Researchers at University of California, San Diego School of Medicine report that more than one in four female sex workers in two Mexican cities on the U.S. border entered the sex trade younger than age 18; one in eight before their 16th birthday. These women were more than three times more likely to become infected with HIV than those who started sex work as adults. They were also three times more likely to be violently coerced to engage in sex with male clients and seven times less likely to use a condom during their first month in the sex trade.
The study is published August 4 in the Journal of the American Medical Association.
"The far higher rates of HIV infection among those women reporting being a minor in the sex trade is likely, at least in part, due to the combination of being violently compelled to have sex with male clients, being exposed to significantly more male sex clients each day and the lack of any condom use during their initiation to the sex industry," said first author Jay Silverman, PhD, director of research for the Center on Gender Equity and Health and professor of medicine in the Division of Global Public Health at UC San Diego School of Medicine.
In the study, 603 female sex workers 18 years and older were recruited from Tijuana and Ciudad Juarez, Mexico between March 2013 and January 2014. The participants took confidential surveys that assessed their age at entry into the sex trade, experiences with violence to force commercial sex, client volume and condom use. Participants also provided blood samples for HIV testing.
Specifically, the researchers found:
- More than 25 percent of participants reported entering the sex trade before age 18 years.
- Nearly 12 percent reported entering under age 16 years.
- Compared with those who entered sex work as adults, participants who started in the sex trade as adolescents were more likely to report experiencing violence to force commercial sex, having more than 10 male clients per day, and no use of condoms with clients during their first 30 days in the sex industry.
- Six percent of participants who reported entering the sex trade as adolescents tested positive for HIV, compared to slightly less than two percent among those starting sex work as adults.
- After consideration of the effects of injection drug use and not using condoms more recently, those entering the sex industry as minors were three times more likely to be infected with HIV than those entering as adults.
"Our study highlights the importance of social and structural factors, especially high levels of violence encountered by adolescents in the sex trade, in understanding vulnerability to HIV," said senior author Kimberly Brouwer, PhD, director of the Prevention Scientific Working Group of the UC San Diego Center for AIDS Research and associate professor of medicine in the UC San Diego School of Medicine Division of Global Public Health.
"Based on these findings, it's clear that we need to do far more to protect adolescents vulnerable to sex trade entry, and to find ways to protect the many young people in the sex industry from the serious abuse that they too often suffer," said study co-author Carlos Magis-Rodriguez, MD, PhD, director of Comprehensive Care at the Mexican National Center for the Prevention and Control of HIV/AIDS (CENSIDA) at the Ministry of Health of Mexico.
Other co-authors of this study include Argentina Servin, Julie Ritter, and Anita Raj, UC San Diego; and Shira M. Goldenberg, University of British Columbia.
This research was funded, in part, by the National Institutes of Health (grants R01DA033194, R01DA028692 and P30A136214).