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Try out PMC Labs and tell us what you think. Learn More. Recent studies have documented frequent use of female sex workers among Latino migrant men in the southeastern United States, yet little is known about the context in which sex work takes place, or the women who provide these services. As anthropologists working in applied public health, we use rapid ethnographic assessment as a technical assistance tool to document local understandings of the organization and typology of sex work and patterns of mobility among sex workers and their Latino migrant clients. By incorporating ethnographic methods in traditional public health needs assessments, we were able to highlight the diversity of migrant experiences and better understand the health needs of mobile populations more broadly.
We can do a lot to improve access if they [migrant workers] could be part of the regular infrastructure. They are not integrated into society. When you push people Women seeking sex Pike Road Alabama of the mainstream, they go off into different venues to get sex and other needs met.
Although a Women seeking sex Pike Road Alabama proportion of Latinos still live in states with established Latino populations such as California, Florida and New York, their share has been rapidly growing in other places, most notably in the southeastern United States, where states such as Kentucky, Mississippi, North Carolina and South Carolina more than doubled their Latino population sizes.
North Carolina, for example, experienced a rapid increase in the Latino population, from 1. The migration of Latinos into these southeastern states has been driven by employment opportunities in construction and agriculture. Public health studies focusing on the South have documented the social dimensions that facilitate exposure to sexual risk for these men Painter For instance, Parrado and Flippen found that migration to the United States was associated with a younger age of sexual debut and that sexual initiation was more likely to take place with a sex worker.
Knipper and colleagues observed that in rural North Carolina, Another study reported that all Latino migrants identified as having syphilis during an outbreak in Alabama were found to have had sex with female sex workers Paz-Bailey et al.
Apostolopoulos and colleagues found that Mexican male migrant laborers in South Carolina experienced high levels of social isolation, anxiety and depression, and reported high rates of risky sexual and substance abuse behaviors. There are few data available on the organization of sex work in the southeastern United States; that is, the localized structures and processes through which sex is exchanged for money in what is generally regarded as a commercial transaction.
Studies carried out in the s largely addressed female sex work in conjunction with crack cocaine use in large urban areas such as Atlanta Sterk An ethnographic study in Florida described the context of female sex work in agricultural areas, noting that sex workers with a history of substance abuse often canvassed large areas in search of clients or travelled to migrant camps to solicit men Bletzer More recent studies with migrant farmworkers indicate that some sex workers work alone, while others appear to be housed in brothels and are moved Women seeking sex Pike Road Alabama throughout the South and along migrant labor streams NC Farmworker Health Program ; Parrado et al.
Rhodes and colleaguesfor instance, found differing structures of sex work with distinct referral processes among Latinos in North Carolina, including sex workers who operate out of bars, work for controllers, and function independently. To better understand the structure and context of sex work, the social and structural dimensions that facilitate exposure to sexual risk, and the potential mechanisms for effective intervention among highly mobile and hidden populations, we conducted a rapid ethnographic assessment REA to obtain the views of health and social service providers.
Our findings suggest that there is substantial diversity in patterns and experiences of mobility for both migrant men and sex workers. Latino migrant workers in North Carolina, a vast majority of who are unauthorized, were reported to have high rates of mobility which reduced their access to health care and contributed to their engagement with varied types of sex work services.
Providers indicated that sex work in the area is characterized by several different factors including the location in which sex work takes place, the demographics of sex workers, the organizational structure of sex work, and the patterns of mobility associated with these structures.
also suggest that available health and social services appear to be tailored for migrant men and sex workers who are less mobile i. Based on our findings, we advocate for more ethnographically grounded, long-term approaches to understanding mobility as an organizing principle in public health research and practice. Accessing highly mobile populations, especially those involved in activities that are hidden and criminalized, with health and other services is complex and challenging Abrams ; Braunstein ; Singer But involvement in these activities and the elevated levels of mobility associated with them necessitates the urgent need to provide basic access to health and social services to these populations.
Recognition of the need to address structural and social influences of poor health has been growing, with particular emphasis on understanding local health and cultural practices of populations impacted by severe health inequities Krieger ; Marmot and Wilkinson ; Navarro ; CSDH The focus on distal causes of disease has propelled health research to include interdisciplinary and social science approaches.
