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Australian studies in law, crime and justice
Criminality, addiction and contagion
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Working girls : prostitutes, their life and social control / Roberta Perkins
ISBN 0 642 15877 0
Canberra : Australian Institute of Criminology, 1991
(Australian studies in law, crime and justice series)
So far we have seen some convincing arguments from the prostitutes interviewed telling us about the positive aspects of working in the sex industry. Whilst the money is good, the work offers a flexibility rare in most other employments, for the lonely woman there is female companionship, and, for many, it has the curious effect of developing character, making a weak woman strong and providing a social confidence that was previously lacking, these benefits are not without their price. The risk of violence has already been mentioned - a subject we will return to in the next Section. Here, however, three hazards of prostitution that are well documented in the research data on sex workers will be discussed. These hazards are police involvement, drug addiction and infection by sexually transmissible diseases. While the criminal behaviour and health of prostitutes are well studied, this is less for the benefit of sex workers and more for the community at large with its phobias about prostitutes as social and health contaminates. Studies of health in prostitution, in fact, represents a fifth of all research on the sex industry, or the most prolific of all disciplines in the literature (see Table 1.1), a clear reflection of the community's greatest concern for commercial sex.
A number of American studies indicate that prostitution and crime are closely related. Jennifer James (1978), for instance, found that 40 per cent of her sample of juvenile prostitutes had been in trouble with the authorities because of their sexual behaviour. Vitaliano, Boyer and James (1981, p. 325ff) compared a group of juvenile prostitutes with a group of property offenders, concluding that the prostitutes had criminal records for theft and fraud almost as high as the women convicted of larceny. Datesman and Inciardi (1979, p. 455ff) argue that the use of heroin by some prostitutes forces these women to commit crimes in order to pay for their habits because income from prostitution is not enough. These latter researchers have a valid point, which corresponds with the activities of certain heavily addicted street prostitutes in Sydney. The reader is referred to previous comments on the effects of a law change in 1983 driving women from their commercial sex income source and increasing the rate of female crimes in New South Wales (p. 145).
Table 4.10 compares the prostitute sample with the samples of the two non-prostitute groups to determine juvenile criminality.
Some 40 per cent of the prostitutes were before the authorities for juvenile offences, compared to about five per cent each of the other two groups. However, "uncontrollable" and "in moral danger" are very likely linked to juvenile promiscuity, so that, together with prostitution offences, half of these offences are for sexual misbehaviour. As pointed out earlier, drugs were a likely commitment in early adolescence, and if we deduct the "possession" offences, we find that less than a third of the offences were for crimes against the person. But what is important to note here is not committing the offence so much as being before the authorities, who act to remind the culprit that she is a criminal, a fact which may not have occurred to the person before that. This then would be the first step in processing the female adolescent into psychologically adopting an identity as "bad girl".
In the case of those who were incarcerated in a state juvenile detention centre, this is the public and institutional reinforcement of what they had already believed of themselves when they were hauled into court. Only one of the non-prostitutes was detained, and 20, or 15.6 per cent of the prostitute sample had been detained. More than half of these prostitute detainees were sentenced only the one time, while four had been sentenced more than four times and may be considered hardened juvenile offenders. This is hardly the sort of statistic to support a contention of prostitutes as criminally inclined women from early ages. These findings confirm evidence from Kerry Carrington's (1989) doctoral thesis, in which 2,046 cases of juvenile female offenders were investigated, and only I 1, or about a half per cent of the total number, had been charged with a prostitution offence. Thus, just as most prostitutes were not "bad girls", most "bad girls" do not prostitute themselves.
In some instances detention might be a preferred option to homelife. Sharleen recalls her own situation:
We liked it in there and didn't want to go back home to get more beatings from our mother. She used to go to court and fight for our release and usually get us back again just to beat us again, and then back in we would go again.
Thus, protection from a negative home environment can be as frequent a reason for detaining a juvenile as the child's behaviour. But whichever is the case, the result is the same. Juvenile detention centres are notable as hot-beds of learning about crime, so that the novice will emerge from it with more skills than simply sexual misbehaviour and petty theft.
The pattern for adult criminal behaviour is much the same as the juvenile criminality for the prostitute sample. Table 4.11 compares the three groups on adult crimes.
