Through an ethnographic lens: The HIV risk environment of exotic dance clubs Susan G. Sherman, Jacqueline Reuben, Pam Lilleston, Chris Serio Chapman

“The Block” Established (70+ years) red light district 25 strip clubs, bars, and other adult- entertainment establishments 1.5 block strip (down the street from Central Police Station) Dancing on the block = selling sex (for many women)

Exploratory What is the prevalence of transactional sex and illicit drug use on the Block? What are correlates of transactional sex and illicit drug use on the Block?

Methods Baltimore Needle Exchange Program began in May, night/week (10pm-1am) JHBSPH Cross-sectional survey: 05/08 – 01/09 (N=101) Ethnographic study: 06/09 – 08/09 (N=40) Inclusion criteria (both studies) >18 dance on the block

Demographics (N=101) % ≥24 years of age50% African American 30% Graduated high school 57% >2 residences in past year 61% Current main partner 74% Have children 59% Ever arrested 75% Currently use heroin, crack, and/or cocaine 55% * initiated drug use after began dancing 62%

Current Sexual and Drug Behaviors 42% sold sex (95% began in clubs) 25% injected drugs (50% started in clubs) –64% injected weekly 28% smoked crack (54% started in clubs) 13% snorted cocaine (38% started in clubs) 22% drank alcohol daily

Correlates of Transactional Sex Current Transactional Sex Individual Level African American (PrR: 0.43) Ever arrested (PrR: 3.0) Used drugs in clubs (PrR: 4.0) controlling for age, heroin use, crack smoking Context??

Led to…. What are the characteristics of exotic dance clubs that are associated with risk? – Risk Environment Framework Policy Social Economic physical

Qualitative Methods Interviews (30-75 minutes) conducted privately by three trained interviewers Taped and transcribed verbatim Inductive coding approach developed by three analysts, compared, revised, and finalized Transcripts entered into Atlas.ti and coded

Coding Scheme DomainCodeDetails Work Information WRKLOG WRKFEEL How many clubs on block dancer has worked; similarities and differences these between clubs; differences between Block and county clubs Feelings about stripping; vision of what working on the Block would be like before starting; how dancing on the Block is same/different from expectations; how long dancer envisions herself working on the Block; work/school plans for the future CustomersCUSTYP CUSSRV Types of customers Types of services the dancer provides to customers; Payment for for services

Risk Environment Conceptual Framework Micro-environment PhysicalSecluded rooms for selling sex Social Condom/ payment negotiation Norms /expectations about selling sex Economic Economic incentive to sell sex dancers clubs PolicyClub rules

Physical Environment Where are the cameras? Everywhere. We have somebody that does watch them. If they see something they'll come charging down the steps. He'll watch-- he's like behind the scenes. You don't even know he's here, but he's here. So we feel pretty secure in here. (24 years old) [Why she does not sell sex] Because when you're going in the basement of the club, they can do whatever they want to do to you while you're there nobody hears you, and that's my dilemma. (20 years old)

Social Environment: Expectations Who is putting the pressure on you [to sell sex]? The bartender a lot of times will try to sell it cuz he gets money every time you do anything. A lot of bartenders force girls to do bottles. Well it is like the mixture of people, like the bartender and the customers. The men expect stuff. They don't expect to talk to some 18-year-old, paying $20.00 just to talk to you and not to touch you. (21 years old). (23 years old)

Economic Environment: Incentives for Dancers Why did you start selling sex? I wasn't making it, $30 a night and paying my bills. So I had to step up the pace a little bit. And then I see how much money I made on that and I was like, ‘Hmm, walking out of the club with $30 or walking out of the club with $700,’ big difference. (24 years old) Why don’t you leave? This place is like a vacuum cleaner, man. I think right now, it's actually because I can't find a job that pays me the money that I make here. I can't make money like this anywhere else that's enough to pay my bills. That's the honest to G-d's truth. (27 year old)

Selling Sex What sex is sold in the club? Sex. Oral sex, regular sex, lap dances. The lap dances kind of turn into sex anyway, but it’s really ridiculous. You know, you can do what you want. As long as you got the money, you can do what you want. (38 year old staff)

Using Drugs Why do dancers start using drugs? Dancing ain't me. I've got to get messed up in order to do it. The Block is a real bad place to be if you are struggling from drug addiction, struggling from an alcohol problem. It will bring you down in a heartbeat…. Ninety-nine point nine percent of the people that you see walking on the block are drug dealers. They come down here. The dancers make money. They sell their drugs. (24 years old)

Conceptual Framework

Research Questions 1.To characterize the RE of exotic dance clubs through the development of four measures that capture the risk environment domains. 2.To determine whether the length of time dancing in a riskier exotic dance club environment predicts the cumulative incidence of HIV/STIs and initiation or escalation of sexual and drug) risk behaviors and among female exotic dancers in Baltimore, MD over 12 months.

Acknowledgements NIDA Women who dance numerous hours for little pay on the block

Risk Environment Conceptual Framework Micro-environmentMacro-environment PhysicalSecluded rooms for selling sexSex venues in Baltimore Social Condom/ payment negotiation Norms /expectations about selling sex Gender inequities Stigmatization of sex work Illegality of sex work Economic Economic incentive to sell sex dancers clubs Poverty Lack of Job opportunities Lack of employment rights PolicyClub rulesNudity, drug use, and prostitution laws