Prostitution

Unsafe Sexual Practices

Prostitution is associated with an increased risk for engaging in unsafe sexual practices (inconsistent contraceptive and condom use, multiple sexual partners, and needle sharing). In turn, unsafe sex places individuals at greater risk for unwanted pregnancy and for contracting sexually transmitted diseases (STDs) including the human immunodeficiency virus (HIV) and other blood-borne viruses such as hepatitis B. Homeless youth often become sexually active at an early age and are likely to practice unsafe sex. The HIV infection rates, especially among young males living in the streets, may be two to ten times higher than in the general population. Among homeless female adolescents, teen pregnancy rates are still disproportionately high despite a recent decrease among the general adolescent population.

Substance Abuse and other Psychiatric Disorders

Approximately 70 percent of homeless adults exhibit a substance abuse disorder. Drug injection is a risk factor for homelessness and elevates the risk for unsafe sex and prostitution. Among homeless adults who use crack and/or heroin, 31 percent of the women and 9 percent of the men engage in prostitution. Among a male sample of street youth living in California, more than 50 percent reported being intoxicated on drugs and/or alcohol “most of the time” during their sexual encounters. Trading sex for drugs or money often serves as a makeshift solution to support an expensive drug habit and can evolve into a long-term pattern of prostitution. Youth are at a particularly high risk because the early onset of homelessness increases the possibility of a substance abuse disorder. Additionally, homeless individuals who display substance use disorders often exhibit psychiatric illnesses such as depression and posttraumatic stress disorder (PTSD), as well as conduct disorders.

Sexual and Physical Abuse Histories

Many homeless people grew up in households characterized by high levels of conflict and abuse from which they ran away or were thrown away. Among homeless youth, the rates of sexual abuse prior to a first episode of homelessness range from 21 percent to 42 percent (compared to the rate of 1 to 3 percent reported by youth in the general population). Childhood sexual abuse increases the odds that a homeless person will trade sex, which is associated with a greater chance of being sexually victimized on the [Page 468]streets (especially for females). Several factors appear to influence the relationship between childhood sexual abuse, entry into prostitution, and subsequent victimization, including becoming homeless at an early age, reporting early childhood sexual abuse, using drugs, and associating with deviant peers on the streets. Sexually abused youth who live on the streets were two to four times more likely to attempt suicide than non-victims. Drug use and assault while trading sex greatly increased the risk that a youth would attempt suicide. These data support the Risk Amplification model developed by sociologist Les Whitbeck and his colleagues in 1999, which stresses the role of street life in exacerbating the distress experienced by youth from abusive families.

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