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From Bag Brides to Skeezers: A Historical Perspective on Sex-for-Drugs Behavior† Paul J. Goldstein, Ph.D.*; Lawrence J. Ouellet, Ph.D.* & Michael Fendrich, Ph.D.** Abstract -- There are many ways that women support their use of crack cocaine, including sex-for-crack bartering and other forms of prostitution. Empirical studies conducted in the mid-1970s and in the mid-1980s in New York City, and in Chicago in the late 1980s to early 1990s are compared, analyzing similarities and differences between the contemporary crack-prostitution scene and previous prostitution scenes. Findings suggest that the arrival of crack cocaine has directly and indirectly affected the drugs-prostitution nexus by lowering the price of sex for street prostitutes, altering the social status of cocaine, and increasing the level of social disorganization in illicit street activities, including prostitution. Barterers are shown to be the heaviest drug users, using the greatest variety of drugs, using larger amounts of drugs, and using more frequently. Keywords -- AIDS, crack cocaine, sex-for-drugs behavior, prostitution The impact of drug use and prostitution on the spread of AIDS and other sexually transmitted diseases (STDs) has increased the need for empirical data and conceptual understanding of these phenomena and their interrelationships. The widespread use of crack cocaine is alleged to have altered the drugs-prostitution nexus in a dangerous direction. Some women's desire for crack is alleged to be so strong that it overcomes all their moral boundaries, and they freely engage in prostitution, including sex-for-drags bartering, in order to obtain crack. It is also alleged that crack has a power in this regard that is greater than previous drugs of choice, such as heroin. Persons who are knowledgeable about the history of drug issues are aware that similar claims of inevitable moral degeneracy have been made with regard to a wide variety of drugs, including marijuana (e.g., the film Reefer Madness) and heroin. There is now a large body of literature that questions these claims (Faupel 1987; Johnson etal. 1985; Rosenbaum 1981; Inciardi 1981; Hughes 1977; †Supported in part by National Institute on Drug Abuse Grants DA 04017, DA 05285, R29 DA 07995-01, and Contract 27188248. *School of Public Health. University of Illinois at Chicago. **Institute for Juvenile Research, University of Illinois at Chicago. Please address reprint requests to Paul J. Goldstein, Ph.D., University of Illinois at Chicago, School of Public Health, 2121 W. Taylor, Room 554, Chicago, Illinois 60612.

Journal of Psychoactive Drugs

Waldorf 1973; Preble & Casey 1969; Lindesmith 1940; Dai 1937; Kolb 1925). Are contemporary descriptions of crack users accurate or are they as rife with excess as those of previous eras that purported to accurately describe other sorts of drug users? Research experiences of the present authors in the area of female drug use and prostitution span nearly two decades. Empirical data are presented below from field studies done by the authors in New York City (and to a lesser extent in Boston, Fort Lauderdale, and Cleveland) in the mid-1970s; New York City in the mid-1980s; and Chicago in the late 1980s to early 1990s. The basic intent is to elaborate on the drugs-prostitution nexus, and to compare the contemporary crack-prostitution scene to previous prostitution scenes. DATA BASES Drugs-Prostitution Study In the mid-1970s, 60 women were interviewed specifically for a study of the relationship between drugs and prostitution (Goldstein 1979). Subjects were contacted through a state-operated drug abuse treatment facility (n=24) in New York; through two different private programs for female ex-offenders (n=16); through prostitutes' organizations, such as Prostitutes Union of Massachusetts

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Goldstein, Ouellet & Fendrich

Sex-for-Drugs Behavior

TABLE I DRUGS-PROSTITUTION STUDY: DEMOGRAPHIC CHARACTERISTICS (N=60) Race Black White Hispanic

Education Less than high-school graduate High-school graduate Some college/college graduate

43 27 30

Marital Status Single Formerly married Married

49 31 20

Arrests Drug Offenses Prostitution Property crimes Crimes against persons Never arrested

