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FSW-IDUs there also demonstrated greater perceptions of increased police deployment across allwith army deployment perceived to have increased by the vast majority of respondents. The study's dual-site de affords the opportunity to compare a city experiencing continued escalation in deployment of law enforcement Ciudad Juarez with one where deployment has leveled off Tijuana.

Questions included age, marital status, income, and housing. OBJECTIVE: To compare distributions of human rights violations and disease risk; to juxtapose these patterns against demographic and structural environmental variables, and to formulate implications for structural interventions.

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Disease acquired as a result of adverse police practices can spread quickly through FSW-IDU networks, fueling concentrated epidemics among high-risk groups as well as transmission to the general population. Pervasive corruption, high rates of injection drug use and sexual abuse, and other human rights abuses make them venues for increased sexual and injection risk Sexual violence perpetrated by state actors imposes a particularly heavy burden because of low self-efficacy to seek justice in the aftermath and the lack of adequate medical and social services to mitigate the long-term effects of trauma 30, Especially prevalent and acute in conflict settings, forced sexual encounters with uniformed personnel can generate a cascade of detrimental health consequences, including post-traumatic stress, substance abuse, and elevated risk of STIs Violent conflict produces detrimental consequences on community health independent of police and army abuse 3, 32, 33so contextual levels of structural violence can only aggravate the individual-level risk flowing from the experiences observed in this sample.

Demographically, ificant differences were observed between the Tijuana and Ciudad Juarez samples for a of indicators, including the median percent of respondents describing themselves as homeless 8. Relative to Tijuana, respondents from Ciudad Juarez reported ificantly higher levels of police abuse across the spectrum of San, including syringe confiscation, requests for free sexual services, financial extortion, and robbery.

Eligibility criteria included being at least 18 years escort, reporting unprotected sex with a male client in the past month, having injected drugs and shared injection equipment in the past month, and agreeing to accept free treatment for STIs if medically indicated. Although causality cannot be determined in this cross-sectional analysis, it is notable that ificantly greater prevalence of sexual service extortion and marginally Diego prevalence of police sexual abuse in Ciudad Juarez paralleled larger proportions of respondents pakistani infrequent condom use with clients and being paid more for unprotected sex.

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The Wilcoxon rank sum test was used for all continuous outcomes because these variables tended to have non-normal distributions. Structured interviews and testing for sexually transmitted infections STIs were conducted October to October Frequencies of individual and environmental factors, including police abuse, risk of HIV infection, and protective behaviors, were compared between sites using univariate logistic regression. Compared with women in Ciudad Juarez, a smaller proportion of Tijuana women lived in the city of the interview their entire life The prevalence of risk factors for infectious diseases generally differed ificantly at the two sites.

Se analiza la urgencia para establecer intervenciones estructurales.

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Removal of injection equipment directly reduces IDUs' access to clean injection equipment, while increasing the likelihood of syringe sharing. Experience of extrajudicial syringe confiscation carries a public health detriment through a different set of mechanisms. Key words: Sex workers; substance abuse, intravenous; human rights abuses; violence against women; HIV infections; communicable diseases; vulnerable populations; Mexico. Relative to Ciudad Juarez, a larger proportion of Tijuana respondents reported syringe sharing more than half the time Compared with Ciudad Juarez, more Tijuana respondents reported often or always injecting drugs with sex clients In Ciudad Juarez, sexual risk behaviors were ificantly more prevalent, including higher median monthly of clients [6.

Mexico's northern border conflict: collateral damage to health and human rights of vulnerable groups. As many researchers ly found 15, 19, 23, 27, 28reported levels of police abuse corresponded to elevated vulnerabilities in a of risk behavior and health outcome domains. The urgency for mounting structural interventions is discussed.

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Other components of the physical, social, and economic environments understood to influence disease risk were assessed, including migration and deportation experience, homelessness, and earnings from commercial sex activity Descriptive statistics were used to compare baseline sociodemographic, behavioral, economic, policing, and disease characteristics by city. Analogous paradigms frame the health consequences of extortion and robbery by police. Relative to Tijuana, security deployment, especially the army's presence, was perceived to have increased more in Ciudad Juarez in the past year Itinerant officers may facilitate disease spread beyond the region.

The public health consequences of these macro forces have been analyzed to some extent in conflict and transitional settings 5, 11 but have not been considered in the context of Mexico's violent struggle against drug cartels. Perceptions of changes in the sex work environment, such as levels of police and army deployment, frequency of FSW arrests, cartel visibility, and built environment e.

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On the basis of our findings, this study provides recommendations for public health and public security research and policy. Collected data included sociodemographics and sexual and drug use risk behaviors. Sex work in Tijuana formally exists under a permit system, although approximately half of FSWs skirt requirements such as age limitations and periodic testing for STIs Mexican laws also permit over-the-counter access to pharmaceuticals, but many IDUs report difficulty purchasing syringes because of arbitrary restrictions and discrimination Past research in the U.

Arrest for possessing syringes was also independently associated with a threefold increase in the odds of receptive syringe sharing 23 and use of shooting galleries 24both which are known risk factors for the spread of HIV and other blood-borne infections.

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Despite keen interest in the northern border conflict, its public health impact is poorly understood. Research from postconflict settings indicates that such violence against women, often perpetrated by military groups, can become normalized in the wake of political unrest and displacement 4, 5. As FSWs respond to these practices by protecting their financial interests and physical safety, these behavioral pressures can force even legitimized sex markets underground In the context of furtive sex transactions, FSWs experience decreased ability to negotiate condom use, impaired leverage to demand fair pay, and increased risk of victimization by clients 6.

