A Book Review

Aids, Drugs, and Prostitution

edited by Martin A. Plant

204 pp., London: Routledge. 1990.

In the late 1980's it became apparent that AIDS was no longer a problem only for the homosexual community. How was this disease bridging the gap between homosexuals and heterosexuals? Who is at high risk of contracting AIDS? How can its spread be prevented? To answer these questions many countries and cities performed studies in the late 80's which involved identifying high risk groups and attempting to understand the ways in which HIV could be spread among them. Two high risk groups were immediately identified: prostitutes and IV drug users. This book, published in 1990, is a collection of eleven articles describing these studies, each written by someone who was involved in the study. It also includes a conclusion by Martin Plant which attempts to sum up the findings of these studies and suggest what may be done in the future.

Most of these studies, which were conducted in the U.S., various European cities, and Africa, followed a similar format. First, a risk of spreading HIV infection among the general population was acknowledged. Secondly, prostitutes were identified as a high risk group and possible means of spreading the disease. Prostitutes were then contacted, usually through the "snowball" technique, by which an initial contact introduces other contacts. The purpose of the study was explained to them and a meeting was set up. The meetings could include any of the following: some type of interview, with questions usually inquiring about drug and condom use, a physical exam, an HIV test, education about AIDS, and distribution of free condoms or needles. Follow up meetings were scheduled. Some studies followed subjects for over two years.

The results of these studies were usually displayed in tables. Percentages were given for things like frequency of condom use and frequency of needle sharing. Results for the most part were similar for all the studies. Rates of HIV infection among female prostitutes were low, usually under 10%, and in some cases O%. Many prostitutes are IV drug users, and the greatest (and often only) rate of HIV infection was among IV drug using prostitutes. Most prostitutes were aware of AIDS and many studies showed an increase in safe behaviour since the publicization of AIDS. An especially interesting finding that was common to most studies was the fact that prostitutes practiced safe sex and drug use most or some of the time at work, but almost never with their personal or non paying partners. This was identified as a high risk problem for the spread of AIDS, especially since many of their boyfriends or husbands were IV drug users.

The tone of the articles was, for the most part, statistical and impersonal. This book is a good resource for any type of statistic about prostitutes, drugs, and HIV, although it may be slightly outdated. It is not a good resource for information on the personal lives of prostitutes. Some studies did attempt to delve into the underlying social reasons behind prostitution, drug use, and the spread of HIV, but these findings were limited. Much of the information in different articles is quite repetitive and does not make for very good reading. The conclusion, however, is quite good, and probably contains everything one would want to know from this book.

I originally had a problem with the purpose of this book. "This study and the others described elsewhere in this book were mounted bcause of fears that prostitution might be a medium through which HIV infection is transmitted into the general population." (p.105) I interpreted this as saying, "We don't really care if prostitutes, homosexuals, and drug users have AIDS, but we're afraid they might spread it to the rest of us." I think that this book illustrates that AIDS was not taken seriously until it began showing up among heterosexuals. The conclusion, by Martin Plant, does reconcile this bias somewhat. By saying, "In conclusion, prostitutes are not problems. They are people." (203) and, "Will it be possible to respond to the AIDS crisis pragmatically yet at the same time recognizing that all people have a right to be respected and treated in a humane manner?" (205), he justifies the studies and brings to light a sentiment that was missing in much of the book.