The 2030 Agenda for Sustainable Development [1
] adopted by the United Nations (2015) aims to “achieve gender equality and to empower all women and girls globally” (Goal 5) by “eliminating all forms of violence against women and girls, including trafficking and sexual and other types of exploitation” (5.2), and “ensuring women’s full and effective participation and equal opportunities for leadership at all levels of decision-making in political, economic, and public life (5.5).”
With this in mind, our study, Mujeres Unidas, used asset-based community development (ABCD) as a sustainable development strategy to focus on community strengths and assets as a way of developing and sustaining a supportive community of marginalized women instead of focusing on deficits or needs alone [2
]. Kretzmann and McKnight (1993) developed ABCD with origins in community organizing, sociology, and urban affair, and social work embraces this ABCD’s strengths-based approach to uplifting communities. Applied globally, ABCD recognizes local capacities and mobilizes citizens’ resources in lower-income communities [2
]. As part of ABCD, we focused on community mobilization (CM) as a “capacity-building process through which individuals, groups, or organizations plan, carry out, and evaluate activities to improve their health and other needs” [3
]. CM empowers individuals and groups to take action to affect change at policy levels (e.g., influencing government, police, health systems) via “mobilization of resources, disseminating information, generating support, and fostering cooperation across public and private sectors in the community” [4
]. ABCD encourages a whole community approach to addressing the needs of a group by tapping into external social capital where few supportive services exist.
Related to another UN sustainable development goal to ensure healthy lives and promote the well-being of all (Goal 3) [1
], we focused on examining human immunodeficiency virus and sexually transmitted infections (HIV/STIs) among women in the sex trade. This UN goal aims to “end the epidemics of AIDS and other communicable diseases (3.3), and strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol (3.5)”. Globally, women trading sex have 14 times the risk for HIV relative to same-age women in the general population [6
]. However, social and structural community factors often determine HIV risk among those in the sex trade [7
]. Women using substances in particular face greater harm and social isolation [11
Women trading sex have taken collective action to reduce their risks of violence, abuse, HIV/STIs, and to increase their access to healthcare and other income [13
]. For example, they have mobilized for human rights via a group, meeting, or marches, sharing concerns and helping each other. CM has reduced HIV/STI risk among women in the sex trade in India, the Caribbean, Brazil, and Africa [13
]. Its dissemination in India has resulted in significant reductions in HIV prevalence at regional levels [22
]. Women have built consciousness and solidarity among their peers through rights-based framing while diffusing HIV prevention messages to the community [15
]. In the context of HIV, persons trading sex have mobilized for their occupational health and safety, e.g., through HIV prevention organizations [23
]. Community mobilization has also been successful in reducing HIV among persons using substances in India and the U.S., using a harm reduction approach [28
However, some of the most marginalized women, those using substances in the sex trade, are excluded from mobilization efforts, e.g., from other groups in Mexico [30
]. Yet many could benefit from an ABCD approach to escape substance use, violence victimization, and harms to their health. HIV prevalence is higher among women in the sex trade who use substances (12% among those injecting drugs vs. 6% among those who did not) [31
]. In a study of 924 women trading sex in Tijuana, one in five ever injected drugs and 16% injected in the past month [32
Therefore, Mujeres Unidas integrated community mobilization measures [14
] into the Rhodes’ Risk Environment framework [34
] to examine the prevalence and potential of CM in the micro-and macro-level physical, social, economic, and policy risk environments facing women in the sex trade in Tijuana, Mexico. Until now, the potential for women using substances in the sex trade to engage in CM and ABCD approaches in this US-Mexico border region had not been demonstrated. We argue that the exclusion of women using substances in the sex trade from services and organizations should be re-examined through the contexts of risk environments and ABCD approaches. Therefore, we aimed to examine the prevalence of and potential for community mobilization and its association with HIV/STI risk, substance use, and violence victimization among women in the sex trade in Tijuana, Mexico.
