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In another study Darrow et al. The knowledge that these women bring to a project regarding the local population has often been important in encouraging recruitment, maintaining participation, and ensuring follow-up. The outreach workers provide information about how AIDS is transmitted and how to prevent infection both injection based and Prostitutes Cochrane transmitted.

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Shopbop Designer Fashion Brands. When business is slow, income can often be generated by telephoning known customers and extending invitations. Usually, call girls are more affluent and have better working conditions than most prostitutes Gagnon and Simon, ; James, ; B.

Cohen, ; Shedlin, Prostitutes Cochrane Prices for services may vary, but the generally higher socioeconomic status of Prostitutes Cochrane clients provides call girls with a Prostitutes Cochrane price per transaction than is received by most prostitutes. In addition, because of their lower public visibility, call girls generally have fewer problems with the police than do streetwalkers. The owner of an escort service Prostitutes Cochrane employs female sex workers meets the legal definition of a pimp.

Unlike pimps who may have sexual or personal relationships with Prostitutes Cochrane prostitutes, however, the relationship between the owner of an escort service and a call girl is usually restricted to business.

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In Prostitutes Cochrane, there is little or no personal contact between sex workers and agents. There are certain legal benefits to this new system of services. Managers of escort agencies can deny knowledge of sexual Prostitutes Cochrane between clients and employees, claiming that the only service advertised and offered is companionship.

Moreover, because the fee is understood to include sexual services, the outcall worker does not have to discuss price, which makes it difficult for law enforcement personnel to collect evidence of solicitation Perkins and Prostitutes Cochrane, Many cities license escort services through the police department, again barring anyone with a history of prostitution-related arrests from obtaining a license.

The implications for AIDS prevention of this pattern of prostitution are still unclear. What is clear is that prostitutes who work on an outcall basis either through an escort service or on their own are among the least visible and most independent of Prostitutes Cochrane prostitute subgroups.

In a number of urban settings a new form of sexual barter has arisen in connection with the widespread use of crack. Crack-related prostitution displays some Prostitutes Cochrane with past practices involving drug-sex interaction, but certain features of crack suggest that the use of this drug may evoke a qualitatively Prostitutes Cochrane situation.

Some of these young women engage in sex with men either directly for the drug or for money with which to purchase it.

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Men who wish to have sex with these young women either when they themselves have taken crack or Prostitutes Cochrane they have not can purchase these sexual services quite inexpensively. Because money may not change hands or is Prostitutes Cochrane used for drugs rather than subsistence, the women exchanging sex for drugs may not consider themselves to be prostitutes and, indeed, may not view their actions as work.

Researchers in this area report Prostitutes Cochrane evidence that crack has begun to change street prostitution. Outreach workers in Harlem, for example, have found Prostitutes Cochrane very young teenage girls engage in sexual intercourse with IV drug users to receive crack Friedman et al.

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In a study of 82 teenage female crack users from the San Francisco area, 24 29 percent reported exchanging sexual Prostitutes Cochrane for drugs or money Fullilove et al.

In some areas, older, more experienced women are leaving the streets because of their fear Prostitutes Cochrane AIDS and the violence associated with crack; younger women addicted to this drug are taking Prostitutes Cochrane place Shedlin, In the case of crack, the risk of HIV infection is related to the exchange of sex for drugs and the disinhibition associated with crack use that fosters frequent unprotected sex Friedman et al.

The nature of sex work as a marginal profession, for example, creates barriers for some prostitutes that may impede their implementation of safer-sex behaviors.

Because a woman may have multiple partners during the Prostitutes Cochrane of one time period at a crack house, one would predict a significant level of HIV risk associated with the activity if there is infection among local crack Prostitutes Cochrane or their sexual partners. Cohen et al.

It reiterates Prostitutes Cochrane its counsel on the need to Prostitutes Cochrane the spread of infection among crack users. The picture of prostitution that emerges from these limited data is not an integrated one. Rather, Prostitutes Cochrane is a composite of very different women, some working independently, others with procurers; soliciting on the streets or working in organized sites; earning subsistence wages or lucrative incomes; living with drug dependence or living drug free.

Some women, such as those who Prostitutes Cochrane sex for crack, do Prostitutes Cochrane view their activities as work at all and do not see themselves as part of the sex industry.

Many, perhaps most, have other identities in addition to their Prostitutes Cochrane work roles. This diversity needs to be considered in designing intervention strategies for reducing HIV risk because it has important consequences for selecting access routes to the various subpopulations Prostitutes Cochrane for tailoring the content of interventions. In addition, at least two essential themes have been noted by those who have worked with female Prostitutes Cochrane for a message to be heard, the source must be trustworthy and nonjudgmental, and the content must reflect sex workers' interests.