Once more we see that over half of the offences are for sexual behaviour and drug usage. Very few of the offences could be described as "serious crimes". Some further commentary is necessary here. Prostitution is socially perceived as a breeding ground for female criminals. This common perception makes prostitution appealing to criminal and quasi-criminal "types", whose initial involvement with prostitutes fostered the sex industry's reputation as a haven for male and female criminals. This circular pattern serves to perpetuate the popular notion, while, as we have seen, the "consorting" and "vagrancy" laws reinforce it in officialdom. So it is to be expected that within such a real or constructed scenario the crime rate among prostitutes will be higher than the general population of women. The surprise is not so much that more prostitutes than non-prostitutes have criminal records, but that this is as low as it is, given the pressures and temptations to become involved in crime that prevail in prostitution.
Also, the highly competitive, often stressful nature of the work can unleash abnormal behaviour under tension. Thus, Jeanette, who was charged with assault and malicious wounding, was driven to violence under provocation from another worker who had taunted her until she lost her temper.
On top of this, police notions about prostitutes, which are no different to the popular myths, mean that sex workers are continually under surveillance, and if arrested for prostitution, it simply begins an unwanted association with police and a criminal record.
But, as with juvenile detention, only 21, or 16.5 per cent, of the prostitute sample have been in gaol, half only once and only one person more than four times. With so few recidivists, this record is far from one expected of "hardened" criminals.
The reader might be surprised to find such a small ratio of arrests for prostitution in the sample. This is due to the more relaxed laws in New South Wales, although those with records of "soliciting", "consorting" and other prostitution-related offences are very likely women who worked prior to 1979, when, as pointed out earlier, very few sex workers escaped arrest. Sharleen can remember when arrest was a daily hazard in prostitution:
We used to get arrested every night, and once I got arrested seven times in one night. In all, I've probably been arrested about 2,000 times, at least.
But even in a legally repressive climate such as the past in New South Wales, present-day Queensland or North America, some prostitutes manage to avoid arrest. Goldstein's study (1979, p. 13) of New York street prostitutes reveals that as much as two-thirds of them escape the police cordons. Figure 4.9 (overleaf) shows the number of times the prostitute sample have been arrested for prostitution.
Less than a quarter of the sample had ever been arrested for prostitution. Those with above 20 arrests probably worked prior to 1979, whilst the rest were mostly arrested for soliciting near a dwelling, church, school or hospital. Arrests for prostitution can sometimes lead to arrests for other offences. For example, a woman taken to the police station to be charged with a prostitution related offence provides the arresting officers opportunity for further arrests. They may check her past record and discover an outstanding warrant, or they may search the contents of her handbag and discover evidence of illegal drug usage or a stolen item purchased by the woman from one of the many petty criminals who hawk stolen property around the streets, in bars and brothels. Thus, the fact that prostitutes are vulnerable to arrest for prostitution means they are more likely to be arrested for other offences than the drug using population in general or other members of the community at large.
Figure 4.9 : Prostitution related arrests of prostitutes (n=128)
Prostitutes' relations with police vary from mistrust to open hostility. Most of the women have had at least one unpleasant experience with a policeman. Perhaps the attitude of many policemen might be seen in an experience the author had with a police sergeant in 1982. This officer had responded to a complaint I made that a male resident on Liverpool Street had threatened a young street prostitute with a carving knife. As soon as the culprit saw the sergeant and his police companion he hid the knife inside his shirt. Although this was pointed out to the officers by those nearby who witnessed the entire event, the sergeant refused to search the man. When I insisted he do so he remarked that "If you want my opinion and the opinion of most of us at Darlinghurst (police station), if these women weren't here in the first place this sort of thing wouldn't happen", and he turned on his heel and went away. It is such attitudes which have continued to strain relations between police and prostitutes.
To gauge the extent of mistrust of police by the prostitute sample they were asked about police malpractices. The response is seen in Figure 4.10.
Figure 4.10 : Police malpractices experienced by prostitute sample (n=128)
Although in the 1980s police demands for money from prostitutes were negligible, this was likely to have continued with some managers and owners as indicated in the Select Committee inquires in New South Wales in 1985 and the Commission of Inquiry into Police Corruption in Queensland in 1986-87 which exposed police corruption. But police corruption in Sydney was much more widespread before 1979, according to the views of many prostitutes. Lee, a Kings Cross prostitute of the 1970s comments:
Weighing in was part of the way things ran in those days. What made me angry was that hooning was an offence and the police charged a lot of guys. Yet, I used to think to myself, the cops had a legalised form of hooning.
