Reaching out

November 06, 2007

Baltimore ranks second - behind Miami - on a list of U.S. cities where AIDS cases are spreading fastest. One cause is the large number of women who live on the margins and trade sex for money and drugs. Their harrowing and compelling stories, as detailed this week by The Sun's Jonathan Bor and Kim Hairston, highlight a shadowy world where many urban ills collide.

What's needed is a comprehensive effort, by public officials and private groups, to secure resources and provide services to these women whose private acts of survival have major public health consequences.

The AIDS epidemic here is intertwined with addiction to crack cocaine and other substances, making women who trade sex for drugs "core transmitters," according to experts. Many of these women were victims of sexual abuse as children, and many have turned to drugs as a form of self-medication to deal with their pain and shame.

They often lack an education, a job, a steady income or a home, and they become trapped by their habit into prostitution. Some women can be helped through the criminal justice system. A prostitute might get initial treatment or care for HIV while in jail. And the nonprofit group You Are Never Alone has organized support groups at the Women's Detention Center for a decade, offering women the opportunity to refocus their lives. A proposed prostitution court that would divert women into counseling and treatment also would have a positive impact.

But for hundreds of these women, sex trading goes on in the darker, hidden corners of the drug culture, and they remain unknown to the courts and others who might help. They must be found, and public officials are belatedly making a push to do so.

In January, Baltimore's Health Department will begin a $70,000 one-year pilot program, sending a van out twice a week to the areas where these women often ply their trade. Staffers will offer clean needles and HIV testing as well as counseling and referrals to medical and housing services. That's a good starting point. But it will take even more public and private efforts - and a focused commitment - to provide greater outreach and to ensure that the women's most acute needs, including housing, drug treatment and health care, are available once they decide to accept a helping hand.

As the progress of AIDS shows, leaving these women in the shadows endangers not only them but also an increasing number of city residents.

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