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Sex Work and the City

Sex Work and the City
The Social Geography of Health and Safety in Tijuana, Mexico

A revealing study of the sex trade in Tijuana (where approximately one thousand registered prostitutes work quasi-legally) and its effects on public health, economics, and the local culture of sexuality.

Series: Inter America Series, Duncan Earle, Howard Campbell, and John Peterson, series editors

January 2009
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190 pages | 6 x 9 | 16 photos, 2 maps, 1 diagram, 1 chart, 24 tables |

A gateway at the U.S.-Mexico border, Tijuana is a complex urban center with a sizeable population of sex workers. An in-depth case study of the trade, Sex Work and the City is the first major ethnographic publication on contemporary prostitution in this locale, providing a detailed analysis of how sex workers' experiences and practices are shaped by policing and regulation.

Contextualizing her research within the realm of occupational risk, Yasmina Katsulis examines the experiences of a diverse range of sex workers in the region and explores the implications of prostitution, particularly regarding the spheres of class hierarchies, public health, and other broad social effects. Based on eighteen months of intensive fieldwork and nearly 400 interviews with sex workers, customers, city officials, police, local health providers, and advocates, Sex Work and the City describes the arenas of power and the potential for disenfranchisement created by municipal laws designed to regulate the trade. Providing a detailed analysis of this subculture's significance within Tijuana and its implications for debates over legalization of "vice" elsewhere in the world, Katsulis draws on powerful narratives as workers describe the risks of their world, ranging from HIV/AIDS and rape (by police or customers) to depression, work-related stress, drug and alcohol addiction, and social stigma. Insightful and compelling, Sex Work and the City captures the lives (and deaths) of a population whose industry has broad implications for contemporary society at large.

  • Preface
  • Acknowledgments
  • Introduction
  • Chapter One: Tijuana's Origins
  • Chapter Two: Tijuana Today
  • Chapter Three: Milk Money, Drug Money, and the Sexual Entrepreneur
  • Chapter Four: Commercial Sex and the Social Landscape
  • Chapter Five: Legal Status and Policing
  • Chapter Six: Gender Diversity
  • Conclusions and Recommendations
  • Notes
  • Glossary
  • Bibliography
  • Index

Yasmina Katsulis is Assistant Professor of Women's and Gender Studies at Arizona State University in Tempe. A medical anthropologist with postdoctoral training at Yale's Center for Interdisciplinary Research on AIDS, she has garnered research support from the National Institutes of Health and the National Science Foundation.


I grew up in California near a town called Nevada City. Established in 1849, Nevada City was a prosperous gold mining town, one of many in California. As a young girl, I visited its historic buildings and Victorian houses and marveled at the luxurious hand-carved stairways and dark red carpets of its stagecoach hotel. Just a few doors from the hotel stood a grand three-story building now used as a restaurant. It was filled with fine antique furniture, velvet-papered walls, and finely wrought mirrored sconces. A long oak bar and a player piano stood prominently in the center of its large first floor. When a friend of the family took over the business, I gained access to the upper floors, which had sat unused and empty for many decades. It was a tenement house of sorts, and, as a young girl is wont to do, I wandered about dreamily, looking for bits of evidence of lives left behind.


Only later was I told that it was a "whorehouse," long since abandoned by the history of the town. I could only imagine what its residents' lives had been like. Who were they, the women who had lived and worked here? why had they come to this frontier town so far from the bustling Eastern seaboard? had they found happiness here or misery? what became of them? Little did I know then that I would continue to ask similar questions about "working women" of the Californias. Having traveled all the way to the East Coast to pursue my doctorate, I returned to the West—to Tijuana, Mexico, a border town containing many of the same human elements left behind by the history of Nevada City, only on a much larger scale. This book is a product of those questions I asked as a girl in Nevada City and answered so many years later in Tijuana, a frontier town that is now the world's most frequently visited border city.


In thinking about a field project, I initially wrote a number of grant applications to study Mexican housewives, normative sexuality, and risk for HIV/AIDS. Having completed a project in college on normative sexual practices among Catholic college students, I was eager to explore the topic further by studying how housewives manage sexual risk within relationships that, while understood on an ideological level to be risk-free, are the primary route of infection for women across the world. I soon realized that because of the paucity of epidemiological evidence needed to persuade funding organizations that this was a topic worthy of study, each application was rejected (the funding climate surrounding the study of normative sexuality has changed somewhat since I submitted those first applications in 1998). Nothing if not practical, and needing to obtain funding to support my dissertation research, I eventually modified my proposals. Although I ended up receiving a grant to study the sex workers upon which this book is based, and although I am confident that the project led to useful and interesting findings, I must begin with this small caveat. My experience in trying to get funding for this project reflects the general funding climate that surrounds public health research on HIV/AIDS and the continued reinforcement of prostitute sexuality as deviant, dangerous, and polluting. Funding organizations continue to be attracted to ideas about sexual deviance and the dangers it appears to represent. Ironically, the commodification of sexuality, particularly women's sexuality, is anything but deviant, although its more obvious forms continue to be subject to public scrutiny and social control.