Jeanette also worked in the 1970s:
Most of the cops weighed-in, but I've never known any to demand a "freebie", not to me anyway. I think the idea was always put to the police by the girls who flirted with them. I've worked over 20 years and I've never seen it happen where it was put on the girl. But I have known girls who put it on them. The police were more interested in money; the "freebies" they could get anyway. There's a lot of cops' wives whom I've helped put fur coats on their backs, and a lot of cops' kids whom I've helped to educate right up until the laws changed in 1979, and all of a sudden I had surplus money.
If a parlour did not pay up Zoe tells us the consequences:
The Parlour was paying protection money to a police undercover guy who came around occasionally. But the Council was trying to close us because we weren't a health studio. We began losing money because the clients were getting scared with Council men snooping around, so we didn't have the pay-offs for the cops, who began putting pressure on us to pay up or get busted. In the end the manager had no choice but to shut down and we were all out of a job.
But after the soliciting law was introduced in 1983 some of the police attempted to reinstate the previous extortion of the street workers, as Bonnie points out:
They're so corrupt in Sydney. Cops pick me up [in 1983] and say: "Well, it's like the old days girls, cough up or you're going to get busted".
Other kinds of malpractices were mentioned by the women I interviewed. Katherine mentioned one incident:
A friend of mine had drugs planted in her handbag and one detective wanted her to go down on him.
Jeanette was also a victim of some mistreatment:
It gave me lots of courage, and leaves me with nothing but contempt for them today. Of course, we were also young and cheeky, but it was a power trip for them. They'd push you and you'd say "Don't push me", but they'd push you more. So we just gave them a mouthful of cheek. For me, it was standing up for my rights. I had two cigarette burns here [her breasts] that I got from police.
In 1982 a new Vice Squad Inspector was appointed. This was Ernest Septimus Shephard, a man with a reputation for strict morals and high principles. Within a year major re-shuffles occurred in the rank and file detectives, with certain policemen being transferred to outer suburban and country stations. The corruption began to decline, and suddenly former policemen known for their extortion methods among the women ceased visiting them on the streets. Since Shephard's appointment and subsequent promotion to the Internal Investigation Branch the situation for prostitutes in Sydney has much improved.
Drug use is popularly considered to be extremely high among prostitutes (see p.255 , Table 4.1). Silbert, Pines and Lynch (1982, p. 193ff) found that 59 per cent of a sample of San Francisco street prostitutes were current users of various drugs, and 39 per cent had done so in the past. Among New York prostitutes, Goldstein (1979) found that 84 per cent of streetwalkers used heroin, 33 per cent of call girls and brothel workers were using amphetamines, 81 per cent of streetwalkers were alcohol addicted, a further 20 per cent were regular users of sedatives, and all of the sex workers were regular smokers of marijuana. With findings like these overseas, it is little wonder that a common assumption of prostitutes as drug addicts prevails in the community.
George Klein (1983) in Sydney in 1982 found a 76 per cent rate of heroin addiction, costing as much as $3,000 a week for some individuals, in a sample of 101 street prostitutes. Perkins and Bennett in 1983 found 27 per cent of their sample of 121 inner city brothel and street prostitutes were regular drug users, while in another sample of 91 prostitutes who had sheltered in a woman's refuge in Kings Cross they found 69 per cent addicted to drugs. They concluded:
Boredom, frustration, lack of opportunities for employment, emotions in everyday relations, peer pressures, all play their part in making young women conform to the experimentation with drugs that goes on in various youth cults. In the end prostitution is the only work that will supply the necessary money (Perkins &Bennett 1983, p. 243).
But prostitution itself can also be stressful enough to indicate a need for powerful drugs. Bondage mistress Kellie describes her experience:
I wasn't coping with screwing all these guys, and from the first night when I screwed 14 men I knew I was going to need something a little stronger than smoking dope. I was using heavily and started to go into debt - my money outlay was way over my inlay. I dropped a trip one night at work in the middle of a B &D job. I cracked up completely and I guess I was on the verge of a nervous breakdown. I became so hooked on drugs, so introverted, and in the end I was living in this one-room cold water place with a mattress on the floor, no blankets, no sheets, no food, no nothing, and finally someone rang up the drug rehab centre.
Table 4.12 indicates the type of drugs used by the three sample groups in this study in their past.