Relative to Tijuana, substantially larger proportions of Juarez respondents reported earning more for unprotected sex Lifetime experiences with public health services were similar across sites, including the proportion who had attended a syringe exchange program in the past month However, the sites differed ificantly in terms of lifetime prevalence of drug treatment Experiences with police and trends in structural environment.

Items related to sexual behavior included age at initiation and reasons for entering sex work and sexual practices. According to international best practices and guidelines of the United Nations Office of Drugs and Crime 38contact with these institutional structures can serve as an important opportunity for delivery of HIV testing, treatment, education, and opioid substitution therapy.

The median age of drug initiation was 20 years and median age of sex work initiation was 19 years.

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Sexual and gender-based violence has been inflicted in war zones and refugee camps throughout the world, with grave implications for physical and mental health outcomes 2, 3. Meanwhile, given the large of itinerant federal military and police personnel in the Northern Border Region, these data illuminate a substantial risk of diffusion of STIs once itinerant soldiers return to their places of origin 36, This pattern would parallel phenomena repeatedly observed on other continents, where itinerant troops effectively distributed an epidemic from an epicenter conflict locale to populations in their places of origin 33, Only about half of the respondents in this study reported ever having an HIV test, and only about 1 in 10 had ever participated in a syringe exchange program.

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Questions on drug use included age at first injection, drugs used, and frequency. These questions included lifetime and past 6 months' experience of syringe confiscation, extortion, and physical and sexual abuse, although respondents were not asked about their experience of unwanted or unplanned pregnancies. At a time when deaths from drug-related violence along the northern Mexico border continue to mount, the deployment and militarization of law enforcement in the region has reached unprecedented levels 13, Composed of federal army and police working alongside state and municipal law enforcement, this force lacks coordination in command and control and has been implicated in a range of human rights abuses, including violence against FSWs 13, 15, Law enforcement officers especially at the municipal level have been accused of corruption, including racketeering, extortion, and actually managing drug and sex markets Elevated levels of drug use have resulted from spillover along the U.

FSW-IDUs exhibit particular vulnerability because they can acquire communicable infections through both the sexual and the injection routes; this subgroup may also act as a bridge through which HIV and other sexually transmitted infections STIs are spread from higher-prevalence to lower-prevalence populations 15, 20, Unlike many other countries, Mexico does not formally prohibit prostitution on a national level, leaving its regulation up to local determination.

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Respondents reported relatively high prevalence of incarceration and drug treatment experiences. Providing free sexual services is a frequent form of extortion by police and the military 25, Widespread abuses of FSWs by police and the army in hotspots like Tijuana and Ciudad Juarez can have public health consequences far beyond the region.

Strathdee I. Send correspondence to: Leo Beletsky, lbeletsky gmail.

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Such activity also deters IDUs from carrying syringes to avoid confiscation and extortion practices, while potentially creating real and perceived barriers to utilization of syringe exchange programs, pharmacies, and related public health prevention services 33, Syringe confiscation has been associated with increased risk of infection 28, 35, In this escort, although a larger proportion of Ciudad Juarez respondents reported syringe confiscation and a slightly larger proportion reported lifetime prevalence of syringe sharing, other indicators of injection risk, such as frequent receptive syringe sharing, were higher in Tijuana.

After informed pakistani was received, computer-assisted surveys and biological testing for HIV and STIs were administered by outreach staff. The study instrument and research methodology have been described in detail elsewhere Between October and Octoberparticipants were recruited in venues frequented by FSWs bars, street corners, motels as part of a behavioral intervention study to reduce injection and sexual risks. Horrific and irreparable damage caused by these civil and human rights violations goes well beyond the physical and psychological health of the individual women.

In recent decades, public health research has become increasingly concerned with the effect of structural violence and militarized conflict, including violence against women and broader gendered human rights violations on long-term physical and mental health outcomes 1. Univariate logistic regression was used to compare individual and structural HIV risk and protective factors between cities, treating Ciudad Juarez as the reference group.

An even larger proportion Across the samples, As shown in Table 3across severallaw enforcement deployment was perceived to have increased more in Ciudad Juarez, including federal police There were no Diego differences between cities in terms of perceived changes in levels of street violence However, Tijuana respondents reported more of an increase in client violence In terms of trends in service access, Tijuana respondents reported ificantly improved access to health care This study analyzes FSW-IDUs' experiences relating to the risk environment related to criminal justice in the context of Mexico's northern border conflict.

Given the dynamics of survival and street-based sex work, FSW-IDUs face elevated risk of violence from clients, pimps, and law enforcement Human rights abuses such as physical violence and extortion by uniformed personnel San especially dangerous because they push commercial sex activity underground, where FSWs are less able to negotiate safer practices 6.

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The substantially higher prevalence of STIs in this city and lack of improved access to prevention and health services further underscores the dire situation of vulnerable populations in this conflict setting. Given the compounded gender and power imbalance, it is unlikely that FSWs can exert control over their sexual encounters with police, which contributes to the individual and network risk of transmission of STIs, including their abusers.

Given that HIV prevalence was comparable across cities, research assessing additional proximal risk factors is needed to unveil the public health impact of syringe confiscation on risk of infection.

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Reports of recent solicitation of sexual favors Ciudad Juarez respondents reported ificantly higher median of monthly clients 6. In contrast, in Ciudad Juarez, few women reported improvements in any of these services over the past year.