35 32 43 27 20

(PUMA), Scapegoat (a New York City group), and Coyote of Florida (n=12); and through referrals from friends and colleagues (n=8). The ages of interviewees ranged from 18 to 47, with a mean age of about 26. The most commonly used substances included marijuana (93% of interviewees), alcohol (87%), cocaine (83%), and heroin (72%). Forty-two women (70%) reported being addicted to some drug during their lives. Subjects were most likely to be addicted to heroin (55%). Table I presents demographic data on this sample. A total of 43 women reported having engaged in prostitution. These women worked at all levels of prostitution; and most had worked at more than one level. The sample included women who had worked on the streets (n=20), as call girls (n=20), as mistresses (n= 14), in brothels (n=9), as madams (n=6), and in massage parlors (n=5). The sample also included 14 women who reported bartering sex for drugs. Of the 60 women, 17 were drug users who had never engaged in any form of prostitution. A search for prostitutes who had never engaged in any drug use was unsuccessful. FEMDRIVE STUDY Two ethnographic studies were undertaken on the Lower East Side of New York City between 1984 and 1987. One study, called DRIVE, examined the drugs-violence nexus among male drug users and distributors (Goldstein et al. 1987). The other study, called FEMDRIVE, focused on females (Goldstein et al. 1988). Both studies aimed at documenting the nature, scope, Journal of Psychoactive Drugs

% 40 50 10

and drug relatedness of all violent perpetrations and violent victimizations taking place during the study period (Fendrich et al. 1992; Goldstein et al 1991a, 1991b, 1990; Spunt et al. 1990a, 1990b; Goldstein 1986). A substantial amount of data concerning women's prostitution and sexual bartering for drugs was also collected on FEMDRIVE, but was not previously analyzed. Research subjects were drug users or distributors who lived in, or frequented, the Lower East Side of Manhattan. They were recruited primarily from field contacts and through snowball sampling techniques. Only persons over the age of eighteen were eligible to participate in the study. Interviewing took place in an ethnographic field station established solely for the purposes of these projects. All subjects were given a life-history interview. After completing the lifehistory interview, subjects were put on a weekly reporting schedule for at least eight weeks. The analytic time unit for the weekly interview was the day; data covering seven discrete days were collected each week. The weekly interviews collected quantified data on drug use and drug dealing, criminal activities (including prostitution), violent perpetrations and victimizations, sources of income and types of expenditures, and varied dimensions of individual lifestyles (including sexual bar-tering for drugs). Narrative descriptions of activities were frequently obtained. Special tape-recorded interviews were

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TABLE II FEMDRIVE STUDY: DEMOGRAPHIC CHARACTERISTICS (N=133) Race Black White Hispanic Other

% 53 26 20 2

Education Less than high-school graduate High-school graduate Some college/college graduate

47 26 27

Martial Status Single Formerly married Married

57 30 13

Current Living Situation Shelter 40 Spouse/lover 10 Family 24 Friend 16 TABLE II Alone 5 FEMDRIVE STUDY: DEMOGRAPHIC CHARACTERISTICS (N-133) Vagrant 4 Currently Employed

conducted around topics or events of special interest to project staff. The field site became a hangout for drug users. Staff also went with research subjects to their homes, to shelters for the homeless, to shooting galleries, and to other places where they congregated to use or to sell drugs. A total of 133 women (median age of 32) completed the FEMDRIVE research protocol (life history and eight weekly interviews). Table II presents demographic data on the FEMDRIVE sample. Given the focus of this article on crack, it is important to note that no data were systematically collected on the FEMDRIVE project that differentiated types of cocaine or modes of cocaine ingestion. When the research began in 1984, crack was not an issue. As the crack problem escalated, project staff considered whether or not to add questions that would specify forms of cocaine use. This notion was rejected in order to maintain comparability between data collected early in the study with those collected at a later date. However, as the research progressed and staff became more cognizant of the importance of the emerging crack problem, they frequently noted and described increased crack use and attendant behaviors among the women.


7

CHICAGO STUDY Data from Chicago were drawn from interviews of 13 crack ("ready-rock") smokers from the city's North Side, all of whom are either prostitutes or associates of street prostitution. Eight subjects participated in a focus group, while the other five took part in individual ethnographic interviews. The focus group, which was composed entirely of African-Americans, consisted of three women and five men in their early twenties to late forties. The individual interviews were with a 19-yearold Puerto Rican female, two African-American females in their late twenties to early thirties, an AfricanAmerican male in his early thirties, and a 38-year-old White female. Both the focus group meeting and individual interviews were audiotaped and transcribed. The Chicago study also drew on data from an earlier examination of sexual behavior among Chicago's cocaine users, 77% of whom smoked crack (Ouellet et al. In press). Additional ethnographic data were collected as part of the AIDS Outreach Intervention Project-Chicago, a NIDAfunded effort to better understand and inhibit human immunodeficiency virus (HIV) transmission among injection drug users 0DUs) and their sex partners. This project used a multimethod approach that combined the basic principles of medical epidemiology with those of community ethnog-

