Economic vulnerability, violence, and sexual risk factors for HIV among female sex workers in Tijuana, Mexico.

Economic vulnerability is often reported to underlie involvement in sex work among female sex workers (FSW), but may also create urgency in women's work, limiting women's negotiating power with clients and in turn, increasing their vulnerability for violence and HIV. This study assessed economic vulnerability in relation to violence and sexual risk behaviors for HIV among a sample of FSW in Tijuana, Mexico. FSW at least 18 years of age were recruited through venue-based sampling for a survey (n = 228) and in-depth interviews (n = 50) to investigate HIV risk factors in this region. Using crude and adjusted logistic regression models, we assessed lack of financial support from others as well as reports of financial hardship separately in relation to experiencing sexual violence (e.g. by clients, police, relationship partners, in the past 6 months), physical violence (past 6 months), STI diagnosis, and inconsistent condom use (past 30 days). Qualitative interviews (n = 50), conducted with a subsample of the survey participants, were also examined for related themes. FSW who reported no financial support were more likely to report sexual violence (OR = 2.1; 95% CI:1.1-4.2). FSW who reported financial hardship were more likely to experience sexual violence (OR = 1.9; 95% CI:1.1-3.6) and physical violence (OR = 1.9; 95% CI:1.1-3.6), as well as to report past 30-day inconsistent condom use (OR = 2.4; 95%CI: 1.3-4.6) and to test positive for an STI (OR = 1.9; 95% CI:1.1-3.4). Qualitative data substantiated these findings. Findings suggest that interventions to improve economic well-being may be useful to prevent the intersecting concerns of violence and HIV among FSW.

The California Border Health Collaborative: A Strategy for Leading the Border to Better Health.

There are hundreds of people and organizations working on border health issues in the California-Baja California border region trying to protect and improve health. These efforts are being conducted without a collaborative structure that integrates jurisdictions and organizations. Thus, there is a need to coordinate these organizations to work together and benefit from their collective effort and each other's best practices. The outcome of such an effort could effectively improve the health in the border region. The newly developed "California Border Health Collaborative" unites organizations and provides the leadership and collaborative culture to positively improve the health of the border region; it is referred to as the "Collaborative." This article describes the developmental process of this Collaborative, including partner engagement, governance, strategic planning, key elements for success, the roles of multi-level jurisdictions, and policy implications. This paper focuses on describing the preparation and processes that created the U.S./California side of this binational collaborative effort and is a strong reflection of the theory of border collaboration as described by Denman and De Sonora (1) in "Working beyond Borders: A Handbook for Transborder Projects in Health."