The Context of HIV Risk Among Drug Users and Their Sexual Partners

Drug Use and HIV Risk Among
Male Sex Workers: Results of
Two Samples in San Francisco
Dan Waldorf
INTRODUCTION
Shortly after it was discovered that the human immunodeficiency virus
(HIV) could be transmitted by sexual activities, there was concern that
prostitutes might be active HIV transmitters and might also be vectors of
transmission to low-risk groups such as heterosexual men, women who
were not prostitutes, and children. The first concerns were about female
prostitutes, particularly after it was learned that prostitutes who worked
along arterial highways in several African countries were transmitting
HIV to men who traveled such routes. Somewhat later, male prostitutes
also were considered as a potential high-risk group and a possible vector
to bisexual family men, their wives, and children. This chapter
summarizes the research that describes the contexts of HIV risk among
prostitutes, with a particular emphasis on males.
HIV SEROPREVALENCE TESTING AMONG PROSTITUTES
In response to the concern about female prostitution and the spread of
HIV in the United States, the Centers for Disease Control and Prevention
(CDC) undertook eight different studies of 1,396 female sex workers in
the United States during 1986. A summary of these findings was
reported in Scotland during 1989 and was subsequently published in
1990 (Darrow et al. 1990). The studies found that only 4.8 percent of the
non-injecting drug using (non-IDU) female prostitutes were HIV positive.
Among IDU female prostitutes, the percentage who were HIV positive
was considerably greater at 19.9 percent. Among the 8 sites for the
studies, HIV rates varied considerably for IDU female prostitutes, from 0
percent to 58.3 percent. The highest percentages of HIV-positive IDU
female prostitutes were in New Jersey (42.9 percent in southern New
Jersey and 58.3 percent in northern New Jersey) and Miami (26.6
percent). In Atlanta, the percentage was only 1.5 percent.
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