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Published in final edited form as: Cult Health Sex. 2017 Nov 24;20(9):961–975. doi: 10.1080/13691058.2017.1403651

‘He’s not my pimp’: toward an understanding of intimate male partner involvement in female sex work at the Mexico–US border

María Luisa Mittal a,b, Angela Robertson Bazzi a,c, María Gudelia Rangel d, Hugo Staines e, Kelly Yotebieng f, Steffanie A Strathdee a, Jennifer L Syvertsen a,g
PMCID: PMC5967977  NIHMSID: NIHMS923243  PMID: 29171796

Abstract

Female sex work is often perceived as women being controlled by men. We used surveys and qualitative interviews with female sex workers and their intimate partners in two Northern Mexico cities to examine couples’ own perceptions of their relationships and male partners’ involvement in sex work. Among 214 couples, the median age was 34 and relationship duration was approximately 3 years. Only 10 women in the survey reported having a pimp, and the majority reported sole control over sex work decisions. Qualitative analyses revealed that while most men avoided direct involvement in sex work, they offered advice that was largely driven by concern for their partner’s well-being. Our discussion of these results considers the broader socio-political context surrounding these relationships and how changing gender roles, economic insecurity and stigma shape couples’ everyday social interactions. Assumptions that all sex workers’ relationships are coercive and commercial marginalises these couples while leaving their health concerns unaddressed.

Keywords: Sex work, pimp, couples, stigma, people who use drugs, Mexico

Introduction

Female sex work is often perceived as women being controlled by men. The very mention of sex work or prostitution can evoke powerful images of vulnerable women being trafficked and controlled by violent male authority figures. While such characterisations accurately reflect some contexts of sex work, there is also a great diversity of social relationships within the sex industry (Harcourt and Donovan 2005; Sterk 2000) that often gets lost in debates about the exploitation of women. Stereotypes prevail that female sex workers’ boyfriends, husbands and steady partners are ‘pimps’ who exert control over their lives (Sterk 2000). Related assumptions that women who engage in sex work are incapable of maintaining intimate relationships apart from their work imply that women are rendered powerless vis-à-vis pimps, managers, clients, partners and other men whose intentions are questionable at best and viciously exploitative at worst.

Worldwide, female sex workers have 13 times the odds of being HIV-positive compared with the general female population (Baral et al. 2012). Along the Mexico–USA border, HIV prevalence among female sex workers has been reported to be 5.3% (Ulibarri et al. 2010) and many women report engaging in unprotected sex with intimate partners more often than with their clients (Ulibarri et al. 2012). Sex workers’ diverse interpersonal relationships are one key factor shaping their risk; thus, understanding how women draw boundaries around their different relationships is critical to assessing health risks and developing interventions. During the course of our five-year study of the social epidemiology of HIV and other sexually transmitted infections (STIs) among female sex workers and their intimate, non-commercial male partners along the Mexico–USA border, we personally found that lay people, colleagues and reviewers alike constrained these women’s relationships into a monolithic sex worker identity by assuming that ‘male partners’ in this context referred to ‘pimps.’

Based on our mixed methods analysis, we argue for greater attention to women’s agency in their sex work because the diversity in their personal relationships extends beyond notions of male control. Failure to address these non-commercial relationships could limit the success of health interventions by leaving female sex workers at risk for HIV, STIs, interpersonal violence and other health harms (Day, Ward, and Perrotta 1993; Ulibarri et al. 2010; Voeten et al. 2007; Waddell 1996).

Perspectives on sex workers’ relationships

Across geographic, socio-economic and cultural contexts, motivations for entering into and continuing sex work differ. Diverse types of behaviours, forms of payment, roles of others in women’s negotiations of services and other factors vary widely (Harcourt and Donovan 2005). Some women use sex work to find partners, particularly in well-known regions of sex tourism with extreme income inequality, as documented in the Dominican Republic (Brennan 2004) and South Korea (Cheng 2010). Other women practise formal sex work occasionally but have regular partners with whom they exchange services for material goods, rent or other living expenses, particularly across sub-Saharan Africa (Romero-Daza 1994), where relationship categories may be fluid and shift (Stoebenau et al. 2009). Importantly, these differing partner identities have health implications, as research has consistently shown that sex workers are less likely to use condoms with intimate partners than with clients to physically demonstrate emotional distinctions (Deering et al. 2011; Murray et al. 2007; Robertson et al. 2014).

