Professional Documents
Culture Documents
Alys Willman
ABSTRACT
This study analyzes the commercial sex market in Managua, Nicaragua, to
understand risky behavior among sex workers. While health risks are a major
concern for sex workers, the risk of violence weighs more heavily in decision
making, such that they more often take risks to their health than to their
immediate, physical well-being. These concerns are reflected in the lower
premiums sex workers charge for unprotected sex (39 percent more for vaginal
sex without a condom) compared with risks of violence, such as accompanying a
client to an unknown place (a 118 percent premium). Risk behaviors reflect a
rational calculation of actual risk: while only 9 percent of the sample knew
anyone diagnosed with HIV, nearly 44 percent of sex workers had been
assaulted. These observations indicate the need to consider sex workers
physical safety in policies to contain the spread of HIV/AIDS and other sexually
transmitted diseases.
K EY W O R D S
Nicaragua, risky behavior, violence, HIV/AIDS, public policy, sex work
INTRODUCTION
You want to know about risk? The biggest problem, the biggest source of
the violence, is because of the condom. The man doesnt like to wear a
condom. He says, I want to take it off, and she says no. Then he says
yes, and she says no, and theres a fight, and sometimes he abuses
her. And many times hes already started, and theyre both naked,
and hes inside her, and now he doesnt want to pay, but hes already
halfway done. Thats when there are problems. If he doesnt get violent,
he wants his money back. (Samantha,1 bar-based sex worker in
Managua)
M ET HO D
Researching sex work brings specific challenges that call for creative
methods in obtaining access to a fluid and often hidden population,
garnering trust with interviewees, and understanding the complex
processes that operate within the sector. This study builds on others that
use sex workers perspective as a point of departure and focus on sex
workers agency in managing occupational risks (Luise White 1990; Kamala
Kempadoo and Jo Doezema 1998; Lin Lean Lim 1998; Denise Brennan
2004; Teela Sanders 2004; Laura Agustn 2005). I define prostitution here
as a form of sex work the provision of sexual services as a business
transaction and use the two terms interchangeably.
This article draws from ethnographic material obtained when I lived in
Managua from 19982001 and from interview and survey data collected
during field visits between 2004 and 2007. In all, the study included a
formal, thirty-minute survey of 138 sex workers at fourteen sites in
Managua; ninety hours of observation on various sites; twenty-three long
interviews and twenty-eight short (informal) interviews with sex workers;
five focus groups; and twenty formal interviews with Nicaraguan outreach
workers, medical health professionals, and economic and gender analysts.
Informal interviews were conducted on-site during field visits in Managua
in 2005 and 2006 and were used to inform the survey design as well as
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interpret quantitative data. The survey and additional long interviews were
conducted in August 2006 with the support of the outreach organization
called the Association of Workers for Education, Health, and Social
Integration (TESIS) and sex workers in Managua. Working closely with sex
workers in the implementation of the survey was key to gaining access to
sites where many women were present but only a portion were sex workers
for example, in bar settings and to adapting survey language and
content to the local context.
The survey data collection process entailed two levels of selection. First, I
devised strata for the representation of sites based on previous mapping
exercises (McKay, Campbell, and Gorter 2006) and interviews and focus
groups with key informants, including outreach workers, health workers,
and taxi drivers. Selection of the fourteen survey sites was based on this
information and the level of access available to TESIS. The sites surveyed
included: highways and streets (forty-seven sex workers), bars (twenty),
nightclubs (twenty-three), markets (thirty-three),7 and private, informal
brothels called reservados (ten). In 2006, the survey team was unable to
administer the survey in massage parlors because of difficulties gaining
access to these often clandestine operations. Prostitution is legal in
Nicaragua, but pimping and operating a brothel are not, so many reservados
and massage parlors operate underground. To address this, I recruited five
massage parlor workers for long off-site interviews in July 2007 and
administered the survey to them at that time. Overall, the resulting sample
(N 138) roughly reflects the distribution of Nicaraguas sex workers in
different sectors previously estimated by health and outreach organizations
(Zoyla Segura 2006), which place the largest number of sex workers in
markets, followed by streets, bars, and nightclubs, with the smallest number
operating in massage parlors and reservados.
