Segmenting Prostitutes' Need For Information About Aids: a Field Study

Per +stergaard, Odense University, Denmark
ABSTRACT - This paper presents results of a field study on prostitutes' knowledge concerning HIV/AIDS. Ethnographic methods are used to reveal the prostitutes' attitudes toward HIV/AIDS. The prostitutes are divided into three segments: the drug abusive prostitute, the "sociable" prostitute and the professional prostitute. It is shown how these segments display a different attitude toward AIDS, and how the segments therefore require a differentiated campaign effort in a future information strategy.
[ to cite ]:
Per +stergaard (1993) ,"Segmenting Prostitutes' Need For Information About Aids: a Field Study", in NA - Advances in Consumer Research Volume 20, eds. Leigh McAlister and Michael L. Rothschild, Provo, UT : Association for Consumer Research, Pages: 565-569.

Advances in Consumer Research Volume 20, 1993      Pages 565-569

SEGMENTING PROSTITUTES' NEED FOR INFORMATION ABOUT AIDS: A FIELD STUDY

Per +stergaard, Odense University, Denmark

[The author is indebted to Hanne Manata and Morten Elbaek Petersen regarding several ideas in this paper.]

ABSTRACT -

This paper presents results of a field study on prostitutes' knowledge concerning HIV/AIDS. Ethnographic methods are used to reveal the prostitutes' attitudes toward HIV/AIDS. The prostitutes are divided into three segments: the drug abusive prostitute, the "sociable" prostitute and the professional prostitute. It is shown how these segments display a different attitude toward AIDS, and how the segments therefore require a differentiated campaign effort in a future information strategy.

INTRODUCTION

Since 1985 a comprehensive campaign drive has been conducted in most European countries and in North America with the intention of informing about the risk of being infected with HIV, and thereby the risk of developing AIDS (Misztal and Moss 1990). In Denmark, the campaigns have been very comprehensive, and just about every possibility and opportunity to inform people have been explored. With the exception of the special campaign efforts aimed at the two traditional high-risk groups, gays and bleeders, it has been characteristic of the information campaigns not to attempt to categorize the recipients of information according to their needs.

The research leading to the results presented was motivated by considerations concerning the fact that there are actually other high-risk groups apart from gays and bleeders. Female prostitutes constitute one of these groups. The health authorities had no information concerning the effect of existing campaigns on female prostitutes, whereas a number of field studies had been completed concerning the general population's knowledge of HIV/AIDS, and possible effects of the campaign.

In order to be able to establish the extent to which female prostitutes had been affected by these previous general information campaigns, a field study was initiated with financial support from the Danish Ministry of Health.

It has not only been the intention with this study to establish how previous information campaigns have affected female prostitutes, but also to attempt to uncover how it would be possible to inform this target group in a more effective way, should it turn out to be necessary.

When studying literature in consumer research it soon becomes apparent that, with a few exceptions (e.g. Gould 1989, 1990), the question of HIV/AIDS is an untouched subject in consumer research. The issue of HIV/AIDS has been subject to growing attention among sociologists (e.g. Muir 1991; Huber and Schneider 1992) during the last five years. Especially, attention is payed to the possibilities of applying experiences from marketing and consumer research to campaign actions concerning HIV/AIDS (Muir 1991). Plant (1990) being an exception, it has not been possible to find much information regarding the issue concerning female prostitutes and their knowledge of HIV/AIDS. Therefore this field study practically started from scratch.

THE PROSTITUTION MARKET

The field study has taken place in a medium-sized Danish city (200,000 inhabitants) in the time between May and September 1990. It is difficult to state the exact number of prostitutes in any Danish city although prostitution takes place quite openly and the authorities do not interfere directly, even though prostitution is not legal.