Despite this variation, research and popular discourse often conflate sex work with sex trafficking (Marcus et al. 2014; Weitzer 2015). Similarly, the popular but problematic conception of the pimp is a dominant figure in our collective imagination of sex work. Holsopple (1999) defines a pimp as a person who ‘induces, promotes, and profits from the prostitution of women and children’ and uses ‘physical and sexual violence to control where [a sex worker] goes, sell her as a commodity, force her into unwanted sex, and prevent her from escaping prostitution’ (Holsopple 1999). Other definitions similarly emphasise the management of women through exploitation, violence and drug addiction (Cobbina and Oselin 2011; Dank et al. 2014). While research has documented that some female sex workers are indeed victims of abusive pimps (Norton-Hawk 2004; Raphael, Reichert, and Powers 2010), variability exists even across contexts of ‘pimping’ (Staiger 2005). Some women are lured into sex work by men who are initially perceived as intimate partners but subsequently transition into pimps (van San and Bovenkerk 2013; Shannon et al. 2008). In other contexts, women act as managers of other women’s sex work, offering protection and social support (Yi et al. 2012). While violence may be a common tactic among male pimps, some women also receive financial and emotional security in these relationships (Williamson and Cluse-Tolar 2002).

Curiously, the perspectives of the men who fulfil diverse roles ranging from pimp to partner are largely absent in the literature. A limited body of research has focused on processes of becoming a pimp, which has been associated with past physical and sexual abuse, limited economic opportunity and being recruited by kin and acquaintances as a means to overcome adversity and gain power (Raphael and Myers-Powell 2010). Moreover, little is known about the perspectives of other men who have the potential to be involved in some aspect of women’s sex work, including boyfriends and husbands.

Taken together, the literature suggests that considerable nuances exist within sex workers’ various relationships. Furthermore, many conceptions of the ‘pimp’ are underdeveloped and likely not relevant in all cultural contexts of sex work. Despite the tendency to focus on negative and violent depictions of sex workers’ relationships with men, research privileging sex worker couples’ own perceptions and experiences of sex work may help demystify and destigmatise these relationships, leading to more effective health programming.

Sex work on the Mexico–USA border

Our study took place on the Mexico–US border: Tijuana, Baja California, adjacent to San Diego, California, is the largest border city (population 1.7 million), and Ciudad Juárez, Chihuahua, across from El Paso, Texas, is the second largest border city (population 1.3 million). While both cities have active sex industries, including evidence of sex trafficking (Collins et al. 2013), sex work across the region is heterogeneous. In Tijuana, although working in the red-light district (zona roja) requires registration with the municipal health authorities, many women work without proper permits (Sirotin et al. 2010; Collins et al. 2013). Ciudad Juárez has no such registration system. Depending on registration status, sex work venue and other factors, women exert various levels of agency in their sex work. In contrast to formal sex work venues (e.g. bars, hotels) (Zhang 2011), women who engage in ‘freelance’ forms of sexual exchange (Brennan 2004) may have more autonomy over their work and earnings. Although the prevalence of particular types of sex work in this region has not been established, previous research with primarily street-based female sex workers found that only 2.7% reported having a pimp (Strathdee et al. 2008).

The majority of women in our study are freelance sex workers who privately negotiate arrangements with different types of clients based on financial need and drug addiction (Robertson et al. 2014). As adult women (≥18) whose male partners are aware of their involvement in sex work, they exercise considerable agency in their work. While some of these women engage with one-time clients, freelancers often form regular relationships with men for steady sources of income (Robertson et al. 2014). Within their intimate, non-commercial relationships, female sex workers and their partners differed with respect to emotional bonds, relationship quality and conflict levels, all of which are shaped by structural vulnerability, financial need and addiction (Syvertsen et al. 2013a; Ulibarri et al. 2015). We have conceptualised these intimate relationships as ‘dangerous safe havens’ in which HIV risk behaviours such as unprotected sex and syringe sharing demonstrate emotional intimacy and forms of care but also increase potential viral risk (Syvertsen and Bazzi 2015). Within this context, our analysis examines relationship conceptions, sex work decision-making (e.g. number of clients per day, earnings per act) and male partner involvement in women’s sex work as a means to better understand dynamics surrounding health risks, particularly in response to common notions that these men must be ‘pimps.’

