The Use of Female Commercial Sex Workers’ Services by Latino Day Laborers

Abstract

This article reports the characteristics of Latino day laborers who have sex with female commercial sex workers (CSWs). A sample of 450 day laborers in Los Angeles was utilized. Multivariate logistic regression was used to determine the association of independent variables with the likelihood of having sex with a CSW. Overall, 26% of the 450 day laborers reported having had sex with a CSW in the previous 12 months. A lower likelihood of having sex with a CSW was found for those with more than six years of education and for those who were married and living with their spouses. A higher likelihood of having sex with a CSW was found for those who met the criteria for harmful drinking or drug dependence. Commercial sex work has been associated with sexually transmitted infections and other problems among clients of CSWs and warrants further attention by providers working with day laborers.

For many migrant men who travel from one region or country to another, migration may disrupt their romantic relationships and change their sexual activities (Gonzalez-Lopez, 2005). Many migrant men have sexual relations with female commercial sex workers (CSWs) when they are away from their home and families for long periods of time (Caldwell, Anarfi, and Caldwell, 1997; Parrado, Flippen, and McQuiston, 2004). The use of commercial sex work by migrant men can be found around the world (Caldwell et al., 1997; Levy et al., 2005; Organista, 2007). This paper will report the results of a study conducted to examine the use of female CSW services by a sample of a specific subgroup of Latino immigrants to the United States, namely male urban day laborers, that has been understudied to date.

Factors Associated with Having Sex with Female Commercial Sex Workers by Migrant Men

There are many factors which can encourage migrant men to have sex with CSWs. Migrant men are often young and either single or traveling without their wives or families (Levy et al., 2005; Magis-Rodríguez et al., 2004). Migrant men may also experience a sense of overwhelming loneliness in new surrounding, which may serve as a factor for engaging in extramarital relationships, including having sex with a CSW (Viadro and Earp, 2000). Other reasons that have been documented in the literature on migrants are “structural influences,” that is, aspects of the new geographical environment that increase the possibility of engaging in sex with CSWs, such as the freedoms and opportunities offered by a new setting (Viadro and Earp).

Finally, there are also individual-level differences among migrant men that may be associated with having sex with a CSW. For example, recent migrants are more likely to have had sex with a sex worker in comparison to more established migrants (Levy et al., 2005). This suggests that as a migrant extends his stay in the new geographical area, other alternatives may be found for dealing with loneliness and expressing one’s sexuality without having to have sex with CSWs.

Factors Associated with Having Sex with Female Commercial Sex Workers by Men in General

In addition to these migrant-specific characteristics associated with having sex with a CSW, other factors may be similar to those reported by men in general who have sex with CSWs. Although men who have sex with female CSWs come from all nationalities, races and backgrounds (Raymond, 2004), data from a national probability study conducted by the National Opinion Research Center (NORC) of the University of Chicago suggests that certain socio-demographic factors may be associated with having sex with female CSWs by men (Smith, 2006).

In this NORC sample from 2004, 12.9% of the male population in the U.S. reported ever having paid for sex and 0.7% of the men reported having done so in the previous year (Smith, 2006). Those men reporting having paid for sex in the last year were more likely to have been residents of metropolitan areas, have less than $10,000 income, or be separated, divorced or never married (Smith). Sex with CSWs was not related to age and had an irregular relationship to education (with the highest use of CSW services reported by those with an associate college degree, followed by those with less than a high school diploma).

Men may have sex with CSWs to meet their sexual and emotional needs for companionship, especially when a more permanent sexual partner is not available or is one with whom one is currently experiencing relationship problems (Monto, 2004; Monto and McRee, 2005). Other men may have sex with CSWs because they are shy or perceive of themselves as unattractive (Monto and McRee). Other reported motivations by men using CSW services include having wives or partners unable to sexually satisfy them, desiring sexual experiences that they feel they may not be able to request of their regular partners, wanting a large number of sexual partners or preferring the convenience of sex with a sex worker compared to a more-involved committed relationship (Monto). In addition, others may be attracted to the risky nature of commercial sex work because of its illegal nature, since no state in the U.S. permits street prostitution and only two states, Nevada and Rhode Island, permit in-door commercial sex under very restricted conditions (Lucas, 2008; Political Base, 2008). All of these factors found among men in general who are customers of CSWs may also account for the use of CSW services by migrants, including Latino migrants who come to the United States.