The prostitution market can be divided into four categories representing a status hierarchy: 1) Escort-prostitution; 2) Bar and hotel prostitution; 3) Massage prostitution; 4) Street prostitution. In this study, massage and street prostitution have primarily been the centre of focus because these forms are most commonly seen in this city. Escort prostitution and bar and hotel prostitution do exist, but only as a limited proportion of the total market. One possible estimate of the total number of prostitutes could be a maximum of 100, but the figure is probably closer to 50 if only "full-time" prostitutes are considered.

On a prostitution market like the one described, there is furthermore great mobility between the different prostitution categories. Within a year it is quite possible for a prostitute to have worked within all four categories. Taking this into consideration, we chose to focus our field study on street prostitution making a few "detours" into massage prostitution. Hereby, we could gain contact to all types of prostitutes in this city.

APPROACH

Prostitutes can be regarded as producers of sexual services. In this paper though, they are not seen in this perspective. Instead, the prostitutes are regarded as consumers of information concerning HIV/AIDS. When we divide the prostitutes into segments later on, it is not due to their differing services, but according to differences in the way they perceive information. This perception process is determined by a number of relations. It has been crucial to move beyond traditional variables such as social background, media consumption and specific knowledge of HIV/AIDS. These aspects have of course been taken into account, but focus has been put on e.g. the prostitute's perception of the future, of herself as a prostitute and of social authorities. These relations are to be regarded as ideal type constructions. According to Weber (1972), the concept of ideal type has been developed regarding social action. In other words, it is a theoretical construction which should increase the understanding of why different groups act and perceive differently in their life-world.

When it is important to illustrate the prostitute's perception of the future, of herself and of the authorities, it is because a thorough description of these concepts in the interviews can provide us with information concerning the prostitutes' life-world. In relation to a future campaign strategy, knowledge of their life-world will be essential. This is because the possibilities of affecting the prostitutes through information depend on their perception of the future, of themselves as prostitutes, of the authorities and of the importance and significance of HIV/AIDS (Uexknll 1986; Treichler 1987). It has not been the intention with this field study to deliver final results for a future campaign strategy. For this purpose the topic is too new and unexplored.

METHOD

Since no significant research on the topic was available beforehand, we had to practically start from scratch. This implied that we had to work up a theory on the topic. In our opinion, the best way of doing this was to use "Grounded Theory" by Glaser and Strauss (1967), in spite of the various objections which can be made against this theory (e.g. Brown 1973). Our primary reason for using "Grounded Theory" was that, when the methodological perspective had to be determined, two male-researchers were working on the project, and men could not conduct these field studies within the prostitution environment. At least not if reliable data were supposed to be the outcome. We therefore planned to hire a woman to conduct the field work. In the initial planning phase we did not know whom we were eventually going to hire and therefore wanted to ensure that our method was understandable to a non-academic person.

From the beginning we were aware of the necessity of establishing a platform in the environment in order to be able to enter this very closed circle. Our plan was to establish a free coffee bar in the street were most prostitutes hang out. We had many worries though, concerning how to establish this coffee bar. We did not want to establish a place to conduct our research, and then simply close down the place when the work had been completed. This would be too cynical. Luckily, we discovered that the Y.W.C.A. was planning to open up a permanent coffee bar in the area. We allied ourselves with the Y.W.C.A. and we were able to sponsor them with a relatively large amount. After the establishment of the coffee bar as the base from which the research was to be conducted, we hired a woman (with an academic background) as our field worker.

The research was supposed to be completed within a time span of 6 months during which the field worker worked part time in the coffee bar. We had decided not to withhold the identity and reason for employment of our field worker. The plan was that the first two months were to be spent on participant observation and on collecting secondary data, as well as interviews with key informants outside the prostitution environment but with thorough knowledge of the environment.

During the first two months when interviews were not carried out within the environment, the time was used for gaining thorough knowledge of life in the street and in the coffee bar. This thorough knowledge of the everyday life of the prostitutes would be of great help to us later, in relation to questions of validity. In these situations it would be easier for us to judge the reliability of the different statements made by respondents. This introductory period was furthermore used for selecting subjects for the personal interviews and for establishing confidence in the field worker who was going to conduct the interviews.

