Sex work is regulated in Tijuana, Mexico, but only half of the city's female sex workers FSWs are registered with the municipal health department, which requires regular screening for sexually transmitted infections STIs and human immunodeficiency virus HIV. We examined correlates of registration to determine if it confers measurable health benefits. Logistic regression identified factors associated with registration. Current regulation of FSWs in Tijuana should be further examined to enhance the potential public health benefits of registration.
Governments in many countries have regulated sex work as a public health measure, and traditionally such regulation has focused on increasing condom use or STI diagnosis and treatment. Other models of legalization and registration of sex workers exist. In Mexico, commercial sex is culturally accepted. The latter type of state, which includes the Mexico-U. Due to Tijuana's proximity to San Diego, the city's zona roja is a destination for sex tourism. At the time of this study, approximately half of the city's 5, sex workers were registered with the MHD, 29 enabling them to work legally in the zona roja.
Enforcement of registration is difficult; anecdotal reports indicate that some bars and dance halls require women to be registered to work on their premises and, to evade such requirements, many women work on street corners, where they are often harassed by police. No systematic evaluation of the sex-work registration system in Tijuana has been conducted. Due to the financial burden registration poses, we also predicted that poorer women would be less likely to be registered. To understand the role of government registration and health screening as public health measures, we compared the characteristics and health outcomes of registered vs.
These will help inform systems of sex-work regulation to effectively operate as public health programs. Tijuana, in the state of Baja California, Mexico, is situated on the U. From toFSWs in Tijuana and Ciudad Juarez were enrolled in a behavioral intervention study to increase condom use, as ly described.
FSWs were recruited by outreach workers and at community health clinics. Spanish-speaking counselors conducted baseline interviews. Trained study nurses obtained venous blood samples and cervical swabs.
Interview questions covered demographics, socioeconomic factors, working conditions, cost per sex act with and without condoms, and sexual and drug-related behaviors. Statistical analysis compared FSWs who reported being registered with the MHD to those who were not, using Wilcoxon's rank sum for continuous variables and Fisher's exact test for dichotomous variables. Table 1 shows the baseline demographic, socioeconomic, and working conditions of the FSWs.
Dichotomous outcomes were examined using Fisher's exact test. Continuous outcomes were examined using Wilcoxon's rank sum test for differences in group distributions. Certain percentages may reflect denominators smaller than the n -value given in the column head; these discrepancies are due to missing data.
Age did not differ ificantly between the groups. There were no statistically ificant differences between registered and unregistered FSWs in terms of their working at brothels, hotels, or shooting galleries a deated place where drugs are purchased and used.
The median of unprotected vaginal sex acts in the last month was five IQR: 2— Interestingly, compared with unregistered FSWs, registered FSWs had lower risk profiles for both sexual and drug-related behaviors, and fewer sex partners in the last month median: 70 vs. Certain percentages may reflect denominators smaller than the n -value given in the column head.
These discrepancies are due to missing data. Factors associated with FSW registration identified in univariate and multivariate regression models are shown in Table 3.
In univariate analyses, factors associated with increased odds of registration included having a greater of people living with one, living and working in the same location, earning more money for sexual transactions with a condom, and ever having been tested for HIV. Factors inversely associated with registration included having migrated to Baja California; working on the street; having clients who inject drugs; ever having injected drugs; injecting cocaine; non-injection use of methamphetamine; and testing positive for HIV, syphilis, gonorrhea, or any STI including HIV.
Variables not associated with registration were age, lifetime duration Back Escorts Vega Alta PR sex work, and the percent of unprotected sex acts with clients. In multivariate analyses, four factors were found to be independently associated with elevated odds of registration. To eliminate the effects of collinearity, we repeated the model, removing the variable for HIV testing, and the remaining variables and their corresponding parameter estimates were essentially unchanged.
In examining the system for regulating FSWs in Tijuana, we found that registration with the MHD was associated with higher odds of HIV testing, as one would expect, but registration was not associated with lower risk of testing positive for HIV or STIs, after adjusting for other confounders associated with registration.
We identified two patterns related to sex-worker registration that have implications for HIV and STI prevention and policies. First, registered FSWs tended to work in venue-based establishments, lived and worked in the same location, and earned more money per transaction. Conversely, women who worked primarily on the street were less likely to be registered, as were Back Escorts Vega Alta PR who injected drugs and those who used stimulants i.