Estimates of the Number of Latino Immigrant Men who Have Sex with Female Commercial Sex Workers

Estimates of the number of Latino immigrant men who have sex with CSWs have varied depending on how this population has been described. The literature on Latino immigrant men has utilized a variety of different terms in describing this population including simply “migrants,” “migrant farm workers,” “urban migrants” and “urban migrant day laborers.” In addition, the data obtained are sometimes not fully comparable to each other because of different time frames used. Nonetheless, a brief review of the literature can provide us with some estimates of the extent of the use of CSW services by male Latino immigrants.

Studies using the term, “migrants,” have generally been conducted in Mexico and refer to Mexican nationals who have resided at some point in the United States. When examining the use of CSW services among Mexican “migrants,” Magis-Rodriguez et al. (2004) reported that 40.6% of 71 Mexican male migrants sampled reported having had sex in the previous year with CSWs. Using samples interviewed at the Tijuana International Airport, four Tijuana bus stations and two Tijuana deportation stations, Rangel et al. (2006) reported that none of 78 Mexican migrants deported to Mexico by the U.S. Border Patrol and 3% of 497 Mexican migrants returning voluntarily to Mexico reported having had vaginal sex with CSWs in the previous 6 months. Finally, Organista et al. (1997), in their study of five “sending towns” in Jalisco, Mexico, reported that 44% of their sample of Mexican migrants reported having had sex with a CSW during some time that they were in the United States.

Lifetime rates of the use of female CSW services by Latino male “migrant and seasonal farm workers” in the United States have ranged from 18% to more than 40% (Fernandez et al., 2004). In their study of 121 male farm workers in South Florida (with the majority from Mexico), Fernandez et al. reported that 33% of the men had paid for sex in the previous 12 months. A survey of Mexican farm workers in Northern California found that as many as 30% had reported having sex with a CSW (Lopez and Ruiz (1995), reported in Organista and Organista, 1997).

Studies of the use of CSW services among migrants living in cities, “urban migrants,” employed in businesses such as construction or food services, have also been conducted. Parrado et al. (2004) reported that 28% of 442 Latino migrant men (primarily from Mexico) in Durham, North Carolina, reported having had sex with a CSW in the previous year. A higher prevalence was reported for a much shorter window in a sample of migrant workers in post-Hurricane Katrina New Orleans (with half from Honduras and a quarter from Mexico) with 36% of 180 men reporting having had sex with a CSW in the previous month (Kissinger et al., 2008). Finally, in a population-based household survey in 3 Northern California counties (Contra Costa, San Francisco and San Mateo), 36.4% of 410 Latino immigrant men (primarily from Mexico) reported having ever had sex with a CSW (Levy et al., 2005).

The use of CSW services by the least examined group of Latino immigrants, “migrant urban day laborers,” has been reported by only one small study, Organista and Kubo (2005). “Day laborers” are a special case of “urban migrants” mentioned above and are described in more detail below. In their sample of 102 migrant day laborers in Northern California, Organista and Kubo found that 23.4% of them reported having had sex with CSWs in just the previous two months. However, they did not describe the characteristics of those day laborers who were more likely to have sex with a CSW.

Most of these estimates of the use of CSW services by Latino immigrants are considerably higher than those reported for the general population in the United States as reported by the NORC (Smith, 2006). These higher estimates may be in part related to immigrants’ physical separation from their social networks and home environments with attendant feelings of loneliness and isolation. Under these circumstances, seeking the services of a CSW may be a way of addressing several needs in addition to just the physical.

Overall, the majority of the estimates presented here suggest significant use of CSW services by Latino immigrants. This warrants further investigation, in particular because of the risk behaviors found to be associated with the use of CSW services.

Correlates with Having Sex with Female Commercial Sex Workers

Having sex with female CSWs has been found to be associated with other risk behaviors, and thus their use by Latino migrants could be reflective of the presence of other potential problem areas in their lives. For example, alcohol consumption has been found to be associated with having sex with a female CSW (Rissel, Richters, Grulich, de Visser and Smith, 2003; Sawyer, Metz, Hinds and Brucker, 2001–02). Drug use has also been found to be associated with using CSW services (Sawyer et al.; Paz-Bailey, Teran, Levine and Markowitz, 2003). In addition, men using CSW services are also more likely to report having more sexual partners (Rissel et al.; Organista et al., 1997).

Commercial sex has also been associated with sexually transmitted infections (STI) among Latino immigrants (Paz-Baily et al., 2003). Different estimates of the prevalence of various STIs for Latino immigrants have been reported (without identifying the sources) of 0.4% to 3.5% (Wong, Tambis, Hernandez, Chaw and Klausner, 2003), 7.9% and 8.2% (Martinez-Donate et al., 2005), 12% (Sanchez et al., 2004) and 22.7% (Denner, Organista, Dupree and Thursh, 2005). The 12% prevalence reported (for syphilis) by Sanchez et al. was from a sample of 4,500 Latino day laborers in Los Angeles County, the location of this present study.