At first glance, it might seem sensible to launch AIDS intervention activities from existing Prostitutes Cochrane bases such as law enforcement agencies, STD clinics, or other public health programs because these locations are typical points of contact with some sex workers.

However, prostitutes' experiences with these institutions in many instances have not led to relationships of trust. As a result, intervention efforts made by or through these agencies may be severely handicapped in terms of earning participant trust and gaining acceptance of the AIDS prevention messages being delivered Stephens et al. The theory of adoption and diffusion of innovation predicts that trusted and respected Prostitutes Cochrane in any Prostitutes Cochrane are important resources to be mobilized in the design and implementation stages of activities to introduce a new product or procedure Rogers, ; Becker, ; Rogers and Adhikarya, For this reason, involving prostitutes and ex-prostitutes directly in the design and implementation of AIDS prevention programs may instill trust and facilitate access to the population and the recruitment of Prostitutes Cochrane it may also help to ensure that the Prostitutes Cochrane programs reflect the needs of prostitutes and Prostitutes Cochrane diversity of contexts in which they work.

Peer-led programs involve the target audience as part of the solution to the problem rather than as merely the object of their efforts. Several existing AIDS Prostitutes Cochrane for female prostitutes in Prostitutes Cochrane country and abroad have used women from the sex industry as part of their outreach and educational efforts Locking, ; Sanchez, ; J. The knowledge that these women bring to a project regarding the local population Prostitutes Cochrane often been important in encouraging recruitment, maintaining Prostitutes Cochrane, and ensuring follow-up.

Understanding how the business of prostitution is organized is important for designing methods to gain access to the different groups of female sex workers. Prostitutes who work independently e. In addition, they may be the most isolated of all sex workers and the least integrated into information networks.

Researchers have located independent sex workers through ads in Prostitutes Cochrane newspapers, classified telephone directories, Prostitutes Cochrane newspapers, and other media.

For example, Shedlin's model for delivering AIDS prevention education to prostitutes grew out Prostitutes Cochrane her work with a group of female street prostitutes who had initially been recruited to receive other social services.

For descriptions of additional programs, see also B. Cohen [] and Carmen and Moody []. Finally, current and former street prostitutes may be able to deliver health messages effectively by contacting women who are currently in the industry. Workers in organized sites, such as brothels, massage parlors, escort services, and the like, are less visible than street workers but may be more accessible for prevention efforts especially those delivered by former sex workerseven though the illegal nature of prostitution may make managers reluctant to allow educators access to workers.

Individuals who have established intervention programs for prostitutes at organized sites offer the following advice for the design and execution of AIDS prevention projects. First, problems can arise if project staff become overly identified with the owners of organized prostitution sites. The prevention efforts offered by these projects should be presented as a resource for sex workers, acting, Prostitutes Cochrane example, as an advocacy group to support prostitutes' rights to safe working conditions.

Second, in areas where prostitution is illegal, management personnel of organized sites must be convinced of the trustworthiness of AIDS outreach workers and the benefits to be gained from safer sex practices. Without the cooperation of the management, it will be extremely difficult to identify and contact women working in these establishments. The implementation of AIDS prevention efforts may be Prostitutes Cochrane difficult if some sites in a community promote the use of condoms and others do not.

Because some clients are not willing to use condoms, Prostitutes Cochrane a two-tiered system may draw business away from prostitutes who insist on protected sex and contribute to conditions under which HIV and other STDs can spread. Alternatively, with the appropriate introduction, condom use may provide a positive selling point for such businesses, as both prostitutes and clients become more aware of Prostitutes Cochrane.

The Australian experiment discussed in the next section has tried to implement a universal condom policy in a manner that enhances the attractiveness of a brothel. Ideally, any intervention program for female prostitutes should serve its targeted population in a nonjudgmental fashion, forming partnerships that will help each individual understand her level Prostitutes Cochrane risk, make appropriate behavioral changes, and Prostitutes Cochrane the development of required skills to sustain those changes over time.

In the case of sex workers, it may be particularly important to state the spirit and goals of the program in clear, unambiguous language. Because prostitutes have often been stigmatized by society and labeled as Prostitutes Cochrane by some research activities, AIDS education and research programs targeting this population need to stress that their goal is to help prostitutes protect themselves from HIV infection. Conversely, if female sex workers perceive the primary purpose of interventions Prostitutes Cochrane be the protection of clients, it may be difficult to gain their trust and cooperation.

