Graduation Year

2012

Document Type

Dissertation

Degree

Ph.D.

Degree Granting Department

Anthropology

Major Professor

Nancy Romero-Daza

Co-Major Professor

David Himmelgreen

Keywords

couple-based interventions, couples, HIV, Injection Drug Use, photo elicitation, Prostitution

Abstract

This dissertation examines the influence of love and other emotions on sexual and drug-related HIV risk among female sex workers who inject drugs and their intimate, non-commercial partners in Tijuana, Mexico. My work on a public health study along the Mexico-U.S. border and independent ethnographic research in Tijuana suggests the importance of emotions in shaping sex workers' relationships and health risks.

Love is a universal human emotional experience embodied within broader cultural, social, and economic contexts. A growing body of cross-cultural research suggests that modern relationships have transformed to emphasize love and emotional intimacy over moral or kinship obligations. Particularly in contexts of risk and uncertainty, intimate relationships provide emotional security. Drug-using couples may engage in unprotected sex or even needle sharing to convey notions of love and trust and help sustain emotional unity, but such acts also place partners at heightened risk for HIV.

For female sex workers in Tijuana who endure poverty, marginality, and an increased risk of contracting HIV, establishing and maintaining emotional bonds with intimate partners may be of paramount importance. Yet little is known about how female sex workers' intimate male partners shape their HIV risk perceptions and practices. Moreover, male partners' perspectives are critically absent in HIV prevention strategies.

This dissertation is nested within Proyecto Parejas, a study of the social context and epidemiology of HIV among sex workers and their non-commercial male partners in Tijuana and Ciudad Juarez, Mexico. Through semi-structured and ethnographic interviews, photo elicitation interviews, and participant observation, I got to know seven of the couples in Tijuana who are enrolled in Parejas. I examine their relationships through the lens of critical phenomenology, which combines concern with experience, emotions, and subjectivity with political economy perspectives that argue sex work, drug use, and HIV/AIDS is not randomly distributed but historically and structurally produced.

My work suggests that female sex workers and their intimate partners experience their relationships in gradations of love and emotional content. These relationships hold significant meaning in both partners' lives for emotional and material reasons, and shape each partner's HIV risk within and outside of the relationships. Couples choose not to use condoms with each other, often to define themselves as a couple. Sex outside of the relationship occurs for economic and culturally conditioned reasons, but does not necessarily diminish the meaning of the primary relationship. Motivations and ability to use condoms with clients and outside partners are context dependent and, in order to preserve trust and unity, sexual risks are typically not discussed. Partners share drugs and syringes with each other as a sign of care within a context of scarce material resources. Emotionally close couples tend to confine their sharing within the relationship, whereas less close couples also share with friends and family in more social forms of drug use.

Given their vulnerability within a milieu of poverty, social marginalization, and discrimination, love alone cannot explain the HIV risk that female sex workers and their partners face. Nevertheless, emotions are significant factors in both risk taking and risk management. This study encourages researchers, practitioners, and policy makers to consider the affective dimensions of HIV risk within sex workers' intimate relationships as an integral part of a multi-level strategy to address each partner's health and wellbeing.

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