From this it is apparent that prostitutes are more likely to have higher drug consumptions than health-workers, students and the broad female population. However, what is learned from this comparison is that, whilst more prostitutes took more drugs, neither of the other two groups are entirely free from drug addiction, and, in fact, we find that only 15 per cent less of the prostitutes than the health-workers never took any drugs regularly in the past.
The next question that arises is when these women began taking drugs. The results of this can be seen in Table 4.13.
This pattern bears a broad resemblance to the configurations of the early sexual experiences, initial coitus and first love affairs in that the two non-prostitute groups have higher ratios in pre-pubescence, and the prostitutes lead in early adolescence with some levelling in mid-adolescence., The differences are slight but it might reflect a parallel between drug experimenting and sexual maturity in adolescence. What is even more significant is the relationship between earliest drug taking and entrance into prostitution. Table 4.13 shows that nearly a third of the prostitutes had begun experimenting with drugs when under the age of 16, while between 16 and 18 more than a quarter of the sample commenced drug taking. Figure 4.6 shows us that a little more than five per cent of the prostitutes entered prostitution when under the age of 16, and over a quarter did so at 16 to 18. Figure 4.5 indicates that only about 9 per cent of the prostitutes began prostitution because of a drug habit. What all of this suggests is that whilst most of the prostitutes were experimenting with drugs in their early to mid-adolescence, only a small number of them entered prostitution because of it. In other words most of these drug takers were not sufficiently addicted at that stage to seek prostitution as a source to pay for their habits. Most were regular users of tobacco, alcohol and various "pills" for a "booster" or to complete a "stone". The minority of drug-addicted teenagers who entered prostitution in order to pay for expensive habits were very likely committed to costly drugs such as heroin and cocaine.
One of the drugs most used by prostitutes is tobacco. Many of the women in brothels complain that boredom sitting around waiting for clients is responsible for smokers increasing their consumption. Table 4.14 compares the prostitute sample with the other two groups.
The two non-prostitute groups correspond with a survey of females in New South Wales. The youngest of the groups, the students, are parallel with the census figure of 77.8 per cent of females aged 15-17 years who have never smoked, while the health-workers resemble the census population of 54.3 per cent of females aged 18-24, 51.2 per cent aged 25-34 and 55.2 per cent aged 35-44 who have never smoked. Over 30 per cent more prostitutes than the general population of females smoke on a pro rata comparison, and they smoke more cigarettes a day on an individual comparison, with over half the prostitute smokers consuming 21-40 cigarettes a day compared to only a fifth of the general female smoking population who smoke that number (Australian Bureau of Statistics 1985).
The stereotype of the hard-drinking prostitute has long been a figment of popular culture. Table 4.15 provides a more realistic picture.
The prostitutes do not appear to consume as much alcohol as the health-workers. If we accept a weekly drink as the boundary between heavy and medium drinking, then 46 per cent of the health-workers are heavy drinkers compared to 30 per cent of the prostitutes. The few prostitutes who drink more than once a day are well into the danger zone for alcoholism. In any case, all three sample groups are considerably above the New South Wales census for drinking among females, with 21 per cent of women 18-24 years, 16 per cent between 25-34 years and 19 per cent between 35-44 years moderate to heavy drinkers (Australian Bureau of Statistics 1985).
The prostitutes are by far the heaviest current consumers of a variety of cannabis products. If any particular illegal drug is a likely candidate as "the prostitutes' drug" it is cannabis. It is a pleasant social drug, which is sometimes smoked either before a job for relaxing nerves or with a client to make the time pass with less tension. As regular consumers of the drug with surplus cash, prostitutes are a prime attraction for dealers. But the problem with smoking "grass" at work is its illegality, and most cases of arrest for drug offences in brothels involves the possession of a small quantity of marijuana by one or two of the prostitutes on the premises. Consequently, most managers ban it in brothels.
Table 4.17 compares the consumption of "pills" and other drugs by prostitutes with the two non-prostitute samples.
Once again the prostitutes currently consume much larger quantities of "pills" than the other two groups. These are usually not the major drug consumed by drug-addicted prostitutes, although some of the women have made the stimulant "speed" (amphetamine) important as a means of coping with boredom in a parlour and have become addicted to it. Hallucinogenic drugs are usually avoided by most prostitutes, especially bondage mistresses, whose consumption of LSD in a dungeon could have a disastrous effect.