Given the greater diversity among Nicaraguas street-based sex workers,8
as opposed to market-based sex workers, special effort was made to collect
a larger number of surveys on the street. The methodology did not include
a systematic interviewing of clients but instead relied on sex-worker
interviews to gather information about the clients characteristics at
different sites.
The second level of selection involved the random recruitment of
respondents at the fourteen survey sites based on the number of sex
workers present at the site when the survey took place. All sex workers
interviewed for the study regularly participated in prostitution, and some
engaged in other forms of sex work as well, including erotic dance and
massage. All participants in the study identified themselves as 18 years or
older, and all responses were anonymous as per my Institutional Review
Board (IRB) authorization for the study. This may have contributed to the
selection of women who had more years of experience in the sex industry
compared to previous studies (Anna C. Gorter, Zoyla Segura, J.A. Medina,
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SAFETY FIRST, THEN CONDOMS
and Julienne McKay 2006a). The selection of women with more experience
may offer fewer insights into the behavior of younger women with less
experience, who may be higher risk-takers; however, more experienced sex
workers can provide important information about risk assessment and
management techniques developed over time.
I conducted a training and pilot survey with three TESIS outreach
workers, who then administered the survey under my supervision. TESIS
workers relied on current and former sex workers to identify and facilitate
access to respondents. Each survey took 3045 minutes, and all participants
were paid US$2.80 to compensate them for their time. I participated in
about twenty of the total surveys, with explicit verbal consent from the
respondent.
In my fieldwork, establishing insider status was nearly impossible. My
prior visits had made me a familiar face in some of the sites, in which case I
could more easily engage in informal conversations with women while
outreach workers administered the survey. However, as both a foreigner
and a non-sex worker, I was still viewed as an outsider. As a result, I worked
to minimize my presence by seeking out a comfortable distance from
interviewers and respondents and allowing sex workers to approach me if
they wished. The general curiosity about me as a foreigner, especially in
places where foreign women rarely go, provided ample opportunities for
informal conversation.9
The study included feminist applications to both qualitative and
quantitative data gathering methods. While there is no feminist method
per se, feminist approaches generally seek to combine activism with
research by including components to validate personal experiences in the
research process and empower research subjects (Gunseli Berik 1997;
Jennifer Olmsted 1997). This project applied a feminist dimension by
working with current and former sex workers and outreach workers to
design and implement the survey, strengthening the relationship between
sex workers and the outreach organization, and improving the quantity and
quality of responses.
Sample characteristics
The survey was administered to 138 respondents, which included 136
women and two male-to-female transgendered persons. The average age of
respondents was 27. Sixty-six percent of respondents were single, 31
percent lived with a romantic partner, and 3 percent were married. Eighty-
seven percent of respondents were mothers, with an average of two
children, and 86 percent were heads of families, compared with an average
of roughly 40 percent of households in Nicaraguas urban areas headed by
women (Nicaragua National Institute of Statistics and Census and Ministry
of Health 2002). In 63 percent of the cases, survey respondents families
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were aware that the respondents were sex workers. Levels of education were
relatively low, with 62 percent of respondents having only a primary school
education. The time respondents had spent in sex work ranged from two
months to twenty-six years, with an average of six years.
among clients and the ways they define, negotiate, and justify different
types of violence.
Economists have only recently taken an interest in the commercial sex
market. Initially economists focused attention narrowly on explaining wage
differentials (Lena Edlund and Evelyn Korn 2002; Marina Della Giusta,
Maria Laura Di Tommaso, and Steinar Strom 2004). More recently, they
have examined premiums for unprotected sex in different contexts. Two
studies modeling the estimated returns for unprotected sex in Mexico
(Paul Gertler, Manisha Shah, and Stefano M. Bertozzi 2005) and India
(Vijayendra Rao, Indrani Gupta, Michael Lokshin, and Smarajit Jana 2002)
have been particularly instrumental. By highlighting the economic
incentives for unprotected sex, these studies have challenged the dominant
health-policy view that the spread of STDs was mostly due to a lack of
awareness about diseases like HIV/AIDS or a lack of access to condoms.
Even so, these studies have ignored the role that other types of risks,
especially the risk of violence, play in influencing decisions about health-
related risks.