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raphy (Wiebel 1988). A key feature was its targeting of social networks of active on-the-street IDUs as opposed to individual IDUs who are in the process of passing through an official institution of some sort, such as a drug abuse treatment program, hospital or jail. By early 1988, the project established storefront field stations in three areas of Chicago that varied from one another in their ethnic and community characteristics: the mostly African-American South Side, the ethnically mixed North Side, and the largely Puerto Rican Northwest Side. Field stations in these neighborhoods were staffed by interviewers, ethnographers, and indigenous sex-IDU outreach workers. Besides serving as research sites, field stations are drop-in centers for local IDUs and, more recently, crack smokers. One station provides on-site medical services and the other two will soon do likewise. Every workday, outreach workers and ethnographers go into the neighborhoods and congregation sites of IDUs and crack smokers to do AIDS education and individual risk assessments, pass out bleach and condoms, provide referrals to appropriate social and medical services, and conduct research. This ongoing involvement in subjects' lives over the years, in a helpful service-oriented fashion, has facilitated the gathering of data for the present article. Both the drugs-prostitution study and the Chicago study reported herein are primarily qualitative, although the drugs-prostitution study did achieve some quantification of data. FEMDRIVE, although also heavily qualitative, contains the most rigorously collected quantitative data of the three studies. For this reason, the presentations of data from the three studies vary. PROSTITUTION: DEFINITIONAL ISSUES Prostitution is not an easy activity to define or categorize. Common elements of most legal or social scientific definitions include sexual acts characterized by barter, promiscuity, and emotional indifference (e.g., Gagnon & Simon 1973; Lemert 1951; Flexner 1914). When prostitution is treated as a moral category, the element of promiscuity is typically emphasized. When prostitution is treated as a legal category, the element of barter is typically emphasized. In this sense, barter can include both cash-for-sex transactions and the trading of services or goods (including drugs) for sex. Goldstein (1979) found that female research subjects frequently reported exchanging sexual services for professional or other services, or for material goods. For example, a well-educated professional woman reported engaging in "single woman's survival tactics." This woman, who was not an avowed prostitute, reported exchanging sex for professional services from both physicians and lawyers. A call girl specializing in sadomasoJournal of Psychoactive Drugs


chism (S&M) reported exchanging S&M time with a leather maker for S&M equipment. Other call girls reported exchanging sex for furniture, dental work, automobile repairs and tires, television sets, and clothes. In May 1992, the State of Illinois suspended the prescription license and revoked the medical license of a Chicago physician for prescribing tranquilizers, stimulants, and sleeping pills to two women in exchange for sexual favors (Unsigned 1992). It is therefore not surprising that poor drug-using women with scarce economic resources would employ sex in order to obtain desired drugs. Some of these women identify themselves as prostitutes, walk the streets, flag down automobiles, and behave in general as traditional prostitutes. They take the money that they have earned and purchase drugs. Other drug-using women may trade sex for drugs without walking the streets like traditional prostitutes. Such women may form relatively long-term relationships with specific male drug users or dealers who take care of the women's drug needs. Other female drug barterers may engage in frequent, brief, and impersonal sexual encounters with men who may have drugs available at a particular time. There are complex nuances to these activities, both with regard to how participating men and women perceive them, and with regard to social antecedents, circumstances, and correlates of the behavior. Findings reported below examine these nuances with regard to changes over time and between women who are motivated by the desire for either heroin or crack. The present article focuses exclusively on female prostitution, especially sexual bartering for drugs. There were a number of reports and observations on both the DRIVE project and in the Chicago studies about males engaging in homosexual acts in order to obtain drugs or the cash for drugs. However, male prostitution is excluded from this analysis for reasons of economy and because those data are sparser and were not consistently collected between the three separate studies. In the discussions that follow, traditional prostitution for cash is frequently distinguished from sex-for-drugs bartering. Although bartering fits within the authors' definition of prostitution, it was felt that discriminating between the two behaviors was useful for heuristic purposes.

