Extent, trends, and perpetrators of prostitution-related homicide in the United States.

Prostitute women have the highest homicide victimization rate of any set of women ever studied. We analyzed nine diverse homicide data sets to examine the extent, trends, and perpetrators of prostitution-related homicide in the United States. Most data sources substantially under-ascertained prostitute homicides. As estimated from a conservative capture-recapture analysis, 2.7% of female homicide victims in the United States between 1982 and 2000 were prostitutes. Frequencies of recorded prostitute and client homicides increased substantially in the late 1980s and early 1990s; nearly all of the few observed pimp homicides occurred before the late 1980s. These trends may be linked to the rise of crack cocaine use. Prostitutes were killed primarily by clients, clients were killed mainly by prostitutes, and pimps were killed predominantly by pimps. Another conservative estimate suggests that serial killers accounted for 35% of prostitute homicides. Proactive surveillance of, and evidence collection from, clients and prostitutes might enhance the investigation of prostitution-related homicide.

Social and geographic distance in HIV risk.

OBJECTIVE: The objective of this study was to examine the relationship between social distance (measured as the geodesic, or shortest distance, between 2 people in a connected network) and geographic distance (measured as the actual distance between them in kilometers [km]). STUDY: We used data from a study of 595 persons at risk for HIV and their sexual and drug-using partners (total N = 8920 unique individuals) conducted in Colorado Springs, Colorado, from 1988 to 1992--a longitudinal cohort study that ascertained sociodemographic, clinical, behavioral, and network information about participants. We used place of residence as the geographic marker and calculated distance between people grouped by various characteristics of interest. RESULTS: Fifty-two percent of all dyads were separated by a distance of 4 km or less. The closest pairs were persons who both shared needles and had sexual contact (mean = 3.2 km), and HIV-positive persons and their contacts (mean = 2.9). The most distant pairs were prostitutes and their paying partners (mean = 6.1 km). In a connected subset of 348 respondents, almost half the persons were between 3 and 6 steps from each other in the social network and were separated by a distance of 2 to 8 km. Using block group centroids, the mean distance between all persons in Colorado Springs was 12.4 km compared with a mean distance of 5.4 km between all dyads in this study (P <0.0001). The subgroup of HIV-positive people and their contacts was drawn in real space on a map of Colorado Springs and revealed tight clustering of this group in the downtown area. CONCLUSION: The association of social and geographic distance in an urban group of people at risk for HIV provides demonstration of the importance of geographic clustering in the potential transmission of HIV. The proximity of persons connected within a network, but not necessarily known to each other, suggests that a high probability of partner selection from within the group may be an important factor in maintenance of HIV endemicity.

Psychiatric and characterological factors relevant to excess mortality in a long-term cohort of prostitute women.

We previously reported on the causes of death in a 30-year open cohort of 1,969 prostitute women. Excess mortality was mostly accounted for by homicide, suicide, drug and alcohol toxicity, and AIDS, with AIDS deaths occurring in prostitutes identified as injecting drug users. Presently, we examine observed mortality trends in light of the literature on personality and psychopathological characteristics reported for prostitute women, and with reports linking such personality characteristics to excess mortality. We observed consistency between the observed pattern of mortality in prostitute women and mortality that would be expected in a sample of persons at high risk for antisocial and borderline personality disorder.

Mortality in a long-term open cohort of prostitute women.

In this study, the authors estimated overall and cause-specific mortality among prostitute women. They recorded information on prostitute women identified by police and health department surveillance in Colorado Springs, Colorado, from 1967 to 1999. The authors assessed cause-specific mortality in this open cohort of 1,969 women using the Social Security Death Index and the National Death Index, augmented by individual investigations. They identified 117 definite or probable deaths and had sufficient information on 100 to calculate a crude mortality rate (CMR) of 391 per 100,000 (95% confidence interval (CI): 314, 471). In comparison with the general population, the standardized mortality ratio (SMR), adjusted for age and race, was 1.9 (95% CI: 1.5, 2.3). For the period of presumed active prostitution only, the CMR was 459 per 100,000 (95% CI: 246, 695) and the SMR was 5.9 (95% CI: 3.2, 9.0). Violence and drug use were the predominant causes of death, both during periods of prostitution and during the whole observation period. The CMR for death by homicide among active prostitutes was 229 per 100,000 (95% CI: 79, 378), and the SMR was 17.7 (95% CI: 6.2, 29.3). Deaths from acquired immunodeficiency syndrome occurred exclusively among prostitutes who admitted to injecting drug use or were inferred to have a history of it.