CDC AIDS Project 72: The Prostitute Study

In the early years of the AIDS epidemic, the occurrence and potential for heterosexual transmission of human immunodeficiency virus type 1 (HIV 1) in the United States were uncertain. To better understand infection among women and the possible role of prostitution in the emerging epidemic, the Centers for Disease Control and Prevention established CDC AIDS Project 72, a multisite study of 1 410 women with recent histories of prostitution recruited from eight areas of the United States during 1986 and 1987. Participants were interviewed, examined, and tested for serologic markers of HIV 1, hepatitis B virus (HBV), syphilis, herpes simplex virus types 1 and 2 (HSV 1 and HSV 2), and human T cell lymphotropic virus types I and II (HTLV I/II). HIV 1 antibodies were detected in approximately 12% of women tested, but prevalence varied considerably across study sites. HSV 2 was the most commonly detected infection, followed by HSV 1, HBV, syphilis, HIV 1, and HTLV I/II. HIV 1, HBV, and HTLV I/II were strongly associated with injection drug use, whereas syphilis and HSV 2 followed different patterns related to sexual exposure. Among women without evidence of injection drug use, infrequent condom use during vaginal intercourse with clients was associated with HIV 1 infection. Project 72 showed that prostitution alone did not explain infection risk among these women. Injection drug use, sexual and injection networks, local prevalence of infection, and the social circumstances in which women lived and worked were also important. The project contributed to an evolving public health approach that emphasized epidemiologic evidence, cooperation with affected communities, and practical strategies for reducing risk rather than assumptions about stigmatized populations.