Abstract
Background:
Some female sex workers (FSW) are initiated into sex work underage (<18 years) and/or through coercion, potentially increasing vulnerability. We estimated the contribution of these factors to HIV transmission in Tijuana, Mexico.
Methods:
Using data from three bio-behavioural studies among adult FSWs in Tijuana (2003–2015), regression analysis assessed associations between underage or coerced entry into sex work and increased sexual or injecting risk behaviours. A dynamic HIV transmission model projected the proportion of new HIV infections prevented among FSWs over 2025–2034 from removing any additional risk behaviours associated with underage or coerced entry into sex work.
Results:
Across studies (881 FSW), 10.1–39.0% of FSW reported initiating sex work underage, which was associated with client volume (adjusted rate ratio: 1.33; 95%CI:1.15–1.54), recent injecting drug use (IDU last 6 months) (adjusted odds ratio [aOR]: 1.74; 95%CI:1.08–2.79) and decreased odds of always using condoms (aOR: 0.75; 95%CI:0.53–1.06). Additionally, 19.0–20.7% reported coerced entry into sex work, which was marginally associated with recent IDU (aOR: 1.50; 95%CI:0.97–2.31).
Removing the additional risks associated with underage or coerced entry into sex work from 2025 could prevent 33.0% (95%CrI:23.8–40.8%) of HIV infections amongst FSWs that started underage, 18.5% (95%CrI:11.3–28.3%) among FSW that were coerced, and 10.3% (95%CrI:6.8–14.5%) among all FSWs. If underage and coerced entry into sex work could also be stopped, then 22.3% (95%CrI:18.4–26.9) of HIV infections could be prevented among all FSWs.
Conclusions:
Underage and coerced entry into sex work could be important drivers of HIV transmission among FSWs in Tijuana.
| Original language | English |
|---|---|
| Journal | AIDS (London, England) |
| Early online date | 23 Jan 2026 |
| DOIs | |
| Publication status | E-pub ahead of print - 23 Jan 2026 |
Bibliographical note
Publisher Copyright:© 2026 Wolters Kluwer Health, Inc. All rights reserved.
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This is the accepted author manuscript (AAM) of the article which has been made Open Access under the University of Bristol's Scholarly Works Policy. The final published version (Version of Record) can be found on the publisher's website. The copyright of any third-party content, such as images, remains with the copyright holder.
- Supplementary information PDF
This is the accepted author manuscript (AAM) of the article which has been made Open Access under the University of Bristol's Scholarly Works Policy. The final published version (Version of Record) can be found on the publisher's website. The copyright of any third-party content, such as images, remains with the copyright holder.