Interest in using ethnographic approaches in health care research to conduct cultural analyses and to reach hidden populations is also growing. Although some scholars continue to debate over the differences between qualitative and ethnographic research Beebe ; Handwerkermany anthropologists working in applied public Women seeking sex Pike Road Alabama settings argue that essential ethnographic data can be collected within the realities of programmatic time and budgetary constraints Agar ; Bentley et al.
Rapid qualitative and anthropological data collection methods have been used in development and health projects since the s. These include rapid appraisal Hildebrandrapid-feedback evaluation Wholeyrapid ethnographic assessment Scrimshaw and Hurtadorapid evaluation methods Anker et al. Although these approaches have distinct origins, methods, and frameworks, they all emphasize the rapid collection and dissemination of information useful for key decision makers, the use of multi-disciplinary Women seeking sex Pike Road Alabama teams, and triangulation to verify multiple data collection methods and sources Harris, Jerome, and Fawcett Drawing upon the principles of ethnography, REAs complement and offer alternatives to traditional public health data collection methods i.
REAs help identify social and structural factors that contribute to poor health outcomes Women seeking sex Pike Road Alabama are often used to conduct research on hidden, highly mobile, or hard-to-reach populations.
Key characteristics of REAs are that they are focused on a few key questions and deed to achieve depth of understanding. They are carried out over a compressed period of time, with data collection usually taking several days to several weeks and analysis of data and report writing taking from a few weeks up to several months.
Supporters of REAs consider it an approach that is a compressed but not a diluted version of traditional ethnography that uses an integrated set of ethnographic methods, including mapping, observation, and key informant and focus group interviews Needle et al. Skeptics question the legitimacy of the method itself, arguing that the potential for misapplication of the technique is too great. In response, anthropologists who advocate for REAs maintain that such assessments are highly pragmatic given the lack of availability of qualified researchers, severe time and budgetary restrictions, and critical programmatic limitations in many applied public health settings Manderson and Aaby ; Needle et al.
Lawrence ; Aral et al. Our assessment did not attempt to address the entire scope of sex work within North Carolina; it focused on health and social service providers in a four-county area surrounding Raleigh to examine organizational patterns or Women seeking sex Pike Road Alabama of sex work and engagement of migrant men as clients within these organizational patterns.
Health care providers are key but grossly untapped sources of information because they regularly make difficult decisions about the delivery of adequate care in uncertain and tenuous immigration policy environments cf. Because sex work and unauthorized migrant labor is hidden, front-line providers are often the only people who have access to those directly involved in such activities. The assessment was carried out by an interdisciplinary team of public health professionals, including two anthropologists.
The REA began with discussions with experts familiar with the migrant Latino population in North Carolina, the use of Google Earth to identify locations of agencies providing services to migrant Latinos, and a review of published and unpublished data to compile a social and demographic overview of the study area.
Key informants, those likely to have knowledge of or contact with migrant laborers and female sex workers in a four-county area surrounding Raliegh, were sampled purposively and invited to participate in interviews. In all, 28 key informant interviews were carried out: ten interviews were conducted with persons from community-based organizations CBOsnine with persons from state and county HIV and STD programs, five with persons from state and local rural health programs, and four with persons from legal services and law enforcement.
In addition, the team conducted field observations in truck stops, trailer parks, migrant worker camps, and apartment complexes where sex work is known to take place. Field notes taken during data collection were expanded into detailed notes and used for qualitative data analysis As is customary in rapid assessments, all four members of the team participated in the analysis and report writing, and a follow-up stakeholder meeting was held in North Carolina to present the findings outlined below and obtain feedback.
Provider interviews revealed mobility in the context of migration and sex work in North Carolina is a multi-dimensional construct, encompassing such characteristics as frequency and timing of movement, direction and distance traveled, spatial or geographic range, and location, place, or destination. Although both migrant men and sex workers were said to experience a high degree of occupational mobility travelling substantial distances to find and secure work, there was considerable diversity in their patterns and experiences of mobility. A better understanding of the dynamics, characteristics, and key patterns in mobility—who, how, where and why travel occurs, and under what circumstances different groups of people come into social and sexual contact with each other—gives us additional insight into developing strategies to reach these hidden populations with critically needed services and interventions.