Methods

Study design and population

Proyecto Parejas (Couples Project) is a study of the social epidemiology of HIV and STIs among female sex workers and their intimate male partners in Tijuana and Ciudad Juárez, Mexico. Women who engaged in street-based (freelance) sex work were recruited using targeted and snowball sampling beginning with known contacts in areas where drug use and sex work occur (Syvertsen et al. 2012). Eligible women were at least 18 years old, in a non- commercial heterosexual relationship for at least 6 months, and reported lifetime hard drug use (heroin, cocaine/crack or methamphetamine) and sex with non-commercial partners and clients within the past month. Women were recruited first, and those who feared life-threatening intimate partner violence were screened out (and referred to local services) owing to safety concerns. Eligible women brought their intimate male partners to study offices to assess men’s eligibility (≥18 years old) and verify relationship status through additional screening. Couples provided written consent upon enrolment. Protocols were approved by Institutional Review Boards at the University of California, San Diego, the Hospital General Tijuana and El Colegio de la Frontera Norte.

Quantitative data

From 2010 to 2011, 214 couples (214 women and their 214 non-commercial male partners) completed individual quantitative surveys that covered socio-demographics, relationship characteristics, sexual behaviours and drug use every six months over a two-year period. Surveys were administered in English or Spanish by trained interviewers. A series of five questions about pimps and managers were asked at baseline. Individual participants were also asked a set of 11 decision-making questions that the study team developed to assess who made key decisions regarding sex work practices. The 11 decision-making variables tested between partners included sex work locations (where to take clients), time allocation (days and times used for sex work), client recruitment (where to locate clients), number of clients per day/night, types of sexual activities, cost for sex (e.g. ‘Between you and your partner, who decides how much money to charge clients?’), condom acquisition (where to get condoms), condom use per sexual activity, types of payment (money or other material goods), sex work earnings distribution (how much of the payment each person gets to keep) and use of sex work earnings (how and when to spend sex work income). Likert-type responses included (1) you decide exclusively; (2) you mostly decide, but your partner provides some input; (3) you and your partner decide together and equally; (4) your partner mostly decides, but you provide some input; and (5) your partner decides exclusively. Cohen’s Kappa was used to compute inter-rater reliability to determine the extent of agreement between female and male partners with respect to men’s involvement in women’s sex work decision-making (Hallgren 2012). We also calculated summary statistics (medians, frequencies) to describe demographic and sex work characteristics; relationship variables that theoretically should not vary within couples (e.g. relationship duration) were averaged within dyads using both partners’ responses (Kenny, Kashy, and Cook 2006).

Qualitative Data

For the individual and couple ( joint) qualitative interviews described below, we purposively sampled 41 couples representing a range of characteristics, including relationship duration and drug use. Interviews explored the social contexts of relationships, drug use and sex work, including male involvement regarding women’s sex work. Audio-recorded interviews were conducted in Spanish or English by trained interviewers at the project offices and lasted between 30–90 min. Between February 2010 and March 2011, we interviewed 18 couples in Tijuana (18 joint and 36 individual interviews) and 23 couples in Ciudad Juarez (23 joint and 45 individual interviews). In a total of 122 interviews (both individual and joint), we repeatedly heard similar information about our primary topics of interest and determined that we had reached saturation, or confidence that the sample was sufficient to adequately explore themes of interest (Guest, Bunce, and Johnson 2006).

Interviews were audio-recorded, transcribed and translated for text analysis by trained bilingual staff following a structured protocol. We employed a collaborative process of building the codebook and analysing the data (MacQueen et al. 1998). First, we read selected interview texts and independently generated codes based on the primary topics from the interview guide as well as emergent themes (Ryan and Bernard 2003). We then met to discuss and refine the codes and construct a draft codebook for an initial round of coding. A core group of four bilingual analysts applied finalised codes to transcripts and met regularly to resolve discrepancies as needed and discuss emergent findings.

