The High-Risk Sexual Practices of Crack-Smoking Sex Workers Recruited From the Streets of Three American Cities

Background and Objectives: Small ethnographic and clinicbased studies indicate that crack-smoking sex workers are at high risk for human immunodeficiency virus (HIV) and sexually transmitted diseases (STD). Study Goals: To examine the prevalence of risky sexual behaviors and HIV and STD in a large sample of streetrecruited crack-smoking sex workers. Study Design: From 1991 to 1992, 419 crack-smoking sex workers were recruited from urban neighborhoods, interviewed, and serologically tested. Results: Many female and male sex workers reported sex with injectors (30% to 41%) or HIV-infected persons (8% to 19%), past STD (73% to 93%), and inconsistent condom use (>50% for all types of sex). Sex workers who worked in crack houses or vacant lots, were paid with crack, or injected drugs had the riskiest sex practices. Most sex workers initiated sex work before they first smoked crack. More than 25% were infected with HIV (27.9%), syphilis (37.5%), or herpes simplex virus type 2 (66.8%). Conclusions: Interventions to prevent HIV/STD transmission among crack-smoking sex workers are urgently needed.