For many years Baltimore’s prostitutes have been overlooked in the fight against the AIDS epidemic.
But now health officials are taking more notice of the high-risk group in a city that has the country’s second highest AIDS rate.
“There’s a growing recognition at the health department of the importance and need for better outreach and services to this group of women,” said Baltimore City Health Commissioner Joshua Sharfstein.
Commercial sex workers aren’t included in Centers for Disease Control and Prevention statistics as a transmission group like men who have sex with men or injection drug users, perhaps because they have lacked a strong voice in policy discussions, advocates say.
But city officials have started gathering information about prostitutes, along with other high-risk groups, to help the city better direct outreach and prevention efforts, said Dr. Laura Herrera, Baltimore’s deputy health commissioner.
Since January, city health officials have collaborated with advocacy group Power Inside to provide food and outreach to prostitutes two mornings a week.
The city also is crafting a citywide HIV prevention plan that will be more in-depth and help coordinate current efforts, Sharfstein said.
For the city’s prostitutes, HIV treatment and health care often compete with more pressing demands, such as safety, housing or drug addiction, said Sidney Ford, executive director for You Are Never Alone, a city outreach organization that provides services to prostitutes.
Now, some of these women are more scared of being murdered than of a disease that might take their life in 10 years, she said. Five women with records of prostitution have been strangled to death this year.
“Because it doesn’t seem to be an immediate threat, it gets put on the back burner,” Ford said.
As much as 40 percent, of the women coming into YANA on any given day are HIV-positive, Ford estimated. About 20 or 30 percent of the women are from surrounding counties, Ford said. They relocate to the city because of the prostitution strips.
Often, HIV-positive prostitutes tell their “dates” of their status, but the men don’t seem to care, said Angela Jackson, 45, an ex-prostitute and ex-addict who works as a peer counselor.
“They’re willing to take the risk for the sake of having these women build up their self-esteem,” Jackson said.
Jackson knows what it’s like for HIV treatment to get the back burner. She used to skip appointments because she didn’t have a baby-sitter.
“It’s day by day and what they’re dealing with,” she said.
As long as the city struggles with a drug epidemic, HIV cases won’t decline, said Becky Brothemarkle, clinical instructor at the University of Maryland School of Nursing.
Addicts put themselves at risk for a high, and women who aren’t regularly prostituting will sell sex for a fix, she said.
“It impairs your behavior and then you have that desperation,” she said.
Baltimore epidemic hits blacks, heterosexuals
AIDS has been prevalent in Baltimore and the state for more than two decades, and the city was one of the first places the disease generalized, meaning infections weren’t limited to people in a certain population, said Dr. Robert Redfield, director of clinical care and research at University of Maryland School of Medicine’s Institute of Human Virology.
“It clearly is an opportunity to really look at a new multifaceted strategy,” Redfield said.
The epidemic in Maryland and Baltimore has disproportionately impacted blacks, said Heather Hauck, director of Maryland Department of Health and Mental Hygiene’s AIDS Administration.
In 2006, 86 percent of newly reported cases are among blacks, according to the administration.
The virus first emerged among injection drug users, but efforts like the city’s needle exchange program have helped bring those numbers down, Hauck said. Now heterosexual contact is the leading form of transmission. In 2006, 49 percent of new cases were among heterosexuals, according to AIDS Administration data.
The AIDS Administration has developed programs reaching out specifically to the city’s black community, such as one for men who have sex with men and another for men with a history of incarceration.
Prevention programs are crucial, but more federal funding is needed, Hauck said. The CDC’s prevention budget has dropped 19 percent in the last five years to about $470 million nationwide, and at least $1.3 billion is ideal for prevention, she said.
“We have to continue to highlight the need for commitment and increased resources at the federal level, so we can scale up the efforts we know are working,” she said.