Data triangulation

Our analysis integrated descriptive statistics about finances and decision-making around women’s sex work with an inductive analysis of qualitative data on relationship roles and sex work practices to offer a comprehensive description of sex workers’ intimate relationships (Creswell 2014). We first qualitatively examined how partners defined and experienced their relationships, mapping out boundaries between ‘partners’ and ‘pimps.’ We then explored the financial terms of women’s sex work and decision-making in the survey data before returning to the qualitative data in an iterative process of explaining and expanding upon our quantitative findings regarding female autonomy and limited male partner involvement in sex work. The qualitative data provide rich insight into the contexts and motivations surrounding men’s roles in their partner’s work. We selected representative quotes from individual interviews unless otherwise indicated. All names were changed to protect identities.

Results

Characteristics of couples

Among 214 enrolled couples (n=428), the median age was 34 (interquartile range [IQR]: 29–41) and couples had been together for a median of 3 years (IQR: 2–5 years; Table 1). Recent drug use (past six months) was common, with participants primarily using heroin (63%), methamphetamine (31%) and cocaine (20%), and 60% injecting any drugs. Overall, 43% of participants reported earning an average monthly income under US $200 per month, which was more common among men than among women (49% vs. 38%, p<0.05). Qualitative sub-sample characteristics (n=41) mirrored those of the full sample.

Table 1.

Characteristics of 214 female sex workers and their 214 non-commercial male partners in Tijuana and Ciudad Juarez, Mexico (N=428).

Variable Women(n=214) Men(n=214) Overall (n=428)
Participant characteristics
Median age in years (interquartile range; IQR) 33 (26–39) 37 (31–43) 34 (29–41)
Median educational attainment in years (IQR) 6 (6–9) 7 (6–9) 7 (6–9)
Median relationship duration in years (IQR) – – 3.0 (2–5)
Income <2500 pesos per month (<US$200) 81 (38%) 103 (49%) 184 (43%)
Drug use (past 6 months)
 Heroin 136 (64%) 130 (61%) 266 (63%)
 Methamphetamine 69 (33%) 62 (29%) 131 (31%)
 Cocaine 45 (21%) 40 (19%) 85 (20%)
 Injected any drugs 132 (62%) 123 (58%) 255 (60%)
Partners live together and share at least some household expenses – – 370 (87%)
Sex work behaviours
Primarily works on the street 175 (82%) – –
Shares earnings with steady male partner 183 (86%) – –
Median percentage of earnings shared with steady male partner (IQR; n=183 female sex workers) 50% (20–50%) – –
Must pay someone like a pimp/manager 10 (5%) – –
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Perceptions of partners

Only 10 women (5%) in the survey reported having a ‘manager, administrator, or pimp’ (un supervisor, administrador, o padrote). All 10 women said these pimps were men, and five were their steady (study) partners. Within such arrangements, pimps were reported to provide women with protection from drunk and aggressive clients (n=6), drugs (n=5), shelter (n=3), general safety (n=3) and protection from police (n=2). Pimps also handled negotiations with clients (n=3), asked women to have unprotected sex for more money (n=3) or asked women to use condoms with clients (n=2). Intimate partners’ survey responses corroborated their involvement in these specific aspects of sex work, with Kappa statistics ranging from 0.57 to 0.69, suggesting moderate to substantial agreement between partners.

In the majority of qualitative interviews, neither partner considered the man to be a pimp. Most couples distinguished their relationships as separate from sex work, which they perceived to be socially stigmatised despite its quasi-legal status and prevalence in the border region. Several couples said they felt judged and that outsiders were unable to understand the boundaries they drew around their relationships. Karla, 43, described contending with such comments from other women, which often left her exasperated:

There are women who tell me … ‘Oh, don’t be a fool; leave your pimp.’ I tell them ‘you know what? Don’t even talk to me,’ I say, ‘you don’t even know who he is, he is my husband … go to hell … we understand each other, him and I have an agreement.’ – Karla, 43, Tijuana