After two months the semi-structured personal interviews were begun. They were conducted with the aid from an interview guide which was structured in a way which both enabled us to collect information of a factual character (social background, media habits, specific knowledge concerning HIV/AIDS) as well as information of a more metaphysical kind (conception of the future, self conception, the importance and significance of HIV/AIDS). We conducted 13 interviews lasting approximately 1 to 2 hours each. They were all taped and transcribed word for word. The prostitutes were payed a sum equal to 100 $ per interview as compensation for lost earnings. In most cases, this payment of the prostitutes was unnecessary, as they were eager to participate in a project of this kind. However, the payment gave us the opportunity of interviewing a number of prostitutes who would not otherwise have participated in such a project. These prostitutes who did it for the money, so to say, provided us with a lot of information which we would otherwise never have had access to.

RESULTS

Supported by the collected data, the prostitutes' knowledge of HIV/AIDS was initially considered. After this, we started working up our theoretical constructions which were supposed to contribute to understanding differences in the ways in which the prostitutes had perceived the information concerning HIV/AIDS. This was motivated by a wish to provide prostitutes with more effective information in the future.

While working with the data, two obvious segments soon became apparent: the drug-abusive prostitute and the professional prostitute. The drug-abusive prostitute is a woman who is addicted to different kinds of drugs and/or alcohol. The professional prostitute is a woman who is involved in what was earlier defined as massage prostitution. This means that she runs her own independent business where she sells her services more or less legally. These two ideal types reflect different frames of perception or universes of meaning in relation to the perception of information about AIDS. It was more difficult to identify further ideal types from the data. This is not to say that no other types existed, but rather that other types just did not stand out as clearly and well-defined as the two former ones.

After further analysis of the data we identified a third ideal type called the "sociable" prostitute. This type of prostitute is characterized by the fact that she is neither addicted to drugs or alcohol, and that it is not possible specifically to explain why she has become a prostitute. This prostitute cannot be restricted to certain environments, but is found both on a street level, in massage prostitution and maybe especially among escort, bar and hotel prostitution. This prostitute type can be characterized as a woman to whom prostitution has become a "lifestyle".

It is an important condition for understanding these ideal types that one is aware of the fact that these ideal types cannot necessarily be found in a complete form, as real people. They are theoretical constructions made from the collected data. It might seem a bit confusing that two of the ideal types, the drug-abusive and the professional prostitute, seem to be easily identified empirically. This though, should not lead to the conclusion that the ideal types are simply synonymous with people who can be observed in real life. In the further practical and theoretical work with a future campaign strategy, the ideal types can be of great help.

THE DRUG-ABUSIVE PROSTITUTE

This type represents a significant proportion of the prostitution market. She is a woman who is addicted to different kinds of drugs. In most cases she is addicted to heroin, but often she uses various other kinds of narcotics and alcohol because of a lack of money. For this type, prostitution is necessary in order to provide money for narcotics (often 400$ a day is required).

Concerning social background it is not possible to draw up a clear picture of this type of prostitute. It is, however, possible to provide clear guidelines to the present social situation of this type of prostitute. Most often this is a woman who lives alone or temporarily with a boyfriend. If she has any children, they have been removed from her and put into public care. This type normally has no obligations except from providing money for drugs every day. She is a person who rarely feels motivated by anything other than getting money for the next day's drugs.

This type only prostituted because of the need for a large amount of money for drugs. Mostly, she dislikes the whole idea of being a prostitute, and she expresses this feeling frequently. She only does it for the money. A statement about this could be:

"I only stay here until I have the money I need for my shit every day, but I come here every day, summer and winter (...) Now I haven't been here for a few days, because I have worked in a clinique and have made enough money to last for a couple of days (...) I never talk to my customers. It's none of their business, my private life. If they become too personal, I shut up. That isn't what they pay me forBthey pay to get layed."

