'Men at Risk': Sex Work, Tourism & STI/HIV Risk in Jamaica

Female sex tourism has become an accepted income generator for many underemployed men in Jamaica who seek to reap economic benefits from relationships with visiting tourist women. 

This issue provides contexts to explore the numerous ways in which health intersects with issues of masculinity, sexuality and marginality. Based on ethnographic fieldwork in a popular Jamaican resort town, this paper examines the health implications of female sex tourism for the local population and tourist visitors. 

Data from this project indicate the need for improved sexually transmitted infection education and HIV outreach work towards men who are involved in transactional sex with tourist women. Due to prevalent perceptions of masculinity and gendered notions of sexuality, men who engage in sex tourism constitute a population that rarely receives the attention of local and national health authorities. 

Data from this qualitative study suggest that engaging this particular vulnerable population could potentially decrease the risk of STI and HIV infection in the country's most popular resort areas. 

Research of this kind is urgently needed to better understand the risk factors and challenges for Caribbean populations, as well as to inform future prevention efforts in the region.

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By:  Johnson LC^1,2.

¹ Department of Anthropology , University of South Florida , Tampa , USA.

² College of Education , University of North Georgia , Dahlonega , USA.

Cult Health Sex. 2016 Mar 22:1-14

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'Total Girlfriend Experience': Examining Marketplace Mythologies on Sex Tourism Websites

The purpose of this study was to conduct a systematic content analysis of sex tour websites to understand how sex tours are marketed to potential clients. 

A total of 380 web pages from 21 sex tour websites were reviewed. The sex tour websites sought to promote privacy and hassle-free travel with a local 'escort' and the opportunity for 'hooks-ups' with no strings attached. Three themes emerged around the description of sex workers: 

1. enjoyment and complete acceptance,
2. a 'total girlfriend experience' and 
3. exoticisation of the 'Third World' woman. 

The majority of the sex tourism websites used marketplace mythologies concerning racism, sexism and imperialism to appeal to sex tourists' desires for fantasy experiences, power and domination, and a renewed sense of identity. Legal and STI-related information was largely missing from the websites, and when it was included it was aimed at protecting sex tourists, not sex workers. 

It is of importance for researchers, social workers and others engaging with sex workers and sexscapes to recognise the power of language, cultural myths and framings and their ability to generate real-world social and health implications.

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By:  Gezinski LB1, Karandikar S2, Levitt A1, Ghaffarian R1.

• 1 College of Social Work, University of Utah (http://socialwork.utah.edu/), Salt Lake City , USA.
• 2 College of Social Work, The Ohio State University , Columbus , USA.
• Cult Health Sex. 2016 Jan 13:1-14.  

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HIV-Testing among Female Sex Workers on the Border Between Brazil & French Guiana: The Need for Targeted Interventions

The border between Brazil and French Guiana is a place of economic, cultural, social and sexual exchange. Female sex workers represent a high risk population for HIV in this area where sexual tourism is particularly developed. HIV testing seems to be an important element in the fight against the epidemic. Indeed, early HIV testing gives access to treatments and prevention. 

An HIV/AIDS knowledge, attitudes, behaviors and practices survey was conducted in 2011 among sex workers along the border between Brazil and French Guiana. A total of 213 female sex workers were interviewed. 

One third (31.5%) of the interviewed had never tested for HIV. 

• Factors associated with non HIV-testing were the lack of knowledge of places where to do an HIV test, 
• to be 30 or older, 
• feeling at risk of HIV, 
• not evaluating one's own risk towards HIV, 
• and living in Oiapoque. 

These results clearly suggest that targeted interventions are needed to encourage and assist female sex workers to get tested regularly.

Table 2 Predictive factors of having performed a free voluntary HIV test on the border between French Guiana and Brazilian (n = 194): bivariate and multivariate analyses. 

	Has already been tested for HIV n/total (%)	Crude OR (95%CI)	Adjusted OR (95%CI)	Adjusted p-value
Knowledge of where to test
Yes	111/143 (77.6)	1.00	1.00
No	20/51 (39.2)	0.12 (0.07-0.20)	0.23 (0.10-0.52)	0.000
Perceived risk of HIV
Feels at risk	28/43 (65.1)	0.93 (0.46-1.90)	0.26 (0.07-0.93)	0.039
Does not feel at risk	29/35 (82.8)	1.00	1.00
Does not know	35/77 (45.4)	0.21 (0.11-0.40)	0.33 (0.11-0.99)	0.049
No response	40/44 (90.9)	6.85 (2.33-20.10)	3.46 (0.79-15.08)	0.099
Median age
Less than 30	94/129 (72.9)	1.00	1.00
30 or more	38/70 (54.3)	1.40 (0.91-2.15)	0.28 (0.12-0.63)	0.002
Lives in Oiapoque
Yes	104/169 (61.5)	0.11 (0.03-0.49)	0.05 (0.01-0.28)	0.001
No	28/30 (93.3)	1.00	1.00

95%CI: 95% confidence interval; OR: odds ratio.