With regards to HIV, the possibility of infection as a result of an encounter with a CSW in the United States is much less than outside of the country, as the HIV infection rates for CSWs in other countries of the world (such as Asia) are much higher than those in the U.S. (CDC, 2006). Nevertheless, the possibility of HIV infection via a sexual contact still exists. For example, in Los Angeles County, among a sample of 85 female sex workers, 5.9% reported being HIV-positive (Harawa and Bingham, in press).

Not surprisingly, the use of CSW services by men who are married has been found to be associated with low marital satisfaction. Among married men in a national probability study, paying for sex during the previous 12 months was strongly associated with low marital happiness (Smith, 2006). Other studies have also corroborated this finding (Monto and McRee, 2005).

Finally, perceptions of the sexual encounters with CSWs among male customers can be quite varied. They can include feelings of satisfaction; however, negative feelings may also arise from having such encounters, such as guilt, disappointment and anger (Monto, 2004).

Given the limited knowledge of the use of CSW services by one particular subgroup of male Latino immigrants, urban day laborers, we focus our attention on this specific population.

General Overview of Latino Day Laborers

Valenzuela’s ground-breaking studies of urban day laborers provide insight into the living conditions of this population (Valenzuela, 2000; Valenzuela, 2002). Day laborers in Southern California are primarily Latino male immigrants who seek employment on street corners or near home-improvement or paint stores (Valenzuela, 2000). They informally negotiate their payments with their prospective employers. Using a sample of 481 day laborers, Valenzuela (2000) found that over three-fourths (77.5%) were from Mexico and another fifth (20.1%) from Central America. Over a quarter (29.4%) had been in the U.S. for less than a year, 22.9% between 1 to 5 years, 24.4% between 6 to 10 years, and 23.4% over 10 years. Although they ranged in age from 18 to 71 years, the largest number (37.9%) was between the ages of 18 to 27 years. The next largest age category (28.4%) was between 28 to 37 years of age.

Almost a half (47.9%) had never been married, and over a third (37.3%) was married. Almost 8% reported living with a partner (Valenzuela, 2000). Over a half (56.6%) had 6 years of education or less, with a mean of 7 years of education. Over two-fifths (43%) had been a day laborer for less than 1 year, and another third (31%) for 2 to 5 years. Only a fifth (20.3%) had been employed as a day laborer for 6 to 10 years, and a mere 5.2% had had such employment for more than 10 years.

Latino migrants who are day laborers experience many stresses and challenges in their search for employment. They contend with many uncertainties such as the impact of weather on their prospects for work, the changes in the construction market, and the potential of not being selected for work by prospective employers (Valenzuela, 2000). The precariousness of their situation is highlighted by the fact that 90% in Valenzuela’s (2000) study reported having day labor as their only source of employment. The primary reason that prevented them from seeking other types of employment was their undocumented status in the United States.

Day laborers take on jobs that workers in the regular job force may be unwilling to perform (Valenzuela, 2002). In addition, day laborers experience merchants and residents who complain about their presence. They also experience harassment by local police.

Given these stressful conditions experienced by day laborers, it is not surprising that large numbers would report a variety of different psychosocial problems. In the study of 102 day laborers reported by Organista and Kubo (2005), the following problems were identified as having been experienced in the previous 6 months: having little employment (79.4%), lack of sufficient money (67.6%), unemployment (52%), sadness (29.4%), racism (25.5%), health problems (18.6%), lack of health services (18.6%), problems with police (6.9%), problems with the Immigration Service (6.9%), and problems with physical impairment (3.9%). Clearly, these stressors compound the already difficult challenges that Latino immigrants who are day laborers experience in attempting to adjust and succeed in their new environments.

Study Aims

This study had three specific aims: (1) to determine the extent to which male Latino day laborers have sex with female CSWs, (2) to determine the characteristics of day laborers who are likely to have sex with female CSWs, and (3) to determine the characteristics of day laborers who are not likely to always use a condom when having sex with female CSWs. Such information can be of assistance to social service, mental health, public health and other providers working with Latino day laborers as they adjust to living in a new environment with all of the challenges that this involves. For example, this information could be used in public health campaigns targeting day laborers and focusing on the prevention and treatment of sexually transmitted infections and the consequences their actions could have not only on themselves but on their wives and/or sexual partners.

