Pathways to prostitution: The chronology of sexual and drug abuse milestones

To assess the sequence, timing, and prevalence of sexual and illegal drug use milestones in prostitute women, we interviewed 237 prostitutes in the community and 407 comparison women at an STD clinic. Drug use was more commonly reported by prostitutes than comparisons (86% vs. 23%), as was non‐consensual prepubertal sex (32% vs. 13%). Sexual‐ and drug‐related milestones occurred in the same order in both groups, with drug use preceding sexual activity and injecting drug use preceding prostitution. Ninety‐four percent of prostitutes who injected drugs reported noninjectable drug use before prostitution, and 75% of prostitutes who injected drugs reported doing so before beginning prostitution. The age distributions at critical events were similar for prostitutes and comparison women who reported regular drug use. Comparison women who did not report regular drug use were in general older than both these groups at the time of early sexual experience and drug experimentation. However, the ordering of these events was the same. Within the prostitute cohort, ethnic groups differed in their age distributions at several critical events, but not in the order in which these events occurred. Information reported by prostitutes on sex‐ and drug‐related milestones was reproducible on reinterview a year later. Further research is needed to develop a coherent understanding of the relationship of underlying psychological and environmental factors to the observed progression from substance abuse to prostitution.