Women in Sex Work and the Risk Environment: Agency, Risk Perception, and Management in the Sex Work Environments of Two Mexico-U.S. Border Cities

  • Eli Andrade
  • René Leyva
  • Mei-Po Kwan
  • Carlos Magis
  • Hugo Stainez-Orozco
  • Kimberly Brouwer


Sex work around the world takes place under conditions of structural violence and vulnerability. The Mexico-U.S. border region is characterized by the presence of factors that increase the risk for health harms among female sex workers (FSW); located in this context, the risk environments of Tijuana and Ciudad Juárez have similar yet distinct characteristics that influence how risk is produced and experienced among FSWs. Exploring the ways in which FSWs enact agency in risk environments can illustrate how environmental characteristics shape perceived risks and the strategies that FSWs develop to manage them. This approach also identifies the limits that are placed by environmental characteristics over the capacity for harm reduction and prevention practices among FSWs. We analyzed the role of agency in the work environments of female sex workers and its relationship with risk perception and management in the cities of Tijuana and Cd. Juárez.


Female sex workers Risk Agency Structure Mexico-U.S. border Risk environment 



We thank the Mapa de Salud field staff for their technical support in the recruitment of participants for this project. Taylor Munoz for her technical support in the quantitative aspect of this article. Finally, we would like to thank the women participated in this study for sharing their stories of struggle and resistance.


This work was supported by the National Institute of Drug Abuse under grant R01 DA028692.

Compliance with Ethical Standards

The project was approved by the Institutional Review Board at UCSD, as well as the ethical review committees in Tijuana (Colegio de la Frontera Norte), and Cd. Juárez (Universidad Autónoma de Ciudad Juárez).

Conflict of Interest

The authors declare that they have no conflict of interest.