Karla’s frustration demonstrates the emotional separation of sex work from her intimate relationship, which was a common theme for many couples. Even if couples did not have a formal agreement on the terms of sex work, partners understood women’s sex work as grounded in economic need, drug addiction and lack of viable opportunities for both partners. Eva, 20, viewed her sex work in terms of its financial contribution to the relationship. Because her partner is bothered by her work, she distinguishes him from a pimp:

Well I do it [sex work] … not because he is my pimp. I don’t say that he is my pimp because if it were like that, he wouldn’t care that I would be doing all of those things [with clients], right? And I see it that way, I mean it’s my work and that’s it. And sometimes if I can’t work, well, he helps me. I mean, I don’t see him as my pimp. He is my partner and that is it. – Eva, 20, Tijuana

While the majority of couples perceived their relationship as distinct from pimp-sex worker relationships, several confirmed that other sex workers in the border region have pimps. Patricia, 31, compared her relationship with that of other sex workers she knew:

I have seen other couples, well I think that he and I are the only ones who get along better because I see that the women, they say he is a partner, but he is also the pimp because if she doesn’t make money, they leave their eyes purple or their mouth all beaten. Mine doesn’t … I don’t compare myself with those couples, because compared to them, what we have is beautiful. – Patricia, 31, Ciudad Juarez

However, a few women relayed stories of what could be constructed as pimp behaviours by their current intimate partners. Imelda, 34, said her partner brought her to the zona roja in Tijuana shortly after they moved there as a way of hinting that she could do sex work to earn money. While she felt that he was exploitative, she fell short of labelling him a pimp. Similarly, although Katrina, 28, emphasised that it happened ‘just that one time,’ her partner forced her to go with a client when they were both in heroin withdrawal and did not have money for their fix:

He even slapped me because I did not want to go; I was ashamed that he saw who I was going to go with to get some money. He was adamant that I should go with the guy because of the money. But I felt bad and asked him, where is the love? Don’t you love me? Why are you sending me to do this? – Katrina, 28, Tijuana

While couples’ self-assessments of male partners’ roles as pimp versus partner tended to favour the latter construction, the lines were sometimes blurred, and partners may not have wanted to talk about such circumstances.

Sex work and household finances

Examining couples’ decision-making and behavioural patterns also provided insight into the extent to which men were involved in women’s sex work. The unstable economy throughout the border region, combined with couples’ marginalisation from formal-sector employment owing to low education levels, addiction, criminal records and deportation underlie much of the street-based sex work in which women in our sample engaged. Women primarily worked in sex work, but 21% also reported other informal employment. Men reported a range of jobs in the informal (62%) and formal (23%) sectors, including day labour and other part-time work in construction, the service and entertainment industries, street-based vending and petty crime.

According to the survey data, nearly all couples lived together (99%), and most reported that both partners contributed ‘equally’ toward household expenses including rent (74%), utilities (72%), food (78%), childcare (73%) and other household items and maintenance expenses (75%). Most women (86%) reported sharing earnings from sex work with their steady male partner, with a median of 50% of total earnings shared (IQR: 20–50%; Table 1). Men generally agreed that female partners shared about 50% of their sex work earnings (IQR: 25–50%). However, women exerted substantial individual decision-making control over specific aspects of their sex work, particularly regarding earnings: 88% of women made decisions on how much to charge clients, 88% decided on the type of sex work for income generation, and 86% decided how much money they kept (Figure 1). Qualitatively, many couples confirmed that the women were in charge of finances and decision-making about sex work:

No, actually my money is my money… you could say that I have worn the pants at home, I have done everything. – Martina, 34, Tijuana

No, he doesn’t meddle at all, if one day I didn’t make any money, you know what? There wasn’t anything and there aren’t any arguments about why, why not? – Diana, 31, Ciudad Juarez

Figure 1.

Figure 1

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Sex work decision-making among 214 female sex workers and their 214 non-commercial male partners in Tijuana and Ciudad Juarez, Mexico (N=428).

