syphilis and prostitution: a view from the stroll n.l. winterbauer, m.s., ph.d community outreach...
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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