The public image of prostitution is often a heavily dosed heroin addict on the street propped up by a lamp-post or shop front. Many people, therefore have the impression that heroin is the major drug taken by prostitutes. They are wrong, of course, as heroin was a drug in use mainly among streetwalkers in the late 1970s and early 1980s. With the introduction of methadone treatment programs, heroin addiction has declined considerably over the past few years, although cocaine consumption is increasing among both street addicts and other former heroin and "speed' addicts in other areas of prostitution. Tables 4.18 and 4.19 compare the consumption of these two drugs in the sample groups.
Among American prostitutes Goldstein (1979, pp. 70-86) found that a class distinction of drug use existed, with street addicts working as prostitutes using heroin and brothel prostitute drug addicts using cocaine. That distinction is less apparent in Australia (and probably now in the United States too), for, if anything, cocaine, which a few years ago was cheaper than the opiates, is gradually replacing heroin as the main street drug. The prostitutes in the sample were surveyed in 1985-86, and the above figures reflect the earlier stages of this process, with an infrequent use of cocaine and a more committed use of heroin, as though they were still "dabbling" with the former. I suspect that in time cocaine (or its derivative "crack") will have all but replaced heroin as the major intravenous drug, just as it seems to have done in the United States.
Philpot, Harcourt and Edwards (1989, p. 499ff) have investigated prostitutes attending the Sydney Hospital STD Centre to determine the effect of drugs on their health, especially intravenous drugs as a major contributor of AIDS. The study involved two samples: 122 sex workers in 1985, and 150 in 1987. Both groups were almost exclusively brothel workers. Of the earlier group 18 per cent took tranquillisers, 6 per cent amphetamines, 42 per cent marijuana, 15 per cent cocaine and I I per cent heroin. Of the latter group 26 per cent took sleeping pills, 8 per cent tranquillisers, 19 per cent amphetamines, 48 per cent marijuana, 16 per cent cocaine and 11per cent heroin. On smoking tobacco both groups were similar, with 36 per cent in 1987 non-smokers, 14 per cent up to I 0 cigarettes a day, 13 per cent smoking up to 20, 28 per cent up to 30 and 9 per cent above 30. There are broad similarities between this and the present study, with striking correspondence in marijuana and tobacco use. Philpot et al. (1989) concluded that differences in drug use between prostitutes and non-prostitutes related to the work experiences in commercial sex. This has already been noted in relation to cigarette and marijuana smoking.
Goldstein (1979, pp. 53-70) thought that most intravenous drug-using prostitutes had entered prostitution to support their habits. This was also the case in the present study, but it is not the case for drugs generally. However, as with cigarettes, it does seem that more prostitutes with habits of marijuana, narcotics and "pills" increased their consumption since working as prostitutes rather than decreased it. Figure 4.11 confirms this.
Figure 4.11 : Drug habit after taking up prostitution (n = 128)
Undoubtedly, prostitutes take more drugs more often than non-prostitute women. In the case of intravenous drugs, such as heroin and cocaine (which is inhaled as well), sex work was undertaken to support the habit. In the case of other drugs, as well as tobacco, there is a tendency to increase an existing habit but this was not the reason for entering prostitution in the first instance.
An important reason for the nexus between drugs and prostitution is drug dealers, along with other peddlers and penny capitalists of commodities (such as "hot" property), who are attracted to the surplus cash of prostitutes. With various drugs pushed under their noses and with the power to purchase expensive items, it is little wonder that so many prostitutes indulge in drug consumption, one of modem society's most sought after luxuries. To a much lesser extent some prostitutes will seek out drugs as a means of relieving stress at work. Finally, between ten and fifteen per cent of sex workers use prostitution just to support their drug habits.
As with crime and drugs, sexually transmitted diseases (STDS) are considered in popular thought to be closely associated with prostitution as a source for public contagion with its high level ratio of infection among prostitutes. In the climate of fear following the spread of AIDS throughout the community, prostitutes are often assumed to be a "high risk" group by the public, the press and health authorities regardless of contrary evidence. As always, the truth paints a very different picture. In 1983 the World Health Organization claimed that no more than 6 per cent of male cases of STDs were contracted through female prostitution. In 1985 the NSW Select Committee On Prostitution (1985, p. 154) was informed that: 11 probably around 10 per cent of the total incidence of STD in New South Wales is prostitution-derived". But with less than 0.06 per cent of the State's females regularly employed as prostitutes, and only 4 per cent or 5 per cent of the male population (see next Section) as regular customers, this is a considerable output. Thus, while not a cauldron for diseases for the community at large, prostitution may still be an important contributor.
