Women who exchange sex for money, drugs, or goods are disproportionately infected with HIV and have high rates of illicit drug use. A growing body of research has underscored the primacy of environmental factors in shaping individual behaviors. HIV/STI rates among sex workers are influenced by environmental factors such as the physical (e.g., brothel) and economic (e.g., increased pay for unsafe sex) context in which sex work occurs. Exotic dance clubs (EDCs) could be a risk environment that is epidemiologically significant to the transmission of HIV/STIs among vulnerable women, but it is a context that has received scant research attention. This study examines the nature of the physical, social, and economic risk environments in promoting drug and sexual risk behaviors. Structured observations and semi-structured qualitative interviews (N = 40) were conducted with club dancers, doormen, managers, and bartenders from May through August, 2009. Data were analyzed inductively using the constant comparative method common to grounded theory methods. Atlas-ti was used for data analysis. Dancers began working in exotic dance clubs primarily because of financial need and lack of employment opportunities, and to a lesser extent, the need to support illicit drug habits. The interviews illuminated the extent to which the EDCs’ physical (e.g., secluded areas for lap dances), economic (e.g., high earnings from dancers selling sex), and social (e.g., prevailing social norms condoning sex work) environments facilitated dancers’ engaging in sex work. Drug use and alcohol use were reported as coping mechanisms in response to these stressful working conditions and often escalated sexual risk behaviors. The study illuminated characteristics of the environment that should be targeted for interventions.
In the U.S., as throughout the world, HIV infection occurs most commonly in women from economically disadvantaged backgrounds (Farmer, Connors, & Simmons, 1996, p. 3; Gupta, Parkhurst, Ogden, Aggleton, & Mahal, 2008). Sex work is defined as the exchange of sex for money, drugs, or goods and is often fueled by economic need and characterized by economic deprivation (Elwood et al., 1997, Exner et al., 2003 and Harcourt and Donovan, 2005). Female sex workers (FSWs) have been disproportionately infected with HIV and STIs compared to similarly aged populations throughout the world (Loza et al., 2010 and Platt et al., 2007). Infectious diseases are often occupational hazards of sex work, facilitated by high rates of unprotected sex as well as multiple and high risk sex partners (Inciardi et al., 2006 and Sanders, 2004). In a range of contexts (e.g., brothels, street-based), sex work is characterized by a number of factors that inhibit FSWs’ ability to protect themselves against HIV/STIs, including the illegal nature of sex work (Elwood et al., 1997, Inciardi et al., 2006 and Shannon et al., 2009), the high prevalence of physical, verbal, and sexual abuse (Goodyear & Cusick, 2007), and high rates of illicit drug and alcohol use (Booth et al., 2000 and Surratt, 2007).
Direct sex work is defined as when the main purpose of an interaction is the sale of sex. It occurs in a number of venues including brothels and on the street, both of which have been well characterized in terms of associated HIV and other risks (Harcourt and Donovan, 2005, Shannon et al., 2009 and Trotter, 2007). Contexts that could be particularly relevant to the link between sex work and HIV, but less obvious, are those in which sex is indirectly sold, such as massage parlors and exotic dance clubs (EDCs) (Frank, 2002, Maticka-Tyndale et al., 1999 and Nemoto et al., 2005). A dearth of research has examined EDCs’ role in facilitating HIV risk, with the preponderance of published literature on EDCs stemming from anthropology and feminism, focusing on EDC culture, gendered power dynamics, and the relationships between clients and dancers (Chapkis, 1997, Eaves, 2002 and Frank, 2002). There are an estimated 3000 EDCs in the U.S. and the industry is estimated to be a 15 billion dollar business annually (Frank, 2002 and Hanna, 2005). EDCs range in size and exclusivity, and offer an array of services from stage dancing to sex work (Chapkis, 1997, Frank, 2002 and Maticka-Tyndale et al., 1999). Parallel to sexual transactions sold in other venues (Harcourt & Donovan, 2005), sexual activities within EDCs range from exotic dancing without physical contact to oral and vaginal sex.
The preponderance of observational HIV research among FSWs is focused on the individual level, largely concentrating on factors associated with condom use with clients (Hansen et al., 2002 and Vanwesenbeeck, 2001). Alternatively, there is a growing awareness of the role of exogenous, environmental factors in shaping HIV risk including those that are structural (e.g., poverty), social (e.g., peer norms, violence), and geospatial (e.g., where sex work is sold) in nature (Blankenship et al., 2006, Fast et al., 2010, Hansen et al., 2002, Rhodes, 2009, Shannon et al., 2009, Strathdee et al., 2010 and Trotter, 2007).
One framework that has been used to examine how the relationship between individuals and environments impact both the “production and reduction of risk” is that of the “risk environment” (Rhodes, 2009, p. 193; Rhodes, Singer, Bourgois, Friedman, & Strathdee, 2005). Rhodes (2009) defined the risk environment as “the space, either social or physical, in which factors increase the risk of harm occurring”(p. 193). The framework emphasizes the primacy of context and shifts the focus for risk and therefore responsibility for behavior change from individuals to the social situations and structures in which risk behaviors occur. Socially situated risk provides an opportunity for us to understand how the environment generates risk as well as how individuals within a given environment experience risk. The risk environment framework is comprised of two key dimensions: the type and level of environmental influence (Rhodes et al., 2005). The four types of environments are physical, economic, social, and policy. These operate at the micro-level of interpersonal relationships, meso-level of social interactions (i.e., group norms) or institutions, and macro-level of social structures such as laws and social inequities. The risk environment is dynamic, in that it is a product of the interplay of the three levels that produce environmental conditions that can generate risk. The risk environment was developed to describe that of injection drug users (Rhodes, 2009 and Rhodes et al., 2005) with a nascent body of literature examining that of sex work (Shannon et al., 2009 and Trotter, 2007).
The current study aims to explore the physical, social, and economic environments of exotic dance clubs that function as HIV risk micro-environments for female exotic dancers in Baltimore, MD. We posit that the complex HIV vulnerabilities of exotic dancers are rooted and spawned by the social and spatial context of the EDCs in which they work.