Studies that incorporate sex workers into the methodology as active
subjects of the research have yielded a much richer understanding of the
experiences of sex work, including how sex workers manage risk and how
different types of risk interact (Teela Sanders and Rosie Campbell 2007).
This growing body of work has broadened conceptualizations of risk to
include disease as a form of violence to the body (Brents and Hausbeck
2005) and emotional risks such as the risk of being found out (Teela
Sanders 2004, 2006). Later in this paper, I will discuss how these layers of
risk interact and influence behavior to add an essential dimension to
conceptualizations of risk and how risks can be reduced.
T H E M A R K E T F O R C O M M E R C IA L S E X IN MA N A G U A
Sex is sold in Managua in bars, truck stops, nightclubs, highways and street
corners, markets, massage parlors, and reservados. Although a detailed
institutional analysis is beyond the scope of this paper, the descriptive
statistics in Table 1 suggest that there are three main segments in the sex
market.
The top segment is occupied by workers in nightclubs, reservados, and
massage parlors. In these places, workers generally remain on-site,
conducting sexual transactions in rooms at the back of the establishments.
In some reservados, workers negotiate directly with clients at the bar;
however, in most cases, clients visiting reservados, massage parlors, and strip
clubs often first speak with a manager, who gives them a price and requires
payment up-front before the client may enter a room with the sex worker.
Because massage parlors generally remove the sex worker from the
negotiation entirely and offer little more than sexual services, they fall
43
Table 1 Selected labor market indicators by type of workplace
Massage parlorc 5 31 2.40 some secondary school 278.40 5.00 3.40 5.80
Nightclub 23 22 1.82 some secondary school 252.00 1.80 2.10 6.00
Reservado (brothel) 10 23 2.10 some secondary school 156.60 6.00 2.50 6.00
Street (red-light district, upscale) 22 23 1.21 some secondary school 130.61 3.60 4.60 4.87
Bar 20 26.20 2.28 some secondary school 122.86 3.90 5.70 5.10
44
Street (outside red-light district) 25 26.70 2.22 did not complete 72.86 4.40 7.10 5.71
primary school
ARTICLES
Market 33 32.70 2.96 did not complete 28.71 7.10 10.92 6.20
primary school
Overall sample 138 26.60 2.14 some secondary school 148.77 4.54 5.18 5.66
Notes: aAverage weekly earnings are estimated as the respondents estimate of average earnings for a day/night multiplied by average number of days worked per
week.
b
Calculated as the average of number clients on a good day and those for a bad day, as reported in the surveys.
c
Massage parlors were not surveyed on site for the 2006 survey due to lack of access. Information about these sites is drawn from long interviews with current massage
parlor workers conducted off-site in July 2007.
SAFETY FIRST, THEN CONDOMS
put it: In a reservado I know I can get five or six clients, and on the street I
might not even get one in a night.
The bottom segment, suggested by the statistics in Table 1, includes street
locations outside the red-light district and rooms in open-air markets in the
poorest areas of the city. These sites are not formally managed, and barriers
to entry are low, provided the woman gets along with the owner of the
establishment where transactions are conducted, and to a lesser extent, the
other women at the site. These sites are connected to low-end hotels and
informal market brothels, which restricts them generally to low-income
clients.
Street-based workers outside the urban center earn about US$73 weekly,
given that they do not pay for the use of a room but instead go to nearby
hotels, paid for by the client. Market-based workers have the lowest
earnings of all groups, at only US$29 for an average of seven clients a day,
and from these wages they must give at least 25 percent of payments from
clients to the owners of the rooms where they work. Market workers attend
almost exclusively regular clients, usually vendors or laborers in the same
market. There are very few barriers to entry in this sector, provided the
worker gets along with the other women at the site and especially the owner
of the rooms.
