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Abstract: Sexual risk variability among brothel-based sex workers has been shown to be influenced by fear of HIV transmission, and by culture-bound gender norms as well as economic need, yet the effect of sexual agency on impoverished Latina sex workers' risk behavior with their clients remains poorly characterized. We investigated perceived health beliefs regarding susceptibility to/severity of HIV/AIDS, and sexual agency regarding barriers to condom use, benefits of unprotected sex, and risk-reduction behavior with clients among a sample of 33 brothel workers in Belize. Although 77% of participants felt at risk for HIV, only 30% always use condoms and 43%) did not refuse unprotected sex with clients. Participants' narrative explanations for unprotected sex emphasized that clients' preferences often overrode brothel workers fear of HIV, and that the health benefits of using condoms with clients were often weighed against the social benefits of unprotected sex. Implications for brothel-based condom promotion programs and further research are discussed.
Key Words: Helarothels, Female Sex Work, Latinas, Sexual Agency, Health Belief Model
Early in the HIV /AIDS pandemic, female sex workers (FSW) became a focus of epidemiological concern as "vectors" of heterosexual transmission during unprotected sex between infected females and their clients (Vanwesenbeeck, 2001). This characterization failed to account for the sexual risk faced by FSW from clients and primary partners who refused to practice safer sex, while it glossed over the multiplicity of factors that compel impoverished women to voluntarily engage in sex work (Cabezas, 2004; Ragsdale & Anders, 1999; Wardlow, 2004). As Kempadoo (2001) notes, "the lines between autonomy and coercion" within voluntary sex work are "neither rigid nor always easily discernible" (p. 53), including those that impact women's sexual risk behavior. As a more holistic understanding of sex work has emerged, it is clear that various types of sexual labor involve diverse kinds of sexual partners, offer disparate opportunities for sexual agency, and pose different sexual risks to women.
Although correct and consistent condom use with clients can significantly decrease FSW risk of exposure to HIV and other sexually transmitted infections (STIs), condom use can vary depending on whether women are engaged in, for example, street-based sexfor-drug exchanges, occasional sex-for-money transactions, or brothel-based sex work (Gysels, Pool & Nnalusibi, 2002; Romero-Daza, Weeks & Singer, 2003; Wojcicki...