Because the major risk factor associated with infection among prostitutes appears to be IV drug use, AIDS prevention should highlight drug treatment and safer injection projects, as well as Prostitutes Cochrane prevention of IV Prostitutes Cochrane use.

As noted earlier, such efforts would surely benefit from a better understanding of the connection between IV Prostitutes Cochrane use and prostitution. It is also vital to provide instructions regarding safer needle use for Prostitutes Cochrane who continue to inject drugs. Both referral to treatment and education about safer injection practices can be delivered through street outreach projects.

For example, outreach programs to distribute bleach to drug users in New York and San Francisco have incorporated street counseling and drug treatment referral Des Jarlais, These program components are being delivered in outreach projects directed toward prostitutes, using mechanisms as innovative as a prostitute collective, which was organized by the New York City ADAPT Association for Drug Abuse Prevention and Treatment project for participation in a series of weekly meetings to discuss drug and sex risk reduction techniques Friedman et al.

The second Prostitutes Cochrane risk factor for female sex workers is multiple unprotected sex acts. Many of the safer sex education programs designed for the broader population of women at risk may also be appropriate for women who work in the sex industry. In their personal lives, prostitutes enact the same intimate roles e. In addition, however, they face unique problems in changing high-risk sexual practices because sex occurs not only in a personal context but also with clients. Intervention programs for prostitutes must take into account the number and diversity of Prostitutes Cochrane behaviors in which sex workers engage and the contexts in which these behaviors are enacted.

Many existing street outreach programs are designed to protect street prostitutes from HIV infection by providing them with information about safer sex and IV drug use practices.

Infection was not associated with number of sexual partners.

This program employs former female street prostitutes who walk through stroll districts, introducing themselves and the program as they Prostitutes Cochrane sex workers. The outreach workers provide Prostitutes Cochrane about how AIDS is transmitted and how to prevent infection both injection based and sexually transmitted. They distribute small bottles of bleach and instructions on how to clean injection equipment, as well as safer-sex kits small plastic bags containing five different kinds of condoms and safer-sex guidelines Alexander, Training sessions include a number of components: a discussion of how Prostitutes Cochrane is transmitted and how to prevent infection; a demonstration of how to clean injection equipment; a demonstration of how to use condoms including instructions on using condoms for oral sex as well as for vaginal and anal intercourse, avoiding breakage, and using a lubricating spermicide for additional protection ; and a practice session for newly learned skills and roles, with special emphasis on encouraging the cooperation of both paying clients and nonpaying partners in the use of safer-sex practices.

The project has also established support groups to provide a comfortable opportunity for prostitutes to continue to discuss their concerns about AIDS, obstacles to behavioral change, and strategies for facilitating change.

Support group sessions have been held in a van, in hotel rooms, and in places where prostitutes congregate. Similar peer-led intervention workshops have also been conducted for Prostitutes Cochrane workers in brothels, massage parlors, sex clubs, erotic dancing theaters, and other locations that employ sex Prostitutes Cochrane.

This program also developed a Safe House Endorsement policy: houses that enacted and enforced mandatory condom policies and maintained good working conditions received a certificate of endorsement from the project. Project planners hoped to encourage the patronage of only those houses that had received endorsements. Another type of intervention—voluntary anonymous counseling and HIV antibody testing of Prostitutes Cochrane in the context of a supportive environment —has been advocated and implemented in several communities.

However, the lack of solid evaluation data on the vast majority of programs precludes drawing firm conclusions about the effectiveness of these efforts in changing behavior. Jurisdictions that encourage voluntary testing while mandating HIV tests for women convicted of prostitution may compromise the usefulness of voluntary testing. At the least, such a policy sends out mixed messages to sex workers, raising serious doubts about the benefits these women may gain from testing and how information on test results is to be used Decker, ; J.

Cohen, Alexander, and Wofsy, ; Rosenberg and Weiner, Some intervention programs advocate eliminating prostitution but neglect important economic realities. Prostitution provides better economic incentives and Prostitutes Cochrane flexible work schedules than many other jobs available to women who Prostitutes Cochrane likely to have few alternative employment opportunities.

If intervention programs do not include vocational training components, they may well be unsuccessful because they do not address the limited occupational skills and survival needs of this population Decker, Making the transition to lower-paying legitimate jobs can be difficult for many female sex workers, but the process may be eased with the help of former prostitutes who can provide role Prostitutes Cochrane as well as support and counseling Alexander, ; J.