As mentioned previously, under Nicaraguan law prostitution is legal, but
pimping and operating a brothel are illegal and punishable by fines or jail
(Gustavo Leal 2002; United States Department of State 2003). Definitions
of pimping and brothel owning are loosely interpreted in practice, and
police enforcement tends to focus only on removing underage girls from
places where sex is sold, rather than on any regulation of working
conditions. Standard pimping relationships are relatively uncommon in
Managua, in all strata of the sector (Leal 2002; US Department of State
2003).11 Although some women do work under the protection (and
exploitation) of pimps, the interviews and surveys indicate that this is not
typical. When asked whether they shared their earnings with anyone else,
most women immediately said either no or with my children. When
asked specifically about pimps, several joked: the pimp is the one whos
waiting for you when you get home, referring to husbands or partners who
live off their earnings.
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SAFETY FIRST, THEN CONDOMS
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H I V / A I D S A N D ST D S I N N I C A R A G U A
According to the Nicaraguan Ministry of Health (2005), the HIV-
prevalence rate for the population aged 1549 in Nicaragua is 0.13
percent. Although Nicaraguas prevalence rates are low compared to
neighboring countries, if current trends persist, the spread of HIV/AIDS is
expected to pose a larger problem in the coming years. Rising prevalence
rates among high-risk groups (especially men having sex with men [MSM]),
an increasingly mobile population, and the health systems inability to
respond to a larger epidemic are key contributing factors.
The number of people diagnosed with HIV/AIDS has grown steadily
from 2.52 per 100,000 inhabitants in 2000 to 8.24 in 2005, and the
Nicaraguan Ministry of Health warns that current rates are almost out of
control, in terms of the countrys ability to respond effectively (Republic
of Nicaragua 2005: 1). The primary mode of transmission is through sexual
intercourse (92 percent of total cases), with heterosexual contact
accounting for 73 percent of these cases (Republic of Nicaragua 2005).
The number of women infected has been rising steadily, with the male-to-
female ratio dropping from 3.12:1 in 2001 to 2.61:1 in 2005. Young women
are especially at risk; among people aged 15 to 19 the male-to-female ratio
dropped to 1.2:1 in 2005 (Republic of Nicaragua 2005).
Sex workers are considered a high-risk group in national health policy,
although HIV-prevalence rates among sex workers are lower relative to
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SAFETY FIRST, THEN CONDOMS
other groups. For example, one study found the prevalence rates of 9.3
percent for MSM and 4.6 percent for prisoners, although samples were
small and non-random (Nicaraguan Ministry of Health 2005). In contrast,
the overall prevalence rate for sex workers is officially estimated at 0.3
percent (Republic of Nicaragua 2005). However, the independent Central
American Health Institute (ICAS), which conducted a competitive health
voucher program for sex workers from 19952005 in Managua, estimates
that the prevalence rate is much higher, at 2.7 percent (Anna C. Gorter,
Zoyla Segura, J.A. Medina, and Julienne McKay 2006b).
The relatively low prevalence rates help explain why HIV infection does
not figure among the top concerns for the sex workers I encountered. Only
9 percent of respondents had ever known anyone who had been infected
with HIV, and only 23 percent had ever been tested for HIV. The risk of
other types of STDs was perceived as much more real: 49 percent reported
having an STD at least once. The presence of an STD has been associated
with higher risk of HIV transmission (Global HIV Prevention Working
Group 2004; R. Scott McClelland, Laura Sangare, Wisal M. Hassan, Ludo
Lavreys, Kishorchandra Mandaliya, James Kiarie, Jeckoniah Ndinya-Achola,
Walter Jaoko, and Jared M. Baeten 2007), so interventions focused on STD
infections in low-prevalence countries may help stem a larger HIV epidemic
(Emily Oster 2005). My data support this assertion. Of those in my sample
who had previously had an STD, 99 percent subsequently received
treatment, 45 percent of whom used the competitive voucher program
mentioned previously, which ended the year prior to the survey.
Preventative healthcare was also a common measure: 43 percent reported
receiving a medical checkup at least once a month, and 88 percent received
a checkup at least once a year.
Sex workers in my sample reported high rates of condom use with clients,
with 83 percent reporting they always used condoms with clients and 93
percent reporting they used a condom with their most recent client. This
percentage may be overestimated because the survey was administered by
outreach workers and sex-worker-health promoters who regularly advocate
condom use. In Managua, health-outreach organizations report that 67
percent of sex workers used a condom with their last client (Gorter et al.