Markets for sex work have traditionally emerged wherever there are large s of unaccompanied men who congregate for extended periods of time, and in North Carolina, providers suggested that migrant Latino men are perceived as prime clients by those involved in sex work because they carry cash, are seen as lonelier, and are believed to be less violent than other men.
Key informant interviews and observations revealed that sex work services are available to Latino men in a diverse array of settings and venues, including migrant camps, brothels, cantinas and residential areas such as trailer parks and apartment complexes. As Latino men migrate into and out of North Carolina, sex work also adapts and develops structures and patterns to reach new clients. Large s of Latino men migrate to North Carolina for work each year, and provider interviews and a review of the literature indicate that the patterns of mobility and their daily experiences differs considerably based on whether they are temporary Women seeking sex Pike Road Alabama guest workers in possession of H-2A visas or unauthorized workers in the country for an undetermined length of time.
For instance, providers conveyed that men with H-2A visas typically arrive in the United States at the beginning of the growing season and work for one grower until the end of their contract before returning home. These workers live in camps or dormitory style housing provided by growers located at the edge of agricultural fields in rural areas isolated from the nearest town.
Their mobility, therefore, is relatively limited and primarily local; they eat, sleep, cook, do laundry, and work in the same location. Providers who conduct outreach at these farms described camp life as geographically and socially isolated, and often lonely and boring for the men who live there. The vast majority of agricultural workers in North Carolina, however, are not H2-A visa holders; inonly 8, of an estimated 69, workers held H-2A visas Arcury and Quandt Most agricultural workers in North Carolina are unauthorized and are in persistent threat of deportation.
The living and working circumstances of these workers are much more chaotic and unstable, characterized by a higher degree of mobility and a broader range of living situations, than those of H-2A workers. Providers stated that conditions for unauthorized agricultural workers are substantially worse than those faced by H-2A workers due to a lack of regulatory protections and engagement with unscrupulous labor contractors or crew leaders cf. Hubnerwho recruit mainly young, single, and unauthorized Latino men from states like Texas, Florida and Georgia to work in North Carolina or other states.
Smith-Nonini Unauthorized agricultural workers were reported to experience more mobility than H-2A workers because they have few legal protections and many are under the control of crew leaders; as a result, these men were described as fearful and likely to change jobs or living arrangements if they feel threatened. Providers also described large s of unauthorized men in non-agricultural work such as construction, landscaping, painting and other kinds of short-term labor. They indicated that while these men may be socially hidden due to their unauthorized status, they are not as geographically isolated in rural areas as farm workers.
They often reside in peri-urban and urban trailer parks, apartment complexes and residential situations where there are large s of men without female partners, and where, as a consequence, they come into contact with a variety of sex work services.
Within the four-county area, sex work services are available in a diverse array of settings and venues, including streets, brothels, camps, and residential settings. Providers noted that sex work in the area is characterized not only by venue and demographics of the women providing services, but by differences in the organizational structure of sex work and the patterns of mobility associated with these structures. Vissman et al. Brothels are heterogeneous and are likely products of large criminal networks Polaris Project They are also rudimentary and transient structures, setting up operations in trailers, houses or apartments in residential areas, and then moving location or disappearing entirely to evade law enforcement.
Polaris Project, an anti-trafficking organization, reported that brothels are usually set up in residential areas and housed in Women seeking sex Pike Road Alabama, low value properties, in an effort to remain portable and flexible Polaris Project Outside of Siler City, for example, we saw two abandoned house trailers that had recently functioned as brothels servicing Latino men. An outreach worker explained that when a raid had closed one trailer, operations had moved up the road to the other, but recently they had both closed due to pressure from law enforcement.
Most providers perceived the brothels as being part of different networks and possibly linked to Mexican drug cartels. Groups of women, described as primarily from the Dominican Republic, Mexico and Central America, and Puerto Rico reportedly rotate on a weekly or bi-weekly basis across a large region that extends from New York to Florida along the Eastern corridor; this pattern has also been documented by Polaris Project Many of these women are likely unauthorized and vulnerable due to economic or other factors; and some have been trafficked.
