PERSPECTIVES May-01 Sex Work and HIV Risk

“Sex worker” is a broad umbrella term that can refer to anyone who works in the sex industry. Although some people use this term to include exotic dancers, actors in pornographic films, and nude models, this issue of PERSPECTIVES uses “sex worker” to refer specifically to people who exchange sex for money. Using “sex work” recognizes this activity as an occupation that provides a source of income, without conferring the stigma associated with more judgmental terms such as “prostitution.” “Survival sex” refers to the exchange of sex for food, shelter, clothing, drugs, or other items.1 Sex workers, whether they are male or female, tend to be at high risk for HIV infection. A 1987 study of female sex workers in six U.S. cities found that an average of 12 percent were HIV-positive, and the infection rate was as high as 48 percent in some cities, depending on the level of injection drug use, the main risk factor for female sex workers.2 A 1993 Atlanta study found a 30 percent infection rate among male street sex workers, also known as “hustlers.”3 In a study of female drug users, 82 percent of HIV-positive study participants in New York had ever exchanged sex for money or drugs, in contrast with 48 percent of HIVnegative participants. The study also found that 78 percent of HIV-positive participants in Miami had engaged in sex work, compared with 64 percent of HIV-negative women.4 It is difficult to obtain current HIV infection data on the sex worker population. For example, the California Department of Health Services Office of AIDS database indicates that only one of 460 sex workers on file reports HIV infection. However, 3.7 percent of sex workers in this sample report indeterminate HIV antibody test results, a rate 50 times that of the general population. Under California law, trading sex for money is a misdemeanor, but the offense is elevated to a felony if the sex worker knows that he or she is infected. This can explain the reluctance of many sex workers to test for HIV; it can also account for the high incidence of self-reported indeterminate HIV test results in this sample.1 HIV risk for sex workers grows out of a complex set of factors, some of which may be only indirectly related to sex work. A Harlem study found that women who traded sex for money or drugs had significantly higher levels of psychological distress than other women. Psychological distress—which includes such symptoms as depression, anxiety, and hostility—may decrease sex workers’ motivations and abilities to engage in safer sexual and injecting behaviors.5 HIV COUNSELOR PERSPECTIVES