In comparison, we can now observe what a "sociable" prostitute stated about the same topic:

"I like my work, and I'm proud of what I do. I think many are. Actually I think all real hookers are (...) It's not just a job that has to be done. It is people who come to you and want to buy you. And what you give them cannot be translated into money. We can feel the personal warmth, and they say: 'We need a hug today', and then they get a hug and maybe a bit more."

Later on these differences will be discussed more thoroughly.

The drug-abusive prostitute has sufficient knowledge of HIV/AIDS, and she knows that she must use a condom and have her own needles for narcotics. We are dealing with a type of prostitute whose life is split up into working to provide money for drugs, and sleeping as much as possible. The more sleep, the less narcotics she needs.

This type often has a very negative view on information stemming from the public system, and this is why she is very difficult to reach through information campaigns. It is also doubtful whether the information has any effect. Because even though the drug-abusive prostitute constantly swears that she always uses condoms, the accuracy of her statement is questionable. It is a well-known fact within the environment that the drug-abusive prostitute is willing to sell sex without the use of a condom when she needs money, and she often does. Thus it is very difficult to handle this type of prostitute.

THE "SOCIABLE" PROSTITUTE

Here we are dealing with a prostitute who is neither addicted to drugs nor alcohol. It is not possible to give specific reasons for her choice of profession. When we call her a "sociable" prostitute, we are not indicating that she only does it for the company, but we are pointing to the fact that, at the moment, it would be hard for her to live without the social life linked to prostitution. As one prostitute expressed this:

"Maybe it started out as a tragedy, but it ended up being a lifestyle."

A common background for this kind of prostitute is some kind of feeling of having been let down in the past. This could have happened in different ways. All from the parents' divorce or other problems to the prostitute's own divorce are common reasons. Situations when her trust in other people has been broken down. This ideal type has been able to rebuild that lack of self-confidence through prostitution. As a street prostitute expresses it:

"Why I'm a prostitute? Well, first of all it is for the money, and that is 100%. Another thing is probably the environment. With time, I have gotten to know so many people down here. I can just sit and talk and talk, but I think some of the girls are a bit mad at me. They are on drugs, whereas I don't need the sort of money they do."

As another one expresses it:

"I was 37 years old when I started, I was alone with two grown up kids with problems in school. But I thought my kids were smart enough to be able to graduate with some kind of diploma. So I sent them to a private boarding school where they had to stay for 3 years, and that was expensive. And I couldn't get any subsidies because it wasn't the school psychologist who had sent them. At first I took an overdraft in order to pay the school fees, but shit man, I ran out of money. That alone cost 1500$ a month plus clothes and pocket money. Therefore I started as a prostitute. I had never heard about it before, otherwise I would have started earlier."

Here we are dealing with a woman who, at least on the surface, is fairly well-balanced socially. In a way, she has rebuilt a personal integrity through life as a prostitute which has allowed her to become economically independent and to practice a social life. One prostitute says:

"Shit, I have to admit that I wouldn't miss this. Now I haven't been able to work for some time, well, I really have to admit that I was bored shitless at home."

These women are very open and interested, both in general social problems, and in living conditions among prostitutes. Therefore the AIDS issue also occupies them very much. It is characteristic of these women that they have obtained knowledge of AIDS on their own initiative, and they often have a very thorough knowledge of the subject. Since these women furthermore have a very varied media usage, it ought to be easy to inform these prostitutes. Very often their knowledge of HIV/AIDS is satisfactory, but there is often a gap between their knowledge and their behavior, because the "sociable" prostitute has many regular customers whom she has known for a very long time (often several years). In such cases, it can be difficult to use a condom. As one "sociable" prostitute notes:

"But this one I've been to bed with at least 500 times through many years. He only has me and his wife, so there's no risk."

