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Female Crack Users and Their Sexual Relationships: The Role of Sex-For-Crack Exchanges.



In just over a decade, the percentage of Acquired Immunodeficiency Syndrome acquired immunodeficiency syndrome, see AIDS.  (AIDS) cases among women in the United States United States, officially United States of America, republic (2005 est. pop. 295,734,000), 3,539,227 sq mi (9,166,598 sq km), North America. The United States is the world's third largest country in population and the fourth largest country in area.  has more than tripled, from 7% in 1985 to 23% in 1998 (Centers for Disease Control and Prevention Centers for Disease Control and Prevention (CDC), agency of the U.S. Public Health Service since 1973, with headquarters in Atlanta; it was established in 1946 as the Communicable Disease Center. , 1999). These same surveillance data show the disproportionate dis·pro·por·tion·ate  
adj.
Out of proportion, as in size, shape, or amount.



dispro·por
 impact of the AIDS epidemic on racial and ethnic minority populations, especially women of color not of the white race; - commonly meaning, esp. in the United States, of negro blood, pure or mixed.

See also: Color
. Almost two thirds (62%) of reported female AIDS cases are among African American African American Multiculture A person having origins in any of the black racial groups of Africa. See Race.  women, and of these cases, 37% are due to heterosexual heterosexual /het·ero·sex·u·al/ (-sek´shoo-al)
1. pertaining to, characteristic of, or directed toward the opposite sex.

2. one who is sexually attracted to persons of the opposite sex.
 contact. Although no data are available indicating the extent to which these cases are linked to unsafe sex in the context of crack cocaine use, researchers have associated crack cocaine use with high-risk sex high-risk sex Safe sex practices, see there , including unprotected sex Unprotected sex refers to any act of sexual intercourse in which the participants use no form of barrier contraception. Sexually transmitted infections
Specifically, unprotected sex
 and sex with multiple partners (e.g., Edlin et al., 1994; Inciardi, 1995; Jones et al., 1998; Siegal et al., 1992).

Despite a lack of reliable data on the prevalence of sex-for-crack exchanges among female crack cocaine users, individuals often assume that most, if not all, of these women support their drug habit by bartering sex for crack (Inciardi, Lockwood, & Pottieger, 1993; Ratner, 1993). Few researchers have investigated differences between female crack cocaine users who do exchange sex for crack (exchangers) and those who do not (nonexchangers). An exception is El-Bassel et al. (1997), who did explore differences in psychological distress psychological distress The end result of factors–eg, psychogenic pain, internal conflicts, and external stress that prevent a person from self-actualization and connecting with 'significant others'. See Humanistic psychology.  among women who did and those who did not exchange sex for crack.

Many female crack users support their habit through other means, including legal jobs, involvement in the drug business, and petty crimes (Fagan, 1994; Sterk, 1999). Those women who do exchange sex for crack tend to hold a marginal position among crack users and often have little power and status (Amaro, 1995; Maher & Curtis, 1992). Furthermore, their environment encourages the potential for coercion coercion, in law, the unlawful act of compelling a person to do, or to abstain from doing, something by depriving him of the exercise of his free will, particularly by use or threat of physical or moral force.  surrounding sex-for-crack exchanges (Barry, 1995; Fullilove, Lown, & Fullilove, 1992; Kalichman, Williams, Cherry, Belcher, & Nachimson, 1998; Lown, Winkler Winkler may refer to:
  • Winkler, Manitoba, a Canadian city
  • Winkler (novel), by Giles Coren
  • Winkler (crater), a crater on the Moon
  • Winkler (surname), people with the surname Winkler or Winckler
See also
, Fullilove, & Fullilove, 1993; Maher, 1997; Sterk, 1999). Exchangers often have to cope with men who expect cut-rate sex in return for crack, men who are craving craving Psychology A strong desire to consume a particular substance–eg of abuse, or food; craving is a major factor in relapse and/or continued use after withdrawal from a substance of abuse and is both imprecisely defined and difficult to measure.  crack themselves, and men who fail to respect them as equals (Sterk, 1999).