While I will always be grateful for the financial support I received, it's very important to me that my readers understand how we, as social scientists, become socialized to reproduce and reinforce the surveillance of so-called deviant sexualities, even when we begin with a very different agenda. Having decided to become at least somewhat compliant does not mean I failed to approach this study through a critical framework. First, although sexual health research in the era of HIV/AIDS tends to concentrate on female prostitution or male homosexuality or both, I sought to disrupt these stereotypes by including male, transgender, and female sex workers in my study and to focus on the gendered dimensions of sexual behavior within the industry. Work-related sexual behavior is also not conflated with assumptions of sexual orientation, and data on partnering practices were collected with a greater level of specificity than one might find in other studies. In addition, although funding was available through the National Security Administration for the study of Mexican sexualities as a national security issue for the United States, I instead concentrated on seeking basic science funding through the National Science Foundation America's Program. Also, in setting up this study I used every tool I knew of to avoid reinforcing the common stereotype of prostitutes as dangerous vectors of disease in need of control from above. I approached this topic with the idea that while there was bound to be a high level of diversity among sex workers, it was likely that, in comparison with their peers who were not sex workers, sex workers were more likely to be aware of sexual risks and more likely to take precautions to minimize them, at least when they were able to. I believe this is so for a number of reasons: sex workers have greater experience in the realm of sexual activity; they are likely to have more skill in negotiating sexual activities with their partners and controlling the sexual transaction; and finally, they are likely to more correctly identify and be aware of treatment options for sexually transmitted infections, including HIV/AIDS, and to understand and be actively engaged in protecting their reproductive health. Indeed, we now know that in the United States, for example, non-drug-using female sex workers consistently require their customers to use condoms in their commercial transactions, but not in their nonwork sexual relationships with boyfriends or husbands and are therefore more likely to become infected with a sexually transmitted infection through normative relationships than through sexual relations at work. The negotiation of occupational health risks does, however, take place within a multilayered context of intersecting social positions. Those who have the most difficult time negotiating these risks are women who are largely poor, who are often from a rural or indigenous background, and who often lack the documentation or are not of legal age to work legally. Transgender and youth sex workers also have a difficult time because of their place in the general social hierarchy. Drug-addicted sex workers, who may use sex work as a way to support their addiction, have a very difficult time negotiating safer sex at work because of the potential loss of income. On the other hand, those at the top of the sex work hierarchy as well as those involved in the sex workers' union have an easier time protecting both their financial interests and their physical safety at work. Thus social location within the hierarchy has a direct impact on workplace health and safety, making considerations such as social mobility, legal issues, and policy issues integral to understanding and minimizing sex workers' risk.


When some members of the local sex workers' union, tired of public health scrutiny and interference, remained skeptical and resentful of my project, I became frustrated, but I understood. As a researcher studying sex workers' health, particularly sexual health issues, I was perceived as part of the much larger picture of social control and body regulation that city officials, police, policymakers, and scientists enact through interventions that target prostitutes as reservoirs of infectious disease. However, I was convinced I could use this research as an opportunity to broaden the debate by moving beyond individual risk behavior in the sexual domain to incorporate the social determinants of occupational health and specifically the complex relationships among social hierarchy, working conditions, and occupational risk. This was also an opportunity, as I saw it, to broaden the way in which the health of sex workers is perceived, in that it should encompass more than genital health and include those aspects of health and safety seen as a significant priority among workers themselves, namely, workplace violence, mental health, drug use and addiction, social stigma, and human rights abuses by police.




Note: All photos are by the author. All gender-based tables refer to survey data collected from female (N=140), male (N=42), and transgender (N=16) sex workers involved in this study. All legal status tables refer to survey data collected from female sex workers only and are categorized as either Registered Female Sex Workers (RFSW) (N=33) or Unregistered Female Sex Workers (UFSW) (N=107).

"Health policy formation and implementation unfold in a world of competitive social interests, opposed class agendas, unequal genders, and overt and covert power conflicts. Health policy may produce structural violence, defined as the set of large-scale social forces, such as racism, sexism, political violence, poverty, and other social inequalities, which are rooted in historical and economic processes. As a result, health-related policies, which have the ostensive goal of improving and protecting the health of the general public or sectors thereof, may, in their service of other masters, harm rather than enhance public health."