There are, nevertheless, many conflicting studies on the subject of contagion in prostitution. Conrad, Klefis, Rush and Darrow in 1981 tested 237 Atlanta prostitutes and found 20 per cent infected with Neisseria gonorrhoea. They compared these findings with those of studies elsewhere, such as an infection rate among prostitutes of 28 per cent in Fresno, 42 per cent in Agra, 51 per cent in Butare, 62 per cent in Stuttgart and 63 per cent in Colorado Springs. They were forced to conclude that prostitutes were "major transmitters of gonorrhoea and other sexually transmitted diseases" (Conrad et al. 1981, p. 244). An investigation of patient files at Sydney's STD Centre revealed that of 100 prostitutes who sought a total of 695 medical screenings, nearly a quarter were found to be infected (Jones 1984, p 303).
The recent findings have a remarkable similarity with earlier studies. For instance, in the mid- 19th century, medical practitioner, William Sanger (1858), investigated some 2,000 New York prostitutes and found 41 per cent with infections. At the turn of the century Flexner (1914) reported rates of infection among registered brothel inmates in Berlin at between 22 per cent and 32 per cent. Rosenthal and Vandow (1958, p. 94ff) found that an infection rate of 24 per cent for gonorrhoea in New York Prostitutes in 1946 had declined to five per cent in 1956, no doubt due to the widespread use of penicillin as treatment as well as improved methods of prevention. The cruder methodologies for detection and investigation in these earlier studies compared to current medical diagnoses make some of them unreliable.
There are also conflicting findings on the role of the brothel in STD infections. Some argue that its presence contains disease. When authorities closed the famous Chicken Ranch brothel in La Fayette County, Texas, on moral grounds in 1973, cases of gonorrhoea in the local population spread from 12 in the period 1967-72 to 93 between 1974-79, while syphilis increased from 12 to 17 cases in the same time. There appears some evidence that the brothel had minimised the spread of infection, but William Darrow (1984) pointed out that a rise in population following an oil boom or more diligent screening for gonorrhoea are other factors that should be considered. On the other hand, a study conducted by Basil Donovan in a Sydney brothel over a period of a year provided opposite evidence. In that time he screened 70 prostitutes on a regular basis, discovering 53 episodes of gonorrhoea, or a weekly rate of 10 per cent new infections. Among new workers he found an infection rate of 44 per cent in their first month of work, compared to only a weekly yield of 5.5 per cent of infections contributed by the regular workers, which, he feels, may be due to the latter's greater ability to detect infections in their clients. Lack of awareness in uses of prophylaxis were probable causes. Donovan (1984a, p. 268ff) concluded that the situation might best be rectified through cooperation between brothel managers and health authorities.
Table 4.20 compares the three sample groups in the present study to determine which STD infections they have experienced.
The pattern of the three groups varies slightly in order of STD prevalence, but in all cases thrush is the most prevalent by far. The fact that this infection does not always occur through sexual transmission alters the rate of infection between the three groups very slightly compared to other rates of infection. What is most striking about the configuration, though, is its similarity in overall pattern to the ratio of previous drug uses. In other words, about 19 per cent less of the prostitutes than the health-workers, and 15 per cent less of them than the students were never infected nor indulged in drugs. The connection here is not clear, except that sex work and social experiences somehow increases the likelihood of contagion and addiction (for example the older health-workers possess greater experiences of life than the younger students).
Table 4.20 demonstrates that the work of prostitution puts women at considerably greater risk of gonorrhoea, hepatitis B (more likely through intravenous drug use sharing of needles) and pelvic inflammatory disease (PID), and at moderately higher risk of herpes, chlamydia, trichomonas, warts and lice infections. Table 4.21 compares the frequency of infection.
This Table makes it clear that while prostitutes might be more likely to be infected, the rates of recurring diseases are not any more frequent than the non-prostitutes. They are not, therefore, continually infectious creatures. In a study by the Sydney STD Centre 132 prostitute patrons were infected most with thrush (64 per cent), gonorrhoea (58 per cent), trichomonas (52 per cent), herpes (51 per cent), and chlamydia (46 per cent), while a control group of 55 non-prostitutes followed the same pattern, except for gonorrhoea and much lower constellations of overall occurrence. But, interestingly, the pattern of recurrence was almost identical (Philpot et al. 1988, p. 195).