Cohen, Alexander, and Wofsy, Finally, AIDS prevention programs related to prostitution must look at both the supply of and demand for these services. Client demand for unprotected sex can make it difficult for prostitutes to adopt safer-sex technologies Rosenberg and Weiner, Thus, safer-sex intervention efforts that focus exclusively on sex workers and fail to include their clients neglect an important aspect of AIDS prevention and may prove unsuccessful.

Although the current risk of HIV infection associated with unprotected sex with a female sex worker is small, it will remain so only if both clients and prostitutes adopt safer sexual practices on a wider scale and more consistent basis. Given that there is both a supply of and demand for prostitution and little likelihood that the AIDS epidemic will eliminate either, messages designed to protect the health of all participants should tell men to use condoms if they have sex with prostitutes.

The barriers that have impeded AIDS prevention efforts among prostitutes fall into several categories. In some cases the obstacles to prevention Prostitutes Cochrane this population are similar to those hindering interventions among other groups.

For example, because the major HIV risk factor in the sex worker population is IV drug use, providing treatment for drug use and information about safer injection practices is of paramount importance.

Long waiting lists for admission are common, program retention rates are low, and support services, such as job training, are deficient. The lack of drug-use treatment facilities is of particular concern because the risk of transmission among IV drug users is clear and efforts to prevent this type of transmission have lagged far behind what is needed.

Prostitutes who are drug users may have a difficult time securing needed services because there are fewer drug treatment openings for women than for men, especially for women with children. Prostitutes Cochrane illegality and marginality of prostitution constitute another series of barriers to deploying interventions and adopting new behaviors Decker, ; Prostitutes Cochrane.

In particular, the illegal nature of prostitution often forces female sex workers and their agents pimps, madams, massage parlor and outcall service operators to conceal their practices, thereby limiting educators' access to these groups and restricting support group and outreach activities.

Laws against prostitution have other ramifications for intervention as well, which are discussed in Prostitutes Cochrane sections below. It is a crime to solicit or engage in an act of prostitution in all 50 Prostitutes Cochrane and the District of Columbia; the only legal exception is brothel prostitution, which is a local option in rural Nevada counties with populations of fewer thaninhabitants Decker, ; Rowe and Ryan, Prostitutes Cochrane Prostitution is defined as a lewd act in Prostitutes Cochrane for money or other consideration.

Violation of these laws is generally a misdemeanor, except in states that have passed AIDS-related legislation increasing the charge to a felony for an individual arrested after testing positive for HIV infection see, for example, Shaw, In addition, all states have laws against living off the earnings of a prostitute pimpingencouraging anyone to work as a prostitute pandering or procuringor running a house of prostitution.

Various statutes also deal with Prostitutes Cochrane abuse of minors in prostitution. Federal law is applied when a person crosses state lines to work Prostitutes Cochrane a prostitute or sends money earned by prostitution in one state to another state.

In addition, U. Such laws can also be used to deport aliens who work as prostitutes after entering the United States, even if the work is legal Alexander, Enforcement rates of laws against prostitution appear to vary by state and region as well as over time. There is anecdotal evidence that law Prostitutes Cochrane officials in some locales seize condoms as evidence of intent to commit or solicit prostitution.

Although many prostitution laws were originally enacted to protect women from exploitation, such laws can also Prostitutes Cochrane the effect of cultivating secrecy among prostitutes and a wariness of outsiders that impedes outreach efforts to promote health education and risk reduction.

Research has shown that in jurisdictions in which prostitution is illegal and the law is enforced, it does not go out of existence but instead goes underground in a way that increases the difficulties of outreach to female sex Prostitutes Cochrane for public health purposes B.

Cohen, ; Carmen and Moody, ; Alexander, If police confiscate condoms as evidence of intent to solicit prostitution or if possession of condoms is listed on an arrest record, prostitutes receive a message that is inconsistent with Prostitutes Cochrane is being asked of them by public health authorities.

Prostitutes may thus be discouraged from carrying condoms on their person, making it even more likely that they will engage in unprotected sex. In an attempt to control the spread of HIV, some states have proposed or passed special AIDS legislation that targets persons Prostitutes Cochrane as prostitutes Rowe and Ryan, One type of statute restricts the activities of infected individuals, and another calls for mandatory HIV testing of prostitutes.

Not much Prostitutes Cochrane currently known about the enforcement of these laws, but both types of legislation have consequences for the implementation of AIDS prevention programs.

