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Guatemala’s Security Challenges and the Government’s Response

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Official websites use. Share sensitive information only on official, secure websites. Crude and adjusted logistic regression models were used to evaluate the relation- ships. HIV risks, such as frequent hard drug use and drug use in another country, were greater for migrant compared to non- migrant FSW. However, more migrant versus nonmigrant FSW reported consistent condom use with clients and having a health card. Our study highlights regional patterns of sub- stance use among FSW and risk or protective behaviors related to migration status. Migration has been linked to increased anonymity, disconnection from cultural norms, and economic and social vulnerability, which in turn has been associated with risk behaviors, such as sexual risk taking Deane et al. Isolation, structural barriers e. Over the past decade, illicit substance use has increased considerably in border regions and along migration routes in Latin America Bucardo et al. This is especially visible in the Mexico-Guatemala border region, which has a key geographical position as a major transit point for migration from South and Central America to northern countries United Nations Office on Drugs and Crime, This region is also a key location for the sex trade Bronfman et al. Previous research conducted in the region has found that some of the drivers of migration to this border include community violence e. The overlap between rising substance use, sex work, and a highly mobile population at the Mexico-Guatemala border might have implications on risk behaviors and disease transmission throughout the region and warrants further exploration. Social norms in the sex trade dictate that sex workers often are compelled to use substances i. Substance use in the workplace by sex workers may lead to unsafe sexual practices, such as high client volume to pay for drugs or difficulty negotiating condom use with clients Conners et al. Consequently, sex workers who report heavy drug use have been more likely to report STI sexually transmitted infections symptoms than sex workers who do not use drugs Surratt, Migrant sex workers may be at particularly high risk of substance use within the workplace due to vulnerability associated with their undocumented status and the stressors associated with migration Li et al. Research conducted in multiple settings e. While local substance use has increased tremendously over the past decade in the Mexico-Guatemala border region, little information is available on the possible intersection of sex work, migration, and substance use in this key geographical region. Exploration of such intersections may have implications beyond the border to other regions of Latin America. Based on the literature and on the previous research conducted in the region, we hypothesized that international migrant will have higher odds of increased substance use as well as sexual risk behaviors in the context of sex work in comparison with their non-migrant counterparts. Structural e. The present analysis may help inform and improve prevention programs, and highlight migration in the context of substance use and sex work. From September to July , we recruited actively practicing female sex workers as part of a cross-sectional study within a larger NIH-funded study Cruzando Fronteras of substance use and HIV risk. Using a combination of modified time-location sampling of different sex work venues e. Eligibility criteria for the study included: a Being biologically female, b using illicit substances including cocaine, crack, heroin, inhalants, amphetamines, tranquilizers, and the combination of these substances in any mode of administration beyond marijuana by itself in the past 2 months, c having reported exchanging sex for money, drugs or goods in the last month, d 18 years old or older, e Spanish speaker, f willing and able to provide informed consent, g willing to undergo on site HIV testing. Upon written consent, trained interviewers conducted face-to-face interviews to obtain information on sociodemographics, substance use practices, occupational related factors and migration experiences. Interviews were conducted in private rooms i. The rest of the participants are local residents or internal migrants, which encompass the non-migrant category for this analysis. Categorical variables were created to reflect hazardous drinking for women: a drinking more than 4 times per week, b drinking more than 7 drinks on a typical day, and c drinking 4 or more drinks on one occasion weekly or more often. Participants were asked if they have ever used drugs and how often during the last 6 months they used a certain drug. Dichotomous categories for substance use to reflect type and frequency of use were created. For analysis purposes, hard drug use included the use of: cocaine, crack, or heroin in any mode of administration Cross et al. Marijuana, inhalants, amphetamines, and tranquilizers were excluded from this definition but still were reported if relevant use of them was found. We created a variable that captured participants who reported having more than 20 new clients in the past 30 days based on 75th percentile. Venues were categorized as formal venues e. Whereas informal venues are clandestine and sometimes far from the tolerance zones and women find their own clients and the place e. Participants were asked how often they used