Methods

Sample

A convenience sample of 450 male Latino day laborers was obtained as part of a larger study examining the sexual risk factors of day laborers over 18 and under 40 years of age (Galván et al., 2008). Six day laborers sites in the city of Los Angeles, California, were chosen based on information that five of these sites were being targeted by men interested in having sex with day laborers, the primary research focus of the original study. The sixth site was in close proximity to one of the others (and identified to the research staff by day laborers themselves) and hence was also included.

Procedures

The study procedures were approved by the Institutional Review Board of Charles Drew University of Medicine and Science in Los Angeles, California. Individuals at the day labor sites who appeared to be within the appropriate age range were approached and informed about the study. Those interested in participating were then escorted to a private location and administered the consent form and the study questionnaire.

The research interviewers were two Spanish-speaking Latino male employees of the Latino community based organization that partnered with the academic institution to conduct this research. The agency had a long history of conducting HIV prevention education and services to diverse Latino populations, including day laborers, and already had developed a presence at some of the same day labor sites used in this study. The interviews occurred in Spanish and lasted between 30 and 45 minutes. Participants received $15 for their participation.

Measures

Socio-demographic characteristics

Information was obtained on the participant’s age, country of birth, years lived in the U.S., years of education, relationship status (single, not married but living with a partner, or married), years working as a day laborer, previous year’s income, sexual orientation and residency status in the U.S. Individuals reporting being married were also asked if their spouse was living with them in the United States. A composite variable was then constructed combining “relationship status” and, if married, “spouse living with them in the United States” resulting in four categories: single, not married but living with a partner, married but not living with spouse in the United States, and married and living with spouse.

Harmful drinking

Harmful drinking was assessed through the Alcohol Use Disorders Identification Test (AUDIT) (Babor, de la Fuente, Saunders, and Grant, 1992; Saunders, Aasland, Babor, de la Fuente, and Grant, 1993), with scores of 8 or higher indicating a strong likelihood of harmful alcohol consumption. The questions of the AUDIT inquire about alcohol use at the present time, in the past year and prior to the past year.

Drug dependence

Drug dependence was assessed using the Texas Christian University Drug Screen II (TCUDS II) (Simpson and Knight, 1998), with values of 3 or greater indicating relatively severe drug-related problems and corresponding approximately to a drug dependence diagnosis. Drug use questions cover the previous 12 months. Those reporting drug use were asked to indicate the drug that caused them the worst problems during that period. Referrals for follow-up substance abuse care were provided as necessary.

History of HIV testing

Questions were asked regarding whether an HIV test had ever been taken and, if so, the date of their last HIV test. They were also asked whether they had ever been told that they were HIV-positive.

Sexual partner

Participants were questioned about the number of sexual partners they had had in the previous 12 months. For those who responded that they had had one or more sexual partners during that period, they were then asked about the number of sexual partners, whether they had had vaginal sex with a woman, whether they had oral or anal and insertive or receptive sex with another man, and whether they had had sex with a transgendered person. A composite variable was created (coded to “yes” or “no”) referring to having had sex with a man based on a positive response to any item indicating that they had had oral or anal sex with another man, either insertive or receptive.

Sex with female commercial sex workers

Participants were also asked the following question: “During the past 12 months, have you had sexual relations with a prostitute?” If an individual responded in the affirmative to this question, he was then asked, “During those instances, did you have penetrative vaginal sex?” Finally, those answering yes were then asked, “How frequently did you use a condom in those instances?” The possible responses were always, usually, sometimes or never.

From these latter data, three variables were then developed. The first variable assessed whether an individual had had sexual relations with a CSW in the previous 12 months (yes/no). The second determined if the individual had had penetrative vaginal sex (yes/no). The third assessed how often a condom had been used in those circumstances (the original responses were condensed to “always” versus “less than always”).

Analyses

Descriptive statistics were obtained on all the study variables. In addition, bivariate and multivariate logistic regressions were used to determine the association of independent variables with the likelihood of having had sex with a female CSW (among those who were sexually active in the previous 12 months) and of not always having used a condom when having sex with a female CSW (among those reporting having had vaginal sex with CSWs). The multivariate models include variables that were significant at the bivariate level at p ≤ 0.25 following the recommendations of Hosmer and Lemeshow (1989).

Demographic and substance use variables were used in the bivariate and multivariate analyses. Several of these had their categories consolidated when used in these analyses because there were too few responses in some categories. This consolidation was done for “country of birth,” “years of education” and “residency status in the United States.” “Sexual orientation” was omitted for these analyses because nearly all of the sample (98.4%) described themselves as “heterosexual.”