Merrill Singer and Arachu Castro, 2004




This book is based on eighteen months of intensive anthropological field research conducted in Tijuana, Mexico (2000-2001). My primary goals were, first, to document the experiences of a diverse range of sex workers who live and work on the U.S.–Mexican border, and, second, to understand the impact of one's location in the social hierarchy on occupational health and safety. Although municipal laws, policies, and practices are shaped by existing social relations outside of the industry, they have a profound effect on social hierarchy within the sex industry itself. They may shift existing power relations, providing new arenas in which power can be claimed or negotiated. Alternatively, they may reinforce existing disparities and further disenfranchise those already marginalized by their position in society. An understanding of these complex relationships is therefore essential in developing effective programs and policies that positively impact sex workers' health and safety.


A variety of disciplines, from feminist social ecology to spatial epidemiology, have adopted, created, and transformed the concept of social geography in an effort to understand a multiplicity of social locations within the increasingly complex postmodern landscape. Feminist geography, for example, emphasizes the centrality of the body as a site of material, symbolic, and political struggle. It is a springboard for understanding everything from the gendered impact of economic development in industrializing countries to the polemics of sexual citizenship and gay marriage in the United States. Local struggles about prostitution law and policy form part of a larger story in which we tell ourselves which bodies need to be regulated and policed and which are safe to ignore. The bodies of prostitutes, prisoners, and immigrants, for example, tend to be seen as sources of danger and treated accordingly, whereas the bodies of "good citizens," however that locution is defined, tend to be viewed as embodiments of the sacred.


As the title of this book suggests, the concept of social geography and the mapping of health disparities and social difference are central to my approach in this book. The mapping of this social geography, if thought of in visual terms, would represent a series of intersecting continuums of power, identity, and difference upon which sex workers with a variety of background characteristics are located. Their locations, however, are not necessarily determined by their past so much as they are shaped and influenced by it. They are also shaped by the ways in which these social actors choose to navigate this complex social environment. These choices should be understood as rational (as opposed to a free choice), according to the distinction made by sex worker activists who acknowledge varying levels of opportunity, agency, and coercion constraining the decision-making ability and autonomy of the social actors involved. In this way, one's social location as a sex worker is incredibly significant in shaping not only the occupational risks one is exposed to, but also one's ability to negotiate or avoid those risks.


My definition of occupational health and safety is intentionally broad, encompassing quality of life issues, mental health, substance use and addiction, social stigma, and violence as well as the more familiar sexual health issues linked to the sex industry. In order to understand the effect of legalization on sex workers' occupational health, I approached this research with the following strategies in mind: (1) to compare occupational risk exposure and health outcomes between sex workers who work legally and those who work illegally; (2) to identify the impact of legal status on working conditions as well as the ability to negotiate improved working conditions; (3) to identify barriers to working legally; and (4) to generate ideas for structural interventions to improve health and safety. This approach raised interesting methodological challenges in terms of gaining access to what is essentially a bifurcated system with two sectors coexisting in the same geographical area—one formal, well organized, and legal, the other informal, individualistic, and criminalized.


Because sex work in Tijuana has a quasi-legal status (that is, it is neither explicitly legal nor illegal in law), the response to it has been mixed and varied over time. Grounded in a politics of difference that singles out some groups and geographical areas and ignores others, law enforcement and health inspectors have helped to create a social hierarchy of sex work that mirrors everyday relations of power intersected by gendered, classed, and racialized differences. While the harm reduction approach popularized by public health advocates emphasizes legal regulation, licensing, registration, and mandatory health screening, barriers to registration and licensing effectively limit the benefits of legal status to those at the top of the social hierarchy and further marginalize those at the bottom. Crackdowns by law enforcement fine, shut down, and imprison those who work illegally, thereby increasing their vulnerabilities, exacerbating their occupational risks, and limiting their ability to respond to these risks.


Sex workers (rather than their customers) have been conventionally portrayed as a bridge between low- and high-risk groups, a "disease vector" that in most countries has been controlled through various legal and public health mechanisms for hundred of years. Research on sex workers' health is generally conceived of in vary narrow terms. Sex workers tend to be viewed not in terms of their human complexity, but as prostitutes first and foremost, while other aspects of their lives that may influence their approach to sex work, their experiences while at work, their motivations to work, their family roles and responsibilities, and so on are ignored. When their personal histories are documented, it is often to present a picture of family dysfunction or sexual abuse or both, an inability to function in other forms of work, vulnerability to being manipulated by a pimp, and an inability to form affective attachments. Their lives are individuated and pathologized, while the political and economic factors that ensure an increasing supply of sex workers to serve an increasing demand for their services are rendered invisible. Often the nature of their work, because it includes sex, has been sexualized to the point that other aspects of the workplace are overlooked, discouraging a more systematic analysis of organizational dynamics, labor rights issues, and workplace health and safety. Thus nearly all public health research on sex work tends to focus on sexually transmitted infections (STIs) and, more recently, on HIV/AIDS, while other health and safety issues are disregarded.