The customers become friends because this kind of prostitute seldom has any social contacts apart from the other prostitutes and her customers. On the whole though, one must say that this type of prostitute is easier to inform about HIV/AIDS than the drug-abusive prostitute. The "sociable" prostitute fears AIDS and sees it as a threat to her life which is completely centred around being a prostitute. A certain lack of a sense of reality can be characteristic of this type of prostitute, especially concerning future plans where the dreams often seem completely unrealistic. It is not as easy as it might seem to inform this type of prostitute in a way which will also make her change her behavior.

THE PROFESSIONAL PROSTITUTE

This type of prostitute is a well-known phenomenon in Denmark, and every day a great number (often more than 100) of ads specifying their services can be found in one of the biggest newspapers in the country. This type of prostitute runs her own small business where she offers different kinds of massage. Often there are more than one owner of each clinique, or other prostitutes can be employed there.

When it comes to social background and upbringing, these women do not differ from the two other groups. The professional prostitute is never a drug addict, but sometimes she has a drinking or a hash problem. What characterizes the professional prostitute in comparison with the two other groups is that she wishes to be open about her profession. She would like her business to be recognized just like any other business. One of them expresses it like this:

"There was a time when I used to say to myself, but only because of other people's opinions, you know - 'I can't go on doing this, I have to earn some money so that I can get started on something else'. I like my job today, and personally I feel good about it. My surroundings don't mind my job either. Neither my family, my sportsclub nor my neighbours."

Because of the need for openness concerning her profession, this type of prostitute is very interested in information on HIV/AIDS. She sees AIDS as a threat to her livelihood and to the profession as a whole. That this type of prostitute actually perceives herself as an ordinary business woman is illustrated by this statement:

"I have a massive income. I run faster and faster, and I've never worked as hard as I do now to pay my taxes. That's the reason why you get sick of your job. But unfortunately, that goes for all small business people. It's not only me, it's not only to aim specifically at prostitution. Our tax system is constructed like that, it gets the small ones."

This great need for recognition of the profession also leads to demands that the public authorities introduce some kind of health guarantee for prostitutes. This would imply that the professional prostitutes could be guaranteed HIV/AIDS-free. Their openness concerning their own profession (many are registered companies) could provide them with a competitive advantage over the two other groups. One professional prostitute says:

"I think we need an adviser on the cliniques for a face to face discussion about HIV/AIDS. They must look at our remedies, and consider what can be done to help us. Bring along a thermometer and take the temperature of the water. What I'm trying to say is that if this had been a bakers shop, they would have been here a long time ago to take the temperature of the water. But just because this is a massage parlour everything, so to say, is permitted concerning hygiene. They don't show the least interest in this."

The professional prostitute is very active in her search for information. Since she perceives her own body as a means of production which must function in the most optimal way, she is also very careful concerning having her regular medical check-ups and being tested for venereal diseases.

It is not difficult to inform these women about the risk of HIV/AIDS. The difficult part about the information campaign is whether it is possible to provide her with sufficient information, and in a serious manner. One of the most common complaints from this type of prostitute is that the hospital is unable to answer her questions concerning the risk connected with different kinds of uncommon sexual behavior. If the intention is to keep in touch with these women in the future, it is essential that they have access to such specific information.

IMPLICATIONS FOR FUTURE INFORMATION CAMPAIGNS

The general level of knowledge concerning the risk of HIV/AIDS was found to be satisfactory among the prostitutes who participated in the field study, since it is our belief that their knowledge is at least comparable to the rest of the Danish population. The field study also shows though that the prostitutes have a need for much more detailed information concerning the risk of HIV/AIDS. In their work, the prostitutes in some cases participate in sexual behavior which most of the population cannot even imagine. Therefore prostitutes often confront doctors with questions which they can only answer very hesitatingly and conditionally because medical science simply has no certain answers to the, often highly unusual, questions.