In Colorado, for example, the statute is rather Prostitutes Cochrane and singles out HIV as an isolable condition. If a person is reasonably believed to be infected with HIV, a representative of Colorado's public health office can issue a cease-and-desist order for specified dangerous conduct in this case, prostitution ; violation can result in a criminal penalty Gostin and Ziegler, The impact of such laws on HIV transmission and on the ability to provide intervention and other services is not known.

Indeed, the threat of such restrictive action may cause at-risk individuals, including prostitutes, to avoid HIV testing and other help-seeking measures in order to Prostitutes Cochrane identification by the authorities. A few states have passed legislation or have bills pending that would require anyone convicted or arrested for prostitution to be tested for HIV infection Gostin and Ziegler, ; Rowe and Ryan, For example, Florida requires women convicted of prostitution to undergo screening for a variety of STDs, including HIV; women who are found to be infected must submit to treatment and counseling as a condition for release Gostin and Ziegler, In addition, some states have imposed penalties on HIV-infected persons Prostitutes Cochrane are convicted of exposing other individuals Prostitutes Cochrane the virus.

Prostitutes obviously will be affected by these laws, even when they are not specific targets of Prostitutes Cochrane legislation Gostin and Ziegler, It is unclear whether mandatory Prostitutes Cochrane laws are effective in reducing the rate of transmission of HIV infection. Certainly, other attempts to legislate the control of STDs have not met with great success. Moreover, such laws may divert resources from educational efforts that could be more effective in reducing the epidemic's spread.

Even in locales in which prostitution is legal, the benefits of mandatory HIV testing are not entirely clear. Policies that enforce regular medical examinations of prostitutes may also foster risk taking by engendering a false sense of security i. Of course, this perception of eliminated risk does not take into account the possibility that the client could infect the Prostitutes Cochrane.

Very few countries have begun intervention efforts to educate customers about their responsibility for condom use. Groups such as prostitutes and drug users who live and work on the margins of society often experience subtle consequences of this marginality that Prostitutes Cochrane affect any attempts to facilitate behavioral change. The nature of sex work as Prostitutes Cochrane marginal profession, for example, creates barriers for some prostitutes that may impede their implementation of safer-sex behaviors.

In legitimate workplaces, employees are protected by law from many hazardous conditions; they are able to organize to promote occupational safety and guaranteed fair wages. These patterns and practices are not necessarily available to prostitutes, even though safeguards, such as the technology currently advocated to reduce sexually Prostitutes Cochrane HIV infection latex condoms and spermicides with nonoxinol-9 have been available for decades to Prostitutes Cochrane other STDs.

At the same time, female prostitutes report Prostitutes Cochrane persuading their partners, both paying and nonpaying, to use condoms J. A prostitute's precarious financial position may make her vulnerable to customers who offer a higher price for sex without a condom.

Moreover, prostitutes are at least as vulnerable as other women in their personal relationships. In contrast to Prostitutes Cochrane relationships, the way in which personal sexual relationships are defined by sex workers and their partners often precludes condom use or other protective measures J.

Prostitutes Cochrane, the marginality of their profession and prostitutes' need to earn a living may engender a quite practical apprehension about AIDS education. It thus becomes a wise business decision to refuse risk reduction literature Shedlin, Although female prostitutes do not appear to play an important role in transmitting HIV, a significant proportion of Prostitutes Cochrane workers in some locales are infected with the virus, mainly from IV drug use practices and, to a lesser extent, from sexual contact with infected husbands and boyfriends.

For this reason, it is important to extend to sex workers the services and education they need to prevent acquisition of the disease.

Options for future HIV prevention efforts are presented below. Female prostitutes as drug users mandate a specific set of HIV Prostitutes Cochrane strategies, the most prominent of which include access to drug treatment centers and, for women who continue injecting, instructions on cleaning injection equipment. These interventions were discussed at length in Chapter 3 of the committee's first report Turner, Miller, and Prostitutes Cochrane, In addition, prostitutes in their capacity as prostitutes have unique needs.

The illegality and marginality of the sex industry raise a number of stubborn issues that resist resolution, but some of these issues can be affected by changes that would further the implementation of HIV interventions. First, nationwide agreement is needed Prostitutes Cochrane enforcement Prostitutes Cochrane criminal justice personnel that the possession of condoms will not be used as evidence of intent to commit or solicit prostitution or, in the case of brothel owners and managers, as evidence of intent to commit the more serious offenses of pimping, pandering, or procuring.

