An activist hooker speaks out on safe sex

But again, the concept of "safe" keeps changing. This year I began to read about the possible dangers posed by monthly ovulation and the likely benefits of the Pill. I was horrified and humbled by the realization that my Pill-taking friend -- the self-confessed sexual amateur who'd slept with perhaps seven men in her entire life, who once told me "there has to be a patina of respectability" when she goes to bed with a man -- had probably done a better job of protecting her ovaries and her uterus than I had! While practicing safe sex with condoms and reducing one set of risks, I had inadvertently exposed myself to other risks.

I called up a fellow activist, an ex-prostitute with a Ph.D. in public health who frequently gives lectures on how to reduce HIV risk among sex workers. I railed about the possible harm caused by our movement's obsession with HIV -- condom-using sex workers are exposing their ovaries to possible cancer for years on end!

"Is it possible that, in some cases, a female prostitute is more at risk of contracting ovarian cancer than HIV? That if she had to choose between the Pill and a condom she might, because of her particular style of working, be safer with the Pill?" I asked.

I expected her to cluck disapprovingly. HIV after all is a sacred cow. I didn't know what she would say about the ovarian cancer risk posed by monthly ovulation. Just another crackpot theory?

"Actually," she said, "I think there's something to it. In the Netherlands, a lot of prostitutes use Depo-Provera. Their work schedules aren't interrupted by menstruation and they use condoms, too." She surprised me by agreeing that a sex worker's HIV risk can be grossly exaggerated. But we both felt that saying this too loudly in the prostitutes movement would be perceived as irresponsible.

Just as professionals are often divided from "amateurs" by their attitudes toward safe sex, testing and risk, prostitutes themselves are sexually factionalized.

There is the faction that always uses a condom for oral sex. There is the faction that prefers to but sometimes goes without.

There's also a generation gap. Call girls and madams of a certain age, who still embrace the free and easy mores of the '60s and '70s, are often repelled by the idea of performing oral sex with a condom. Or they have trouble taking the idea seriously.

Prostitutes in their 20s and 30s are accustomed to taking extra precautions. They're often impatient with relaxed sexual attitudes. "Forget it!" a friend once said, describing a madam's special request. "Never! It's not worth getting gonorrhea of the throat for $300."

It's commonly accepted that while AIDS is the harbinger, the use of latex protects working girls against less deadly bugs. Despite all the talk of death, the working girl feels she is winning a daily, weekly, hourly battle with mundane things like trichomoniasis, nonspecific vaginal infections, gonorrhea and chlamydia.

But some professionals feel justified in making exceptions. "I have a regular who is so biiiiiig," says another girl. "I just can't get a latex condom onto him. We've tried everything, even the larger latex ones." When she confessed to using a rolled Trojan lambskin, she quickly added, "I put nonoxynol-9 in the tip, just in case." Why, some readers might wonder, doesn't a successful call girl just drop a client if he's too well-endowed to deal with a latex condom? Nobody knows better than she that we're experiencing an economic boom.

"I like him," she shrugs, "and he's really quick. I know latex is the safest and lambskin's kind of risky. But really, I think the risk is minimal."

Safer sex is harder sex. In assessing a client's value, some prostitutes just look at his price. Others realize that a client's true "price" or value isn't just what he pays.

"My safest client," says my friend with the well-endowed client, "is a guy who takes forever in bed. I don't mind because he's so ultrasafe. But he's a lot of work. I feel drained after he leaves. I know he would come so much faster if I took off the damn condom ... Sometimes I'm tempted. I could just take that thing off and he'd be done! It's very tempting. But life is full of temptations, isn't it?"

• View blog reactions