In many countries, legalization of commercial sex work activities has been supported in order to reduce infectious disease among sex workers, their customers, and their customers' partners. Legalization has been conceived as a harm reduction measure meant to improve the health outcomes of sex workers by enforcing mandatory screening and treatment of STIs, including HIV/AIDS, presumably reducing their prevalence among sex workers. The impact of legalization on working conditions and other aspects of workplace health and safety, whether positive or negative, is unknown. Additionally, although the prevalence of STIs and HIV/AIDS among sex workers varies widely from country to country—it is less than 1 percent in some areas but as high as 90 percent in others—the effect of harm reduction through legalization has not been studied systematically. Outside of STI treatment and screening, little attention is paid to the effect of legal status on working conditions, conditions which are relevant not only to STI prevention and risk avoidance, but also to the many competing health and safety issues faced by workers. There is seldom any acknowledgment of those who continue to work illegally, no real engagement with the complexities of, and barriers to, legal status, and little attention to the disparate health outcomes between those who work illegally and those who work legally. Last, there is a need to develop an understanding of occupational health issues among migrant sex workers and those who serve migrant workers. The migration issue points toward the importance of political economy and social change, but additionally is at the center of debates about human trafficking, identity politics, and struggles over sexual citizenship. The volition of migrant sex workers, for example, is often denied or ignored in debates about human trafficking, whereas the rights of migrant sex workers to register and work legally are often limited because of citizenship and documentation restrictions. Thus our understanding of the special circumstances of migrant labor within the sex industry and of the relationship between migration status and occupational health and safety desperately needs to be developed through rigorous scientific research.


I found Tijuana, Mexico, to be the ideal location for this study. It is a city located on the busiest migration corridor in the western hemisphere, and the reputation of its legalized sex industry is fairly well known. When I arrived in Tijuana to begin my research, I was assaulted from every direction by commercialized sexual exchange. Recruitment posters, street workers, strip clubs, neighborhood gossip, planned expeditions—much of my new social world revolved around the most visible form of cross-border sexual relations, Tijuana's commercial sex industry. According to the city clinic that serves legal sex workers in Tijuana, approximately one thousand sex workers are currently working legally in Tijuana, with about three hundred newly legal workers replacing those who leave the industry each year. The number of full-time sex workers who work illegally is unknown. Based on my empirical observations of those whom I saw coming into the clinic (legal sex workers)and those obviously working but not participating in clinic services (and therefore illegal), I estimate that the number of those working illegally is much, much higher than those who work legally. In many parts of the city one can observe a thriving local sex trade, and these areas are not targeted by the health inspectors, who enforce mandatory registration and screening. In addition, certainly a large number work on a part-time basis to make ends meet. In fact, the majority of the sex workers discussed in this book engaged in sex work part-time before officially registering with the clinic. Those who are new to the city often work full-time without registering, until health inspectors and police make this option less appealing. After being threatened, fined, or jailed, some come to the clinic to register only to be told that because of their age or documentation status they aren't eligible to work legally. As a result, many continue to work illegally regardless of the consequences and simply do their best to work in areas where they are less likely to be caught or hassled by inspectors or police. Those who work illegally are not only greater in number, but also the most vulnerable to extortion, manipulation, and violence, and they have little legal recourse owing to their fear of prosecution.


Although there is no estimate of the total population of sex workers in Mexico, it has been increasingly recognized that Mexico is a favored destination for U.S. and European sex tourists (Hughes 1999), as evidenced by the fact that most homeless girls accessing shelter services have engaged in sex work before entering the shelter system (Harris 1997). Reflecting the unequal social standing of the United States and its neighbor to the south, the huge commercial sex industry in Tijuana came into existence primarily to serve the sexual needs, desires, and fantasies of American men; however, the enormous flow of Mexican and Central American male migrants traveling through the city has ensured a growing demand for the industry. Although U.S. tourists are easy to spot in the Zona Norte, the majority of customers seen in the red light areas and elsewhere are Latino migrants, not tourists. This migratory flow, as I illustrate in chapter 1, is closely tied to the historical and contemporary relationship between the United States and Mexico. The supply of and demand for prostitution on the border will continue to expand if these larger demographic shifts remain unchanged.