When variables were correlated with each other, one was excluded in order to avoid problems with multicollinearity in the multivariate models, with one exception. In the model predicting having had sex with a female CSW, “harmful drinking” and “drug dependence,” though correlated with each other (x² = 13.4, p ≤ 0.000) were both kept in the final model for conceptual reasons, i.e., they represent two distinct types of substances with one (alcohol) legally obtainable and the other (drugs) not. In addition, the statistical significances of the other variables in the model were not affected regardless of whether “harmful drinking” and “drug dependence” were both kept in the model or whether either one was dropped.

Regarding other correlations in this same model, “age” was found to be correlated with “years working as a day laborer”; subsequently “age” was retained because it was more strongly associated with the outcome variable of interest. “Age” was then found to be correlated with “relationship status,” and “relationship status” was chosen over “age” for inclusion in the final multivariate model based on its stronger association with the outcome variable. In addition, both “years working as a day laborer” and “relationship status” were also correlated with each other.

In the model predicting not always having used a condom when having sex with a female CSW, “years living in the United States” was found to be correlated with “income”; “income” was retained for inclusion in the final multivariate model based on its stronger association with the outcome variable.

Because of space limitations, the bivariate logistic regression results are not reported. All tests were conducted using Stata 9.2 (Stata Corporation, College Station, TX, 2006).

Results

Sample Characteristics

Of the 450 male Latino day laborers interviewed for the overall study, 378 (84%) reported that they had been sexually active in the previous 12 months. The sample characteristics that follow describe only the sexually active day laborers.

These day laborers were approximately equally represented in the three age categories (> 18 & < 23 years of age; ≥ 24 & ≤ 31 years; and, ≥ 32 & ≤ 40 years). Almost half (48.4%) were born in Mexico and over a third (35.2%) in Guatemala, with the remainder representing primarily other Central American countries. Almost three-quarters (73%) had been living in the United States for 5 years or less. The mean number of years lived in the United States was 4.4 years. Over half (58.7%) had only 6 years of education or less. The mean number of years of education was 6.7 years. Almost sixty percent (59.8%) were single and almost a quarter (24.1%) married. Of the 91 who were married, four-fifths reported that their spouse did not live with them in the United States. Sixteen percent reported being not married but living with a partner.

About ninety percent (89.2%) reported having worked as a day laborer for 5 years or less. The mean number of years reported working as a day laborer was 2.7. Almost four-fifths (78.1%) reported the previous year’s income as having been $8,000 or less. The mean previous year’s income was $6,175. Almost the entire sample (98.4%) described their sexual orientation as being heterosexual. Only 1.3% percent described themselves as bisexual; no one reported being exclusively gay or homosexual. Eighty-eight percent described their residency status as being undocumented.

Almost half (46.8%) met the criteria for harmful drinking. Nineteen percent reported having relatively severe drug-related problems which corresponded approximately to drug dependence. Among these individuals, the drugs causing the most serious problems were marijuana (38%), cocaine or crack (33%), methamphetamines (19%), tranquilizers or sedatives (2%), and inhalants (1%). Eight percent reported no drug in particular as causing them serious problems. (These numbers do not add to 100% due to rounding.)

Over half (53.4%) reported having ever been tested for HIV. Of these, 85.2% reported having done so within the last year. Only one person reported being HIV-positive.

Forty-four percent reported having only one sexual partner in the previous 12 months. Forty-three percent reported two to five partners, and only 13.5% reported more than five. The mean number of sexual partners reported for this period was 3 partners. Ninety-five percent reported having had vaginal sex with a woman. Almost eight percent (7.7%) reported having had male sexual partners, 2.9% had transgendered partners and two percent had both.

Sex with a Female Commercial Sex Worker

About 32% (n = 119) of the sexually active day laborers (or 26% of all 450 day laborers interviewed) reported having had sex with a female CSW in the previous 12 months. Of these, 97% (n = 115) reported having engaged in vaginal sex with the female CSWs. Almost three quarters (n = 85) reported always having used condoms with the CSWs, 4% (n = 5) usually, 14% (n = 16) sometimes and 8% (n = 9) never.

Day laborers in all relationship status categories reported having had sex with female CSWs (Table 1). However, the rates of engaging in this activity varied by relationship status and, if married, whether one was living with his spouse. Whereas about a third of the single day laborers (35%) and those not married but living with a partner (33%) reported having had sex with a female CSW, a quarter of the married day laborers not living with their spouses (25%) and only two (11%) of the married day laborers living with their spouses did so.

TABLE 1.

