Sex work does not make me an indecent woman: A grounded theory study of the process of forming a positive self image and negotiating health in the lives of establishment-based female sex workers in Tijuana

This dissertation is a feminist constructivist grounded theory study of the process of forming a positive self-image and negotiating health in the lives of establishment-based female sex workers in Tijuana, Mexico. Much of the current public health research on female sex workers visualizes them as either a bridge for HIV to cross from high-risk groups to the general populations or as helpless victims. The aims of this dissertation are to develop a contextual understanding of the lives of establishment-based female sex workers; develop an understanding of the ways in which meanings in their lives emerges from interactions; co-construct a localized theory that is grounded in the data; and develop evidence-based recommendations for new approaches to public health research and practice. This dissertation finds that the women working in the commercial sex industry have a strong drive to form a positive self-image as a way to manage their lives and challenge notions that they are women of little to no value. Social interactions both inside and outside the world of commercial sex are central to the shaping self-image of women working in the commercial sex industry and their capacity to take control of their lives and health. The key processes that contribute to a positive self-image include being a good mother, having supportive sisterly relationships with women, managing relationships with men, legitimizing sex work, and rejecting the victim label. Public health interventions that aim to improve the health and well-being of female sex workers should take into account their existing strengths and resources. Programs should incorporate the reinforcement of values relating to staying healthy to be a good mother that are central to most women working in the commercial sex industry. The importance of supportive female figures in their lives can be replicated in a community health model in which sex workers are trained to be "promotoras" (big sister community health workers). Interventions that target sex workers should also take into account their own holistic concepts of health, mental and physical, because narrowly targeting reproductive health undermines their positive self-image as women of value rather than sex objects.