2006b).14
LAYERS OF RISK
The purpose of this study is to understand how women perceive and react
to risk in sex work, specifically trade-offs to health- and violence-related
risks. It is important to note at the outset that these risk calculations
represent rational responses to actual risks. As noted above and illustrated
in Tables 2 and 3, HIV prevalence is low in Nicaragua, and only 9 percent of
my sample had known anyone diagnosed with HIV. Forty-nine percent had
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% of sex % of sex
workers who Avg. reported workers at site
report having of times who report ever
been assaulted assaulted being assaulted
Workplace N last month last month SD at work
Nightclub 23 39.10
Reservados (brothels) 10 70.00
Massage parlors 5 50.00
Street (red-light district) 24 45.80
Bars 20 42.10
Street (outside red-light district) 25 62.50
Markets 33 45.50
TOTAL 138 49.00
Each case was given a score based on the total count of risky behaviors
regularly taken, with a possible score of 04 for violence-related risks and
for health-related risks. Those who did not perform certain services (anal
sex, for example) received a zero for that behavior. Next, I assigned cases
above the mean for each category (2.59 for health; 1.15 for violence) a
value of 1 high risk, while those that scored below the mean received a
0 low risk. This resulted in a typology containing four categories: those
who engage in behavior that contains high potential for both violence- and
health-related risks, those who avoid high-risk behavior for both, and those
who score high on one and low on the other variable. The cross-tabulation
in Table 4 highlights these relationships.
The distribution shows that sex workers are generally not high risk-takers.
The smallest number of cases (eighteen, 13 percent) classify as high risk on
both variables. A much larger number (forty-two cases, 30 percent) fall into
the category of low risk on both.
Table 4 reflects a greater aversion to risks of physical violence. Sixty-eight
percent of the cases (N 95) engage in fewer than the mean number of
risk behaviors with respect to violence. In contrast, sex workers divided
fairly evenly on the health-related risk behaviors, with roughly 48 percent
ranking low risk and 51 percent high risk.
The largest group of cases (N 53, 38 percent) reports regularly taking
risks on their health, but actively avoiding risks of physical violence. For
these sex workers, the risk of physical violence looms larger than the
longer-term risk of disease, such that they regularly engage in more risks to
their health than to their immediate physical well-being.
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SAFETY FIRST, THEN CONDOMS
You may want to use a condom, but the client wants to take it off, or not
use one, and you know hes going to be difficult, maybe get rough. Well,
then you start thinking about your situation, the kids, the debts. Maybe
you havent had a single client all day, and even if you can recite the
entire list of STDs and all their symptoms and consequences, you might
go along anyway.
Adding violence to the equation shows how the risk of violence can
reinforce the health risks sex workers face. That is, sex workers simply
cannot protect their long-term health when their immediate safety is in
danger.
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SAFETY FIRST, THEN CONDOMS
Notes: Calculations are statistically significant at the 95 percent confidence level (p 5 0.05).
*denotes statistical significance at the 10 percent level, **denotes statistical significance at the 5
percent level, and ***denotes statistical significance at the 1 percent level.
a
Calculated as the difference between oral sex with a condom and oral sex without a condom.
There was no statistically significant premium to unprotected anal sex reported in the sample,
although there was a 100 percent premium (US$5.38) to anal sex compared to protected vaginal sex
(N 27; p 5 0.001).
[1995] on South Africa; Rao et al. [2002] on India; and Gertler et al. [2005]
on Mexico). The latter two studies calculated compensating wage differen-
tials for unprotected sex, controlling for unobserved heterogeneity in client
and sex worker preferences. These yielded estimates of a 23 percent
premium in Mexico, which increased to 46 percent if the sex worker was
considered very attractive by the interviewer (Gertler et al. 2005). Similarly,
the Calcutta study reported a loss of 44 percent in average earnings per act
for sex workers who regularly used condoms (Rao et al. 2002).
I estimate a 39 percent observed premium for unprotected vaginal sex in
Managua, and the t-tests show this is statistically significant.16 A premium
for unprotected vaginal sex is the strongest indicator of a premium for
health risks. In Nicaraguan society, both oral and anal sex are strongly
taboo, and many sex workers simply refuse to perform them, especially in
the more upscale segments of the sector in which sex workers hold more
bargaining power. These two services are generally charged as extras in
addition to vaginal sex, and the prices therefore reflect a premium to these
additional services.17 In my sample, the premium for unprotected anal sex
was not statistically significant, and only a small number of sex workers
reported performing it (N 9). The premium for unprotected oral sex was
higher at 44 percent,18 which likely reflects compensation for both the
health risks and cultural norms associated with this service.