This may imply that FSWs, or the establishments for which they work, are finding a way to buy a registration card and bypass the regulation system, or the FSWs may be unaware that they have been tested.
Earlier studies in the Philippines have also showed that STI screening and treatment, in the absence of other prevention -strategies, are not effective for long-term control of STIs or HIV in sex workers. As in studies, sex-work venue was an important correlate of registration, with street-based sex workers being less likely to be registered. First, street-based sex workers often have higher risk profiles, and they may have decreased access to condoms and fewer contacts with screening and treatment services for HIV and STIs.
The current registration system may be excluding sex workers who operate outside of a specific venue, and thus the MHD may not be reaching women at highest risk for HIV and STIs. Since our study was conducted, a mobile HIV-prevention campaign has been initiated in Tijuana, representing a partnership between a local nongovernmental organization and the municipal, state, and federal governments. A novel finding in our study was the relationship between income and registration.
Registered sex workers earned more money per sex act compared with unregistered FSWs. This finding has ificance for the goal of addressing social determinants of health among sex workers.
Poverty, income inequality, and decreased social capital have been linked to women's decisions to engage in risky transactional sex. Lastly, migration status was an important correlate of registration. Unregistered women were more likely to have been born in Baja California. In a study evaluating injection drug users who had recently been deported or who had migrated to Tijuana, the odds of HIV infection among females increased with time spent in Tijuana, but the trend was opposite among males. Several limitations with our study should be noted.
First, the study's cross-sectional nature does not allow us to draw causal inferences. Second, because the population was recruited via convenience sampling and the eligibility criteria for the subsequent intervention study required that women have had recent unprotected sex with clients, our sample likely had a higher risk profile than the general FSW population in Tijuana or other border cities.
Our study included FSWs from Tijuana only and may not be generalizable to other cities, although the most common Mexican FSW workplace venues were represented.
Although participants were asked if they were registered with the MHD, we were unable to confirm if women who were registered actually sought services from the department. There is potentially a reporting bias toward registration, Back Escorts Vega Alta PR the women feared penalties in being unregistered; however, we found little evidence of reporting bias in other sensitive areas, with many women reporting unprotected vaginal sex with clients and drug use. Finally, our study did not elicit details on cost of the registration card.
Future studies will address how the cost of the registration card may affect which women are registered, if the increase in cost has deterred registration, and if anyone other than the sex worker herself is paying for the card. Systems for regulating sex work constitute an important public health measure in settings where HIV and other STIs are rising, as they are in Tijuana.
Our study suggests that the current system of registration of FSWs in Tijuana focuses on screening and treatment of HIV and STIs and may be structured in such a way that it excludes the highest risk subgroups, especially FSWs who are street-based and those who inject drugs or use stimulants. Consideration should also be given to models incorporating incentivized or enforced condom use, which has been found to be successful in other settings. The authors also give special thanks to the participants for their time and cooperation.
Patterson and T32 DA S. National Center for Biotechnology InformationU.
Journal List Public Health Rep v. Public Health Rep. PattersonPhD e, f. Steffanie A. Thomas L. Author information Copyright and information Disclaimer. Address correspondence to: Thomas L. This article has been cited by other articles in PMC. Data collection Spanish-speaking counselors conducted baseline interviews.
Statistical analyses Statistical analysis compared FSWs who reported being registered with the MHD to those who were not, using Wilcoxon's rank sum for continuous variables and Fisher's exact test for dichotomous variables. Demographic and socioeconomic factors Table 1 shows the baseline demographic, socioeconomic, and working conditions of the FSWs. Table 1. Open in a separate window. Table 2. Factors independently associated with FSW registration Factors associated with FSW registration identified in univariate and multivariate regression models are shown in Table 3.
Table 3. For dating in Norwalk USA These will help inform systems of sex-work regulation to effectively operate as public health programs. Singles groups in Norwalk Age did not differ ificantly between the groups.
Communities in Norfolk County, Ontario Our study suggests that the current system of registration of FSWs in Tijuana focuses on screening and treatment of HIV and STIs and may be structured in such a way that it excludes the highest risk subgroups, especially FSWs who are street-based and those who inject drugs or use stimulants. Limitations Several limitations with our study should be noted. Steen R, Dallabetta G.