  1. Baral, S., Beyrer, C., Muessig, K., Poteat, T., Wirtz, A. L., Decker, M. R., et al. (2012). Burden of HIV among female sex workers in low-income and middle-income countries: A systematic review and meta-analysis. The Lancet Infectious Diseases, 12(7), 538–549. CrossRefPubMedGoogle Scholar
  2. Beletsky, L., Agrawal, A., Moreau, B., Kumar, P., Weiss-Laxer, N., & Heimer, R. (2011). Police training to align law enforcement and HIV prevention: Preliminary evidence from the field. American Journal of Public Health, 101(11), 2012–2015.CrossRefPubMedPubMedCentralGoogle Scholar
  3. Beletsky, L., Martinez, G., Gaines, T., Nguyen, L., Lozada, R., Rangel, G., et al. (2012). Mexico’s northern border conflict: Collateral damage to health and human rights of vulnerable groups. Revista Panamericana de Salud Pública, 31(5), 403–410.CrossRefPubMedPubMedCentralGoogle Scholar
  4. Blankenship, K. M., & Koester, S. (2002). Criminal law, policing policy, and HIV risk in female street sex workers and injection drug users. The Journal of Law, Medicine & Ethics, 30(4), 548–559.CrossRefGoogle Scholar
  5. Bronfman, M., & Leyva, R. (2001). Migración y SIDA: Los contextos de riesgo. Higiene, 3(2), 30–31.Google Scholar
  6. Campbell, R., & Kinnell, H. (2000). “We Shouldn’t Have to Put Up with This”: Street sex work and violence.Google Scholar
  7. Castañón, A. (2013, 20 Julio 2013). Clausuran 4 hoteles y 2 casas de huéspedes en lo que va del mes. El Diario. Retrieved from
  8. Charmaz, K. (2006). Constructing grounded theory: A practical guide through qualitative analysis: SAGE Publications.Google Scholar
  9. Conners, E. E., Silverman, J. G., Ulibarri, M., Magis-Rodriguez, C., Strathdee, S. A., Staines-Orozco, H., et al. (2015). Structural determinants of client perpetrated violence among female sex workers in two Mexico-US border cities. AIDS and Behavior.Google Scholar
  10. Conners, E. E., West, B. S., Roth, A. M., Meckel-Parker, K. G., Kwan, M.-P., Magis-Rodriguez, C., et al. (2016). Quantitative, qualitative and geospatial methods to characterize HIV risk environments. PLoS One, 11(5), e0155693.CrossRefPubMedPubMedCentralGoogle Scholar
  11. Cusick, L. (2006). Widening the harm reduction agenda: From drug use to sex work. The International Journal on Drug Policy, 17(1), 3–11.CrossRefGoogle Scholar
  12. Dalla, R. L. (2002). Night moves: A qualitative investigation of street-level sex work. Psychology of Women Quarterly, 26(1), 63–73.CrossRefGoogle Scholar
  13. do Espirito Santo, M. G., & Etheredge, G. (2005). Male clients of brothel prostitutes as a bridge for HIV infection between high risk and low risk groups of women in Senegal. Sexually Transmitted Infections, 81(4), 342–344.CrossRefGoogle Scholar
  14. Fragoso, J. M. (2002). Feminicidio sexual serial en Ciudad Juárez: 1993–2001. Debate feminista, 279–305.Google Scholar
  15. Frenk, J., González-Pier, E., Gómez-Dantés, O., Lezana, M. Á., & Knaul, F. M. (2007). Reforma integral para mejorar el desempeño del sistema de salud en México. Salud Pública de México, 49, s23–s36.CrossRefPubMedGoogle Scholar
  16. Frohlich, K. L., & Potvin, L. (2010). Commentary: Structure or agency? The importance of both for addressing social inequalities in health. International Journal of Epidemiology, 39(2), 378–379.CrossRefPubMedGoogle Scholar
  17. Global Commission on HIV and the Law. (2012). Risks, rights and health. Retrieved from.Google Scholar
  18. Goldenberg, S. M., Cruz, M. G., Strathdee, S. A., Nguyen, L., Semple, S. J., & Patterson, T. L. (2010). Correlates of unprotected sex with female sex workers among male clients in Tijuana, Mexico. Sexually Transmitted Diseases, 37(5), 319.PubMedPubMedCentralGoogle Scholar
  19. Goldenberg, S. M., Engstrom, D., Rolon, M. L., Silverman, J. G., & Strathdee, S. A. (2013). Sex workers perspectives on strategies to reduce sexual exploitation and HIV risk: A qualitative study in Tijuana, Mexico. PLoS One, 8(8), e72982. CrossRefPubMedPubMedCentralGoogle Scholar
  20. Goldenberg, S. M., Strathdee, S. A., Gallardo, M., Rhodes, T., Wagner, K. D., & Patterson, T. L. (2011). “Over here, it’s just drugs, women and all the madness”: The HIV risk environment of clients of female sex workers in Tijuana, Mexico. Social Science & Medicine, 72(7), 1185–1192.CrossRefGoogle Scholar