The growth of a highly commercialized sex industry marked by national and international trade and migration is not unique to the U.S.-Mexico border. Although commercial sex work is a widespread and visible phenomenon, it has been difficult to estimate the extent of industry worldwide because of its illicit nature. Additionally, in many countries, estimates come from a variety of sources using different methods and definitions. That such reports are not always explicit about those methods or definitions makes it impossible to correlate comparative data between national sources. Statistical referents are necessarily partial and flawed.


The portrait painted by these disparate sources, however, remains bleak. It is estimated that two million girls between the ages of five and fifteen are introduced into the commercial sex market each year (UNIFEM 2003), a market which includes up to forty-six million women worldwide. In Southeast Asia, the sex industry can account for up to 14 percent of gross domestic product (GDP), and remittances from sex workers to rural families sometimes exceed the entire budget of government-funded development programs (Lim 1998). Many of the six to eight hundred thousand persons who travel illegally across international borders each year are involved in the commercial sex trade (U.S. Department of State 2005). A recent report suggests that the number of commercial sex workers who migrate legally is estimated to exceed eight million (Health and Medicine Week 2004).


Measuring the extent of sex work is also complicated in that sex work exists on a continuum, with informal sexual exchange for a variety of resources, including food, shelter, and clothing, on the one hand, and commercialized sexual exchange on the other. Some activists in the area of sex work maintain that marriage itself is a form of sex work. Most of those who engage in informal kinds of sexual exchange don't identify themselves as sex workers, nor would they ever be arrested for their activities and counted in a national report. This book is about those who work on the commercialized end of the spectrum, for whom sex work has become the primary source of income.


Primary Findings


Although official discourse depicts sex work as a low-risk, harmless part of the entertainment industry in Tijuana, sex workers, like other workers, are at risk for a variety of health hazards related to their employment. The legalization model appears to benefit sex workers' health outcomes and reduce HIV risk among those who work legally, yet there are three problems with this model that may not be evident at first glance. First, there is little evidence of the impact of legalization on overall occupational risk among sex workers. Second, there is little official acknowledgment of those who continue to work illegally and hardly any research comparing health outcomes between these two groups. And third, given the likelihood that the subpopulation of those who work illegally is larger and that this group is likely to be the more vulnerable of the two, legalization as currently conceived is not enough.


The harm reduction approach offered by the city (legal regulations) has reduced occupational health risks for those women who are able to work legally. However, official portrayals mask severe social inequalities and a decreasing quality of life among Mexican citizens and contrast strongly with the lived experience of occupational risks faced by those who work illegally. Sex work is one of few opportunities for socioeconomic advancement and family survival for poor women. Policy interventions must therefore consider the socioeconomic context of the sex industry, particularly as it is shaped by northward migration within Mexico, continuing gender disparities, and the lack of viable economic alternatives. Any intervention that focuses only on the individual behaviors of sex workers is unlikely to affect the larger social context which allows the sex industry to flourish.


These findings suggest that health interventions and policies related to sex work should acknowledge the impact of legal status and policing on sex workers, the social diversity and stratification of sex workers, and sex workers' health priorities, which may give risk for STIs a lower priority in reference to other occupational hazards, including violence, substance abuse, stress, and depression. Legal status and police practices mitigate or, in the case of illegal workers, increase occupational risks, including risk for extortion, violence, and rape perpetrated by police. The legal and regulatory framework found in Tijuana shapes the social organization and status hierarchy of the sex industry as well as the ability of sex workers not only to claim a more professional and legitimate social status, but also to transcend highly stratified class lines.


In presenting my case, I provide narrative and survey data from both legal and illegal workers, a detailed analysis of the current social organization of the sex industry in Tijuana, the relationship between the sex industry and the political economy of the border region, and the occupational risks that are navigated by sex workers at each level of this stratified hierarchy.


Sexual and economic exchanges take place along a continuum of formal/informal, short-term/long-term social relations, including marriage, casual partnering, and commercialized transactions. Those who are denied access to resources in the formal economy can trade sex for the money or protection provided by men, either in the form of formal sex work or, on a more informal basis, through boyfriends and husbands. Gender, age, and class configure these relations of power, just as they do the social hierarchy found within the industry. A culturally informed understanding of emotion, romance, money, and power is essential in connecting what appear to be highly diverse kinds of sexual relationships. Sex work transactions are not immune to these dynamics. The range of sexual exchanges within this sexual economy could all be considered types of sex "work"—making the study of commercial sexual exchange in isolation problematic.


However, in order to examine particular legal and policy issues more explicitly, I focus on the lived experiences of sex workers involved in formalized commercial sexual exchange. Literature regarding the effects of the legal status of sex work represents a growing debate among social and political scientists and activists. Although such discussions originated in the reformist periods of the United States and Europe, the increasing institutionalization of sex work in many countries makes these renewed debates very relevant in terms of public policy and international relations today. While the debates regarding the ethics and efficacy of social control through regulation or criminalization are interesting theoretically, they often ignore the lived experience of the sex workers and customers who act within these legal systems.