It is very difficult to supply the drug-abusive prostitute with further information on the topic because, in many ways, she is annoyed by the fact that the social authorities interfere with her life. Secondly, her work as a prostitute is a repressed part of her identity. Her most urgent worry is not being infected with HIV/AIDS, but to obtain money for drugs every day. As one of the drug-abusive prostitutes replies when asked about her fear of AIDS:

"You can't walk around thinking about that all the time. I don't walk around thinking of cancer either (...) I take one day at a time, that's all. No, I don't think about the future at all. Only about today."

Here we are dealing with a type of prostitute who's behavior it is very difficult to change because her risky behavior is so closely linked to her life as a drug addict. The only solution to her problem would be to wean her off or to supply her with free drugs.

The "sociable" prostitute and the professional prostitute have a number of common traits which make it possible to treat them as one in relation to considerations concerning the need for further information. Both types of prostitutes are very interested in receiving information concerning the risk of being infected by HIV/AIDS. Both groups require that future campaign efforts must be delivered in a sober and serious fashion, and the sort of information needed goes far beyond the general information needs of the population. It is also important to keep in mind that these women do not need to overcome any mental barriers when it comes to talking freely about sex, as previous campaigns directed at the whole population have tried taking into account. Instead, specialists are required to supply these groups with information in future campaign efforts. This could be practised in different ways. One option is to hire specially trained doctors for the campaign in the prostitutes environment. Another option is to train some of the most qualified prostitutes, and thereby enable them to participate in the campaign work of informing other prostitutes of HIV/AIDS.

In this connection, especially the "sociable" prostitute could prove qualified because of her natural sociable attitude. As a "sociable" prostitute expresses it herself:

"Yes, instead of hiring useless schoolteachers and social workers as AIDS-instructors, I would like to be offered a course as an instructor. Because so many ask me for advice. And they are the users, God damn it."

The solution in relation to future information campaigns aimed at the three groups mentioned here would be to employ specially trained people to work within the environment. In such a case it would be crucial that this staff had a professional attitude, and were able to talk with the prostitute on her own terms. Furthermore it would be unwise to take on the traditional role of a social worker who annoy the prostitutes and therefore would be unlikely to take advice from. A combination of both specially trained doctors and prostitutes would presumably result in the most effective spread of information.

LIMITS TO ENLIGHTENMENT: A CONCLUSION

If one regards the prostitute as a producer of sexual services, the other part of the transaction, namely the customer, has not been discussed. This is not because the customer is not interesting, but rather that we in our research have chosen to perceive the prostitute as a consumer of information, and therefore the customer aspect has been neglected. In relation to the discussion of the gap between specific knowledge of HIV/AIDS and the actual behavior of the prostitute, her customers play an important part. In spite of the fact that the prostitute in some cases has comprehensive knowledge of HIV/AIDS, the customer still exercises a great influence concerning whether this knowledge is translated into proper behavioral patterns.

Irrational behavior on the customer's part creates some limitations as to how much the prostitute can be expected to change her behavior in relation to safe sex. The prostitutes are not necessarily the hardest group to convince of the virtues of safe sex. As a "sociable" prostitute explains it:

"Yes, they still ask for sex without a condom, and how I cried, really, after AIDS had practically been printed into the minds of the Danes, and still 8 cars in a row stopped to ask for sex without a condom."

It is difficult to say whether these numerous requests for sex without a condom are what they seem. It has turned out to be a way for some customers to avoid the most risky groups of prostitutes. If the prostitute agrees to having sex without a condom, the customer will refuse and start the search for another prostitute.

One thing is certain though. When dealing with information campaigns about "unsafe sex", both among prostitutes and among other people, some very complex issues arise. As Georges Bataille (1987) expresses it, sex is marked by a number of mythological, ritual and imaginary forces which very often go beyond our rational and moral defense mechanisms.

These limits to enlightenment concerning information about the risk of being infected by HIV/AIDS though, should not make us give up further campaign efforts and attempts to make the campaigns more effective. We just have to be conscious of and prepared for the limitations we are confronted with in our work.

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