Costa Rican Sex Workers’ Risk
Behaviors and Attitudes Toward
Government Regulation of Safe
Sex Practices: An Exploratory Study
BY: TEQUILLA MANNING
CLENDENING FELLOWSHIP 2014
Presentation Outline

Costa Rica: Basic Country Profile

My Relationship with Costa Rica

Legality of Sex Work (and the Brothels)

Study Design and Objectives

The 3 Hogares

Results

Who cares and why does this matter?

Future Directions
Costa Rica: Country Profile
•
Located in Central America between
Nicaragua and Panama
•
Slightly smaller than West Virginia
•
Tropical and subtropical climate
•
Population: 4,755,234
•
Capital: San José
•
Government: Democratic Republic
•
No military forces
•
Ethnic groups: white, mulato, indigenous,
black of African descent
•
Language: Spanish (official); English
•
Religion: Roman Catholic (76.3%)
•
Contraceptive prevalence rate: 82.2%
•
HIV/AIDS (people living with): 9,800
•
Literacy (total population): 96.3%
•
Universal Healthcare System
Costa Rica and Me

Most Recent (2014): Clendening Fellowship
research

2011: Semester at Sea (SAS)

2010: Study Abroad Program via Grinnell
College
Sex Work in Costa Rica

Legal for men and women 16 years of age and older (dispute over
the age)

Government Regulated

Sex Tourists are mainly those from the United States and Europe—
This is not the full picture!

Prohibited Acts in Costa Rica:
1. Child sex work
2. General Pornography
3. Pimping
4. Exploitation
Research Objectives and Hypothesis

Describe preventative health behaviors of Costa Rican sex workers.

Assess sex workers’ perceptions about the impact of government
regulations on their safe sex practices.

Identify services that the Hogares offer to the sex workers.
Hypothesis: Sex work under government regulation increases health and
safety of sex workers and their customers and that Costa Rican sex
workers are more health conscious and educated about sexuallytransmitted diseases.
Study Design
IRB approved
 Time period: 7 weeks
 Setting: Housing facilities for special and at risk
populations (the Hogares)
 Instrument: 23-item cross-sectional survey that
was administered to a convenience sample of
sex workers

Limitations: small sample size, IRB, IRB, IRB
El Hogar (1)

Located in a neighborhood and two
blocks away from a seminary school for
Catholic priests

Not funded by the Catholic Church

Focus is on harm reduction

No security/Poorly regulated

The majority of the residents have
HIV/AIDS (including the nurse).

Melting pot for the LGBTQ community,
substance abusers, prisoners, etc.

Drama and chaos ALL the time.

The sex workers were welcoming and
friendly.
El Hogar (2)

Located off a highway (very
public view)

Funded by the Catholic Church

More of a hospital (the majority of
the residents have been
diagnosed with AIDS and are
terminally ill)

Highly regulated

I did not administer surveys at this
location.
El Hogar (3)

Also, located in a neighborhood.

Funded partially by the Catholic
Church

Moderately Regulated

Approximately 10 residents

The majority of the residents have
HIV/AIDS.

Small LGBTQ community

People were welcoming and friendly.
Results
Descriptive Information for Study Population
Descriptive Information for Study
Population
Assess sex workers’ perceptions about
the impact of government regulations
on their safe sex practices.
Describe preventative health
behaviors of Costa Rican sex workers.
Describe preventative health
behaviors of Costa Rican sex workers.
Describe preventative health
behaviors of Costa Rican sex workers.
Describe preventative health
behaviors of Costa Rican sex workers.
Describe preventative health
behaviors of Costa Rican sex workers.
Describe preventative health
behaviors of Costa Rican sex workers.
Who Cares and Why Does This Matter?

I care.

More importantly, as a future health professional, I have a duty to ensure the health
and safety of ALL individuals including those from special and at risk populations.

Awareness is important. Many Americans (and Europeans) are engaging in sex
tourism in Costa Rica. Many of the sex workers in Costa Rica have a difficult time
accessing healthcare and have HIV/AIDS and other STIs.

The transgender/transsexual population is most vulnerable to insult and denial of
healthcare.

Sex trafficking, exploitation, and violence are increasing.
Future Directions

Continue research (increase sample size, conduct semi-structured
interviews)

Present research project at North American Primary Care Research Group
(NAPCRG)

Obtain MPH and Diploma in International Medicine
Acknowledgements

Clendening Fellowship: Faculty in the Department of History and
Philosophy of Medicine

Mentor: Dr. Christopher Crenner, M.D., Ph.D

PI and Mentor: Dr. Megha Ramaswamy, Ph.D, MPH

Kat Peters, Director at ICADS

Office of Cultural Enhancement and Diversity (OCED)

Spanish Translator: Ruth Pedraza

Family (including my Costa Rican homestay) and Friends

KU SOM
Questions????
References

Arguedas, J. (2014). El Caso de Costa Rica

Downe, P. J. (1997). "Constructing a complex of contagion: The
perceptions of AIDS among working prostitutes in Costa Rica."
Social Science & Medicine 44(10): 1575-1583.

https://www.cia.gov/library/publications/the-worldfactbook/geos/cs.html