Relationship Status and Having Sex with a Female Commercial Sex Worker (CSW) among Sexually Active Day Laborers (n = 378)

		Relationship Status
	Married & Living with Spouse	Married but Not Living with Spouse	Not Married but Living with Partner	Single
Sex with CSW
Yes	2 (11%)	18 (25%)	20 (33%)	79 (35%)
No	16 (89%)	55 (75%)	41 (67%)	147 (65%)
Totals	18 (100%)	73 (100%)	61 (100%)	226 (100%)

In addition, significant numbers in each relationship category reported not always using condoms when having vaginal sex with CSWs. Twenty eight percent of the single men and a quarter of the men not married but living with a partner reported not always using condoms with CSWs. Three of the 17 married men not living with their spouses who had vaginal sex with CSWs did not always use a condom, and one of the two married men living with their spouses likewise did not always use a condom with CSWs.

Additional analyses found that of the 119 men who had sex with female CSWs in the previous 12 months, 14% (n = 16) also reported having had sex with men during that same period and 6% (n = 7) having had sex with transgendered people. All seven men reporting having had sex with transgendered people also reported having had sex with men.

In addition, 42% (n = 50) of those who had sex with female CSWs reported ever having been tested for HIV. None of these individuals reported being HIV-positive. Of the 378 day laborers who reported being sexually active in the previous 12 months, the only individual who stated he was HIV-positive was one who had indicated that he had not had sex with a female CSW during that period.

Characteristics of Day Laborers Who Have Sex with Female Commercial Sex Workers

A lower likelihood of having had sex with a female CSW was found for day laborers who had more than six years of education and for those who were married and living with their spouses in the U.S. (Table 2). In contrast, a higher likelihood of having sex with a CSW was found for day laborers who met the criteria for either harmful drinking or drug dependence.

TABLE 2.

Likelihoods of Having Sex with a Female Commercial Sex Worker (CSW) and of Not Always Using a Condom when Having Vaginal Sex (multivariate logistic models)

	Likelihood of Having Sex with a CSW (n = 378)		Likelihood of Not Always Using a Condom when Having Vaginal Sex (n = 115)
Variables	AOR	95% CI	AOR	95% CI
Years of Education
≤6	1.00	---
> 6	0.58*	0.36–0.94
Relationship Status
Single	1.00	---
Not married but living with a partner	0.81	0.43–1.54
Married but not living with spouse	0.54§	0.28–1.04
Married but living with spouse in US	0.20*	0.04–0.95
Previous Year’s Income
≤ $4,000			1.00	---
> $4,000 & ≤ $8,000			1.99	0.69–5.75
> $8,000 & ≤ $12,000			1.42	0.37–5.51
> $12,000 & ≤ $29,000			4.02	0.58–27.9
Residency Status in U.S.
Undocumented worker			1.00	---
All others			1.79	0.50–6.39
Harmful Drinking
No	1.00	---
Yes	2.33***	1.42–3.80
Drug Dependence
No	1.00	---	1.00	---
Yes	3.27***	1.82–5.88	3.42**	1.36–8.62

The multivariate models include only those variables that were significant at the bivariate level at p ≤ 0.25 and exclude those factors that were correlated with other variables in the models, with the exception of “harmful drinking” and “drug dependence” in the first model (please see text).

^§p ≤ 0.10;

^*p ≤ 0.05;

^**p ≤ 0.01;

^***p ≤ 0.001

Characteristics of Day Laborers Who Report Not Always Using a Condom when Having Vaginal Sex

Further analysis was done with the 115 day laborers who reported having engaged in vaginal sex with CSWs (Table 2). A higher likelihood of not always using a condom when having vaginal sex with a CSW was found for day laborers who met the criteria for drug dependence. No other variable reached the level of statistical significance in this model.

Discussion

The Use of Female Commercial Sex Worker Services

Overall, 26% of all the 450 Latino day laborers interviewed reported having had sex with a female CSW in the previous 12 months; this represents 32% of the day laborers who were sexually active during that period. In the only other study of the use of CSW services by Latino urban day laborers, 23.4% of the 102 men had reported such behavior (Organista and Kubo, 2005). However, it is possible that, since the period of CSW services use covered in the Organista and Kubo study was for only the previous 2 months, our estimate of 12 months could actually be smaller than theirs.

Nevertheless, the fact that over a quarter of the day laborers had had sex with a CSW during the previous 12 months speaks to the prominence of CSWs in the sexual lives of a significant number of day laborers. This high use of CSW services by these urban Latino migrants is similar to studies with other Latino migrant populations (Fernandez et al., 2004; Levy et al., 2005; Magis-Rodriguez et al., 2004; Organista and Organista, 1997; Organista et al., 1997; Parrado et al., 2004). As noted already above, this is consistent with the association between commercial sex work and migration that is found worldwide (Caldwell et al., 1997; Levy et al., 2005; Organista, 2007).