  21. Jeffreys, E., Fawkes, J., & Stardust, Z. (2012). Mandatory testing for HIV and sexually transmissible infections among sex workers in Australia: A barrier to HIV and STI prevention. World Journal of AIDS, 2(03), 203.CrossRefGoogle Scholar
  22. Krüsi, A., Chettiar, J., Ridgway, A., Abbott, J., Strathdee, S. A., & Shannon, K. (2012). Negotiating safety and sexual risk reduction with clients in unsanctioned safer indoor sex work environments: A qualitative study. American Journal of Public Health, 102(6), 1154–1159.CrossRefPubMedPubMedCentralGoogle Scholar
  23. Kwan, M.-P., & Ding, G. (2008). Geo-narrative: Extending geographic information systems for narrative analysis in qualitative and mixed-method research∗. The Professional Geographer, 60(4), 443–465.CrossRefGoogle Scholar
  24. Lowndes, C. M., Alary, M., Gnintoungbe, C. A., Bédard, E., Mukenge, L., Geraldo, N., et al. (2000). Management of sexually transmitted diseases and HIV prevention in men at high risk: Targeting clients and non-paying sexual partners of female sex workers in Benin. AIDS, 14(16), 2523–2534.CrossRefPubMedGoogle Scholar
  25. Maher, L., Mooney-Somers, J., Phlong, P., Couture, M.-C., Stein, E., Evans, J., et al. (2011). Selling sex in unsafe spaces: Sex work risk environments in Phnom Penh, Cambodia. Harm Reduction Journal, 8(1), 1.CrossRefGoogle Scholar
  26. Monarrez Fragoso, J. E. (2012). Violencia extrema y existencia precaria en Ciudad Juárez. Frontera norte, 24(48), 191–199.Google Scholar
  27. Murray, L., Moreno, L., Rosario, S., Ellen, J., Sweat, M., & Kerrigan, D. (2007). The role of relationship intimacy in consistent condom use among female sex workers and their regular paying partners in the Dominican Republic. AIDS and Behavior, 11(3), 463–470.CrossRefPubMedGoogle Scholar
  28. Odinokova, V., Rusakova, M., Urada, L. A., Silverman, J. G., & Raj, A. (2014). Police sexual coercion and its association with risky sex work and substance use behaviors among female sex workers in St. Petersburg and Orenburg, Russia. International Journal of Drug Policy, 25(1), 96–104.CrossRefPubMedGoogle Scholar
  29. Olivas, J. D. D. (2014, 25 Enero 2014). Calles del Centro alguna vez brillaron...con su vida nocturna. El Diario. Retrieved from
  30. Open Society Foundation. (2011). Common Human Rights Violations Experienced by Sex Workers. Retrieved from
  31. Open Society Foundations. (2015). Ten reasons to decriminalize sex work. Retrieved from.Google Scholar
  32. Patterson, T. L., Semple, S. J., Fraga, M., Bucardo, J., Torre, A. D. L., Salazar, J., et al. (2006). Comparison of sexual and drug use behaviors between female sex workers in Tijuana and Ciudad Juarez, Mexico. Substance Use & Misuse, 41(10–12), 1535–1549. CrossRefGoogle Scholar
  33. Quast, T., & Gonzalez, F. (2016). Sex work regulation and sexually transmitted infections in Tijuana, Mexico. Health economics.Google Scholar
  34. Ramos, R., Ferreira-Pinto, J. B., Brouwer, K. C., Ramos, M. E., Lozada, R. M., Firestone-Cruz, M., & Strathdee, S. A. (2009). A tale of two cities: Social and environmental influences shaping risk factors and protective behaviors in two Mexico–US border cities. Health & Place, 15(4), 999–1005. CrossRefGoogle Scholar
  35. Reglamento para el control de enfermedades de transmisión sexual para el municipio de Tijuana, Baja California, (2005).Google Scholar
  36. Rekart, M. L. (2005). Sex-work harm reduction. Lancet, 366(9503), 2123–2134. CrossRefPubMedGoogle Scholar
  37. Rhodes, T. (2002). The ‘risk environment’: A framework for understanding and reducing drug-related harm. The International Journal on Drug Policy, 13(2), 85–94. CrossRefGoogle Scholar
  38. Rhodes, T., & Cusick, L. (2002). Accounting for unprotected sex: Stories of agency and acceptability. Social Science & Medicine, 55(2), 211–226.CrossRefGoogle Scholar
  39. Rhodes, T., Singer, M., Bourgois, P., Friedman, S. R., & Strathdee, S. A. (2005). The social structural production of HIV risk among injecting drug users. Social Science & Medicine, 61(5), 1026–1044. CrossRefGoogle Scholar
  40. Rhodes, T., Wagner, K., Strathdee, S. A., Shannon, K., Davidson, P., & Bourgois, P. (2012). Structural violence and structural vulnerability within the risk environment: Theoretical and methodological perspectives for a social epidemiology of HIV risk among injection drug users and sex workers Rethinking social epidemiology (pp. 205–230): Springer.Google Scholar
