Original paper

AIDS and Behavior

, Volume 15, Issue 1, pp 179-185

First online:

Open Access This content is freely available online to anyone, anywhere at any time.

Injection Drug Use as a Mediator Between Client-perpetrated Abuse and HIV Status Among Female Sex Workers in Two Mexico-US Border Cities

  • Monica D. UlibarriAffiliated withDepartment of Psychiatry, School of Medicine, University of California, San Diego
  • , Steffanie A. StrathdeeAffiliated withDepartment of Medicine, School of Medicine, University of California, San Diego
  • , Emilio C. UlloaAffiliated withDepartment of Psychology, San Diego State University
  • , Remedios LozadaAffiliated withPro-COMUSIDA
  • , Miguel A. FragaAffiliated withFacultad de Medicina y Psicología, Universidad Autónoma de Baja California
  • , Carlos Magis-RodríguezAffiliated withCentro Nacional para la Prevención y el Control del VIH/SIDA (CENSIDA), Secretaría de Salud
  • , Adela De La TorreAffiliated withChicana/o Studies, University of California
  • , Hortensia AmaroAffiliated withInstitute on Urban Health Research, Bouvé College of Health Sciences, Northeastern University
  • , Patricia O’CampoAffiliated withCentre for Research on Inner City Health, University of Toronto
    • , Thomas L. PattersonAffiliated withDepartment of Psychiatry, School of Medicine, University of California, San Diego Email author 


We examined relationships between client-perpetrated emotional, physical, and sexual abuse, injection drug use, and HIV-serostatus among 924 female sex workers (FSWs) in Tijuana and Ciudad Juarez, two large Mexico-US border cities. We hypothesized that FSWs’ injection drug use would mediate the relationship between client-perpetrated abuse and HIV-seropositivity. The prevalence of client-perpetrated emotional, physical, and sexual abuse in the past 6 months was 26, 18, and 10% respectively; prevalence of current injection drug use and HIV was 12 and 6%, respectively. Logistic regression analyses revealed that client-perpetrated sexual abuse was significantly associated with HIV-seropositivity and injection drug use, and that injection drug use was positively associated with HIV-seropositivity. Injection drug use partially mediated the relationship between client-perpetrated sexual abuse and HIV-seropositivity. Results suggest the need to address client-perpetrated violence and injection drug use when assessing HIV risk among FSWs.


Female sex workers Client-perpetrated abuse Injection drug use HIV