Most of the day laborers (74%) who had vaginal sex with CSWs always used condoms. However, over a quarter (26%) did not. The percent of this sample which always used condoms is considerable lower than that reported in other samples of CSW services use by Latino migrant men, with 91.7% reported by Parrado et al. (2004) and 95% by Viadro and Earp (2000). It is also somewhat lower than the estimate of 77.8% provided by Rangel et al. (2006), who provided a less-clear definition of unprotected vaginal sex with sex workers. Parrado et al.’s estimate of consistent condom among clients of CSWs dropped to 87% if the CSW was seen as having a good reputation and to 64% if she was well known to the respondent. It is possible that these factors may also have contributed to the lower use of consistent condom use in our present sample, despite the fact that these types of questions were not asked of this study’s participants.

It is not immediately clear why the use of condoms with CSWs by the participants of this study was lower than that reported in other studies. In fact, one might have suspected that just the opposite would have been the case with more condom use being reported by the present sample given that it was conducted in a large metropolitan area in contrast to two of the studies referenced above, Parrado et al. (2004) and Viadro and Earp (2000), which were conducted in North Carolina. Living in a large metropolitan area would presumably provide more access to condoms and information about the benefits of their use. Further research examining this finding is warranted. In any case, nonuse of condoms can increase the risk of acquiring sexually transmitted diseases, since condom use has been found to reduce the risk of transmission of diseases such as HIV, gonorrhea, Chlamydia and herpes simplex virus (Steiner and Cates, 2006).

Men who reported having sex with CSWs came from all relationship categories (single, not married by living with a partner, married and living with a spouse, and married and not living with a spouse). However, married men living with their wives were less likely to report having had sex with CSWs compared to single men. No statistically significant difference was found between married men not living with their wives and single men in their likelihood of having sex with CSWs (although marginal significance was found). This provides support to Parrado et al. (2004) who failed to find a difference in the use of CSW services between the married Latino migrant men whose spouses had remained in their countries of origin and the single men.

Although most of the men in each relationship category always used condoms when having sex with a CSW, many did not. Not consistently using a condom places not only the men at risk for different sexually transmitted infections but potentially also the other sexual partners (including the wives) of these men. This is particularly significant because the female sex partners, including wives, of these men do not frequently discuss or negotiate safer sex practices with them (Organista, Carrillo and Ayala, 2004).For example, Mexican women have been found to be reluctant to inquire with their spouses about any sexual experiences that they may have had during their migrations to the United States (Hirsch, Higgins, Bentley and Nathanson, 2002).

Less than half of the men who had sex with female CSWs reported ever having been tested for HIV, and none of these individuals reported being HIV-positive. Although the risk of becoming infected by a female CSW in the United States is lower than that in other countries, there is still a chance of infection, especially in the case of unprotected sex. Any unsafe sexual practices warrant an HIV test for the benefit of not only the male involved but also for his present and future sexual partners. In addition, the clients of CSWs also pose a risk of infection with HIV or other sexually transmitted infections to CSWs, who then may put their own partners and other clients at similar risk.

Factors Associated with Having Sex with Female Commercial Sex Workers

Day laborers with more than six years of education were found to be less likely to have sex with a CSW. This contradicts with Parrado et al. (2004) who found that educational level was not associated with having sex with a CSW among Latino migrants in North Carolina. Nevertheless, they did find that higher education was associated with less frequent visits to CSWs. It is possible that the more educated men in the present sample may have had a greater awareness of the health risks involved with using CSW services and thus may have limited their use of them, similar to the interpretation by Parrado et al. (2004) given for the lower frequency of CSW services use by more educated men.

Similarly, day laborers who were married and living with their spouses also reported a lower likelihood of having sex with a CSW. Thus it appears that, for married day laborers, living with their spouses provides a sufficiently strong deterrent for having sex with a CSW.

A higher likelihood of having sex with a CSW was associated with both harmful drinking and drug dependence. These associations between having sex with CSWs and substance abuse are consistent with what has been reported in the literature. The misuse of alcohol may impair judgment as well as cause social disinhibition, which can result in an increased number of casual sexual partners (Thompson, Kao and Thomas, 2005). Drug use, such as of methamphetamines, has also been found to be associated with impaired judgment (Meredith, Jaffe, Ang-Lee and Saxon, 2005). In addition, having sex with CSWs and the use of substances are both risk-taking activities which may converge in some individuals (Thompson et al.).