The lived experience of sex workers often contradicts assumptions that are made on the basis of a generalized understanding of a criminal versus a legal, or regulated, sex work. First, in a system in which all sex work is criminalized, often only the most visible forms of outdoor, or street, sex work are policed, while indoor sex work through call services, escort agencies, the Internet, and massage parlors remains largely ignored. The existence of street sex work, which is the most visible evidence of an underground sex industry, continues unabated in most cities around the world. Although policing strategies can control the shape of the industry, the particular locations where it may occur, and the consequences of commercial sex transactions, they do not reduce the need for economic alternatives to sex work. The appearance of new solicitation sites following crackdowns is inevitable if there is no strong intervention program in place to offer alternatives. Policing strategies and the treatment of criminalized sex workers differ according to changing political demands—thus the experiences of, and the risks associated with, criminalization fluctuate according to the historical moment. Crackdowns are rarely sustained efforts; they are generally short-term events that give the appearance of solving the problem while only moving it further underground.


In a system in which sex work is regulated through legal means, as is the case in Tijuana, the impact of those regulations varies according to one's position within the formal and legal or informal and illegal sector. In a regulated system, legal age, documentation, and citizenship status largely determine whether one is allowed to work legally within that system. In additional, classed, gendered, and racialized physical attributes and conceptions of beauty form the structure of social stratification within this hierarchy and determine the kind of work venue that is available to any particular individual. Because the work venue plays such a strong role in shaping occupational risks, one's social position prior to entry into sex work is crucial in determining one's occupational experiences.


Theoretical Foundations


My approach to the health of sex workers in this book has been shaped primarily by social science scholarship on women's health, particularly those approaches that emphasize the impact of political economy, structural violence, social geography, gender, and social change. The majority of these scholars are anthropologists (and critical medical anthropologists, more specifically) who have applied their approach to understanding structural risk for HIV/AIDS infection. The framework used by critical medical anthropologists "emphasizes the importance of political and economic forces, including the exercise of power, in shaping health, disease, illness experience, and health care" (Singer and Baer 1995: 5). These contributions demonstrate the interconnectedness of the biological with social, political, economic processes, forcing one to move beyond the medical gaze in understanding health and illness toward an understanding of health disparities and social justice.


The intersectionality paradigm has also been a significant underlying framework of this book. The theory of intersectionality works to highlight the multiple and interconnected ways in which subordination affects women's experiences, their help-seeking behaviors, and their ability to manage the risks in their lives. For example, researchers have examined the multiple structural oppressions faced by victims and survivors of intimate partner violence, and they have explored as well the question of agency in the face of multiple forms of oppression (Connell 1997; Crenshaw 1994). While the threat of male violence may exist for all women, it is only one aspect of the systemic subordination experienced by, for example, poor women of color. Poverty and racism compound both the experience of physical abuse and women's ability to receive the support needed to leave abusive situations or to hold their partners accountable for the abuse they have inflicted. In a move away from a hegemonic feminism that universalizes women's experiences of gendered subordination, many feminist scholars now attend to the complex interrelationships between gendered subordination, racial discrimination, and economic deprivation. It is this framework that sets the foundation for understanding the multidimensional relationship between individuals' position within the sex work hierarchy, their differential exposure to occupational risk, and their capacity to successfully manage those risks in everyday life.


In the hierarchy of sex work, gender, race, and class are not the only social forces impacting the experiences of individual sex workers. Legal status, age, work site, and language skills also shape work experiences by filtering the kinds of customers they may come into contact with, the kinds of working conditions they may have to deal with, and the relationships they might have with health inspectors, clinic staff, and police. Occupational risks are not distributed evenly. And the ability to deal successfully with occupational hazards depends on one's position in the hierarchy and the kinds resources one has at hand.


Because of the high degree of social diversity within the sex industry and the lack of basic research on sex work in Mexico, this book was especially challenging to write. In an effort to encompass the broad range of sex workers' experiences in Tijuana and to illustrate links between their personal narratives and practices and the larger social environment of which they are a part, I attempt to capture a range of experiences within the sex industry and to make sense of how work experiences are related to one's social background. I include personal narratives in order to detail how commercial sex workers navigate and negotiate their everyday work lives; these subjective understandings are contextualized within more quantitative data on health outcomes related to work activities. Along the way, I also suggest structural interventions—that is, interventions that go beyond the realm of individual behavior and into the realm of policy, law, and other reforms—that could facilitate positive health behaviors and outcomes by reducing social constraints.