This study seeks to offer a better understanding of the differences between exchangers and nonexchangers. Studies among female prostitutes have shown the impact of exchanging sex for money or drugs to impact the women's sexual relationships with both steady and casual partners (e.g., Cohen cohen
 or kohen

(Hebrew: “priest”) Jewish priest descended from Zadok (a descendant of Aaron), priest at the First Temple of Jerusalem. The biblical priesthood was hereditary and male.
, 1980; Goldstein, 1979; Hoigard & Finstad, 1992; Sterk, 2000). In general, women's sexuality appears to be more closely linked to emotional factors than the sexuality of men (Carroll, Volk, & Hyde, 1985). In addition, society usually socializes women to have stricter personal standards for sexual conduct than males (Hendrick & Hendrick, 1995; Oliver & Hyde, 1993). Although exchangers challenge these gender role expectations, they are not immune to the stigma stigma: see pistil.
Stigma
mark of Cain

God’s mark on Cain, a sign of his shame for fratricide. [O. T.: Genesis 4:15]

scarlet letter
 and ambivalence ambivalence (ămbĭv`ələns), coexistence of two opposing drives, desires, feelings, or emotions toward the same person, object, or goal. The ambivalent person may be unaware of either of the opposing wishes.  their actions evoke e·voke  
tr.v. e·voked, e·vok·ing, e·vokes
1. To summon or call forth: actions that evoked our mistrust.

2.
. We hypothesize hy·poth·e·size  
v. hy·poth·e·sized, hy·poth·e·siz·ing, hy·poth·e·siz·es

v.tr.
To assert as a hypothesis.

v.intr.
To form a hypothesis.
 that exchangers are more likely to be single, precluding them from dealing with the potential tensions in a steady relationships due to their involvement in sex-for-crack exchanges. In addition, we hypothesize that exchangers are more likely to have experienced infidelity, being involved in a relationship where both the exchanger and their steady partner have been unfaithful to each other. Due to a marginal status in life among crack cocaine users, we further hypothesize that the exchangers also might be less likely to have high levels of interactional competence. Findings from research on interactional patterns of heterosexual encounters have demonstrated the importance of such competence, such as being able to clearly communicate intentions and sexual assertiveness assertiveness /as·ser·tive·ness/ (ah-ser´tiv-nes) the quality or state of bold or confident self-expression, neither aggressive nor submissive.  (Amaro, 1995; Galligan & Terry, 1993; Vanwesenbeeck, Becker, & Van Lenning, 1998).

A better understanding of the impact of sex-for-crack exchanges will assist not only professionals in the substance abuse field but also those involved with HIV HIV (Human Immunodeficiency Virus), either of two closely related retroviruses that invade T-helper lymphocytes and are responsible for AIDS. There are two types of HIV: HIV-1 and HIV-2. HIV-1 is responsible for the vast majority of AIDS in the United States.  risk-reduction programs. Such an analysis will avoid stereotyping all female crack users as crack prostitutes.

To gain a further understanding of the differences between exchangers and nonexchangers, we conducted quantitative interviews with 150 active female crack users in Atlanta, supplemented by qualitative interviews among a random sample of one half. Among the 150 women, almost one half (43.5%) reported exchanging sex for crack. We investigated differences in demographic characteristics, drug use patterns, sexual activity, and relationship characteristics as possible determinants of engaging in sex-for-crack exchanges. Processes involving the selection of a partner, faithfulness, and the relevance of steady and casual partners were included as key relationship characteristics.

METHOD

Procedures

Between June 1997 and February 1999, data were collected from 150 active female crack cocaine users in Atlanta, Georgia. This project was part of a larger study to develop, implement, and evaluate a gender-specific HIV risk-reduction intervention for heterosexual African American female crack users. The community identification (CID Cid or Cid Campeador (sĭd, Span. thēth kämpāäthōr`) [Span.,=lord conqueror], d. 1099, Spanish soldier and national hero, whose real name was Rodrigo (or Ruy) Díaz de Vivar. ) process, a mapping method to record epidemiological epidemiological

emanating from or pertaining to epidemiology.


epidemiological associations
the associative relationships between the frequency of occurrence of a disease and its determinants, its predisposing and precipitating
 indicators of substance abuse (e.g., from emergency room,;, law enforcement, and drug treatment), expert opinions (e.g., local political leaders and public health officials), and ethnographic eth·nog·ra·phy  
n.
The branch of anthropology that deals with the scientific description of specific human cultures.



eth·nog
 information from local researchers (Tashima, Crain, O'Reilly, & Sterk-Elifson, 1996) determined the selection of the geographical areas from which to recruit women. Indigenous outreach Outreach is an effort by an organization or group to connect its ideas or practices to the efforts of other organizations, groups, specific audiences or the general public.  workers familiar with the local drug scene recruited women using targeted sampling (Watters & Biernacki, 1989). Such mapping is useful when the parameters of the population of the study are unknown, as is the case with female crack users. Four trained African American outreach workers, two males and two females, assisted with recruitment.

