Female prostitutes in south London: use of heroin, cocaine and alcohol, and their relationship to health risk behaviours.

The present study looks at the association between drug and alcohol use and sexual risk behaviours in a sample of 51 women who were currently working as prostitutes and also currently using opiates and/or stimulants. Most women reported regularly using condoms with clients but a substantial minority sometimes had unprotected sex with clients. There was no overall association between any of the drug use variables (including the use of crack cocaine) and the likelihood of unprotected sex. The use of drugs appears to have affected the sexual practices of different women in different ways: a substantial minority (just under a quarter of the sample) reported that for them, drug use did reduce the chances that they would use a condom. There was a link between willingness to have unprotected sex for more money and drinking larger amounts and drinking more often. The results also indicate that these women were exposed to a variety of health risks, including sharing injecting equipment and having unprotected sex with their regular partner who was often a current or former drug injector. A sub-sample (n = 34) completed a confidential questionnaire which showed that one-third had previously had at least one sexually transmitted disease and 15% of them had been infected during the previous year. These findings about rates of STD infection raise questions about the extent to which self-reported condom use by prostitutes can be used as an indicator of actual levels of infection risk.