The impact of acquired immune deficiency syndrome (AIDS) on Australian society has wrought changes in prostitution, as in all other social groups where the transmission of human fluids between individuals has played a large part. Table 4.20 indicates not a single case of seropositive human immunodeficiency virus (HIV), the viral cause of AIDS, among this sample of prostitutes surveyed in 198586. About the same time the Sydney STD Centre tested 132 prostitute patrons for HIV and also reported no cases of seropositivity (Philpot et al. 1988, p. 195). In the United States, where the disease has existed longer and is more entrenched in the population, similar results of either negative infection or very small numbers of infected prostitutes have also been reported. The US Federal Centres for Disease Control conducted a massive national survey of prostitutes and found 1. I per cent seropositive women in a sample of 94 mostly female prostitutes in Georgia, none among 34 brothel prostitutes in Nevada, 1.4 per cent in 71 Colorado Springs women, 4.3 per cent in 184 Los Angeles women, 6.2 per cent in 146 San Francisco women and 57.1 per cent in 56 intravenous drug using women in New Jersey. In all these cases there was a close correlation between seropositivity and intravenous drug use and women with histories of other STDs were more likely to contract HIV (Centres for Disease Control 1987, pp. 157-61). There have been a number of more recent studies whose findings continue to support this trend in America (see Cohen et al. 1988; Fischl et al. 1987; New York Times, 20 September 1988).
In Europe no seropositivity was located in samples of prostitutes in London, Paris and Nuremberg (Smith &Smith 1986, p. 1392), but 6 per cent of 200 prostitutes in Athens were reported seropositive, none of whom were known as intravenous drug users (Papaevangelou 1985, p. 10 1 8). Reports of infection in Africa are far more alarming. In Rwanda 88 per cent of 33 prostitutes were reported as seropositive (van de Perre et al. 1985, p. 245), while in Kenya 54 per cent of 90 sex-workers were found to be seropositive, most of whom bore symptoms of AIDS Related Complex (Kreiss et al. 1986, p. 414ff). It must be realised, though, that in central Africa there is a much higher ratio of casual prostitution than in western countries, that the social identification of "prostitute" is much more broadly applied (as it was in early colonial Australia), and the ratio of HIV infection in the population is as high for females as it is for males (it is much more heterosexually located than in Australia).
In 1985 no Australian female prostitutes were seropositive. However, by 1989 a handful of street prostitutes with histories of intravenous drug use were found seropositive in Sydney and Melbourne. The New South Wales Liberal Government reaction to the situation indicated panic and repression of individuals, with one prostitute involuntarily detained in hospital (see p. 156). This hard handed response, so reminiscent of 19th century attitudes seen in the Contagious Diseases Acts, attempts to level blame on the individual and a particular group, such as, in this case, prostitutes. Both gay and prostitute advocates have demanded the removal of the tag "high risk group", since it perpetuates the existing stigmas of homosexuals and sex workers, and insisted on replacing it with the term "high risk activities" (referring to sex without a condom and the sharing of needles for example), because most gay men and prostitute women are now practising safe sex.
What is safe sex for prostitutes? Condom use with every client is essential, although some prostitutes switch to bondage services to avoid sexual contact altogether. In America the use of condoms among prostitutes has increased with the spread of AIDS. The Centres for Disease Control in 1987 (p. 158) reported that 16 per cent of prostitutes use condoms with every customer, 80 per cent do so at least some of the time and 4 per cent use them with both their clients and their private sex partners. Sydney STD Centre researchers found that patrons to the clinic had changed their sexual habits quite dramatically. In 1985 less than 20 per cent in a sample of 132 prostitutes used condoms in 80 per cent of their sexual contacts, but in 1987, following a series of explicit television ads in the so-called "Grim Reaper" media campaign by the Federal Government's National AIDS Council, 71 per cent of 200 prostitutes were using condoms on more than 80 per cent of their client contacts. The probable result of this change in habits was a decline in episodes of STDs from 70 cases in 1986-87 to only 30 in 1987-88 in 50 prostitutes attending the STD centre (Harcourt et al. 1989a, p. 4ff). It is possible that prostitutes regularly attending STD centres do not represent the broad population of prostitutes, since many, if not most, seek medical screening from private practitioners.
Figure 4.12 indicates precaution against disease taken by the sample of 128 prostitutes.
