Syphilis and Prostitution: A View from the Stroll

N.L. Winterbauer, M.S., Ph.D

Community Outreach and Intervention Projects

University of Illinois, Chicago

P&S Syphilis, Chicago, by Year

2000 1999 % change

Males 163 166 -2%

Females 129 116 +11%

White 36 28 +28%

Hispanic 12 14 -14%

Black 224 220 +4%

Oth/Unk 20 20

P&S Syphilis Cases by Zip Code, 1999

31st Street

Gunner

Mile Square

Lakeview

Roseland

Englewood

60601

60605

60608

60609

60612

60613

60614

60615

60616

60617

60618

6061960620

60621

60622

60623

60624

60625

60626

60628

60629

60630

60631

60632

60633

60634

60635

6063760638

60639

60640

60641

60643

60646

60647

60649

60651

60652

60653

60655

60656

60657

60658

60659

60671

60701

PS Syphilis Cases

More than 10 (11)6 to 10 (11)1 to 5 (17)0 to 0 (45)

Syphilis and Prostitution: Methods

• 57 Semi-structured, open-ended interviews

• Recruitment – CDPH STD clinic (n=13)– Street outreach (n=44)

• Key informant interviews

• Observations along strolls and other risk venues

Syphilis and Prostitution: “Punishment Stroll”

• Recruitment sites: > 90% African American • Among Chicago’s highest concentration of:

– People living below the poverty line– Unemployment– Persons receiving public aid– Births to mothers younger than 20– All cause mortality– Crime

Syphilis and Prostitution: Sample Characteristics

N %

Previous STD 28 64%

Previous Syphilis 8 18%

Education < HS 31 57%

Homeless 13 23%

Mean Years in Sex Work 6.1 Range: 0.5-16

Primary Drug N %

Heroin 18 32%

Cocaine 27 47%

Methadone 12 21%

Last STD Exam

Jail 10 23%

Treatment Center 13 30%

Public Clinic / ER 14 32%

Don’t know/remember

5 11%

Other 2 5%

The View from the Stroll

• Low levels of community awareness

• Little knowledge regarding:– Symptoms– Treatment – Cure– Reproductive health / biology– Local public health facilities

Syphilis and Prostitution: Barriers to Prevention and Care

• Drug addiction – the drug addicted woman is the most dependent person in the world

• Sex-trading as a survival strategy• Low levels of education / awareness• Little “where-with-all” – diminished

capacity• Police presence on strolls

Police Presence on Strolls

“And I’m like, damn, look like they would, you know, say that you better have a rubber on. But it’s like if you have a rubber on you, they fuck with you more. Yes. Yes.”

Syphilis and Prostitution: Conclusions

• Implications for Programs/Policy:– Street-level reproductive health centers that target

drug-using women– Collaboration with law-enforcement agencies to

develop alternatives to incarceration– Collaboration with service organizations

• Implications for Research:– Sex-trading as a survival strategy– Understanding “triggers” for sex work