Outline of the Book


In chapter 1 I briefly outline the origins of commercial sex work along the border. From the early colonial period onward, residents of the Tijuana–San Diego region have utilized class and race relations to establish a commercialized sex industry and govern sexual relations. Unequal relations between the United States and Mexico have allowed the United States to practice a policy of containment that repeatedly attempts to discourage vice on one side of the border (the United States), while allowing the vice industry on the other side of the border to flourish.


In chapter 2 I examine the role of rapid urbanization, border migration, and structural inequality in furthering the expansion of the Tijuana sex industry. Understanding the sex industry within the context of the shifting political economy of the border helps one develop a more general understanding of the relationship between health and social change as well as of the position of the sex industry in relation to other contemporary social and economic features. For example, the global assembly line, in which the manufacturing industry employs a spatial strategy at the international level to generate increased profits, has had a tremendous impact in drawing young women and girls to the border in search of factory employment. Discouraged by low wages, long hours, sexual harassment, lack of advancement opportunities, and the rising cost of living, some of these new residents leave the factory to engage in sex work, adding to the already plentiful supply of commercial sex workers. Human trafficking and sexual slavery, both of which are encouraged by structural inequalities between the United States and Mexico and facilitated by conditions on the border, also play a role in generating supply and demand of sexual services on both sides of the border. Although none of the participants in this study reported a history of sexual slavery, the relationship of human sexual trafficking and other forms of trafficking to the rest of the industry is too important to be overlooked.


Although their options are limited by the structural violence of material constraints, poverty, lack of education, and gender-based discrimination, those who engage in sex work continue to act within these constraints in an effort to improve their quality of life. In chapter 3 I explore, through their own words, the ways in which my participants became familiar with and interested in commercial sex work. Although engaging in sex work negatively impacts one’s sexual and social respectability, the reality of life in Tijuana, poverty, limited opportunities for economic advancement, partner abandonment, family responsibilities, and drug addiction create a context wherein sex work, which certainly carries very obvious physical and social risks, begins to make sense in relation to the available alternatives.


I continue in chapter 4 by illustrating the social and geographic contours of the industry, highlighting the role of


policing and social stratification in shaping a social hierarchy that has a profound influence on how sex work activities are experienced and managed. I adduce specific details about the social geography of the industry, laying the groundwork for understanding the relationship between social relations and occupational health outcomes.


Fear of sex workers as vectors of sexually transmitted infection has led to calls for the increased regulation of sex workers via registration, mandatory testing, and criminal penalties. Though this system is intrusive, compliance can benefit workers in the formal system. Illegal workers, however, face added risk as a result of their legal status. Thus, in chapter 5 I present the intricacies of the regulation system in Tijuana and consider how policing strategies affect occupational risk for violence, mental health problems, and STIs, including HIV/AIDS. In particular, I compare the differing risks faced by legal and illegal workers and discuss how the police mitigate or, in the case of illegal workers, increase occupational risks. This regulatory framework shapes not only the occupational risks faced by sex workers, but also the social organization of sex work more generally as well as the particular place of a sex worker within the commercial sex hierarchy, the ability to claim a more professional social status, and the likelihood of transcending highly stratified class lines. Last, I profile those female sex workers who tested positive for HIV in this study and examine how one might understand their risk for HIV infection in light of these findings.


In chapter 6 I discuss the effects of gender in defining the experiences of individual sex workers. I present a discussion of narratives on stigma, mental health, and drug addiction to deepen understanding of this process and help address the special needs of female, male, and transgender sex workers within this system. I pay particular attention to the role of gender in organizing sexual and drug-related risk for HIV/AIDS.


In the conclusion, I summarize the major findings of my research in Tijuana and the role of law and policy in shaping occupational health and safety. I then identify the specific problems with the Tijuana regulatory model and examine these findings in light of the debates surrounding sex work and the law. Finally, I explore how these policies might be reimagined in order to better address sex workers' occupational health.




It was not until I had been living in Tijuana for a number of months that I realized how structurally diverse the commercial sex industry is. My goal of writing a purely qualitative study shifted as I began to strategize about how to incorporate this diversity and, more specifically, to identify patterns in the relationships between social diversity, social hierarchy, and health outcomes. In order to capture a multiplicity of experiences and perspectives from different points within the sex work hierarchy, I used a combination of participant observation, informal conversational interviews, semistructured interviews, and surveys conducted in a variety of settings. The use of targeted, purposive sampling allowed me to explore potential themes within a broad range of diverse work experiences. I talked with customers, professionals, researchers, and policymakers—but I collected the most extensive data from talking with sex workers themselves. In all, I carried out 251 formal interviews with sex workers, 88 of whom worked legally (86 females, 2 transgendered females), and 160 of whom worked illegally (107 females, 14 transgendered females, 42 males).


