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

HIV seroprevelance studies among female sex workers outside the United
States reveal rates of 0 to 88 percent. The highest rates have been in
Nagoma, Rwanda, where 88 percent of 33 female prostitutes (IDU status
unknown) were found to be HIV positive. In a study in Zurich only
1 percent of 103 prostitutes who were not IDUs were HIV positive, while
78 percent of the 18 IDU prostitutes were positive. Most of the studies
that find high rates of HIV infection are those conducted in Africa
(Darrow et al. 1990).
In general, there have been far fewer HIV seroprevalence studies of male
sex workers for unknown reasons. Perhaps it is because most people do
not realize how widespread the practice is and how criminal justice
agencies respond to male prostitution; male prostitutes are not arrested for
solicitation at the rate that females are arrested. A review of the literature
reveals only five HIV seroprevalence studies of male prostitutes-one in
New York City, another in New Orleans, a third in northeast Italy, and
two (the most recent) in Atlanta. Chaisson and associates were the first to
offer findings about male prostitutes. During 1986 and 1987, tests were
conducted on 84 male prostitutes appearing at a New York City sexually
transmitted disease (STD) clinic; more than half (52) reported exchanging
sex for money with females only and 32 with males only. Among those
who reported receiving money for sex from men, 17 of 32 (53 percent)
were HIV positive, and 1 of 8 (12 percent) who reported intravenous (IV)
drug use were positive (Chaisson et al. 1988).
Morse and associates conducted the study of New Orleans male street
prostitutes in 1988 and 1989 (Morse et al. 1991). They found that
17.5 percent of 211 prostitutes were HIV positive, but there were no
differences in rates of seropositivity between African-American and white
prostitutes. Among IDUs (20.2 percent of 109), there was a slightly
higher rate than among non-IDUs (14.7 percent of 102), but the
differences were not statistically significant.
The third study took place in northeast Italy during 1987 and 1988 and
included only 27 male prostitutes; 1 of 4 (25 percent) IDUs were positive,
and only 1 of 7 (14 percent) homosexuals and 1 of 16 (6 percent)
transvestites were positive (Tirelli et al. 1987, 1988).
The last two studies were funded by CDC and undertaken in Atlanta.
The first, which was of 235 male street prostitutes (hustlers) working in
1988 and 1989, found that 29 percent were HIV positive. IDUs were
HIV positive at greater rates than non-IDUs: 35 percent of 120 IDU male
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