Figure 4.12 : Precautions taken by prostitutes (n=128) against infection
Irregular use of condoms, washing and douching after each client and inserting a sponge or diaphragm into the vagina are not sufficient methods of prevention. Medical testing is only satisfactory for detecting infection and is only useful for this purpose until the next sexual contact. In fact, some diseases, HIV for example, have long incubation periods and may not be detected in an initial test but will be exposed only in subsequent tests. The only safe method of precaution is the use of condoms on every occasion. But even here with a condom failure rate of around 1: 121 (see Richters et al. 1988, p. 1488) this is not absolutely foolproof. It is, though, as safe as you can expect and with infection rates of HIV, for instance, much lower than that, the likelihood of being infected with AIDS from a single burst condom in a hundred sexual contacts in a client pool of 40,000 men is extremely minimal. As Figure 4.12 shows, more than 30 per cent of the prostitutes at that time were at considerable risk of infection from one kind or another of STDS. In more recent times, brothel owners have responded positively and most houses now have a mandatory condom policy, or at the minimum, each woman has the final choice (personal communication, Sydney brothels; see also Harcourt et al. 1988b, p. 540).
Medical testing has become essential for most prostitutes. Over 48 per cent of the sample said they sought testing for HIV antibodies once a month, and a further 39 per cent did so less frequently. The Sydney STD Centre reported a slight increase in numbers of prostitutes seeking HIV antibody test shortly after the "Grim Reaper" media campaign, but the frequency dropped to normal in subsequent months (Harcourt et al. 1988). Thus, there appears to be increases in medical checks as levels of anxiety rise. But growing awareness of proper prevention should reduce both anxiety and these "panic" tests.
Figure 4.13 indicates the frequency of medical screening by the sample of 128 prostitutes in the present study.
Figure 4.13 : Medical screenings of prostitutes (n=128)
Over half of the prostitutes felt it necessary to have medical checks every week. Due to the incubation variation of diseases it is probably insufficient for detecting every infection in a week, and if the person is safeguarded by condoms on every sexual contact it is certainly excessive. But weekly checks assure some brothel managers that their staff are "clean", and, especially in brothels where the use of condoms is forbidden, it is considered necessary to protect the customer. However, apart from the complete lack of sensitivity for the worker, it is far from a positive security for clients. Such prevention methods are only as good as the medical report provided a week or so after the check-up, and then only for those diseases detected. In the meantime the worker may have been infected by her next client and will continue working and unwittingly infecting as many as 50 men a week until the report is known to her. She will be laid off, but it is too late. Unfortunately, such false security precautions are too often profit-motivated with an attitude that workers are a dispensable component of the business.
Another problem facing prostitutes in the workplace is the possibility of pregnancy. In an effort to avoid such a crisis the worker has to take precautions. Table 4.22 compares contraception methods employed by the three sample groups in this study.
The most outstanding feature of this configuration is the much higher ratio of prostitutes using more contraceptive devices. This obviously reflects their repugnance for failing pregnant to a client. This contradicts the response by a handful of sex workers who use no contraceptive device whatsoever, unless these women are regular users of condoms, whose main purpose is to avoid disease but of course it serves the extra function of preventing pregnancy.
Other health problems in prostitution have been reported. "Dr Mack", whose Kings Cross practice introduced him to many concerns of prostitutes working in the area, found fatigue, emotional stress, poor nutrition, and injuries from assaults common health hazards in their lifestyles. Improper hygiene was also a concern. One patient suffered cervix malignancy due to advanced syphilis, and another had acute salpingitis due to PID (Perkins & Bennett 1985, pp. 274-8). Donovan (1984b, p. 272ff) also noted stress due to competition, tension with management, overwork, chronic depression and over indulgence in social activities common to brothel workers he treated regularly in a western suburbs premises. Thai prostitutes in the present study complained of continual pelvic pain due to their small frames accommodating relatively large size penises of Australian men. Although most brothels in metropolitan Sydney are scrupulously clean places with generally healthy spatial environments, some are obviously unhygienic and unkempt, adding to the problems of over-stressed workers.
In this study there are clearly more prostitutes than non-prostitutes involved in crime, drug addiction and disease contagion. On closer inspection it is not a matter of the majority of prostitutes, but 37 per cent more of them committed criminal offences than the health-workers; 15 per cent more of them took drugs at some time; and 19 per cent more were infected with STDS. In other words, it is a matter of degree not kind. The evidence throughout points to a clear fact. It is not so much that criminals, drug addicts and women deliberately testing fate with diseases are more inclined towards sex work, but that women who enter prostitution significantly increase the probability of involvement in crime, taking more drugs and being infected more often.
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