Partners discussed how they both tried to contribute financially when they could, but women in particular discussed using their sex work earnings to pay for rent, childcare, and drugs. Despite sharing their earnings with male partners, most women did not consider it as exploitative or profitable for men, as men were often expected to take over other household responsibilities in exchange. Pilar, 40, had an arrangement with her partner to watch their son while she worked. She explained that her partner, Manuel, 42, was not involved with her sex work:

No, well, I mean, in that stuff he doesn’t [get involved] because he stays home with the kid … until I come back home because I tell him, unless something big happens, an emergency for the baby, if you need anything or something that is really urgent, and he knows he should go to the corner [street where she works] and meet me there … Because otherwise, well, he will wait for me to come back. – Pilar, 40, Tijuana

As illustrated in this passage, each partner had a distinct role. Moreover, like many women, she did not want her partner to interfere with her work, as further explored below.

Male partner involvement in sex work

In addition to financial decisions, survey data indicated that women primarily made individual decisions around other specific aspects their sex work: 85% decided on condom use, 87% made decisions about locating clients, and 80% decided when to work. Qualitative analyses also reflected these trends, suggesting that men were typically uninvolved in decisions about specific clients or sexual exchanges because it was emotionally hurtful, generated jealousy, or promoted conflict within steady relationships. Women expressed their preference for not involving partners in these decisions in order to reinforce the boundaries between work with clients and home lives with intimate partners. Suzy, 50, said she and her partner enjoyed a close relationship, but she made all her own decisions regarding sex work:

He doesn’t demand a fee from me, he doesn’t demand that I choose the clients. He can’t tell me, ‘put these clothes on,’ no, I wear what I want, that’s how I take it … not for him to tell me, oh no, those clothes don’t look good on you, or go like this, no, I make the decision ... – Suzy, 50, Ciudad Juarez

Similar patterns held for couples entrenched in drug dependency who relied on sex work to purchase drugs:

She makes her own decisions in that aspect [sex work]. I don’t interfere because even though I’m an addict, the fact that she works in [sex work] still hurts me, but we do it because we need money for our addiction, unfortunately, right? But she’s the one that makes choices on her own. – Javier, 20, Ciudad Juárez

As reflected in survey data, men were not typically involved in decision-making processes around sex work, but partners often maintained general agreements about work. Roberto, 43, and Nancy, 31, had a typical agreement about her sex work. Although he benefited from her earnings, he did not get involved because, ‘I don’t feel good watching her go into a room with a man, you know?’ Instead, they agreed on a set time that she came home so he knew that nothing bad had happened to her, and he did not offer input into her decision-making around sex work because he was emotionally invested in the relationship:

[For sex] work, how am I going to tell her to wear this or that? No… I think that would be like being her pimp, right? Because ‘wear this and that so that you get more clients,’ I think that is what men who don’t support their women will do, a pimp, for me that would be a pimp … No, tell her wear this so that your clients look at you? No, nothing like that, that for me … is wrong. I actually never ask her how much she charges … No, that is her thing. – Roberto, 43, Ciudad Juarez

While most male partners were not directly involved in details of their partner’s sex work, some men shared opinions and offered advice to their partners. Typically, these suggestions were framed as ways for male partners to protect the physical and emotional aspects of their intimate relationships. For example, many men did not want their female partners to wear short skirts, low cut shirts, or other revealing clothing, and instead preferred that women wore pants when working. Unlike Roberto, who did not provide input on his partner’s work clothes, other men advised their partners not to dress in ways to attract attention:

Sometimes she has too much cleavage … I don’t like her to wear skirts or nothing, no, not skirts, miniskirts, no … I don’t like it. – Carlito, 35, Ciudad Juarez

For the client, if you’re dressed like a nun or you’re naked, he doesn’t care. The client is going to go with you, so you don’t have to reveal that much. Be a little more demure. I’m not going to tell you to cover up your ankles, but a little more demure, why? I say at least give yourself some respect, why? I tell her, because your worth is what you want to give yourself …. – Juan Carlos, 53, Ciudad Juarez

Men also worried about their partners physically putting themselves at risk through their work. While men often took for granted that their partner knew how ‘to protect herself,’ some men reminded women to use condoms. Rather than helping women negotiate safe sex with specific clients, this was given as general safety advice and because men worried about their own risk of acquiring infections. Men also cautioned women to select clients carefully and avoid those who looked sick or appeared to be drunk or high. They advised their female partners against going to unfamiliar locations or placing themselves in risky situations:

I give her advice about not getting into people’s cars, and not going with clients if they’re too drunk. Also, about not doing things without a condom, even if they give her a lot of money. I try to guide her so that nothing bad will happen to her. I don’t do it just to bother her. – Marco, 27, Ciudad Juárez

Discussion

Our research on Mexico’s Northern border suggests that in this context freelance female sex workers exert considerable agency and control over the management of their resources, bodies, and decision-making. Contrary to popular cultural and academic accounts of sex worker–pimp relationships, women’s non-commercial intimate male partners in this context had limited involvement in their sex work. We situate our discussion of these findings within the broader literatures on sex work and intimate relationships to contend that female sex workers are not exclusively defined by their occupation, nor are all intimate male partners emotionless managers exclusively motivated by financial gain. We conclude with suggestions for global HIV prevention interventions and health promotion programming.

In our survey, women reported autonomy in their sex work decisions, and few reported that their partner was a pimp, which was corroborated in qualitative interviews discussing sex work within relationship contexts. The majority of couples explained that men had little direct involvement in sex work, and couples often avoided discussing the topic in order to preserve the emotional quality of their relationship (Syvertsen et al. 2013b). The emotional aspects of these relationships clearly differentiated intimate partners from pimps: participants’ descriptions of pimps reflected popular notions of control, coercion and management of women without caring about them in the ways that intimate partners did. These distinctions suggest that most couples were in emotionally caring relationships where male partners’ advice on the women’s sex work was predominantly driven by concerns regarding health and physical safety rather than financial gain.

However, even if male partners did not self-identify or fit prevailing definitions of pimps, our findings do not imply a total absence of control within relationships. Instead, gendered power dynamics within these relationships may play out in more subtle ways. Decisions related to finances and forms of male advice are negotiated within particular social contexts wherein multiple competing concerns may drive decision-making. While couples portrayed men’s involvement in sex work as part of a strategy of safety and protection, which could actually reflect functions of traditional pimp roles, deeper physical and social forms of male self-preservation may also be at work. In the cultural context of Mexico, the honour and prerogative of men remain at stake regarding their reputations and sense of masculinity (Hirsch et al. 2007), particularly when shifting gender roles render women as primary financial providers (Syvertsen et al. 2013b). Outward discussions and displays of behaviour differentiating male partners’ roles from that of pimps may be a social technique to preserve couples’ identities as ‘normal’ men and women (Goffman 2009). Nevertheless, that both partners drew clear distinctions between intimacy and pimping conveys the subjective importance attached to sex workers’ non-commercial relationships, as other global research has demonstrated (Deering et al. 2011; Murray et al. 2007).

Importantly, both partners within these relationships experience multiple social and economic pressures, and owing to non-traditional relationship roles, many feel judged and stigmatised by others, including their own social networks. Stigma, whether experienced or perceived, is a critical barrier to effective outreach in health promotion, including the provision of HIV prevention services (Padilla et al. 2008; Parker and Aggleton 2003). Our work suggests that healthcare providers should avoid blanket assumptions about sex workers’ intimate relationships to prevent inadvertently stigmatising this population even further. Particularly in the context of ongoing debates surrounding the health and social benefits of decriminalising sex work (Shannon et al. 2015) and Amnesty International’s declaration in support of such a global initiative (Amnesty International 2016), it is critical to keep in mind the diversity of relationships that sex workers form with men and to acknowledge that not all of these relationships are predatory. Women’s own definitions of their intimate relationships and their significance in their lives should be included within broader agendas to address stigma and promote sex workers’ health and human rights.