To be eligible, women had to reside in Atlanta, be 18 years or older, be out of drug treatment or any other institutional setting, and be active users of crack cocaine. The outreach workers used a screening form on the street to identify potential respondents In the context of marketing research, a representative sample drawn from a larger population of people from whom information is collected and used to develop or confirm marketing strategy. . Those who met the criteria and expressed an interest in the study were scheduled for an interview at a centrally located research field site, at their home, or at other community locations selected by the respondents such as fast food restaurants or community centers. Outreach logs indicate that approximately three women needed to be approached and screened for every woman enrolled in the study. The main reasons for nonparticipation were a craving for drugs among one third of the women, and having other obligations, frequently child care, among the remaining two thirds.

Prior to the actual interview, trained staff informed the respondents of the nature of the study, the time required, and other informed consent procedures. The respondent In Equity practice, the party who answers a bill or other proceeding in equity. The party against whom an appeal or motion, an application for a court order, is instituted and who is required to answer in order to protect his or her interests.  and the interviewer each retained a copy of a signed consent form. Respondents received $15 for an interview. The consent form indicated that one half of the women would be randomly selected for a quantitative interview. Every other woman interviewed was asked to participate in a qualitative interview for which an additional incentive of $15 was paid; if a woman refused, the next respondent was approached.

All screened women who indicated a willingness to participate reported for the quantitative interview. Interviews with 12 women had to be rescheduled because they had a previous commitment or were too high or too tired to complete the interview. The quantitative interview took approximately 1 hour. The average length of the qualitative interview also was 1 hour with ranges from 30 minutes to 2 hours. Five women who completed the quantitative interview and who were randomly selected for participation in the qualitative interview refused. Five substitutes were randomly selected from respondents who completed the quantitative interview but who originally were not selected for a qualitative review. The average number of days between the quantitative and qualitative interviews was 6 days, with a range between 4 to 16 days. Of the three female interviewers, two were African American and one was White. All received extensive training in both quantitative and qualitative interviewing techniques.

Data Collection

Data collection involved both quantitative and qualitative interviews. A combination of quantitative and qualitative methodologies is more likely to yield reliable as well as valid data (Patton, 1990). This result can be achieved either by first collecting qualitative data, followed by quantitative data collection, or vice versa VICE VERSA. On the contrary; on opposite sides. . Researchers first conducting qualitative elicitation e·lic·it  
tr.v. e·lic·it·ed, e·lic·it·ing, e·lic·its
1.
a. To bring or draw out (something latent); educe.

b. To arrive at (a truth, for example) by logic.

2.
 research often do so to develop study hypotheses, gain knowledge regarding appropriate question wording, or generate response categories. For this study, we followed the quantitative-qualitative scenario, allowing us to place the quantitative findings in context by exploring more in-depth issues in the qualitative interviews such as relationship status, the role of steady partners, and communication with sex partners.

Quantitative instrument. The quantitative instrument covered six main domains. In addition to standard demographic characteristics, questions elicited e·lic·it  
tr.v. e·lic·it·ed, e·lic·it·ing, e·lic·its
1.
a. To bring or draw out (something latent); educe.

b. To arrive at (a truth, for example) by logic.

2.
 information regarding past and current drug use patterns, sexual HIV risk-taking, and relationship experiences. Drug use history and sexual HIV risk-taking were assessed using the Risk Behavior Assessment (RBA RBA Rare Bird Alert
RBA Reserve Bank of Australia
RBA Run Book Automation
RBA Rochester Business Alliance
RBA Rights-Based Approach
RBA Royal Brunei Airlines (ICAO code)
RBA Relative Byte Address
RBA relative binding affinity
) developed by the National Institute on Drug Abuse The National Institute on Drug Abuse (NIDA) is a United States federal-government research institute whose mission is to "lead the Nation in bringing the power of science to bear on drug abuse and addiction. . Drug use was measured by five items: lifetime use, use in the last 30 days, frequency of use in the last 30 days, use in the last 2 days, and polydrug use in the last 30 days. Regarding their sexual HIV risk-taking, respondents were asked to indicate the number of sex partners, type (vaginal vag·i·nal
adj.
1. Of or relating to the vagina.

2. Relating to or resembling a sheath.



vaginal

pertaining to the vagina, the tunica vaginalis testis, or to any sheath.
, oral, and anal) and frequency of sex by partner type (steady, casual nonpaying, and casual paying) in the last 30 days, and any involvement in exchanging sex for crack.

