PROSTITUTION: EFFECTS AND CULTURAL DIFFERENCES
No discussion of prostitution can be complete without examining sexually transmitted infections, life after prostitution, and prostitution in other cultures.
Prostitution and Sexually Transmitted Infections
Most prostitutes are knowledgeable about STIs and AIDS. They try to minimize their risks by using condoms, rejecting clients with obvious STIs, and routinely taking antibiotics. However, although female prostitutes often do feel they are at risk of infection with STIs or AIDS with clients, they usually do not feel this way with their husbands or boyfriends (Dorfman et al., 1992). Condoms are used less frequently with their own sexual partners than with clients. Among homosexual male prostitutes, receptive anal intercourse without a condom is the most common mode of HIV transmission (Elifson et al., 1993a), whereas among female prostitutes, intravenous drug use is the most common mode of HIV transmission.
Many opponents of legalized prostitution claim that legalization would lead to increases in the transmission of various STIs. However, STI transmission and prostitution have been found to have less of a relationship than you might think. Rates of STIs in Europe were found to decrease when prostitution was legalized and to increase when it was illegal (Rio, 1991). This is probably because when prostitution is legal, restrictions can be placed on the actual practice and medical evaluations are often required. Many prostitutes take antibiotics sporadically to reduce the risk of STIs; however, this practice has led some strains of STIs to become resistant to many antibiotics. Long-term use of antibiotics diminishes their effectiveness in an individual. Also, viral STIs, such as AIDS and herpes, are not cured by antibiotics.
Male prostitutes have sex with multiple partners, are exposed to blood and semen, frequently practice high-risk sexual behaviors, and may continue prostituting even after they find out they are HIV-positive. In addition, many have been infected with other STIs, which may make HIV transmission easier (Morse et al., 1991).
Outside the United States, increasing prostitutes’ condom use and knowledge about AIDS has been an important task. There has been a lot of attention to AIDS transmission among prostitutes in Africa, for example. In Nigeria, AIDS prevention programs, which include health education, condom promotion and distribution, and a sexually transmitted infection treatment clinic, resulted in two-thirds of prostitutes using condoms (E. Williams et al., 1992). In Somalia, the prevalence of HIV in nonprostitute populations is 16 per 1,000; and, in prostitutes, 30 per 1,000 (Corwin et al., 1991). Men and nonprostitute women knew more about AIDS and preventive information than female prostitutes. In Zaire, 99% of prostitutes reported hearing of AIDS, but only 77% knew that sex was the predominant mode of transmission (Nzila et al., 1991). Seventy-five percent of prostitutes had at least one sexually transmitted disease, and 35% were HIV-positive.