“If He Looks Clean…”: Condom Use Decisions in Prostitution

ABSTRACT

Prostitutes engage in sex acts with multiple partners and have higher than average rates of intravenous drug use. For these reasons, unprotected sexual contact with a prostitute constitutes high-risk activity. The present study includes interviews with 34 indoor and outdoor sex workers that explore the factors involved in their condom use decisions. Three themes common to participants’ protective behavior decisions (interpersonal, situational, and personal factors) were elucidated and then analyzed within a rational choice framework. Policy implications include court-ordered sex education programs for women cited for prostitution and the expansion of harm reduction programs.

Notes

¹ These are acts involving the mouth, rectum, anus, vulva, vagina, and/or penis in which there is contact with blood and/or other bodily fluids, such as pre-ejaculate, semen, and vaginal secretions.

² Eight major STIs were included in the CDC’s prevalence calculations: gonorrhea, hepatitis B virus (HBV), herpes simplex virus type 2 (HSV-2), HIV, human papillomavirus (HPV), syphilis, and trichomoniasis.

³ This references male and female condoms made of latex, polyurethane, or polyisoprene.

⁴ These participants reported only performing manual stimulation for customers and were not heavily factored into the analysis.

⁵ Subjects were assessed according to The American Psychiatric Association’s criteria for substance intoxication as delineated in the Diagnostic and Statistical Manual, 4^th Edition, Treatment Revision (APA, 2000): slurred speech, incoordination, unsteady gait, psychomotor agitation, aggression, extreme pupillary dilation or constriction (not in response to light levels), confusion, sedation, and/or impaired attention and concentration.

⁶ All names were substituted with pseudonyms chosen by the participants.

Additional information

Notes on contributors

Maggie McCandless Stone

Maggie McCandless Stone holds a doctorate in Applied Sociology from the University of Louisville and is a Licensed Psychological Associate with a Master’s degree in Counseling Psychology. Previously an Assistant Professor of Sociology and the Director of Graduate Studies for Marshall University, she continues her work in academia as part-time faculty for Bellarmine University, Marshall University, and the University of Louisville while working full-time as the Clinical Quality Improvement Specialist at the Home of the Innocents. Her research interests include sexual deviance, stigma, and health.