Relationship experiences included status, selectiveness with partners, importance of steady partners, fidelity, and communication. Relationship status was measured contrasting those women who were single versus those who reported a steady relationship. Women responded to questions about their selectiveness of partners, the importance of having a steady partner, and fidelity. They identified whether they were more, the same, or less selective than other women when assessing a potential partner. Those women who believed having a steady partner was important were questioned further about a partner's influence in terms of emotional and economic support. Each respondent indicated if she talked with her most recent steady partner about his expectations of the relationship, finances, and past sex partners, to measure communication patterns. Finally, participants answered two questions about fidelity: "Have you ever cheated on one of your steady partners?" and "Do you think one of your steady partners has ever cheated on you?"

Qualitative interview. The qualitative interview focused on the respondents' relationship experiences. Consistent with the quantitative instrument, participants responded to queries that investigated their selectiveness with partners, fidelity, steady relationships, communication with steady partners, and the role of casual partners.

Data Analysis

All data were collected without personal identifiers. The quantitative and qualitative interviews were linked using study participant numbers. The Statistical Package for Social Sciences (SPSS A statistical package from SPSS, Inc., Chicago (www.spss.com) that runs on PCs, most mainframes and minis and is used extensively in marketing research. It provides over 50 statistical processes, including regression analysis, correlation and analysis of variance. ) was used for the quantitative data analysis. This analysis included descriptive statistics descriptive statistics

see statistics.
, contingency analysis with Pearson's chi square chi square (kī),
n a nonparametric statistic used with discrete data in the form of frequency count (nominal data) or percentages or proportions that can be reduced to frequencies.
, and bivariate bi·var·i·ate  
adj.
Mathematics Having two variables: bivariate binomial distribution.

Adj. 1.
 logistic regression In statistics, logistic regression is a regression model for binomially distributed response/dependent variables. It is useful for modeling the probability of an event occurring as a function of other factors.  analysis.

Using QSR QSR Quick Service Restaurant
QSR QoS (Quality of Service) Satisfaction Rate
QSR Quality System Regulations
QSR Quality Status Report
QSR Quality System Review
QSR Quarterly Status Report
QSR Quality System Requirement
 Nu*Dist, a qualitative data management program, the textual tex·tu·al  
adj.
Of, relating to, or conforming to a text.



textu·al·ly adv.
 data were analyzed an·a·lyze  
tr.v. an·a·lyzed, an·a·lyz·ing, an·a·lyz·es
1. To examine methodically by separating into parts and studying their interrelations.

2. Chemistry To make a chemical analysis of.

3.
. The coding was guided by the constant comparison method used in grounded theory (Strauss & Corbin, 1990). This data management program allows for a complex analysis of the main themes by combining all the transcripts and associated codes in one data set. The coding scheme was developed from the interview guide and the first five interviews. Multiple staff (interviewers and project director) developed separate coding schemes to ensure interrater reliability.

RESULTS

Participants

Participants were 150 active female crack cocaine users, with a mean age of 35.5 (SD = 7.8, range = 17-22) and a mean level of educational attainment Educational attainment is a term commonly used by statisticans to refer to the highest degree of education an individual has completed.[1]

The US Census Bureau Glossary defines educational attainment as "the highest level of education completed in terms of the
 of 11.4 years (SD = 2.1, range 6-17). Sex-for-crack exchanges, involving either vaginal or oral sex, were reported by 65 women (43.3%). The prevalence of anal sex Noun 1. anal sex - intercourse via the anus, committed by a man with a man or woman
anal intercourse, buggery, sodomy

sexual perversion, perversion - an aberrant sexual practice;
 was too low to be included. Nonexchangers reported never having bartered sex for crack.

Group Comparisons

On average, the exchangers tended to be slightly younger (mean age = 33.7 years) than the nonexchangers (mean age = 36.9 years, p [is less than] .01). As shown in Table 1, the relationship status in the two groups of women differed significantly (p [is less than] .01), with 58.5% of the exchangers being single versus 36.5% of the nonexchangers. The exchangers also were significantly more likely to have history of homelessness (84.6% versus 69.4%, p [is less than] .05). Women in both groups reported similar levels of educational attainment and annual income.

Table 1. Selected Demographic and Drug Use Characteristics of Exchangers and Nonexchangers
                                                            Non-
  Variables                               Exchangers     exchangers
                                          N = 65 (%)     N = 85 (%)