Such an agreement is consistent with Prostitutes Cochrane public health practices and has already been adopted by a handful of U. Moreover, the policy of mandatory HIV testing for arrested or convicted prostitutes is not warranted at Prostitutes Cochrane time. Prostitutes' risk of HIV transmission is more closely associated with drug use than with sexual activity and appears to be greater in personal relationships than in paying ones.

Mandatory testing programs that focus on female prostitutes as professional sex workers are thus mistargeted Prostitutes Cochrane reflect an injudicious use of resources, given that most serologic studies of prostitutes who do not inject drugs find few who are infected.

In addition, one-sided testing policies that do not include the clients Prostitutes Cochrane prostitutes are not sound public health practice. The committee Prostitutes Cochrane, therefore, that mandatory testing of prostitutes is unlikely to address the real sources of increased risk, which are tied to private, Prostitutes Cochrane relationships and clandestine use of illicit substances.

The committee concurs with that position and urges the rejection of such policies. Second, the connection between HIV infection and prostitution needs to be better understood. The known facts about this diverse population are few. There is currently some sense of the prevalence of HIV infection among female prostitutes, although studies to date have relied on small, geographically discrete groups that may or may not be representative of the larger population.

Although some information is available Prostitutes Cochrane how and why women enter prostitution, little is known about how and why they leave this work see, for example, Potterat and colleagues [].

Most existing studies are based on discrete groups of prostitutes and are outdated. In addition, support is needed for studies of men who are clients of prostitutes. For the purposes of understanding both HIV transmission and the design and implementation of intervention programs, data are needed on the Prostitutes Cochrane contexts of prostitutes, their personal social networks, their occupational histories, and their clients.

The committee believes such research efforts will benefit from input by women who have actually worked as prostitutes. The relationship between crack use and sexual transmission of HIV is just beginning to be understood; a fuller understanding requires careful study of the subpopulation of women and men who exchange Prostitutes Cochrane for crack to shed light on emerging patterns and risks.

It is likely, however, that IV drug use will continue Prostitutes Cochrane be the major route of infection for prostitutes in the industrialized countries. Finally, there is little information about the effectiveness of recently begun intervention efforts for this population, and the committee urges Prostitutes Cochrane this situation be corrected.

Longitudinal studies of planned variations accompanied by rigorous evaluation are just as necessary and desirable for this population as for others at risk for HIV infection.

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Strategies for evaluating the risk reduction projects of community-based organizations have been laid out in Coyle, Boruch, and Turner and could prove to be useful in Prostitutes Cochrane arena as well. Without some evaluation of the effects of a project, Prostitutes Cochrane they positive or negative, planners lose the opportunity to Prostitutes Cochrane what best facilitates change and where resources are best expended.

The term prostitute Prostitutes Cochrane used to denote the diverse group of women who exchange sexual acts for money, goods, or services as a means or partial means of their livelihood or survival. Other Prostitutes Cochrane as sex workers, sex industry workers, and commercial Prostitutes Cochrane workers—have also been used to describe this population in an effort to avoid the judgments that are often associated with the term prostitute.

The committee appreciates this distinction but has chosen to use the terms interchangeably. None of the terms are intended to convey any judgment about individuals who work in this area. Because so Prostitutes Cochrane is known about male prostitutes, the committee has restricted its focus to females, although male prostitutes are also at risk of acquiring and spreading HIV infection.

One study of male prostitutes recruited from the streets of Atlanta, Georgia, found that 27 percent were infected. Compared with seronegative respondents, male prostitutes who were HIV positive had spent more years as prostitutes, were more likely to self-identify as homosexual, and had had Prostitutes Cochrane encounters involving receptive anal intercourse in the month prior to the interview Elifson et al.

In addition, a recent study of prostitutes who did not use drugs found a significant relationship between infection and the number of personal i. For examples of research that reflect the perspective of prostitutes, see Prostitutes CochranePerkins and Bennettand Delacoste and Alexander These data correct Table 2. That the source of infection was contaminated injection equipment rather than multiple professional customers is given further credence by the results of Wolfe and colleagues Infection was not associated with number of sexual partners.

In a survey of 1, female Prostitutes Cochrane from the Prostitutes Cochrane multicenter study, Prostitutes Cochrane that they had injected illicit drugs at some time in their lives or had physical signs needle Prostitutes Cochrane of IV drug use Khabbaz et al. Slightly more than halfor 53 percent were nonwhite blacks, 73 white Hispanics, 13 black Hispanics, 10 American Indians, and 5 Asians.

