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Earlier this year, UCSD researcher Stephanie Strathdee released a study chronicling various characteristics of female sex workers in Tijuana and other border cities.
The results were shocking. Twenty-seven percent of the women Strathdee studied tested positive for at least one sexually transmitted infection; 14 percent almost always use drugs before sex; 73 percent have clients who use drugs. When examining sex workers with U.S. clients, she found the median price per sex act with a condom was $20. The price for a sex act without a condom: $30.
Strathdee and her colleagues’ study was interventionist in nature. The researchers aimed to encourage safe-sex practices, such as wearing condoms and receiving regular tests for STIs. But Strathdee says that more intervention is needed, and it’s needed now.
“What we’re seeing in Tijuana is the edge of an emerging HIV epidemic,” Strathdee says. “And, if we don’t do something about it — not just as individuals, but as a society, as a border community on both sides — then we’re going to be paying the price.”
Strathdee sat down with voiceofsandiego.org to talk about her research.
If there is one message that you want to get across with your study, what would that be?
Well, I think the study shows that female sex workers that are in Tijuana that have American clients have a different risk profile than those who don’t have American clients. And, that was a surprise to us. So, what it shows really is that those who have had sex with American clients are riskier and that there’s some suggestion that Americans may be at risk if they’re under the impression that because they’re in Tijuana and some sex workers have permits to work that they might be free of infectious diseases. And, so, at the very minimum, I hope that people that are trading sex are going to be aware of these risks and will protect themselves. Because, in doing so, they’re going to protect themselves and the sex worker and her family and potentially the community as a result.
Ok, so would you say the message was directed at the people soliciting sex or the sex workers themselves?
Well, both. Because this is a binational study. We have team members that are from the U.S. We have team workers that are from Mexico. But when we release this data to the U.S., the message is mostly intended for people who may be availing themselves of the sex workers trade as opposed to the sex workers themselves. But, we have certainly shared these results in Mexico. And the hope there is that we can strengthen the binational capacity to try to reduce the spread of HIV and STDs. So, we’re working very closely with health officials in the city of Tijuana, the state of Baja California and even at a national level to draw attention to this problem and to try to bolster the efforts to reduce the threat of infection.
What originally compelled you personally to take on a study like this?
Well the study was actually designed to address a completely different question. The money is being allocated from the National Institute of Mental Health to researchers at UCSD and in Baja California to determine whether behavioral intervention to increase condom use will work. And actually we have preliminary data that it does work — and, that’s great news. This particular study was an offshoot of that study. When the National Institute of Health invests in a project like this, they hope that they aren’t just going to see one scientific paper with one message. They’re hoping for many scientific papers with lots of different important messages. So, this study was actually an offshoot from the parent study, which is still ongoing.
I think it is interesting to note that there was an intervention outreach component to this program — and it’s an element that perhaps went a bit unreported or underreported at least. Could you tell me a bit about that?
Sure. And, parallel to this, we don’t see ourselves as just researchers who are going to parachute into a community, take data away and then you know point fingers and blame. That’s not our intention at all. In fact, that would be the exact opposite of what we’re trying to do. Our team here at UCSD actually donated a mobile vehicle — actually, a modified RV — that became the prototype for HIV service delivery; not just in Tijuana but all across Mexico. And now, the Mexican federal government that is responsible for AIDS prevention has modeled these vehicles after ours to be able to go around the streets of Tijuana and other cities delivering condoms and also exchanging needles and providing free HIV tests. So that’s one thing that our team has contributed to.
We’re also advocating — and part of this study is intending to draw attention to the problems so that more resources will be directed toward HIV prevention because sometimes people feel that communities of sex workers or drug workers are disposable or are marginalized people that deserve their fate. Certainly we don’t share in any way their opinion.
The last thing that we’ve done as a team is to help form a new non-profit association called the Preven Casa, which means prevention house, that is set up in these zona rojas, the red light zones of Tijuana, to be able to mobilize these prevention efforts so that we can make it a safe haven for people in the community who really have nowhere else to go. And, going to the Preven Casa, they can get HIV testing, they can get condoms or needles if they need it. And, really we’ve seen a terrific response to that. And, that’s what I’m most proud of.
One of the most alarming things that came out of this study is that for 10 extra dollars, many sex workers would have sex without a condom. Is that an issue of not thinking much about their health or is it an issue of education.
I think that’s an important point, that for just a little bit of extra money, some sex workers in Tijuana would be having sex without condoms. I think what’s important for people in San Diego and in the armchairs of middle America to understand is that some people who are involved in sex work are involved in the trade because they are economically deprived and socially disadvantaged. And the only way that they can make ends meet is to try to sell their body. And, if somebody’s offering them a little bit of extra money for unprotected sex, they may not realize that not only are they compromising their health and possible they health of their lovers or children, but they’re putting a community at risk. So, what’s important for everybody to realize is that nobody should have to put a price on their health. And, nobody should be putting sex workers in the position where they should have to ask themselves “is it worth it.” And, I think that, nobody really likes condoms, but they are the reality that we have to face in this world until we have a vaccine or we have a microbicide that women can use without men knowing about it that would eradicate the virus. Until that day happens, condoms are going to be a reality and we’re just going to have to deal with that.
When we spoke earlier, you seemed relieved that I used the words “sex worker” instead of “hooker” or “prostitute.” Why is that?
Well, this is actually very interesting. The term sex work is now an accepted term. It’s used in our scientific studies, in the literature and it’s a word that the women use themselves to describe what they do. Unfortunately, there are some factions, especially members of the Republican government, and obviously, editors of the (San Diego Union) Tribune, that will not use the term “sex work” because they feel that it legitimizes the trade and that prostitution is ultimately a terrible thing that everybody must try to eradicate, etcetera, etcetera. And, so, when I discussed this term “sex work” with the (U-T) reporter, she said that she wasn’t allowed to use that term. And, so, we went into a lengthy discussion about what would be an appropriate noun to use. And, I don’ t like the term prostitute because a lot of sex workers don’t like the term prostitute either. And, I respect whatever they want to call themselves. And, so, I said that certainly prostitute was better than any other label that could be interpreted as disparaging or even stigmatizing. And, I was really horrified to see the headline (“Sex with Americans risky for Mexican Hookers“).
And, in fact, as I could see from some of the comments on the article online, some people agreed with me. But, some people used even more stigmatizing labels, which was very distressing. And I think researchers, when we do this kind of work, we’re trying to improve public health. I mean, my goal is to put myself out of the job. This isn’t a job for me — it’s a mission. And I’m very passionate about trying to protect not just the sex workers, but the johns and their families and their lovers, whether they’re paid or not. And, to read that kind of language really made me feel that that headline was perpetuating the stigma and the marginalization that those women feel. And, I felt that it did more harm than good. Now, on the other hand, NPR’s “The World” aired the story the other night in what I thought was a very balanced way. And, that was produced by Kenny Goldberg from KPBS. And, Kenny in particular came down and spent time with the women and talked to them. And, I felt that at least he had a better understating of where they were coming form and why they would have unprotected sex for more money.
— Interview by SAM HODGSON