Saturday, August 15, 2009

Condoms and Prostitutes

Maslow came up with great theory for explaining human behavior. Good to keep in mind when you are doing public health.

I interviewed an incarcerated woman with a host of sexually-transmitted aliments. Part of my job was to educate her how not to become reinfected with the ones that were treatable. Or to catch worse. Here's the trouble though -- she's a prostitute. A prostitute addicted to heroin.

When looking at human behavior and social change, you must first meet people where they are at. She was no Julia Roberts Pretty Woman. This hooker was an unfortunate looking woman. Older than most of her peers. Quite large and round (not your typical heroin physique) but had substantial scaring -- tracks and sores -- on her arms. The prostitute and I had different agendas. I was asking her to use condoms, she was working the streets for drug money. She could get $50 if she had sex bareback (without a condom), or $20 with a condom. So if she needs $100 in a night, she can have sex with 2 guys and hope for the best, or she can protect herself but have to screw 5 guys. Which would you choose?

This is where Maslow comes in handy. The prostitute's need for drugs and food is more important to her than her need to protect herself from invisible germs (add in there that it is difficult to find free condoms in the area where she works -- she would have to buy them, further cutting into her profits). Rather than focusing on condoms, she needs drug treatment and the means for an income other than her current profession. If those to needs are not addressed, all the safe sex education in the world is not going to make much of an impact.

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