Potential subgroups of sex workers were identified through my own observational research and conversations as well as through my familiarity with other research on sex workers in other cities. The subgroups differ in terms of occupational experiences and risks, treatment by city officials and policy, gender and sexual orientation, and educational, class, and regional background. The majority of research on sex workers has focused on one subgroup to the exclusion of others (that is, males or females, strippers or hookers) with the majority of research studies focusing on female street hooking. In this study, I targeted a range of subgroups with respect to their work venue (strippers, brothel workers, street hookers, massage parlor workers, call services). See the accompanying early dendogram, or tree diagram, that I created based on locale and work venue.


Participant Observation


I lived for eighteen months in Tijuana observing the commercial sex scene in Zona Norte, the red light area closest to the U.S.–Mexico border, Avenida Revolución, the most prominent tourist area, and the beaches and parks in Las Playas de Tijuana, a popular cruising and hooking area for men who have sex with men. What does participant observation mean in the study of the sex industry? Although some researchers have relied on their own sexual experiences or participation in a sexual arena (Bolton 1995; Carrier 1999) or commercial sex venue (Frank 2002) to gather data, I did not participate in the sex industry as either a client or a sex worker. I did, however, participate in the social life of people involved in the industry and in that of some of their customers. These informal conversations usually took place outside of the work venue and were very important when I first arrived in the field and was trying to get my bearings. They also helped me revise my survey questions, identify recruitment areas, and discuss my findings. I was straightforward about my intention to study the local sex industry, garnering many interested questions and commentary from local residents. Although many were reluctant to disclose their activities and a few never openly acknowledged their role in the sex industry, fear and mistrust about the project seemed to wane after time.


Semistructured Interviews


After obtaining informed consent, I collected 53 interviews with sex workers at the city clinic. These case studies provided preliminary details about the experiences of 50 female and 3 transgender sex workers who worked legally and received services from the clinic. It soon became clear that the sex workers I was speaking with represented only a small portion of the population of sex workers in Tijuana. This forced me to develop a more complex research design based on the local social organization of the industry. Even though the interviews were collected systematically, some areas within the interview schedule are covered more extensively with some participants than with others. Some included narrative data on areas perceived as significant to a handful of participants or to an individual participant, but not relevant to other participants. Also, as is commonly the case with qualitative data collection, I made constant revisions to the interview schedule, including new lines of inquiry as they emerged. The first set of interviews is therefore different from the last set, making statistical comparisons unfeasible. The interviews, which were carried out in Spanish, ran from one to two hours in length. In compensation for their time, I provided all participants with HIV/AIDS counseling, snacks, and refreshments as well as a copy of my research findings (in Spanish), made available through the clinic. All interviews were confidential and took place over a period of two months, April and May of 2001.




After working in Tijuana for about six months, I received a grant from the National Science Foundation which allowed me to expand my study to include survey data and HIV-antibody testing. My survey instrument included both closed and open-ended questions. After obtaining informed consent, the interviews were conducted in private locations near work sites or in a local café. Occasionally, the interviews were interrupted by potential customers. Each interview was conducted in Spanish and was approximately an hour long. All interviews and HIV tests were confidential. In compensation for their time, all participants received five dollars and refreshments, HIV/AIDS prevention information and counseling, an HIV-antibody test using Orasure, and, when applicable, referrals to public services. The provision of HIV testing undoubtedly encouraged participation in the study, as free, reliable, and confidential HIV testing and counseling were not widely available. The basic demographic distribution of this survey sample is shown in the accompanying chart.


The survey data presented are not representative of the entire population of sex workers in Tijuana. However, these data allowed me to capture the diversity of occupational experiences and practices among sex workers in Tijuana and to make comparisons among workers based on legal status, gender, and sexual orientation. This is highly important because there are no comprehensive or comparative studies on the sex industry in Tijuana. In my study, I found the ratio of those working illegally to those working legally to be approximately two to one. The actual proportion of workers in each sector is unknown. As mentioned previously, because this study started in a clinical setting with legal workers, the number of those working legally is not representative of the total number out in the real world. In addition, although legal workers were not targeted for inclusion in the survey phase of the project, they were not excluded from participating if they asked to do so. In some cases, they were peer leaders whose participation encouraged the participation of less experienced illegal workers. In others, they were enthusiastic, curious, or desirous of a free, reliable HIV test. Their contributions offer an important contrast to the experiences of those working illegally.


After collecting these surveys, I used NudIST ethnographic software to combine narrative data from field notes, semistructured interviews, and surveys. Numeric survey data were assessed and analyzed with SPSS and were then contextualized through narrative data.



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