Demographic variables
  Age(**)
    Mean age                                 33.7           36.9
  Education
    Mean education                           11.2           11.6
  Annual income
    Mean in dollars                       9,960          9,990
  Relationship status(**)
    Single                                   58.5           36.5
    In a relationship                        41.5           63.5
  History of homelessness(*)                 84.6           69.4
Drug use variables
  Crack use
    In the last 30 days                     100.0           92.9
    In the last 2 days                       42.2           37.2
  Polydrug use
    In the last 30 days                      38.5           29.4
  Mean number of days used crack
  In the last 30 days                        16.0           15.0
Relationship variables
  Selectiveness with partners
    Less selective                           21.9           16.3
    The same as most women                   23.4           12.8
    More selective                           54.7           70.9
  Having steady partner
    is important                             83.1           84.7
  Steady partner important
    for emotional support                    63.1           57.6
  Steady partner important
    for economic support                     46.2           42.4
  Talked with most recent steady
    partner about his relationship
    expectations of relationship(*)          70.3           88.0
  Suspects a steady partner
    has cheated                              89.2           84.7
  Has cheated oil a
    steady partner(**)                       90.8           71.8
  Asked most recent steady partner
    about past sex partners                  72.3           68.7
  Sex-related variables last 30 days
    Vaginal sex, steady partner              44.7           57.0
    Oral sex, steady partner                 32.8           26.7
    Vaginal sex, casual,
      nonpaying partner(*)                   51.6           31.4
  Oral sex, casual, nonpaying
      partner(**)                            34.4            7.0
  Vaginal sex, casual, paying
    partner(**)                              65.6           27.9
  Oral sex, casual, paying
    partner(**)                              46.9           15.1


(a) History of homelessness was measured as ever having been homeless.

(*) p < .05.

(**) p < .0l (Pearson's chi square).

We discerned no significant differences between the women's drug use patterns: 100% of the exchangers used crack in the last 30 days, 42.2% used it in the last 2 days, and on the average they used crack 16 out of the last 30 days. By comparison, 92.9% of the nonexchangers reported crack use in the last 30 days, 37.2% in the last 2 days, and on an average, they reported using crack on 15 out of the last 30 days.

The groups did not differ significantly with respect to relationship selectivity selectivity /se·lec·tiv·i·ty/ (se-lek-tiv´i-te) in pharmacology, the degree to which a dose of a drug produces the desired effect in relation to adverse effects.

selectivity

1.
 and importance. The majority of the exchangers (54.7%) and the nonexchangers (70.9%) declared themselves more selective than most people when identifying a partner. In addition, both groups of women perceived having a steady partner as important, with 83.1% of the exchangers and 84.7% of the nonexchangers indicating so. The most commonly mentioned reason for wanting a steady partner was emotional support, which was noted by slightly higher percentage of exchangers (63.1%) than nonexchangers (57.6%). The importance of economic support was the second most frequently stated reason to have a steady partner by the exchangers (46.2%) and the nonexchangers (42.4%). None of the above comparisons were statistically significant.

Nonexchangers were significantly more likely to have communicated with their most recent steady partner about his expectations of the relationship (88.0% versus 70.3%, p [is less than] .05). Finally, a substantial difference existed between both groups in faithfulness to a steady partner. While 90.8% of the exchangers reported being sexually unfaithful, 71.8% of the nonexchangers acknowledged having cheated on a steady partner (p [is less than] .01).

No significant differences were found for sexual activity with steady partners. Women in both groups reported more vaginal than oral sex in the last 30 days. However, important differences were identified regarding sex with casual partners, both paying and nonpaying. Exchangers were significantly more likely to engage in vaginal sex with nonpaying sexual partners (p [is less than] .05). The most significant differences between exchangers and nonexchangers concerned oral sex with nonpaying as well as paying casual partners (p [is less than] .01) as well as vaginal sex with paying casual partners (p [is less than] .01).

Factors Influencing Involvement in Sex-for-Crack Exchanges

Due to the relatively small sample size, bivariate logistic regression analysis was conducted in order to identify factors which influence a woman's involvement in exchanging sex for crack. The results of this analysis are presented in Table 2.

Table 2. Bivariate Logistic Regression Analysis of Factors Influencing Involvement in Sex-for-Crack Exchanges
Variables                            OR         95% CI     p-value