The presence of an observed premium for unprotected vaginal sex to
some extent reflects the efforts of campaigns aimed at encouraging
condom use among this population. Previous studies in Managua based on
interviews with clients of sex workers found no premium for unprotected
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When I worked in the massage parlor, the price was C$300 [US$17] a
client. We got C$200 [US$11.36] and C$100 [US$5.68] went to the
owner for an hour. That price covers massage and los tres platos [vaginal,
oral, and anal sex]. We got our pay when we left in the morning. But
some clients pay you extra for sex without a condom, up to C$800
[US$45], and they pay you right there in the room. The manager never
has to know about it.
The fact that sex workers demand compensation for unprotected sex
indicates an awareness of the associated risks and a rational calculation of
the risk decision. STDs are the most common consequence of
unprotected sex, according to the survey, which shows that 47 percent
had contracted an STD at some point. HIV infection carries a lower
actual risk, given low prevalence rates in general. Sex workers expressed
as much in the survey, where only 9 percent reported having known
anyone who was HIV positive. In addition, in long interviews women
explained that they felt much more control over risks to their health as
compared to the threat of violence, which is much less predictable. Thus,
the premium indicates a rational calculation of actual risks and a
precaution against the perceived potential consequences (paying for
antibiotics to cure an STD).
But while getting sick is an important concern, getting physically
assaulted is a more immediate and pressing fear. As one sex worker
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SAFETY FIRST, THEN CONDOMS
frankly explained when asked about the risks she faces: Our biggest risk
is getting killed out here. These risks are not just perceived but are
quite real in actual terms. In the sample, 44 percent of sex workers
reported having been assaulted at some time at work, and 28 percent of
these were assaulted in the month prior to the survey. This compares to
49 percent who have contracted an STD at some point while working in
commercial sex.
This greater fear of physical violence is reflected in the premiums
charged for violence-related risk behaviors, which are substantially higher
than those for health-related risks: sex workers charge an estimated 118
percent more to accompany a client to a place they do not know well, such
as a hotel room, and an estimated 123 percent more to accompany more
than one client at a time.
In addition to charging a higher premium, sex workers employ
sophisticated strategies to mitigate the risk of violence from clients. Chief
among these is using discretion among clients, an element that sex workers
have cited in many contexts as vital to protecting themselves from assault
(Jo Bindman with Jo Doezema 1997). Assessing the potential risk a client
poses is difficult, so even when formal protections exist, sex workers must
use caution. When sex workers encounter a low-risk client, they work to
cultivate a relationship with him as a regular client. When asked to describe
the type of regular client she prefers, one worker responded: A good
client is one who treats you well and doesnt get violent, who pays and
leaves.
In Nicaragua, the legal infrastructure that would help many sex workers
protect themselves and deter future violence is weak or nonexistent. When
this protective infrastructure is present, it is usually provided by a private
establishment. As is the case in all of the sites, but in indoor environments
especially, internal security strategies are strongly driven by economics as
well as concern for an individual sex workers safety (Brents and Hausbeck
2005). Most indoor places of prostitution in Managua including more
upscale massage parlors, reservados, strip clubs, and bars staff security
guards to keep unruly clients from disrupting the environment and/or
harming the sex workers, both of which can hurt business. If a client in a
strip club wishes to take a woman off the premises to his hotel room or
another location, he will likely be asked to leave a large cash deposit, credit
card, and/or his cars license plate number beforehand. These formal
mechanisms are no guarantee against violence, however. As Table 4
highlights, 35 percent of strip club workers report having been assaulted in
the month prior to the survey.
In other indoor places of prostitution, especially clandestine sites like
massage parlors, managers keep sex workers out of the economic
transaction altogether. As mentioned previously, negotiations for services
and payment are made directly with the owner and paid up-front before a
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client is allowed to enter the room with the sex worker. These practices are
implemented first and foremost to protect profits, but they also have the
effect of removing a potential point of contention between the client and
the sex worker if the client later decides he is not satisfied with the service
or price.
