Angela Jackson strides down Pennsylvania Avenue with pamphlets under her arm, unfazed by the line of dealers hawking drugs beneath blinking police cameras. "James Brown, James Brown!" cries one young man, applying the late soul star's name to his heroin capsules. "Ray Charles, Ray Charles!" cries another.
Places like this are utterly familiar to Jackson, who once supported a heroin addiction by selling sex to men eager to step into an alley or vacant building. Today, she spots someone who's trolling for customers as she once did.
"Hey, miss, you have a minute?" Jackson says to an emaciated woman with hollow eyes. "We're giving information about HIV and condoms." But the woman drifts by, vanishing into an alley.
"I was just like her," says Jackson, 44, who left a life of prostitution nine years ago, found housing and began treatment for HIV. "There's hope for everybody."
There aren't enough hopeful stories like Angela Jackson's. Often homeless and desperate for their next fix, women who exchange sex for drugs are an elusive group for public-health authorities. Many are caught in an incessant rhythm of tricking and drug use rooted in the sexual abuse they suffered as children.
Despite millions of dollars spent on HIV/AIDS programs, the city until recently has taken only a piecemeal approach to helping these women break the cycle. Baltimore's health commissioner, Dr. Joshua Sharfstein, asserted recently that the city lacks a coherent strategy for curbing HIV infections. He vowed to sharpen the focus.
The renewed focus comes at an important juncture in the history of the city's HIV epidemic. With additional people catching the virus each year and better treatments prolonging life, the number of infected residents has more than doubled over the past decade - reaching nearly 16,000 last year.
Women who trade sex for drugs play a central role in spreading the virus, contributing to Baltimore's ranking as the city with the second-highest rate of AIDS diagnoses in the United States. They are "core transmitters," experts agree, because as a group they have high infection rates and large numbers of partners.
Prostitution may be the direct or indirect cause of 20 percent to 40 percent of new infections, estimated Dr. William Blattner, director of epidemiology at the University of Maryland's Institute of Human Virology.
"I think there are certain taboos to even admit that it exists," said Blattner, also co-chairman of the Baltimore City Commission on HIV/AIDS.
"Part of it also is that this is a culture that's very marginalized and hard to wrap your arms around. These people don't pay taxes, don't get counted in the census. It's a forgotten group. It's also one that doesn't raise a lot of voter sympathy," Blattner said.
Women like Jackson who shared their stories with The Sun described a nomadic existence that made it difficult to even contemplate entering treatment for HIV, let alone sticking with it. Those sleeping in vacant buildings lack refrigerators to store medications, addresses to leave at a doctor's office and the confidence of knowing where they're going to stay the night - and the night after that. Advocates say housing is one of this group's greatest needs.
Sharfstein acknowledged that more can be done to stem the spread of HIV among the women and their customers. "There are pieces of different things addressing the problem," he said. "But I think we need to address whether a more systematic approach is indicated."
Recently, he announced the department's first efforts in that direction. Twice a week as the sun rises, the city will dispatch a van staffed with outreach workers just as women start seeking customers to feed their addictions.
On Tuesdays, the van will appear at Monroe and Ramsay streets in West Baltimore, and Thursdays at an east-side location also known for prostitution.
"My primary focus is the women exchanging sex for drugs and money," said Chris Serio-Chapman, director of harm reduction for the city Health Department. "We were missing an entire portion of the day when a lot of these women are awake, outside, providing services to their johns."
The genesis of the idea occurred several months ago, Serio-Chapman said, as she reflected on the absence of programs aimed directly at this population. The city's needle-exchange and testing vans attracted some women engaged in sex work, she said, but didn't offer the concentrated services that the women required.
Sharfstein said that finding $70,000 for a one-year pilot program was "an easy call" because of Serio-Chapman's interest as well as The Sun's inquiries about how the city was addressing the problem.
The department's initiative will start in January. The Health Department and Power Inside, a nonprofit group in East Baltimore, will offer not only HIV testing and clean drug needles, but also counseling and referrals to medical care and housing assistance.