Brothel sex workers were reported to be patronized primarily by Latino men who live in peri-urban and urban areas, most of whom are not farm workers. An outreach worker who had worked as brothel security reported that the fee for sex is usually split between the sex worker and the brothel owner, with earnings collected by the owner on a weekly basis. Providers indicated that there may be owners, transporters, doorman, and look-outs who share in the earnings, depending on the size and complexity of the brothel network. Given the large volume of clients serviced per day, and Women seeking sex Pike Road Alabama low overhead, brothels can be lucrative operations Polaris Project Providers recounted that sex workers were transported across a broad geographic region to migrant camps in rural areas, although it is not entirely clear if these women are part of the same networks as brothel-based sex workers.
They reported that most women appeared to be young and Hispanic, although they also occasionally encountered Caribbean and African-American women. Providers thought that these women, too, travel extensively throughout the region, staying a week or two in one location, and said that the frequency of sex worker visits to migrant camps had increased over the past several years.
Highly mobile sex workers were also reported to target Latino men in residential areas, traveling into a city to provide services for a few months, and then presumably returning to their home location. For example, outreach workers noted an influx of Dominican, Mexican and Central American women traveling into the Raleigh area from New York. These women may take up temporary residence in an apartment complex where there are large s of Latino men, and sometimes go door to door soliciting clients.
Women also travel to the area looking for work in local bars and cantinas bars ; while our assessment did not detect a systematic pattern of sex work services being provided through local cantinasthis pattern has been reported elsewhere Polaris Project ; Rhodes et al. The patterns described above are characterized by a high degree of mobility, with sex workers often traveling routinely throughout an extensive geographic region to serve large s of Latino clients.
While it is clear that many of these highly mobile sex workers reside outside these counties, local women also target Latino men. These women appear to be fewer in and not associated with any organizational structure; they may work autonomously and sporadically as the need arises, although some may have male partners who help them procure clients. When we accompanied a male outreach worker conducting door-to-door activities in a Raleigh apartment complex, Latina residents indicated that individual African-American, Caucasian American, and Latina women all frequented the complex, and would often have sex with men in a wooded area behind the complex.
Providers described street-based sex workers, mostly in Raleigh, also as local women who have Women seeking sex Pike Road Alabama Latino men as clients. Relatively small s of predominantly African-American women can be found in predictable locations on streets near abandoned or condemned houses.
Providers working with this population described them as women with a long history of physical, emotional and sexual trauma, and suffering from substance abuse, mental health issues, and unstable housing situations. These women were reported have a diverse client base that includes migrant Latino men but they see far fewer clients than most women who provide services to Latino men, usually only 2—3 clients a day.
Unauthorized immigration and sex work are hidden, criminalized, and highly stigmatized activities, which makes reaching persons involved in them with health and other services challenging. Even under the best of situations, it takes time to establish trust and credibility and to overcome barriers created by gatekeepers such as crew leaders and pimps, time that may be protracted under conditions of high mobility and turnover in the population.
At the same time, participation in these activities and the high degree of mobility associated with them necessarily increases the need to intervene with services that protect health. Among those we interviewed, there is great concern about the challenges of reaching mobile sex workers and migrant Latino men and the need for structural interventions to address issues of access to care and social marginalization. They think we are going to report them for being undocumented. Providers also expressed concern for the limited Women seeking sex Pike Road Alabama lack of health and social services for all sex workers, despite the alarming conditions in which many sex workers live and work.
Permanent and transitional housing and temporary shelter, along with delivery of mobile health and social services focused on peer mentors, condom provision and mental health and substance abuse treatment were identified as critical needs for women in this population cf.
Thukral and Ditmore The main challenge for providers in working with mobile sex workers is making contact. Lack of knowledge regarding when and where sex workers are working as well as the high degree of mobility among them and the presence of male controllers make it difficult to predict when to provide services and communicate with sex workers.
All we can do is give information and condoms to the farm workers. Providers called for clearer policies and programmatic efforts to reach sex workers with intervention, saying that current efforts to engage with sex workers are sporadic and not actively encouraged.Women seeking sex Pike Road Alabama
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