Epidemiology of Sex Trafficking, Drug Use and HIV at the U.S.-Mexico Border

PI: Jay Silverman, PhD

Across Latin America, virtually no empirical data exist on the subject of sex trafficking, defined by the United Nations as “forced, coerced, fraudulent or deceitful entry in to sex work, entry by abduction, or entry into such work under age 18”. According to recent reports, trafficking of women and girls into sex work, and drug cartel involvement in this form of sexual exploitation, is on the rise in the U.S. Mexico border region, constituting a major human rights crisis. Further, previous research by the PI in South and Southeast Asia has established that entry into sex work via trafficking confers elevated HIV/STI risk. Although the nature and context of sex trafficking in the US-Mexico border region likely differ significantly from that of Asia (e.g., the likely role of illicit drugs), research of our bi-national research team has found that factors often associated with trafficking among FSWs (e.g., young age, violence) relate to increased HIV risk, illicit drug use and forced injection drug use in Tijuana and Ciudad Juarez, suggesting that sex trafficking may be promoting vulnerability to HIV in this region. To both prevent sex trafficking and reduce risk for HIV among women and girls who have been trafficked, data is required a) on how sex trafficking is occurring and what structures facilitate this crime, and b) on whether and how victims, once trafficked, are made vulnerable to HIV. Despite the clear and urgent need in the region, no study of these issues has been conducted to date. The proposed study aims to describe the nature of sex trafficking in two major border cities (Tijuana and Ciudad Juarez) including major structural factors (e.g., those related to drug cartel activities, police violence, northward migration, access to health services) that may affect both sex trafficking and HIV risk among trafficking victims. As an estimated 70% of FSWs in these cities originate from other Mexican states or Central and South America, these locations offer an unparalleled opportunity within Latin America to study these concerns, as well as to inform the development of much-needed interventions. To accomplish this, we propose to conduct a mixed-methods study of 800 FSWs from Tijuana and Ciudad Juarez in consultation with multiple national and state-level systems key informants (SKI) to inform the content, ensure the relevance, and maximize the acceptability and dissemination of our work. Specific Aims of this study are:

  1. To describe the nature of sex trafficking and how major structures (police violence and corruption, activities of drug cartels, northward migration, health services access) affect vulnerability to sex trafficking and HIV risk.
  2. To assess differences between trafficked and non-trafficked FSWs in this region regarding drug use, HIV infection and sexual and drug use-related HIV risk in the first 30 days after entering sex work and the past 30 days, as well as experiences of, or exposure to, structural risk factors (e.g., police violence, drug cartel activities, northward migration, lack of health service access) both prior to and after entry to sex work.
  3. Based on findings from Aims 1 and 2 and consultation with SKI, to identify and prioritize targets for region specific, structural interventions (i.e., those focused structural factors found to be associated with sex trafficking and HIV risk among trafficked FSWs) to prevent sex trafficking and reduce sexual and drug related HIV risk among trafficked FSWs (to be developed and tested via a subsequent R34 application).

To facilitate these aims, the proposed study will be paired with a new 5-year R01 of FSWs in these same cities (R01 DA028692, PI: Brouwer); economies of scale regarding research infrastructure, personnel, and data collection will result in major reductions in direct costs and benefits to both studies in content and statistical power. To address Aim 1, in-depth interviews will be conducted with 30 FSWs (15 per city) age 18 and older and screening positive for sex trafficking (minor or forced/coerced sex work entry). Aims 2-3 will be addressed via surveys of 800 FSWs (400 per city) using venue-based sampling and biologic HIV/STI testing. Consultation with SKI will inform design and interpretation of all phases, particularly regarding prioritization of targets for structural interventions to prevent sex trafficking and reduce coincident HIV risk along the US.-Mexico border.