Other analyses of these data find that 84 percent of IV drug-using women reported street prostitution compared Prostitutes Cochrane a significantly smaller proportion In another study of 60 women who reported drug use, Goldstein found that 43 also reported prostitution.

The vast majority 96 percent of the 25 streetwalkers interviewed in this study reported regular heroin use. In contrast, none Prostitutes Cochrane the 18 prostitutes who worked in massage parlors, as call girls, Prostitutes Cochrane as madams reported regular Prostitutes Cochrane of heroin, although 22 percent had used the drug at least once. Of the 25 streetwalkers interviewed, 64 percent were black, and 20 percent were Hispanic. A serologic survey of 90 streetwalking female prostitutes recruited from a depressed inner-city area of south Florida and 25 women who worked for an escort service in a middle-class urban Prostitutes Cochrane of that state found that 41 percent of the streetwalkers were infected but none of the women from the escort service were seropositive Fischl et al.

These results are consistent with findings from the CDC multicenter study, in which brothel workers and applicants constituted the group with Prostitutes Cochrane lowest rates of IV drug use and the lowest rates of HIV infection Darrow et al.

CDC supports ongoing studies of female prostitutes in several cities see Prostitutes Cochrane 4—1 that are investigating the sexual and social networks of prostitutes as well as strategies for outreach, treatment, and social Prostitutes Cochrane of female sex workers. NIDA funds outreach and education programs for a diverse population of women, including prostitutes.

In a study of HIV infection among patients seeking treatment at an STD clinic, Chiasson and coworkers found that, among twelve infected men who reported no same-gender sexual contact, no IV drug use, and no sexual contact with a person known to be infected with HIV, three had a history of sexual contact with known crack users, one was a crack user himself, and eight reported contacts with prostitutes.

Furthermore, of the six seropositive women identified in this study who also reported no history of IV drug use or sexual contact with an infected individual, four were prostitutes who used crack. In this study, ex-addict street outreach workers were used to identify informants among residents of buildings that served as crack houses. They reported that male addicts found female crack users to be an inexpensive and readily available source of sexual gratification.

There are, however, some preliminary data on this practice from the CDC multicenter study. More than one-third In a study of 91 prostitutes recruited from an STD clinic in London, Day, Ward, and Harris reported that more than half 59 percent of the women reported consistent condom use with paying customers. Of the 71 women who reported vaginal intercourse with their boyfriends, 6 percent said they used condoms consistently with these partners. The differential pattern of condom use did not change over the course of the month study; however, the percentage indicating condom use increased for both groups.

Such differential enforcement often results in an overrepresentation of street prostitutes in statistics generated by the criminal justice system. In Goldstein's research, 58 percent of the streetwalkers participating in the study started using heroin once they became prostitutes; 24 percent had used heroin regularly before their entry into prostitution. Most male Prostitutes Cochrane, also known as call boys, work independently, although there are some organized male escort services Pittman, ; Gagnon and Simon, ; Perkins and Bennett, Prostitutes Cochrane on the street, these young women may also be at increased risk of initiating heroin use Friedman et al.

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In Holland Paalman and deVries,outreach efforts for both female prostitutes and their clients also provide condom-promoting messages in pornographic magazines, on radio stations, and through posters. For additional information Prostitutes Cochrane methods of reaching the population of female prostitutes, see J. Cohen and colleagues b. In such cases it may be possible to design health education projects that involve currently employed women as agents of education Prostitutes Cochrane training.

Prostitutes Cochrane such program in the Dominican Prostitutes Cochrane uses a train-the-trainers strategy wherein working prostitutes are elected by their peers as representatives of the local sex Prostitutes Cochrane community to participate in a Ministry of Public Health project, the National Struggle Against AIDS. These representatives are trained to provide safer sex information, education, and motivation to their fellow workers Rosario et al. In addition, clients of prostitutes have been organized to serve as distributors of condoms to other prospective clients.

Peer-led programs from several other countries have reported promising results in behavioral change among prostitutes Ngugi et al.

In some studies, self-reports of behavioral change have been supported by decreased rates of HIV seroconversion and of other STDs Ngugi et al.

Prostitutes Cochrane a prospective study of sexually active women from the San Francisco area, J. Cohen and coworkers a found substantial risk reduction at 6- to month follow-ups after HIV antibody testing. However, 11 percent of the women tested continued to report IV drug use, 24 percent reported anal sex, and 32 percent reported more than 10 sexual partners. For additional information on designs for the evaluation of both counseling and testing projects and community-based outreach, see Coyle, Boruch, and Turner In most cities, there appear to be periods of intense enforcement, followed by Prostitutes Cochrane of relative inactivity Alexander,as indicated by the fluctuating statistics on arrests related to prostitution.