  41. Sanders, T., & Campbell, R. (2007). Designing out vulnerability, building in respect: Violence, safety and sex work policy. The British Journal of Sociology, 58(1), 1–19.CrossRefPubMedGoogle Scholar
  42. Sevelius, J. M., Reznick, O. G., Hart, S. L., & Schwarcz, S. (2009). Informing interventions: The importance of contextual factors in the prediction of sexual risk behaviors among transgender women. AIDS education and prevention: official publication of the International Society for AIDS Education, 21(2), 113.CrossRefGoogle Scholar
  43. Shannon, K., Kerr, T., Allinott, S., Chettiar, J., Shoveller, J., & Tyndall, M. W. (2008a). Social and structural violence and power relations in mitigating HIV risk of drug-using women in survival sex work. Social Science & Medicine, 66(4), 911–921. CrossRefGoogle Scholar
  44. Shannon, K., Rusch, M., Shoveller, J., Alexson, D., Gibson, K., & Tyndall, M. W. (2008b). Mapping violence and policing as an environmental–structural barrier to health service and syringe availability among substance-using women in street-level sex work. The International Journal on Drug Policy, 19(2), 140–147. CrossRefPubMedGoogle Scholar
  45. Shannon, K., Strathdee, S. A., Goldenberg, S. M., Duff, P., Mwangi, P., Rusakova, M., et al. (2014). Global epidemiology of HIV among female sex workers: Influence of structural determinants. Lancet, 385(9962), 55–71. CrossRefPubMedPubMedCentralGoogle Scholar
  46. Sirotin, N., Strathdee, S. A., Lozada, R., Abramovitz, D., Semple, S. J., Bucardo, J., & Patterson, T. L. (2010). Effects of government registration on unprotected sex amongst female sex workers in Tijuana; Mexico. The International Journal on Drug Policy, 21(6), 466–470.CrossRefPubMedPubMedCentralGoogle Scholar
  47. Sirotin, N., Strathdee, S. A., Lozada, R., Nguyen, L., Gallardo, M., Vera, A., & Patterson, T. L. (2010). A comparison of registered and unregistered female sex workers in Tijuana, Mexico. Public Health Reports, 125(Suppl 4), 101–109.CrossRefPubMedPubMedCentralGoogle Scholar
  48. Strathdee, S. A., Lozada, R., Semple, S. J., Orozovich, P., Pu, M., Staines-Orozco, H., et al. (2008a). Characteristics of female sex workers with US clients in two Mexico-US border cities. Sexually Transmitted Diseases, 35(3), 263–268. CrossRefPubMedPubMedCentralGoogle Scholar
  49. Strathdee, S. A., Philbin, M. M., Semple, S. J., Pu, M., Orozovich, P., Martinez, G., et al. (2008b). Correlates of injection drug use among female sex workers in two Mexico–US border cities. Drug and Alcohol Dependence, 92(1), 132–140.CrossRefPubMedGoogle Scholar
  50. Strathdee, S. A., Lozada, R., Martinez, G., Vera, A., Rusch, M., Nguyen, L., et al. (2011). Social and structural factors associated with HIV infection among female sex workers who inject drugs in the Mexico-US border region. PLoS One, 6(4), e19048. CrossRefPubMedPubMedCentralGoogle Scholar
  51. Wolffers, I., & van Beelen, N. (2003). Public health and the human rights of sex workers. Lancet, 361(9373), 1981–1981.CrossRefPubMedGoogle Scholar
  52. Yi, H., Mantell, J. E., Wu, R., Lu, Z., Zeng, J., & Wan, Y. (2010). A profile of HIV risk factors in the context of sex work environments among migrant female sex workers in Beijing, China. Psychology, Health & Medicine, 15(2), 172–187.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Eli Andrade
    • 1
  • René Leyva
    • 2
  • Mei-Po Kwan
    • 3
  • Carlos Magis
    • 4
  • Hugo Stainez-Orozco
    • 5
  • Kimberly Brouwer
    • 1
    • 6
  1. 1.Division of Global Public HealthUniversity of California San DiegoLa JollaUSA
  2. 2.Centro de Investigación en Sistemas de SaludInstuto Nacional de Salud PúblicaCuernavacaMexico
  3. 3.Department of Geography and Geographic Information ScienceUniversity of Illinois at Urbana-ChampaignUrbanaUSA
  4. 4.Centro Nacional para la Prevención y control del SidaSecretaría de SaludMexico CityMexico
  5. 5.Departamento de Ciencias MédicasUniversidad Autónoma de Ciudad JuárezCiudad JuárezMexico
  6. 6.Department of Family Medicine and Public HealthUniversity of California San DiegoLa JollaUSA

Personalised recommendations