RESULTS: OVERVIEW OF QUANTITATIVE FINDINGS Drugs-Prostitution Study Sixty women (43 prostitutes and 17 nonprostitute drug users) were interviewed. Detailed data were gathered about their drug-using and prostitution experiences as well as the interrelationships between these behaviors. The Vol. 24(4), Oct-Dec 1992


women worked in a variety of prostitution milieus (e.g., streetwalker, call girl, barterer), and used a variety of different drugs, including, heroin, alcohol, and cocaine. The prostitutes were divided into two groups for analytic purposes: low-class prostitutes (n=25) who were primarily streetwalkers and drug barterers, and high-class prostitutes (n=18) who were primarily call girls or madams. The strongest drug associations specific to low-class prostitutes were heroin (96% used regularly) and cocaine (64% used regularly). Heroin- and cocaine-use careers tended to occur concurrently with low-class prostitution careers. The strongest drug association specific to high-class prostitution was stimulants (61% used regularly); however, many of the high-class prostitutes had begun using stimulants prior to entry into prostitution. Both high-and low-class prostitutes were also regular users of marijuana and alcohol; however, substantial periods of alcohol and marijuana use tended to occur prior to, or after, careers in prostitution. Regular use in this context means at least weekly use; periods of addiction are also included. Of the 43 prostitutes, 27 identified themselves as addicted to drugs (primarily heroin). In 48% of these cases, addiction preceded prostitution; in 41% of the cases, prostitution preceded addiction. The remaining 11% of the cases included women who could not specify whether prostitution or addiction had come first. Prostitution was reported by 51% of these women as the primary means by which they supported their drug habits. Drugs were strongly related to becoming a prostitute only for streetwalkers and barterers. Where this relationship existed, it was primarily economic in nature. These women became prostitutes primarily to support their drug use. However, some low-class prostitutes reported that initial prostitution experiences were caused by the psychoactive effects of drugs (mainly barbiturates) or the influence of a drug-using peer group. Certain forms of drag use were deterrents to entry into certain forms of prostitution. Madams and massage parlor managers rejected opioid addicts. Heroin-addicted women were perceived by these authority figures as unreliable, criminalistic, unattractive to customers, and likely to bring police heat down on the establishment. Pimps rejected narcotic addicts because they consumed too much of the money that they earned, were unreliable and unattractive, and were perceived to be more likely to become police informers. All prostitutes were asked whether they had ever engaged in drug use for prostitution-related purposes, and whether drug use had ever caused them any prostitutionrelated problems. A total of 124 "functions" of drug use and 83 "dysfunctions" were recorded. Functions of heroin use (21 mentions) were mainly relief of physical pain and deadening the realities of prostitution. These functions were reported by low-class prostitutes. Functions of cocaine use (15 mentions) were mainly enhancing sociability with


Sex for-Drugs Behavior

clients and assisting the prostitute to maintain an "up" tempo. These functions were reported by high-class prostitutes. Dysfunctions of heroin use (36 mentions) included becoming criminalistic, unattractive, unreliable, nervous and irritable (when experiencing withdrawal symptoms), and being prevented from rising in the hierarchy of prostitution. Interestingly, no dysfunctions were reported to be associated with cocaine use by any of the prostitutes in the sample. FEMDRIVE During the eight-week slice-of-life for which data were collected from 133 female drug users and distributors, the majority (n=81) reported no sexual bartering or other prostitution, although a portion of these women had engaged in these behaviors prior to the study period. During the study period, 37 women reported prostitution, but no sex-for-drugs bartering; an additional 15 women reported both prostitution and sex-for-drug bartering. Thus, all of the drug barterers also engaged in traditional prostitution for cash during the same eight-week period. There were no significant demographic differences between these three groups of FEMDRIVE subjects; however White women (59%) were more likely to report prostitution than were Hispanic women (42%) or Black women (28%). White and Hispanic women were about equally likely to report prostitution for cash (about 35%), while only about 21% of the Black women reported engaging in this activity. White women were more likely to exchange sex for drugs (24%) as compared to Hispanic women (8%) or Black women (7%). The women who traded sex for drugs reported significantly more days of prostitution compared to other prostitutes over the eight-week reporting period. The 15 prostitutes who traded sex for drugs reported working an average of 24 days as prostitutes (about three days per week), compared to an average of 10 days for the 37 prostitutes who did not exchange sex for drugs (t=3.52, d.f.=50, p