Age
  25 years or younger               1.61      1.04-2.49      <.05
  Older than 25 years               1.00
History of homelessness
  Having ever been homeless         2.34      1.03-5.29      <.05
  Never having been homeless        1.00
Relationship status
  Being single                      1.50      1.03-2.19      <.05
  Being in a relationship           1.00
Having children
  Yes                               1.68      0.49-5.76       NS
  No                                1.00
Selectiveness with partners
  More or equally selective
as most women                       1.42      0.94-2.14       NS
  Less selective than
most women                          1.00
Suspects steady partner has
cheated
  Yes                               0.63      0.24-1.67       NS
  No                                1.00
Having cheated on steady
 partner
  Yes                               3.74      1.43-9.81      <.01
  No                                1.00
Importance of having a steady
 relationship
  Important                         0.95      0.39-2.31       NS
  Unimportant                       1.00
Discuss most recent steady
 partner's expectations
  Yes                               0.38      0.16-0.87      <.05
  No                                1.00
Discuss most recent steady
 partner's past sex partners
  Yes                               1.06      0.56-2.03       NS
  No                                1.00
Sex in last 30 days with
 steady partner
 Vaginal sex
  Yes                               0.94      0.63-1.41       NS
  No                                1.00
 Oral sex
  Yes                               1.20      0.77-1.89       NS
  No                                1.00
Sex in last 30 days with
 nonpaying casual partner
 Vaginal sex
  Yes                               2.01      1.18-3.42      <.01
  No                                1.00
 Oral sex
  Yes                               4.00      1.78-8.99      <.01
  No                                1.00
Sex in last 30 days with
 paying partner
 Vaginal sex
  Yes                               2.67      1.75-4.09      <.01
  No                                1.00
 Oral sex
  Yes                               2.34      1.50-3.65      <.01
  No                                1.00


Involvement in sex-for-crack exchanges was significantly associated with age (OR = 1.61; 95% CI, 1.04-2.49), with women 25 years of age or younger being more likely to exchange sex for crack than women older than 25. Those women who had been homeless at some point in their lives (OR = 2.34; 95% CI, 1.03-5.29) were 2.3 times more likely to be exchangers than women who had not experienced homelessness. Single women were 1.5 times more likely to exchange sex for crack than women in a relationship (OR = 1.50; 95% CI, 1.03-2.19). Exchanging sex-for-crack also was strongly associated with having cheated on a steady partner (OR = 3.74; CI, 1.43-9.81) and failing to communicate with the most recent steady partner about his expectations of the relationship (OR = 0.38; 95% CI, 0.16-0.87). In assessing the women's sexual activity during the last 30 days prior to the interview, having engaged in vaginal sex with a nonpaying casual partner (OR = 2.01; 95% CI, 1.18-3.42) or with a paying partner (OR = 2.67; 95% CI, 1.75-4.09) and having engaged in oral sex with a casual nonpaying partner (OR = 4.00; 95% CI, 1.78-8.99) or with a paying partner (OR = 2.34; 95% CI, 1.50-3.65) were all associated with exchanging sex for crack.

RELATIONSHIP CONTEXT: THE QUALITATIVE DIMENSION

Although more than 80% of the women in each group indicated that having a steady partner is important, 58.5% of the exchangers and 36.5% of the nonexchangers reported being single. The qualitative interviews addressed this statistical ambiguity regarding steady relationships. Some women tried to rationalize ra·tion·al·ize
v.
1. To make rational.

2. To devise self-satisfying but false or inconsistent reasons for one's behavior, especially as an unconscious defense mechanism through which irrational acts or feelings are made to appear
 their single status by stating that it was their choice. One of the nonexchangers provided the following explanation for remaining single:
   I had to find out the hard way. You know, like a woman is supposed to have
   a man. I used to believe that stuff ... I don't think so. Every man I have
   ever been with has been a pain. Those guys become like little kids,
   annoying kids. I'm so much better off by myself. That way I know what I
   have, and I don't have to share the little I do have.


Contrary to the woman quoted above, other exchangers (as well as nonexchangers) remained single because they had been unsuccessful in establishing a steady relationship. One of the nonexchangers said:
   I'd like to have an old man, a man who will be there for me, a partner.
   Believe you me. I've been trying to find one and I am a lot less picky than
   I used to be. It just ain't working out ... The last guy I was with almost
   got me fooled. I thought he was my partner and it took me a while to find
   out he wasn't into me ... It finally dawned on me that he only showed up
   when he needed something from me; never to give me something. For me to get
   something from him, like a little money or a treat, I'd have to fuss first.


Among those women who responded negatively to the close-ended question about the importance of having a steady partner, some exchangers explained they had to downplay down·play  
tr.v. down·played, down·play·ing, down·plays
To minimize the significance of; play down: downplayed the bad news.

Verb 1.
 the importance of a steady partner. They were afraid of being perceived as someone who was unable to have such a relationship.

The most frequent reason for valuing a steady relationship noted by the women was emotional support. Many women in both groups described how their crack use had caused alienation alienation, in property laws: see tenure.
alienation

In the social sciences context, the state of feeling estranged or separated from one's milieu, work, products of work, or self.
 from relatives, nonusing friends, and even drug-using friends. Exchangers mentioned such alienation more often than nonexchangers. Many women, especially among the exchangers, interpreted having a steady partner as evidence of being connected with at least one person who cared about them.

