Prevalence and Characteristics of Abuse Experiences and Depression Symptoms among Injection Drug-Using Female Sex Workers in Mexico

This mixed methods study examined the prevalence and characteristics of physical and sexual abuse and depression symptoms among 624 injection drug-using female sex workers (FSW-IDUs) in Tijuana and Ciudad Juarez, Mexico; a subset of 47 from Tijuana also underwent qualitative interviews. Linear regressions identified correlates of current depression symptoms. In the interviews, FSW-IDUs identified drug use as a method of coping with the trauma they experienced from abuse that occurred before and after age 18 and during the course of sex work. In a multivariate linear regression model, two factors—ever experiencing forced sex and forced sex in the context of sex work—were significantly associated with higher levels of depression symptoms. Our findings suggest the need for integrated mental health and drug abuse services for FSW-IDUs addressing history of trauma as well as for further research on violence revictimization in the context of sex work in Mexico. 1. Introduction The United Nations defines violence against women as “any act of gender-based violence that results in, or is likely to result in, physical, sexual or mental harm or suffering to women, including threats of such acts, coercion or arbitrary deprivation of liberty, whether occurring in public or private life [1].” Examples of gender-based violence include but are not limited to intimate partner violence, sexual violence, sexual abuse of female children, sexual harassment and intimidation in the workplace, and commercial sexual exploitation [2, 3]. Various forms of gender-based violence against female sex workers (FSWs) have been documented worldwide [4–13]. Likewise, there is extensive literature examining the mental health consequences for women in general of gender-based violence [14–18]. However, less research has been done on the relationships between FSWs’ mental health status and gender-based violence, especially among FSWs who inject drugs (FSW-IDUs) in Mexico. Several studies find that many FSWs are enmeshed in chronic patterns of violence victimization and substance use resulting in elevated levels of psychological distress [8, 9, 19–21]. Most of this research has focused on psychological distress rather than on depression symptoms. FSWs’ early exposure to violence, such as childhood sexual abuse, may have long-term mental health consequences. For example, Surratt et al. [20] found that history of childhood abuse and recent violence victimization by clients were associated with serious mental illness among street-based FSWs in Miami, Florida. Cwikel et al. [22] found that