Table Of ContentLIVING THE LIFE:
PROSTITUTES AND THEIR HEALTH
IN HET LEVEN:
PROSTITUTEES EN HUN GEZONDHEID
LIVING THE LIFE:
PROSTITUTES AND THEIR HEALTH
IN HET LEVEN:
PROSTITUTEES EN HUN GEZONDHEID
PROEFSCHRIFT
TER VERKRUGING VAN DE GRAAD VAN DOCTOR
AAN DE ERASMUS UNIVERSITEIT
OP GEZAG VAN DE RECTOR MAGNIFICUS
PROF. DR. C.J. RUNVOS
EN VOLGENS BESLUIT VAN HET COLLEGE VAN DEKANEN.
DE OPENBARE VERDEDIGING ZAL PLAATSVINDEN
OP WOENSDAG 3 JANUARI 1990 OM 13.45 UUR.
CLAIRE ELISABETH JOZEF MARIA STERK
GEBOREN TE KERKRADE
0~'-lersite,f.s.
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1989
PROMOTIECOMMISSIE
PROMOTOR: PROF. DR. CH. D. KAPLAN
OVERIGE LEDEN: PROF. DR. J. HUISMAN
PROF. DR. P.J. VAN DE MAAS
PROF. DR. W KORNBLUM
TABLE OF CONTENTS
PREFACE i
ACKNOWLEDGEMENTS iv
INTRODUCTION
Introduction 1
Methodological Overview 3
Literature Overview
Social Science and Female Prostitution 6
Prostitution and Health 9
Prostitution and Drug Use 13
AIDS, Prostitution and Drug Use 17
Hypotheses 21
CHAPTER ONE METHODOLOGY
Introduction 24
Stages in the Research Effort 25
Interview Sites 35
Sociological Research during the AIDS Epidemic 38
CHAPTER TWO WHO ARE WE TALKING ABOUT?
Introduction 45
Street prostitute, prostitute in a brothel or call girl 52
Interaction with Others 57
Violent Encounters 60
Prostitution and Addiction 65
Dopefiend or Crackhead
Intravenous Drug Use 68
Non-Intravenous Cocaine Use 72
summary 75
CHAPTER THREE OCCUPATIONAL TYPES IN THE WORLD OF
PROSTITUTION AND DRUG USE
Introduction 77
Type 1 The syringe user 78
Type 2 The more experienced IV drug using prostitute 81
Type 3 The non-IV cocaine user 84
Type 4 The more experienced non-IV drug using prostitute 86
Type 5 The beginning prostitute 88
Type 6 The experienced prostitute 91
Comparing the types 92
CHAPTER FOUR PROSTITUTES AND THEIR REPRODUCTIVE FUNCTIONING
Introduction 95
Health status and social-economic class 96
Issues related to reproductive health
Menstrual Period 97
Contraceptive Methods 101
Pregnancies 104
Abortions and Miscarriages 106
Prostitutes as Mothers 107
CHAPTER FIVE PROSTITUTES AND INFECTIOUS DISEASES
Introduction 110
Hepatitis B 114
HIV Infection 116
HIV infection among the study participants 120
Prostitution and Safe Sex Practices 131
CONCLUSIONS 142
APPENDIX A Code of Criminal Justice: Prostitution and Related
Offenses 156
APPENDIX B Questionnaire "HTLV-III/LAV in Selected Populations
of Women" 158
APPENDIX C Clinical Findings 163
APPENDIX D Case definition of AIDS 164/
APPENDIX E Glossary 167
APPENDIX F Dutch SummaryjNederlandse Samenvatting 170
NOTES 178
BIBLIOGRAPHY 181
PREFACE
"Living the Life" refers to the experience of the women who
are involved in female heterosexual prostitution. In this context
"the Life" refers to the social world of prostitution. This
reference has been utilized by both prostitutes (e.g., Godelier,
1978} and social scientists (e.g. Boggs, 1979; Enablers, 1978;
Winick and Kinsie, 1971}. The 120 female prostitutes upon whom
this dissertation is based, also described their involvement in
prostitution as being "in the Life". According to the New
Dictionary of American Slang (Chapman, 1986} the term is used to
describe the life of those who are "occupied or engaged in some
specialized or usually socially despised way of living, such as
the homosexual subculture or prostitution". The term "the Life"
can also refer to a broader area, e.g. the world of drug use
(Agar, 1973}, or both the world of drugs and prostitution (Prus
and Irini, 1980). Wepman and his colleagues (1976) point out that
"the Life" more or less covers the entire "culture of poverty",
but warn that this does not mean that all urban, lower-class
blacks participate in "the Life". They state that the community
of "the Life" is, in large measure, defined by illicit activities
as petty crimes, drug use, prostitution and gambling and by unique
behavioral and culture patterns related to these illicit
activities. The behavior of those participating is centered
around "the game--a pattern of exploitative interaction". The key
counterparts of the prostitutes in their "game" are their pimps,
i
their customers and the police. Depending on how successful the
prostitutes are in their game of selling sex for money andjor
drugs, they gain status within the world of prostitution. Call
girls are seen as more successful "players" than "streetwalkers".