condoms with regular and new clients in the past 30 days using a 5-point Likert scale ranging from always to never. Consistent condom use captures participants reporting always using condoms. Univariate logistic regressions were performed to identify factors associated with migration status. In the case of drug use, the analyses were restricted to the drugs that occurred in highest frequency among participants crack, cocaine, crack and cocaine together, inhalants, methamphetamines, and tranquilizers. Using a manual backwards procedure for model building, variables were removed from the model individually. Nine out of participants had a confirmatory HIV test 3. Migrants were defined as women currently living in a different country from where they were born. Includes participants who reported being married or in common law. Includes participants who reported being single, divorced, separated, and widowed. Includes not having legal permission to be in the country where interviewed or not having any personal identification. Based on the 75 th percentile. The number of times crossing the Mexico-Guatemala border ranged from 0— times in the past year. Amongst our substance using study population, univariate and unadjusted logistic regression demonstrated that migrants had increased odds of drinking 4 or more times per week than non-migrants. Unadjusted analyses also showed that migrant female sex workers had increased odds of lifetime hard drug use, past 6 months hard drug use, and weekly or more often hard drug use over the past 6-months compared to non-migrant sex workers. Any hard drugs include cocaine, crack, and heroin in any form smoked, inhaled and injected as well as using some of these drugs together. Inhalants, amphetamines, and tranquilizers were excluded from this definition. Formal venues include reporting working in a bar, nightclub, discoteque, and brothel. First place were participants used drugs is a different country than their origin country. We found that in the past 6-months, migrants were almost 8 times more likely to have used drugs in a different country, excluding the interview location see Table 2. In terms of substance use in the context of sex work, we found that both groups reported drinking alcohol and using drugs with clients in the past month. However, migrant sex workers had significantly lower odds of drinking alcohol and using drugs in the context of sex work compared to their non-migrant counterparts see Table 2. Migrants and non-migrants reported using similar types of drugs e. However, we found that in general migrants reported more frequent use or had higher odds of ever using hard drugs e. Migrants had 2. They also were more likely to have ever used cocaine and in the past 6 months, and to have ever used inhalants compared to non-migrant women sex workers see Table 3. Overall, migrants tended to work in more controlled environments than non-migrants, which offered both positive and negative influences on health. For instance, we found that migrants had almost two times higher odds of working in formal venues, e. For example, consistent condom use with clients was two times more likely to be reported among migrants than non-migrants see Table 2. These types of settings also came with risks, including a higher number of clients; migrants were 2. Sixty percent of the migrant participants reported that there are people using drugs in their workplace and this was borderline statistically significant in comparison with non-migrant participants main workplace. However, when we analyzed alcohol use in the workplace, we found that a higher percentage of non-migrant reported being required to drink with clients than their migrant counterparts Table 2. In the multivariate model, we observed that some risk factors remained significant when comparing migrant and non-migrant sex workers. Although, some risk factors remained, migrant sex workers still had higher odds of more consistent condom use with clients when compared with non-migrant sex workers and a nearly three-fold increase in the odds of having a health card. We also observed that migrants who reported a history of substance use had a significantly lower odds of alcohol use with clients than non-migrants who also previously used illicit substances Table 4. In univariate analysis, sociodemographic variables such as age, education, and civil status were not significant; therefore we did not adjust for those in the final model. No sociodemographic characteristic i. We found differences in HIV risk behaviors and substance use patterns between substance using migrant sex workers compared to substance using non-migrant sex workers. Some of these findings are contrary to what we originally hypothesized before conducting the present analyses. A the time of data collection, there were crack-downs and raids in formal venues, specifically in Tapachula, that had as main consequences the closure of numerous venues Febres-Cordero et al. This could have lead to participants not accessing to local health services as the health card entails self-identifying as a sex worker. The occupational environment may play a key factor in understanding findings regarding HIV risk factors among migrant and non-migrant sex workers working in the Mexico-Guatemala border and may serve as a point of intervention to decrease risks for both groups. Substance use in the context of sex work is common, especially alcohol use in formal venues such as bars, clubs, and table dance halls Chen et al. We found