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Hopkins in Baltimore Series

Hopkins Professor Discusses Risk Environment for Baltimore Sex Workers

Susan Sherman has spent a lot of time hanging out in strip clubs over the years.  

Sherman, a Johns Hopkins professor in the Departments of Epidemiology, is interested in the structural determinants of HIV risk, in particular the work environment of female sex workers and others in the sex industry. Her research for the last eight years has focused on The Block, a short stretch of East Baltimore Street famous for its exotic dance clubs and sex shops. It is an area rife with drug dealing and crime, perhaps surprising considering its proximity to both City Hall and the Baltimore City Police headquarters.

Sherman shared her work in “The Importance of the Margins: The multifaceted HIV Risk Environment for Sex Workers,” a presentation at the Johns Hopkins School of Medicine on Dec. 16.  Her talk was the second in the Hopkins in Baltimore series and was co-sponsored by the Johns Hopkins School of Medicine Departments of Pediatrics, General Pediatrics and Adolescent Medicine (GPAM), and the Primary Care Consortium.

To conduct her research, Sherman and her team had to enter a world where women who exchange sex for money or drugs—or both—are often infected with HIV and have high rates of drug use. “People weren’t being tested there” for HIV, she said. Risk of infection is high there, both because large numbers of men and women pass through The Block each year, and because they have unprotected sex.

“A lot of people touch that space,” Sherman explained. “Women are at risk because their partners don’t use a condom. And the reasons behind that are complicated.”

For a series of studies, Sherman and her team interviewed people working in the clubs: dancers, sex workers, bartenders, bouncers, doormen and managers. The primary focus was on the women.

Women in the clubs of The Block are usually very young and often desperate for money. Many of them come from homes in which they have experienced either child or partner abuse, Sherman said. “The only parameter the clubs care about is that the dancer is 18 or over, because they could lose their liquor license.”

Women often come to The Block thinking they will earn money by dancing, and many begin there. But too often, women end up trading sex for money or drugs.

When Sherman asked women why they became sex workers instead of dancers, the answers were purely about economics; they often could make five times the money performing sex acts than dancing. For women with limited options, especially if they have children or a partner to support, the choice is obvious.

One sex worker told Sherman, “I was doing the best I could, for myself and my son.”

Sherman chronicled a world in which the younger and healthier a woman is, the more money she can make—and the better environment she can work in. As women age, become addicted to drugs or become ill with various STI, including HIV or hepatitis, their earning power decreases.

Even so, Sherman said, most of them can still find work in the clubs.

Public health research can come with its own risks, as Sherman’s team discovered. One team member conducting interviews in a club was “roofied,” or drugged. The team learned that roofies, known as date rape drugs, are often used to spike men’s drinks in the clubs because being drugged makes them more susceptible to being sold alcohol, drugs and sex. “Everything happens through the bartender,” Sherman said.

Although bartenders often obtain drugs for customers, the women working in the clubs use them as well. It is all too easy to become addicted. Why do women take drugs in the first place? Mostly, Sherman said, women report using drugs to help them survive the hopelessness of the environment in which they work. “In some cases, a sense of self inoculates them. Otherwise, it’s all too easy to use drugs and alcohol,” she said.

Her team has launched an effort to empower the women on The Block, in the hope that some of them will find the means to leave the dance clubs behind. Even if they continue as sex workers, she hopes to provide them with the resources that improve their health and give them options.

The intervention they provide includes physical and mental health care, legal services, testing and treatment for STIs and HIV in particular, financial support, parenting classes and child care, advocacy training, a 24-hour-hotline—even showers and makeup for women who have no access to those basic resources.

“Developing a woman’s sense of self and her strength is how we’re really going to begin to make a change.”


The event was the second in the Hopkins in Baltimore series, a program created to stimulate conversations on each Johns Hopkins campus about ways the university and the community can work together to effect change. The next event in the series is planned for Feb. 16, 2016.

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