Drug addicted women whose economic and social base is urban streets face limited options for income generation and multiple dangers of predation, assault, arrest, and illness. Exchanging sex for money or drugs offers one important source of income in this context. Yet the legal, social, and safety risks associated with these exchanges reduce the likelihood of regular safer sex practices during these encounters, thereby increasing the risk of HIV infection. Such conditions lead women engaged in sexual exchanges for money to varied and complex responses influenced by multiple and often contradictory pressures, both personal and contextual. Street-recruited women drug users in an AIDS prevention program in Hart-ford, Connecticut reported a range of condom use when engaging in sex for money exchanges. This paper explores their differences by ethnicity, economic resources, and drug use, and analyzes these and other factors that impact on street risks through sexual income generation. Surveys and in-depth interviews with drug-addicted women sex workers describe their various approaches to addressing multiple risks on the streets and suggest significant effort by women in these contexts to avoid the many risks, including HIV infection.
PIP: AIDS prevention programs directed toward women who exchange sex for money or drugs must address multiple issues, including drug addiction, lack of job opportunities for women, culturally constituted gender relationships, and the power of clients to force unprotected sexual activity. Project COPE II, a collaborative effort on the part of community-based service and research agencies in Hartford, Connecticut (US), conducted street outreach to recruit active heroin injectors and crack cocaine users for AIDS risk assessment and voluntary HIV testing. 46% of the 258 female drug users recruited had exchanged sex for money and 31% had exchanged sex for drugs, but only 21% reported consistent condom use. Of the 128 women who agreed to HIV testing, 19 (15%) were HIV-positive; another 37 women did not undergo testing because they already knew they were infected. There was a positive association between exchanging sex for money and both higher injection rates and crack use, suggesting the former may be a strategy for women to achieve a sufficient income to support an addiction at that level. Open-ended interviews with 22 women who reported engaging in sex for money in the preceding month indicated women's need to acquire drugs and avoid withdrawal symptoms overpowered their determination to insist on condom use. Women tried to reduce their HIV risk by promoting oral sex with clients and sticking with regular clients. Interventions aimed at street-based workers should build on women's existing methods of self-protection and empower them to take greater control over their sexual encounters. Also essential are increased drug treatment availability to reduce the effects of addiction, injection drug use harm reduction techniques for those unwilling to enter treatment, and improved training and employment opportunities for impoverished women.