Another reason for the association between harmful drinking and having sex with a CSW is because bars are oftentimes the locales where Latina CSWs carry out their activities (Ayala, Carrier, and Magaña, 1996; Lever, Kanouse, and Berry, 2005). Latino immigrant men who are interested in finding sex partners can use drinking establishments for that purpose. In fact, bars are seen as safer locales for obtaining a CSW, in contrast to, for example, the streets, with a lower likelihood of being arrested by the police (Ayala et al.). When in the bars, the CSWs then promote the consumption of alcohol to their potential customers as a means of being allowed to operate within these establishments (Ayala et al.).

Factors Associated with Not Always Using Condoms with Female Commercial Sex Workers

When examining the factors associated with the likelihood of not always using condoms with CSWs, the only variable to reach statistical significance was meeting the criterion for drug dependence. A higher likelihood of not always using a condom when having vaginal sex with a CSW was found among day laborers who were drug dependent. This is consistent with another study of day laborers which found that those who used drugs during sex were less likely to use a condom with casual female sex partners compared to men who did not use substances when having sex (Organista and Ehrlich, 2008). This is also consistent with the association between substance use and impaired judgment mentioned above.

Limitations

Since day laborers were not randomly selected, no generalizations are possible beyond the individuals in this study. Similarly, the day labor sites where the interviews took place were also not randomly selected. In addition, the men who chose not to participate in the study may differ from the men who did. Thus the extent to which this study’s results would be similar to those at other day labor sites can not be guaranteed.

In addition, it is possible that the 26% of all 450 day laborers who reported having had sex with a female CSW in the previous 12 months represents a lower bound of those who actually may have engaged in this activity. Because of the potentially embarrassing and stigmatizing nature of commercial sex, it is possible that not all of those who engaged in sex with a CSW were willing to admit this to the research interviewers.

We did not inquire into the number of CSWs the individual had had sex with or the number of sexual episodes with CSWs over the period in question. Thus we are not able to distinguish between those who had regular versus occasional exposures to CSWs.

Nevertheless, despite these limitations, this study provides an indication of the extent of use of CSW services by some Latino day laborers and the factors associated with that use.

Biographies

Frank H. Galván, Ph.D., is an Assistant Professor in the Department of Psychiatry and Human Behavior and a researcher at the Drew Center for AIDS Research, Education and Services at Charles Drew University of Medicine and Science in Los Angeles, California. He is also a Core Scientist with the Policy Core of the UCLA/Drew/RAND Center for HIV Identification, Prevention and Treatment Services. Dr. Galván has conducted a number of research studies examining issues related to HIV prevention and care among Latino and African American populations, with a particular focus on sexual risk behaviors, HIV stigma, social support, engagement in HIV-related medical care, HIV treatment adherence, religiosity, and alcohol use in these populations. In addition to his current domestic research, Dr. Galván is also conducting HIV prevention research in Mexico.

Daniel J. Ortiz, Ph.D., is an Assistant Professor in the Department of Psychiatry and Human Behavior of Charles Drew University of Medicine and Science with a joint appointment at UCLA. He is a researcher at the Drew Center for AIDS Research, Education and Services and a Core Scientist with the International Core at the UCLA/Drew/RAND Center for HIV Identification, Prevention and Treatment Services. His research interests include creating interventions through media, education and structural changes that are sensitive to social and cultural factors and increasing access to medical care and services for disadvantaged populations that may otherwise go unserved.

Victor Martinez, B.S., is the Director of Programs and Services for Bienestar Human Services, Inc. Mr. Martinez has many years of experience in organizing, developing and implementing different HIV prevention and care programs. He has served as a Co-Principal Investigator for research projects focused on the HIV-related risks of Latino men. He has also been recognized as among the leaders of the future by La Opinión, the Spanish-language daily newspaper of Los Angeles, California.

Eric G. Bing, M.D., Ph.D., is a psychiatrist, epidemiologist and Assistant Professor in the Department of Psychiatry and Human Behavior at Charles Drew University of Medicine and Science. He is the founder and Director of the Drew Center for AIDS Research, Education and Services and is a Co-Principal Investigator of the UCLA/Drew/RAND Center for HIV Identification, Prevention and Treatment Services. He is the Principal Investigator on projects funded by the National Institutes of Health, the U.S. Agency for International Development, the U.S. Department of Defense, the California HIV/AIDS Research Program and others. His research focuses primarily on developing and evaluating interventions to improve health care and health outcomes for disadvantaged populations, particularly those affected by HIV, mental illness, and/or alcohol and drug problems in civilian and military populations. He oversees domestic and international HIV prevention and care programs.