The women also viewed economic support as an important dimension of a steady relationship. Typically, the income of the women and their steady partners was below the federally-established poverty level, requiring them to pool financial resources. Among both groups of women, those who lived with their steady partner were more likely to share economic resources than those who did not reside with their partner. A number of women explained that a contribution as small as $20 a week made a difference, allowing them to buy extra food or clothing or to pay a debt. Some of the exchangers noted that every contribution, small or large, provided a temporary respite RESPITE, contracts, civil law. An act by which a debtor who is unable to satisfy his debts at the moment, transacts (i. e. compromises) with his creditors, and obtains from them time or delay for the payment of the sums which he owes to them. Louis. Code, 3051.  from prostitution prostitution, act of granting sexual access for payment. Although most commonly conducted by females for males, it may be performed by females or males for either females or males.  activities. The exchangers described such gifts as a sign of respect, or as one woman said, "a blessing."

Interestingly, few women mentioned sex when elaborating on the importance of steady relationships, a finding which corroborates the quantitative data. In the qualitative interviews, the women stated repeatedly that caring, sharing material resources, and showing respect were more important than having sex. In some ways, the women's accounts of their steady relationships more closely resembled those of friendships than of sexual relationships. A majority of the exchangers viewed sex as negative, associating it with coercion and failing to link it to love.

When asked in the quantitative interview if they had communicated with their most recent steady partner about his expectations of the relationship, a majority of the women indicated such conversations had occurred, although these were more common among the nonexchangers than the exchangers (N.S.). A common fear among the exchangers was their partner's lack of expectations for the relationship, thereby shattering their hopes for a long-term commitment.

An underlying theme in many of the qualitative interviews was the women's perception that they lacked bargaining power both in what they could expect from a steady partner and their selectiveness with potential partners. Particularly among the exchangers, a substantial number of the women referred to this lack of power. One of the exchangers put it this way:
   I'd like to be picky about it, but I don't have anything going for me. An
   old man has to put up with a lady who whores herself. I should be happy if
   any man wants to be with me. Some have tried, but it is hard to know for a
   man that his lady is out there selling herself ... My tricks are no
   different. They know 1 need them. I wouldn't be out there doing what I'm
   doing if it wasn't because of getting high. They know that if they wait
   long enough, they can get a woman to do whatever they want.


The relatively high proportion of women in both groups who suspected that a steady partner had been unfaithful appeared connected to this sense of powerlessness pow·er·less  
adj.
1. Lacking strength or power; helpless and totally ineffectual.

2. Lacking legal or other authority.



pow
. Many women failed to view infidelity as a sign of disrespect as long as the affairs remained "hidden." Further probing revealed that the women's tolerance of their partner's sexual affairs also was related to their own extrarelational sex. Exchangers were significantly more likely to have cheated on a steady partner than nonexchangers. Typically they had a sexual relationship with nonpaying casual partners who provided emotional support, who would share crack without demanding or expecting sex, or with whom they would have sex without smoking crack.

Relatively complex were the women's descriptions of their relationships with casual, nonpaying sex partners, many of whom played a more long-term role in the women's lives than did their steady partners. A 34-year-old exchanger explained:
   Steadies come and go. It lasts for a while, the shit hits the fan, and it
   starts all over. I want to be with a guy but me smoking crack doesn't make
   it easy to find a decent guy ... Like the guy I was telling you about [one
   of her casual, nonpaying partners]. He knows more about my life than any
   old man ever will. I can trust him and I know he won't walk away.


We found that the women's relationships with casual, nonpaying partners have more importance than outsiders often acknowledge.

DISCUSSION

Since the onset of the crack cocaine epidemic, researchers have reported on the exchange of sex for crack as a newly emerging form of prostitution (Barry, 1995; Fullilove et al., 1992; Inciardi et al., 1993; Maher & Curtis, 1992; Ratner, 1993; Sterk & Elifson, 1990). At times these research findings have led to the public misperception mis·per·ceive  
tr.v. mis·per·ceived, mis·per·ceiv·ing, mis·per·ceives
To perceive incorrectly; misunderstand.



mis
 that all female crack users barter barter: see exchange.
barter

Direct exchange of goods or services without the use of money or any other intervening medium of exchange. Barter is conducted either according to established rates of exchange or by bargaining.
 sex for crack. One of our main goals in the present study was to learn more about the differences between those female crack users who do exchange sex for crack and those who do not.

The study findings reveal similarities as well as differences between both groups of women. While one might expect the drug use patterns between the exchangers and nonexchangers to differ, we found this assumption to be untrue un·true  
adj. un·tru·er, un·tru·est
1. Contrary to fact; false.