When formal protection mechanisms are absent, sex workers in Managua
rely on their own informal screening mechanisms. For street-based workers,
accompanying clients to places they dont know well is often part of the job,
so they must carefully screen clients to assess the threat to their safety
before agreeing to the transaction. As one street-based sex worker
explained:
I feel much safer here [than other workplaces] because I dont leave this
area, and the other women look out for me . . . . Theres no real
friendship here theres a lot of rivalry. But we do take care of each
other when we need to. I have one friend here who looks out for me.
If a client wants to hit me, she jumps in to help me. One time a client
spent a long time in the room, more than the two hours, and didnt want
to pay the extra C$10 [US$0.57]. I said he had to pay, and he got mad,
but then she came over, and stood with me, and he eventually paid and
left.
CO N CL U S I ON
The analysis presented here explores some of the ways in which sex
workers, in Nicaragua and elsewhere, can be important allies in containing
the spread of HIV/AIDS when they are sufficiently empowered to negotiate
safe sex. I have shown here that while sex workers are concerned about
their long-term health, they face important, immediate structural con-
straints to protecting themselves from disease, especially the threat of
violence and intense economic pressures. Sex workers are more concerned
with protecting themselves from immediate violence, such that they rarely
engage in risks to their safety, and charge a higher premium when they do,
compared to risks to their health.
These findings suggest that containing the spread of HIV/AIDS is not just
a matter of educating sex workers and their clients about the need to use
condoms or increasing access to preventative healthcare, though both of
these are fundamental to a comprehensive intervention strategy. Sex
workers need a safe working environment to protect themselves from
violence and more long-term risks like disease. Minimizing physical risk
increases sex workers control of the transactions and increases their
bargaining power relative to their clients. In this context, condom use
could be negotiated up-front and would likely continue even if clients
become regulars. These findings have universal applications, given that all
commercial sex transactions involve some degree of negotiation, and the
terms of that negotiation are determined by structural constraints facing
sex workers. On the policy level, this implies the need for structural
interventions that increase sex workers capabilities to make choices in line
with their long-term preferences by avoiding violence in the short term,
including stronger police and workplace protections and stricter deterrents
to violence in the legal framework.
In other countries, such as India and Ecuador, the most successful
initiatives in this regard have involved and empowered sex workers to
report violence and crime and to educate other sex workers about safety
issues (Cheryl Overs 2002). Measures to implement these kinds of initiatives
depend on building trust between sex workers, outreach organizations, and
police, so sex workers can report crimes when they are victimized and alert
police to problems like forced and underage prostitution. One initiative in
particular that was implemented by TESIS in Managua, with support from
the Central American Womens Fund, organizes field visits with police
officers to prostitution sites where they speak with sex workers about their
safety and health concerns. The initiative also includes education
campaigns for sex workers about their rights, so they can report and
challenge threats to their safety.
My study has also highlighted the importance of informal networks in
protecting Nicaraguan sex workers safety. In the absence of reliable police
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ACKNOWLEDGMENTS
I wish to thank the outreach team and promoters at TESIS Managua
(Association for Workers for Education, Health, and Social Integration) for
their indispensable research assistance and the sex workers who openly
shared their stories with me. The staff at Puntos de Encuentro Managua
and the Central American University have been kind in offering
institutional support. I thank also my advisors, Alec Gershberg, Edwin
Melendez, Jennifer Olmsted and Lisa Servon for their continued guidance
on the project.
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SAFETY FIRST, THEN CONDOMS
NOTES
1
The names of all interviewees have been changed to protect confidentiality.
2
Based on Abel Valenzuela Jr. and Edwin Melendezs (2003) method, I estimate the
total population of sex workers in Managua from an August 2006 survey of 138 sex
workers. Survey interviewers counted the number of sex workers present at each site
visited on the day of the survey, while estimates of the number at sites not visited were
derived from the number of women typically present at that type of site. The total
number of sites comes from those surveyed as well as a question on the survey that
asked women to list other sites they knew of. I base the estimate of earnings on the
reported daily earnings per worker at each site, multiplied by the estimated number
of sex workers at each site, the average number of days worked there per week, and
fifty-two weeks in a year.