high levels of alcohol use with clients among our overall sample of substance users, although significant lower levels among migrant sex workers. This is a different trend found in other studies conducted among migrant sex workers in other regions Li et al. In similar settings, such as Tijuana, Mexico, it has been found that managers or pimps in formal work venues water down the drinks of FSW to diminish the risks of drinking with male clients Nowotny et al. Thus, to some extent, the type of venue and sex work context may partially explain some of the variations in behaviors between migrant and non-migrant sex workers in the Mexico-Guatemala border. Therefore, sex workers who are consistently using condoms with clients are getting them elsewhere e. Further research to understand barriers to condom access and use, as well as campaigns that provide free condoms to vulnerable populations in the region, are needed. Client volume per month was higher among migrant sex workers in comparison with non-migrant; a combination of migrant risk perception and the characteristics of their main work venue e. A number of studies in similar settings have found that working in formal venues e. For example, a study conducted in Tijuana, Mexico found that registered sex workers had decreased risky sexual behaviors e. Mobility and migration play a key role in this study. These data reflect general drug use trends that have been rising in the region. There is very limited literature about specific drug use in the Mexico-Guatemala border among vulnerable populations and its effects on health Bronfman et al. Social support and peer relationships may be another form of coping with isolation and occupational stress see Table 2. However, this same study found that establishing networks among their peers might be challenging due to high mobility. This study has several limitations. Because it is cross-sectional, we are not able to draw conclusions about causality. Therefore, it is difficult to determine if substance use among migrants is related to their current sex work venue, the migration journey, or previous experiences in their home country, although most substance use started after migrating Bronfman et al. In addition, behaviors such as substance use, which was not biologically tested, and condom use, may have been under-reported or over-reported due to social desirability bias. We also tried to shield some of the eligibility criteria to participate and we asked about drug use in many different ways while applying the screening tool. Further research contemplating the particularities of internal migration, mobility, and the time in the destination site is needed. Details provided by this study as well as the different nuances surrounding migration and sex work may inform future research on HIV and substance use among migrant and non-migrant sex workers in this region Shannon et al. Programs that target sex workers who engage in sex work in informal and outdoor venues and that consider migration experiences are needed. The authors gratefully acknowledge the participants, community collaborators, and study staff in both Guatemala and Mexico. The Crossing Borders Project was funded by the U. In the Mexico-Guatemala context mobility entails local and regional mobility for the purpose of different activities such as temporary work, buying goods, and using drugs. It may also entail cross border commuting. For the purpose of this paper, closed houses are defined as a clandestine space, usually a big house, where women exchange sex with men. Its clandestine nature can be explained by the illegality of the activities that usually happen in this space i. Participants who reported ever being deported were not necessarily considered to be current migrants because most of them came back to their country of origin and were currently living there. Additionally, we did not have information on when the most recent deportation occurred, so having a history of ever being deported was not considered equivalent to currently living in a foreign country as a migrant. Unfortunately, we do not know if these managers or pimps were actually controlling or coercing participants to engage in specific behaviors e. As a library, NLM provides access to scientific literature. J Ethn Subst Abuse. Published in final edited form as: J Ethn Subst Abuse. Find articles by Sonia Morales-Miranda. Find articles by Kimberly C Brouwer. Issue date Oct-Dec. PMC Copyright notice. The publisher's version of this article is available at J Ethn Subst Abuse. Open in a new tab. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel. Exchanged sex for money for the first time in a foreign country. Exchanged sex for money for the first time when you were trying to move from one place to another. Used illicit drugs for the first time in a foreign country. Have a drink containing alcohol 4 or more times per week. Drinking 4 or more drinks on one occasion weekly or more often. Alcohol use in the context of sex work, past 30 days. Reason for using drugs for the first time: I was curious. Reason for using drugs for the first time: I was stressed or depressed. Pay a pimp or manager a percentage of earnings. Venue rules require to drink alcohol with clients. Consistent condom use with clients, past 30 days. Access to free condoms in the work venue, past 30 days. Smoke Crack and Marijuana together, past 6-months. Frequent hard drug use weekly or more often, last 6 months.

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