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By:  Parriault MC1, van Melle A1, Basurko C1, Gaubert-Marechal E2, Macena RH3, Rogier S1, Kerr LR3, Nacher M1.

• 1Centre d'Investigation Clinique Antilles Guyane, Cayenne General Hospital, Cayenne, GF.
• 2COREVIH Guyane, Cayenne General Hospital, Cayenne, GF.
• 3Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, CE, BR.
• 
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Can’t Buy My Love: A Typology of Female Sex Workers’ Commercial Relationships in the Mexico–U.S. Border Region

Female sex workers (FSWs) experience elevated risk for HIV and sexually transmitted infections (STIs) through unprotected sex with male clients, yet the complexity of these commercial relationships remains understudied. From 2010 to 2011, we explored FSWs’ conceptualizations of various client types and related risk behavior patterns using semistructured interviews with 46 FSWs in Tijuana and Ciudad Juarez, Mexico, where FSWs’ HIV/STI prevalence is increasing. 

Our grounded theory analysis identified four types of commercial relationships: 

1. nonregular clients, 
2. regular clients and friends, 
3. clients who “fell in love” with FSWs, 
4. and long-term financial providers who often originated from the United States. 

As commercial relationships developed, clients’ social and emotional connections to FSWs increased, rendering condom negotiation and maintaining professional boundaries more difficult. Drug abuse and poverty also influenced behaviors, particularly in Ciudad Juárez, where lucrative U.S. clients were increasingly scarce. While struggling to cultivate dependable relationships in a setting marked by historical sex tourism from a wealthier country, some FSWs ceased negotiating condom use. 

We discuss the need for HIV/STI research and prevention interventions to recognize the complexity within FSWs’ commercial relationships and how behaviors (e.g., condom use) evolve as relationships develop through processes that are influenced by local sociopolitical contexts and binational income inequality.

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By: Angela M. Robertson, Jennifer L. Syvertsen, Hortensia Amaro, Gustavo Martinez, M. Gudelia Rangel, Thomas L. Patterson, and Steffanie A. Strathdee
Division of Global Public Health, School of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0507

Vulnerability Factors and Pathways Leading to Underage Entry into Sex Work in Two Mexican-US Border Cities

"...[C]onsequences of early sexual and physical abuse led to running away from home, dropping out of school, and homelessness. The homelessness and lack of social support rendered them vulnerable to underage entry or in some instances to being coerced or forced into sex work. These findings complement prior research conducted in other regions indicating experiences young exposure to sexual and physical abuse and running away as an adolescent are primary risks for the commercial sexual exploitation of children.49–51 Furthermore, it is important to mention that not one of the participants received mental health services or professional services of any kind for the abuse they endured. For many this study was their first time disclosing to someone the abuse they had experienced and many participants expressed relief in doing so. These findings suggest the need in Mexico for more effective child protective service programs to identify and assist children who have been victims of sexual or physical abuse in a timely way given their potential implications.

Economic need is often connected to entry into sex work; evidence indicates that when women lack viable alternatives, they are more likely to perceive sex work as a feasible option for income.52 In our study, teen pregnancy was the common denominator that gave rise to economic need such as child caring needs (i.e., shelter, food, etc.). Because these women were underage at the time of pregnancy, had low levels of education and were poorly skilled, they had limited employment opportunities. These findings complement prior work indicating the role of limited opportunities for women as drivers of entry to sex work and trafficking.53, 54 The Mexican government has gone to great efforts to improve the educational opportunities, and thus the employment opportunities, of young women and girls from lower socioeconomic status with programs such as Prospera (previously referred to as Oportunidades).55 However, these findings indicate that there are other needs that must be addressed (i.e., family issues, sexual and physical abuse) in order to reach these girls or expand their program to target high-risk girls who are suffering from these vulnerabilities as our study revealed." [bold added]

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