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There are many possible explanations for such variability include shifts in the overall economic and political climate of the country and perhaps even the fear of AIDS. Alternatively, changes in criminal justice statistics may reflect differences in the way data are collected and tabulated.

Effective immediately,…[they] shall not be seized as evidence, unless…[as] evidence of a crime other than prostitution…. Turn recording back Prostitutes Cochrane. National Center for Biotechnology InformationU. Search Prostitutes Cochrane. Risks Related to Drug Use and Sexual Transmission Data from Prostitutes Cochrane CDC multicenter study show that rates of HIV infection are much higher among female sex workers who report a history of IV drug use than among those for whom no evidence of drug use is found Context-Related Risks The context Prostitutes Cochrane the sex-for-money exchange involves Prostitutes Cochrane variety of elements, Prostitutes Cochrane setting Prostitutes Cochrane time limitations to cultural preferences and the nature of the relationship between the partners.

Client-Related Risks The extent of the risk of HIV infection for paying customers of prostitutes is not Prostitutes Cochrane with certainty, but the number of cases ascribed to Prostitutes Cochrane with female sex workers has not been large, and the few existing studies of prostitutes' clients have found relatively low rates of HIV infection.

Street Prostitution The most familiar form of prostitution, and the one that draws the most attention, is street prostitution James, ; Alexander, Brothels Prostitutes who work in brothels constitute another subgroup of the female sex worker population, and this subset of women can be further subdivided into workers at legal or illegal houses of prostitution.

Massage Parlors Other prostitutes work in massage parlors, spas, encounter studios, and other businesses with euphemistic names for essentially the same services. Access At first glance, it might seem sensible to launch AIDS intervention activities from existing institutional bases such as law enforcement agencies, STD clinics, or other public health programs because Prostitutes Cochrane locations are typical points of contact with some sex workers.

Types of Interventions Ideally, any intervention program for female prostitutes should serve its targeted population in a nonjudgmental fashion, forming partnerships that will help each individual understand her level of risk, make appropriate behavioral changes, and facilitate the development of required skills to sustain those changes over time. Laws Against Prostitution It is a crime to solicit or engage in an act of prostitution in all 50 states and the District of Columbia; the only legal exception is Prostitutes Cochrane prostitution, which is a local option in rural Nevada counties with populations of fewer thaninhabitants Decker, ; Rowe and Ryan, Mandatory HIV Testing A few states have passed legislation or have bills pending that would require anyone convicted or arrested for prostitution to be tested for HIV infection Gostin and Prostitutes Cochrane, ; Rowe and Ryan, Other Effects of Marginality Groups such as prostitutes and drug users who live and work on the margins of society often experience subtle consequences of this marginality that may affect any attempts to facilitate behavioral change.

Alexander, P. Delacoste, and P. San Francisco: Cleis Press. Altman, R. Becker, M. American Sociological Review — Benjamin, H. New York: Julian. Brandt, A. Pierce, editor;and D. VanDeVeer, editor. Belmont, Calif. Carmen, A. New York: Harper and Row. Castro, K. Journal of the American Medical Association — Morbidity and Mortality Weekly Report — Centers for Disease Control, Atlanta, Ga. Chiasson, M. Cohen, B. Prostitutes Cochrane, Mass.

Prostitutes Cochrane, Where buy a sluts in Cochrane, Alberta: New York: John Wiley and Sons. Because a woman may have multiple partners during the course of one time period at a crack house, one would predict a significant level of HIV risk associated with the activity if there is infection among local crack users or their sexual partners.

First	City	State	Code	Hookers	Sexual massage	Hookers
Prostitutes Cochrane	Cochrane	Alberta	CA	1625	yes	no
30.08.2002	no	yes	43	DBBH	DBBH	20
23.07.2011	yes	no	62	DBBH	DBBH	yes

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Amazon Second Chance Pass it on, trade it in, give it a second life. These businesses are generally identifiable from the street Alexander, Prostitutes Cochrane Many cities license escort services through the police department, again barring anyone with a history of prostitution-related arrests from obtaining a license. For descriptions of additional programs, see also B. In contrast, none of the 18 prostitutes who worked in massage parlors, as call girls, or as madams reported regular use of heroin, although 22 percent had Prostitutes Cochrane the drug at least once.

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