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revealed that 7.7% were infected with HIV and 17% with syphilis.
  More recently, the HIV
Prevention Planning Council also conducted a focus group  of female sex workers.  The group felt that
HIV prevention information had not reached “hard core street-types,”
suggesting the case remains the
same later into the 1990s.
Thus, prostitution is both a risk behavior (because it implies multiple sexual partners), and a
marker for other risk factors, especially injection drug and crack use.
Past street-level outreach conducted during HAP’s HIV mobile testing suggests that women
and men who spend most of their time on the streets in the target neighborhood will not initially self-
identify as drug users or sex workers.  However, over time as a bond of trust is developed with an
outreach worker, such men and women will often indicate that they engage periodically in these
Attitudes of Target Population toward Social Institutions
Because they are involved in illegal activities, sex workers and drug users are understandably
suspicious of criminal justice institutions.  This distrust extends to other institutions, including county
hospitals and county/state social service agencies. Sex workers tell HAP outreach workers that they
feel judged by staff in such organizations. A 1995 review of health outreach to hard-to-reach
populations in Oakland and the Bay Area concluded that, “In other, more mainstream health care
contexts…association with law enforcement and negative provider attitude can be important barriers to
  Two rumors that are widely accepted among the target population indicate the degree of
alienation on the street:  Many believe that the AIDS virus is the result of a U.S. government conspiracy
targeting the African-American community, and many believe that recovery clinics intentionally keep
clients addicted to methadone so the clinic can continue to receive federal funds.
  Sex workers and
drug users, accustomed to the direct talk of the street, also distrust information couched in
“bureaucratese” or educational pamphlets that only use images of people clearly not from the local
Dorfman, L., Derish, P., Cohen, J., “Hey Girlfriend:  An Evaluation of AIDS Prevention among Women in the Sex
Industry,” Health Education Quarterly, Vol. 19(1):  25-40 (Spring 1992), p. 29.
Alameda County HIV Prevention Plan, Appendix B, pp. 41-42.
Harder+Company Community Research, Health to the Streets:  An Assessment of Outreach Services for the
Community Health Outreach Project, commissioned by California Department of Health Services, Division of
Communicable Disease Control, Sexually Transmitted Disease Control Program, August 1995, p. 23.
Conversation with HAP outreach worker, January 14, 1998.
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