3
This study has focused on the experiences of female sex workers, although male sex
workers are present and probably increasing in Managua. Random sampling led to
only two males, both transvestite street-based workers in the tourist-oriented red-light
district. Based on observations and information from informants, more targeted
sampling would be needed in order to contact a greater number of male sex workers.
4
The present study is part of a larger study of the social and economic organization of
the sex sector in Managua. The survey research was approved by the Institutional
Review Board (IRB) of The New School on June 8, 2006 (No. 59-2006). All survey
responses were anonymous.
5
Observed premiums were calculated using a t-test to compare mean wages for risky
behaviors to wages without the risks based on targeted questions about the extra
charges sex workers demand for particular risks. All were statistically significant at the
95 percent confidence level. However, since these estimates do not control for factors
such as sex worker or client heterogeneity or the effects of workplace, they should be
interpreted as suggestive.
6
After ten years of the program, prevalence rates for STDs had dropped by half.
Exogenous changes in timing between voucher distribution without equivalent
changes in other possible explanators allowed the overall STD reduction to be
attributed to the program (McKay, Campbell, and Gorter 2006).
7
Market-based workers rent rooms and solicit clients in Managuas large market areas,
especially the Eastern Market.
8
Street-based workers exhibit more diversity in terms of personal characteristics (for
example, age and education level) and time spent in sex work as well as outcomes,
including their earnings and the number of days worked. See Table 1 for an overview.
9
Fieldwork on commercial sex is often a risky endeavor in itself, although the level of
risk varies with the legal and institutional settings (Teela Sanders 2005). Researchers
focusing on prostitution have faced questioning by police (Lisa Maher 2000), been
called to testify in trials involving sex workers (Maggie ONeill 1996), and described
the emotional strain associated with the death of research subjects and the
researchers own continual exposure to stories of violence (Maher 2000). In my
work, my status as an outsider attracted attention at all sites. I have witnessed illegal
activities, particularly the purchase and use of illegal drugs, and been exposed to
harassment and the dangers of theft or assault. I credit the TESIS outreach workers
who accompanied me with helping me avoid risky situations and acting as deterrents
simply by their established presence as service providers in the communities where we
conducted research.
10
It should be noted that strict legal enforcement of anti-pimping laws is also rare in
these cases. Police raids are uncommon, and when they do occur, the police generally
focus on removing minors from the establishment and extracting small fines from the
owners rather than closing the business entirely.
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11
It should be noted that there are signs that with the rise of transnational trafficking
networks, especially in the border regions, the involvement of pimps to recruit and
control women is more and more common. In my fieldwork, I observed women trying
to recruit street sex workers to travel to Guatemala for sex work and was told by the
sex workers that the recruiter would receive US$100 per woman.
12
It is notable that one of Ortegas first actions as president was to criminalize all
abortions, even when the life of the mother is in danger. This policy promises to have
little direct effect on the sex workers I interviewed, as they indicated that they were
more likely to use clandestine abortion services rather than formal clinics, or to give
the child away (regalarlo) when faced with an unwanted pregnancy. However, it is still
too early to tell whether the social conservatism underlying this policy could
potentially affect womens reproductive and social choices, including the choice to sell
sex.
13
Donna J. Guy has explored this expression of patriarchy in the Latin American
context, emphasizing mens traditional freedom to engage in any kind of sexual
validation of masculinity as long as they acted as men and stayed away from children
(2000: 15). Those who do not conform to the confines of the heterosexual,
monogamous family sex workers among them have been publicly marginalized
even though in private, sex workers affirm and maintain male machismo.
14
These estimates are based on condom use as confidentially reported by sex workers to
medical personnel.
15
The estimated premiums are for sites sampled in the survey only. Therefore, massage
parlors and reservados are excluded.
16
I was unable to control for unobserved heterogeneity, and therefore my estimates
should be interpreted as suggestive.
17
Other extra services include specific sexual positions the clients may request.
Generally, each additional position costs an extra US$1.13.
18
This is calculated as the difference in cost between oral sex with a condom and oral
sex without a condom.
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