San Francisco Chronicle - Monday August 28, 1989
Randy Shilts

News that a streetwalker with early symptoms of AIDS was working San Francisco's Tenderloin a few years back prompted one local television station to talk about a "walking AIDS time bomb."

In no other area of AIDS law have legislatures moved as fast as to enact new criminal codes quarantining or jailing any AIDS-infected prostitute who continues to ply the world's oldest profession.

Although AIDS debates are normally contentious, there has been an unparalleled unanimity on prostitute legislation -- few have argued the wisdom of such laws. Yet, few issues of AIDS policy have proved as groundless.

The stark fact is that there is virtually no evidence that prostitutes are playing any significant role in the spread of this disease.

For several years, the people who track the spread of the epidemic, the epidemiologists at the U.S. Centers for Disease Control, have watched warily for an AIDS-prostitute connection.

What they knew was that huge numbers of prostitutes in Eastern urban areas are infected with HIV, either through their own intravenous drug use or through sex with other addicts. What they feared was that they would go on to infect their clients, who would then bring the virus back to middle-class suburbia and launch a new chain of infection.

In 1985, public health officials -- particularly in New York City, where as many as half of all prostitutes are estimated to be HIV-infected -- predicted that it was only a matter of time before the businessman from Cleveland was spreading around viral souvenirs to his wife or girlfriend.

At the CDC, the epidemiologists waited for evidence that this would happen. And they waited. Several years into their watch, however, it hasn't.

"If there were this suburban propagation of the virus from sources in the inner city, you should start picking it up in blood donors," says Dr. Timothy Dondero Jr. of the CDC. "So far, we haven't seen it."

Sociologist Bill Darrow, who is heading the CDC studies on prostitutes and AIDS, says, "There isn't any evidence that I'm aware of that clearly indicates prostitutes as a transmitter of HIV infection."

Given the fact that HIV-infected prostitutes have been working the streets for at least a decade, most epidemiologists figure that if prostitute-transmitted AIDS was indeed going to turn out to be a major factor in the spread of HIV, it would have happened already.

"Look at New York, where you have had a high number of infected prostitutes for some time," says Priscilla Alexander, executive director of the National Task Force on Prostitution. "A street prostitute is likely to see eight guys a day -- that's 1,500 a year. Given these numbers, if it was going to happen, we would have seen it by now."

Nobody is sure why earlier prostitute fears never panned out.

Several studies have documented the fact that it is more difficult for women to transmit the HIV virus sexually to men than it is for men to infect women. Moreover, most prostitutes apparently prefer servicing clients with oral rather than vaginal sex, making the chances of HIV transmission far less likely. For their part, prostitutes' advocacy groups assert that the proletariand of the sex industry have become some of the most avid condom-users in America.

Clearly, it is the ethical imperative of every HIV-infected person not to behave in a way that transmits this god-awful virus to others. However, in responding to the perceived problem of prostitution and AIDS, legislatures have ignored epidemiological reality and opted to score some easy political points. They have enacted draconian punishments for any HIV-infected prostitute who even solicits an act of prostitution, regardless of whether the act would have or could have transmitted the virus.

According to Alexander's figures, 13 states now have laws relating to AIDS and prostitution, most of which add significant penalties to any HIV-infected woman convicted of prostitution.

In California, for example, prostitutes face an added felony charge if they are arrested for soliciting after they have learned that they are HIV positive. The California law has not yet been implemented, but in Nevada, a Las Vegas prostitute was sentenced to 10 years in prison two months ago under a state law that provides for 20 years' imprisonment of any HIV-infected woman convicted of soliciting for prostitution.

There's more politics than public health in such laws. Put simply, prostitutes are easy people to pick on. Few in respectable quarters see any political gain in rallying to their defense, so prostitutes are easy targets for legislators who are out to prove that they're doing something to fight AIDS.

Hence, the politics of prostitution has left another historical anomaly for the epidemic: The legislative area of AIDS that has seen the most decisive action is also the arena in which action has in fact proved most worthless.

Always watch for outdated information. This article first appeared in 1989. This material is designed to support, not replace, the relationship that exists between you and your doctor.

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