2. Deviating from a standard; not straight, even, level, or exact.

3. Disloyal; unfaithful.
 among the women we interviewed. We did confirm our initial hypothesis that women in both groups might differ in terms of relationship status. Exchangers were significantly more likely to be single. Regarding other demographic characteristics, they tended to be younger than nonexchangers, and the logistic regression analysis showed age to be a significant predictor of involvement in exchanging sex for crack. Two possible explanations for this age trend are that (a) older women may mature beyond the exchange scene, and (b) younger women may find it easier to attract paying sex partners than their older peers. Exchangers also were more likely to have been homeless. However, we were unable to establish a time line to indicate if they were homeless prior to becoming crack users or upon becoming a user.

Much of the study concerned the women's relationship characteristics. We hypothesized that the exchangers would be less interactionally competent than the nonexchangers. This expectation was confirmed. Exchangers were less Likely to discuss a steady partner's expectations of the relationship with the partner. On the other hand, while a slightly higher percentage of exchangers than nonexchangers asked a steady partner about his sexual history, the difference was not significant. Perhaps the exchangers feared having a partner perceive them as a source of prostitution income while the nonexchangers believed partners viewed them as a lover (Sterk, 2000).

In terms of fidelity in steady relationships, a significantly higher proportion of exchangers versus nonexchangers reported having cheated on a steady partner. The qualitative data may shed some light on this observation. While steady partners were considered important to exchangers, many of them indicated casual, nonpaying partners were much more salient in their lives.

Important differences between the exchangers and nonexchangers were identified in their sexual activity with casual partners, both paying and nonpaying. The most significant difference involved oral sex with nonpaying sexual partners. Exchangers were tour times as likely to engage in this act than the nonexchangers, further implicating im·pli·cate  
tr.v. im·pli·cat·ed, im·pli·cat·ing, im·pli·cates
1. To involve or connect intimately or incriminatingly: evidence that implicates others in the plot.

2.
 the importance of the women's relationship with nonpaying casual partners in addition to those with steady and paying partners.

There are several limitations to the findings. The study was not based on a random probability sample of crack users, and the sample size was limited. As a consequence of the latter, we were unable to conduct multivariate The use of multiple variables in a forecasting model.  logistic regression analysis nor analyze the data for differences between crack-using women who never had exchanged sex versus crack-using women who exchanged sex for money. In addition, we collected data only from the women and did not validate their answers through interviews with their partners.

The combined use of quantitative and qualitative methods allowed us to present a more complete picture of the women's lives and to seek further clarification of their answers to the close-ended questions. Nevertheless, more research is needed among a larger sample of women on the role of the different types of partners in the women's lives as well as on the dynamics that lead women to become involved in sex-for-crack bartering. Researchers should explore the involvement in nonheterosexual activities and the prevalence of sex-for-crack exchanges among male crack users. Such knowledge is also important for public health interventions health intervention Health care An activity undertaken to prevent, improve, or stabilize a medical condition  that seek to reduce the risk of sexually transmitted diseases Sexually transmitted diseases

Infections that are acquired and transmitted by sexual contact. Although virtually any infection may be transmitted during intimate contact, the term sexually transmitted disease is restricted to conditions that are largely
, including HIV. Social and health service providers who interact with female crack users would also benefit from this knowledge.

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Manuscript accepted August 28, 2000

This research was supported by funding from the National Institute on Drug Abuse (RO1DA10642 and RO1DA09819) and the Emory/Atlanta Center for AIDS Research. The views presented in this paper are those of the authors and do not represent those of the funding agencies.

Address correspondence to Claire E. Sterk, Emory University Emory University (ĕm`ərē), near Atlanta, Ga.; coeducational; United Methodist; chartered as Emory College 1836, opened 1837 at Oxford. It became Emory Univ. in 1915 and in 1919 moved to Atlanta. , Rollins School of Public Health The Rollins School of Public Health (RSPH) is the public health school of Emory University. Founded in 1990, RSPH has more than 850 students pursuing master's degrees (MPH/MSPH) and over 100 students pursuing doctorate degrees (PhD). , 1518 Clifton Road Clifton Road is main street in Clifton neighborhood of Saddar Town in Karachi, Sindh, Pakistan.

Its name dates from the British Colonial rule, and its market is posh areas of Karachi.
 NE, Atlanta, GA 30322; e-mail: csterk@sph.emory.edu.
COPYRIGHT 2000 Society for the Scientific Study of Sexuality, Inc.
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Author:German, Danielle
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Date:Nov 1, 2000
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