Finally, our findings invite us to think about intimate relationships more broadly. Individuals have diverse motivations for entering and maintaining intimate relationships, and these varying configurations of emotional closeness and gendered power dynamics are profoundly shaped by the political economic and cultural landscapes in which couples’ lives are situated (Hirsch and Wardlow 2006; Padilla et al. 2007). Relationship formation as such is not always a straightforward process of purely defined intentions (e.g. Western notions of marriage based on love), but rather takes on layers of sub-text as partner bonds become enmeshed. Bourgois and Schonberg (2009) suggest that there is a ‘continuum between altruism and instrumentality that haunts all male–female sexual relationships and intimate feelings’ (Bourgois and Schonberg 2009, 52), and other scholars have similarly argued that intimacy and economics intertwine to form the foundation of all close sexual relationships (Zelizer 2005). While the socially marginalised couples in our study rely on each other for numerous forms of support (including the financial gain from sex work), which are vitally important given their socio-economic disadvantage (Syvertsen et al. 2013a), our findings ultimately reflect features of other heterosexual relationships in less stigmatised social contexts. Rather than conceptualising intimate relationships as dichotomies (e.g. pimp vs. partner, exploitation vs. caring), a greater recognition that all intimate relationships are fluid, ongoing social negotiations would create more realistic expectations and improve couples-based research, HIV prevention and health service provision.

Nevertheless, the generalisability of our findings is limited. Our sample comprised stable heterosexual couples (relationship duration ≥6 months at enrolment), and by design, all of the women had used heroin, cocaine or methamphetamine. Although the prevalence of recent intimate partner violence (IPV; i.e. emotional, physical or sexual) reached 35% among our quantitative study sample (Ulibarri et al. 2010, 2015), qualitative accounts of IPV were scarce among the couples in our study perhaps owing to social desirability bias. All of the male partners we enrolled were aware that their partner engaged in sex work, and we excluded those experiencing life-threatening IPV. Couples where the woman hid her sex work from her partner, and those that experienced more serious IPV, may differ from those included in our sample, as might female sex workers working outside a street-based, free-lance context. Our sample also included couples with relationship durations of at least 6 months, which may under-represent shorter-term, less stable and more conflictual relationships. As a cross-sectional study, we are unable to infer temporality from the associations we identified. However, our work is strengthened by the triangulation of survey data and qualitative interviews with both partners, permitting a personal perspective of how couples understood and enacted their relationships.

Conclusions

Our research lends important insight toward the development of health promotion initiatives, including programmes for sex workers and their intimate partners in the Mexico–USA border region and other similarly resource-poor contexts. Clearly, understanding power dynamics within relationships is critical to developing appropriately targeted approaches. Our research suggests that while there is a continuum of power, control and care among these couples, partners overwhelmingly conceptualised their relationships in ways that greatly deviated from stereotyped ‘pimp–sex worker’ arrangements. Assuming that all men in relationships with female sex workers are pimps or exert direct control over women’s behaviours could represent a missed opportunity to provide tailored, couple-based services. For example, a current HIV/STI prevention intervention for female sex workers and their non-commercial partners by our group focuses on increasing communication among partners in order to discuss safer sex and drug use (Ulibarri et al. 2016). We suggest that health and social service providers openly ask sex workers about their intimate relationships. The development and utilisation of brief screening tools to assess experiences of violence could also better serve women dealing with abusive intimate partners or pimps.

Ultimately, how couples themselves define, discuss and experience their relationships should be taken seriously by researchers and interventionists. In our study setting, couples-based approaches could acknowledge the supportive roles that male partners may play in keeping women safe. Such programmes should recognise and build on the agency that women in informal contexts of sex work may exert. In contrast, interventions for pimp-controlled sex workers may require more intensive strategies to address violence, abuse and lack of autonomy in decision-making. Such programmes could also consider involving pimps, but much more ethnographic research involving pimps themselves will be needed to effectively guide such efforts. In conclusion, we should avoid labelling sex workers’ relationships and commoditising them into passive recipients of intervention programming. In the context of health programmes, assumptions that all female sex workers’ relationships are coercive or commercial may inadvertently further marginalise these couples while their needs remain unaddressed.

Acknowledgments

We would like to thank the project staff and participants without whom this study would not have been possible.

Funding

This work was supported by the Center for AIDS Research, University of California, San Diego [grant number NIAID P30AI060354-10, NIAID P30AI36214] Fogarty International Center [grant number D43TW008633, R25TW009343]and National Institute on Drug Abuse [grant number R01DA027772, R36DA032376, R37DA019829, T32DA023356].

Footnotes

Disclosure statement

No potential conflict of interest was reported by the authors.

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