Contexts of Sex-Based Exchange: A Cultural Analysis of Risk Perception and Behavior

This dissertation is a cultural analysis of risk perception and management as a component of sex-based exchange activity. Sixty-one (n=61) women who regularly ingested drugs, such as heroin and crack cocaine, and engaged in sex-based exchange activity were recruited from two Chicago West Side communities. Focus groups, free listing, pile sorting, survey data collection, and semi-structured ethnographic interviews were conducted to examine local perceptions of risks, including HIV risk, among the research participants. This research shows that local models of risk were based on the premise that the closer the relationship between a woman and her exchange partner, the less risky the context. The research participants associated risks with different contexts of sex-based exchange activity and mapped these contexts onto a customer typology. This allowed them to anticipate and manage the risks they associated with their sex-based exchange activity. Local models of risk and epidemiological models of HIV-risk conflicted and formed a paradox: the relationships the participants thought had the least risk actually had the highest probability of exposure to HIV or other STIs. In contrast, the actions seen as having the most risk, actually had the least epidemiological risk of exposure to HIV and other STIs. Drug addiction or the urge to use drugs drove much of the risk-taking behavior. Anxiety induced by the desire to use drugs often preceded participant engagement in sex-based exchange activities that increased the risks, including HIV, that were a part of the these contexts.