra. Me llevo a su casa, me encerró y tuvimos relaciones usando una navaja con la que me amenazo sin llegar a lastimarla. Cuando terminamos, el se quedo dormido y pude salir de la casa. Yo no andaba bajo influencia de ninguna droga y el si de heroína. No use protección. A client who was a young man about 21 years old. He took me from the bar. He took me to his house and locked me in and we had sexual relations while he threatened me with a switchblade. He did not hurt me. When we finished, he stayed asleep and I was able to escape. I was not high on any drugs but he was on heroin. I did not use any protection. A client who was a young man about 21 years old. He took me from the bar. He took me to his house and locked me in and we had sexual relations while he threatened me with a switchblade. He did not hurt me. When we finished, he stayed asleep and I was able to escape. I was not high on any drugs but he was on heroin. I did not use any protection.

22 CONCLUSIONS  Dangerous intersection between high-risk sexual and injecting drug use networks associated with the sex work industry in Nuevo Laredo and Ciudad Juarez.  Dangerous intersection between high-risk sexual and injecting drug use networks associated with the sex work industry in Nuevo Laredo and Ciudad Juarez.  Important implications for the spread of HIV/AIDS, HBV, HCV and other infections in both countries.  Important implications for the spread of HIV/AIDS, HBV, HCV and other infections in both countries.  Insufficient attention has been given to the risk of physical violence sex workers are exposed to in the context of their work.  Insufficient attention has been given to the risk of physical violence sex workers are exposed to in the context of their work.  Appropriate and effective public health interventions need to take into consideration the social context of sex work along the Mexican border to reduce the risk of physical violence.  Appropriate and effective public health interventions need to take into consideration the social context of sex work along the Mexican border to reduce the risk of physical violence.