Marina Barnard and Neil McKeganey
Concern over the presumed potential for prostitutes to act as a bridgehead for HIV infection to pass into the general population has led to the setting up of a number of HIV prevention services targeted specifically at prostitutes. Cynically one might argue that the concern expressed was less for the health and well-being of the prostitute than for the people she might pass infection on to. Nonetheless, the attention (and finance) directed at preventing potential HIV spread through prostitution has resulted in the provision of services specifically aimed at prostitutes enabling them to work more safely and to ensure their own health. Perhaps one of the few good things to come out of the AIDS epidemic has been the forced recognition of the health needs of groups of people (drug users, prostitutes, men who have sex with men) who are socially marginalised and who often remain hidden to services. The onerous task of preventing HIV spread has led to a number of welcome changes in the planning and delivery of services. In their efforts to attract a wider client base, services have had to become more innovative, less agency-based and more attuned to the varying needs of the people they are designed to serve.
However, times are changing. Heterosexually acquired HIV has not spread within the developed world in the dramatic way envisaged in many of the early projections. Moreover, in so far as prostitutes in Britain are concerned, HIV does not appear, at the moment, to be a significant issue. Studies in London and in Glasgow both identified low levels of HIV infection (Ward et al., 1993; McKeganey et al., 1992). The low prevalence of HIV infection among prostitutes in Britain, at least, has implications for the future of HIV prevention services. Certainly with public spending cuts it is at least likely that these services will come under increased financial pressure to cut back both on the range and quality of services on offer.
The point we shall make in this chapter is that whilst it may have taken an epidemic for the health needs of prostitutes to be recognised and attended to, these same needs do not disappear simply because HIV is not spreading in this population as was once thought. The public health concern with the risks