This study broadens previous community mobilization models and the Rhodes risk environment framework to encompass barriers and enabling factors for CM in the context of four risk environments faced by women in the sex trade, particularly those who use substances, in Tijuana, Mexico. The results indicated that the women in the sex trade participated in community mobilization less if they used substances, but more so if they witnessed violence at work or believed in a right to a life free from violence. However, the triangulated results of qualitative interviews with government and non-government service providers and the women using substances who engaged in Community Advisory Board meetings demonstrated a potential for asset-based community development to occur for those who are the most marginalized. The women using substances found community and voice with each other, despite common beliefs that injecting and non-injecting women could not come together. As part of asset-based community development, service providers began to engage with the women during these CAB meetings.
In terms of the integration of CM into Rhode’s risk environment framework, the results indicated that the physical risk environment—witnessing violence where they worked—may motivate women in the sex trade to address their human rights with others. Likewise, in the socio-political risk environment, talking and working with peers to change a situation, and believing in the right to a life without violence, were associated with greater participation in community mobilization. These findings coincide with other studies of women in the sex trade who have experienced violence or police abuse, and at times mobilized against it [61
]. On an economic and individual level, those who mobilized tended to have more access to free condoms, perhaps indicating decreased isolation and greater access to knowledge and resources about HIV prevention.
However, understanding the needs of women in the sex trade beyond HIV prevention and condom distribution can be an important step for delivering more effective structural interventions, especially where women have few resources to stop their substance use or sex trade involvement on their own. Women expressed the need to help those trapped in the sex trade. For those using substances, community mobilization was successful among those in India and the United States, e.g., using peer educators to disseminate information on needle syringe exchange [68
]. Such strategies can assist women with recovery when they need it [70
Findings from the qualitative interviews with service providers illustrate both barriers and potential for asset-based community development to occur in this community. Government and non-government agencies at the municipal and state levels could address the human rights of this vulnerable population through a collective impact model [71
]. Such a model would bring together sectors such as substance use providers, women’s rights and domestic violence agencies, child welfare, homelessness agencies, HIV and medical clinics, police, and human trafficking organizations to address the violence, substance use, and health risks these women face. Such efforts could address the isolation, stigma/discrimination, and abuse the women endure despite the registration of women in the sex trade and mandated government clinic STI check-ups. Women could have a seat at the table such as the human trafficking survivors who now assist others exiting the sex trade in San Diego County, U.S.A.
6. Final Considerations/Recommendations
This study examined the community empowerment of women trading sex in Tijuana, Mexico, corresponding to the World Health Organization guidelines “to reduce HIV infections among women in the sex trade by improving their access to health services based on a human rights approach [69
]” as well as the UN sustainable development goals outlined at the beginning of this paper. Building on CM measures by examining the prevalence of CM within Rhode’s Risk Environment framework, Mujeres Unidas discovered that women using substances in the sex trade were less likely to mobilize, yet they faced the greatest harms and were excluded from some organizational assistance. Taking an asset-based community development approach, this study is the first to examine the potential of CM among women using substances in the sex trade in Tijuana, Mexico. In CAB meetings, we discovered that women’s empowerment and health outcomes might be further enhanced by ABCD, beginning with the government and community supporting the empowerment of the women using substances in the sex trade to engage in supportive services with them, instead of just referring them out to government rehabilitation programs or other limited practices [72
]. This study demonstrated that women using substances (injecting and non-injecting) in the sex trade could participate in community and government organizational efforts to find community and voice amongst themselves, despite often being excluded by others for their substance use
Applying CM to a Risk Environment framework and ABCD lens may open a door to include traditionally isolated groups of women who use substances in settings where they may be excluded from other associations and services. It humanizes their voices and provides spaces such as Mujeres Unidas to invite previously silenced voices to feel empowered, identify common life challenges, and promote group sharing and motivation to gather as a community or a movement. ABCD can help change the situations of women who use substances in the sex trade by assessing their risk environments and connecting them to untapped potential social capital for treatment and recovery support. CM opens an opportunity to advocate for the inclusion of people who use substances in the sex trade into health and social services. Future research can further draw upon existing community and government assets to help women using substances in the sex trade overcome barriers to getting assistance for the substance use, violence, and harms to their health they face.