The economy of risk and respect: accounts by Puerto Rican sex workers of HIV risk taking

Journal of Sex Research, Nov, 2002 by Helena Hansen, Maria Margarita Lopez-Iftikhar, Margarita Alegria

The HIV pandemic has forced us to think of risk in a new way. Knowledge and education about HIV risks alone have largely failed to change sexual and drug-using behaviors among those at the highest risk for infection (Kelly & Murphy, 1991; Khalsa & Kowalewski, 1994; Tice, 1992; Biemiller, 1991). We have begun to ask how "high risk" sexual and drug-use behaviors, often construed as a matter of individual choice, are socially produced (Holland & Ramazanoglu, 1990; MacPhail & Campbell, 1999). Behavior is enabled by specific social circumstances. Acts which we think of as risky from one perspective may actually be seen as safe within other social contexts.

Since the development of the HIV pandemic, many studies have examined high risk drug-use and sexual behavior within an individualist paradigm, framing HIV risk behavior as the result of either poor information or illogical choices with regard to health, and have sought to attribute HIV risk behaviors to individual characteristics of their practitioners (Bourgois, 1999; MacPhail & Campbell, 1999). Alternately, a growing body of literature has focused on the structural factors--such as power inequalities along the lines of gender, social class, income, race, or ethnicity--which predetermine the HIV infection rates experienced by members of groups at elevated risk, such as Latinas and sex workers, and which place constraints on their choices with regard to self-protective sexual and drug-use behavior (Bourgois and Dunlap, 1993; Farmer, Connors, & Simmons, 1996). Fewer studies have examined how these women navigate themselves within the context of their social universe, replete with competing risks and rewards on physical, economic, and moral planes (Rhodes, Stimson, & Quirk, 1996). Given that drug use is associated with higher risk sex exchanges among sex workers, understanding how drug-using sex workers in particular modify the hazards and social symbolism of their work and their addiction is of utmost importance (De Graaf, Vanwesenbeek, Vanzessen, Straver, & Visser, 1995; Estebanez, Fitch, & Najera 1993; Pyett & Warr, 1997). This paper reviewed interviews with female, drug-dependent sex workers recruited from neighborhoods of high volume commercial sex work in urban Puerto Rico. In the process, we attempted to understand how sexual practices which are incomprehensible within an HIV-prevention perspective are actually rooted in a local cultural logic.

In our analysis of these narratives we drew upon the theoretical framework of structured action (Dunn, 1998; Messerschmidt, 1997). Structured action posits that social categories such as race or ethnicity, gender or class are achieved through social interaction. In this context, people draw upon their daily experiences and understandings to provide meaning to their social life (Simmel, 1950). Theorists of structured action have applied this concept to the narratives of structurally marginalized people, such as gang members and women, to show how they adapt to their social circumstances and to explain their nonmainstream behavior as an attempt to parallel mainstream social norms (Dunn, 1998). At the same time, people operating from marginal social positions interpret their actions in nonmainstream ways, imbuing them with locally generated meanings (Messerschmidt, 1997). In this view, a narrator is "neither simply the product of her circumstances (a victim) nor the producer of her world (a powerful female) but, rather ... both" (Dunn, 1998, p. 479).

Puerto Rico is a commonwealth of the United States, meaning that it is subject to most federal regulations and subsidies. Puerto Ricans are U.S. citizens, although they do not vote in presidential elections nor do they have voting representatives in the U.S. Congress. Compared to the 50 United States, Puerto Rico is poor; in 1990, one half of all Puerto Rican families earned less than $10,000 a year, and 20% of eligible Puerto Ricans were unemployed (Chavez, 1998). In 1998, 57% of the population was below the poverty line (Latinamerica Press, 2001). Narcotics trade and use are also documented as wide-reaching problems for the island. Puerto Rico has been federally designated as a zone of high intensity drug traffic (Colombiani, 2001), and a recent household-based survey estimated that 5.6% of the population 15 to 64 years old is currently in need of substance abuse treatment (Colon et al., 1998). While little island-wide data on the extent of commercial sex work in Puerto Rico is available, studies of sex workers in Puerto Rico using street outreach methods found that the majority of those surveyed reported substance use and engaged in sex work for economic reasons (Alegria, Vera, Freeman, et al., 1994; Alegria, Vera, Rivera, et al., 1994; Burgos et al., 1999).

In this context of widespread poverty, substance abuse and related sexual behaviors have conspired to make HIV infection among the most important threats to the health of Puerto Ricans today. Over 14,000 cumulative cases of AIDS have been reported from the San Juan metropolitan region alone, and Puerto Rico has one of the three highest reported AIDS rates among women in the United States (CDC, 1999). Female gender, poverty, and drug use characterize those Puerto Ricans becoming HIV infected at the highest rates.