In this dissertation prostitution is considered a paid sexual
encounter between a male client and a female prostitute. The
exchange between both partners is without social obligation and
the sexual services provided by the women are paid for in
1
moneyjand or drugs. Gifts are not included, since they are not
part of the "business" interaction. Until the 1960s the definition
of prostitution was limited to the exchange of sex for money only.
Due to an increasing attention to drug use among women during the
sixties and the related increase of female drug users involved in
prostitution activities, the definition was expanded to exchange
for money andjor drugs (Goldstein, 1979). Prostitution is a
phenomenon which occurs in most parts of the world, and has
existed throughout history. Its presence has been hotly debated
and simultaneously tolerated. Most studies focussing on
prostitution have examined it from a psychological, psychiatric,
2
medical, economic, criminological or sociological point of view.
According to prostitutes, the majority of the works published on
113
female "sexworkers reveal more about the author's perspective
regarding prostitution than they do about the subjects studied.
"Sexworkers" responded to this by publishing their own works, e.g.
ii
Delacoste and Alexander (1987), French (1988), Hampton (1989).
The questions that have captured the attention of most social
scientists studying commercial vice are "Why do some women become
prostitutes and other women in a similar situation do not?", "What
are their personalities like?", and "What different kinds of
prostitution can be distinguished, if any?" In "Living the Life",
a study of prostitutes in their natural setting, the
methodological procedures upon which this dissertation is based
will be discussed (Chapter One), followed by a description of the
research population (Chapter Two). In Chapter Three different
occupational types, or if one prefers, a stratification system
(Rosenbaum, 1981) will be distinguished among the study-
participants, based on the length of time the women have been
engaged in prostitution and their drug use or non-use.
Prostitutes, like other women, have to deal with health issues
related to their reproductive function. Issues related to their
reproductive function, e.g., menses, contraceptives and birth
control, are presented in Chapter Four. Finally, infections like
hepatitis B, syphilis and HIV among the prostitutes are discussed
(Chapter Five). Also in this chapter, risk and protective factors
for HIV infection are identified among the respondents, e.g. drug
use practices and condom use, and a model to predict HIV infection
among the prostitutes is developed.
iii
ACKNOWLEDGEMENTS
Many people played an important role in giving me the
particular skills and sociological perspective needed to conduct a
study among female prostitutes. I want to thank Charles Kaplan
(Erasmus University Rotterdam). He is the one who initially got
me involved in research in the United States, and who wanted me to
be a "scholar". William Kornblum and Vernon Boggs (City
University of New York) offered scientific and other support and
for many hours were willing to listen to my stories and deal with
my research frustrat,ions. Frequently all three of them created
scientific challenges for me, but at the same time helped me to
find solutions. I would not be the sociologist I am without them.
The Center of Disease Control funded part of this project and
without the assistance of their project staff, Bill Darrow and
Debbie Deppe, and staff from the New Jersey State Department of
Health, especially John French and John Massey, the study might
have never taken place. Financial support was also provided by
the Addiction Research I~stitute at Erasmus University, and the
Center for Social Research at the City University of New York, and
I
the linkage program between these universities. In addition I
want to thank the Volksbond Rotterdam, Stichting Zuiver
Wetenschappelijk OnderzoekjMedigon, the U.S. Embassy (the Hague,
the Netherlands) and the USIA for their support.
iv
