She is a tiny, sweet-appearing student on summer break from a Small Community College – we’ll call it SCC*. Short, curly hair pulled back in a cloth hairband, soft ringlets springing out around her forehead. Pretty eyes. Wears a long cotton skirt and cowboy boots. A bit of a throwback, I think.
She asks if every 3 months is frequent enough for HIV testing. I look at her chart, and see that her last HIV test was just 3 months ago.
Why?” I ask. “Have you had a new partner since your last visit?”
“I’ve had a few,” she says.
“Well,” I prompt, “how many in the past month? ”
“A lot.”
Ah, I think. She’s in that post-high-school wild phase. We’re going to have to talk about this. “Give me a number.”
She looks upwards for a few seconds. “I don’t know,” she says finally.
Oh, c’mon, I think. Tell me. I recall my own post-college wild years. You can’t top me. So, let’s play numbers. “More than 10 or less than 10?”
“More than 10.”
In the past month? “More than….20?” I keep my voice steady, my tone neutral, non-judgemental.
“More than 20,” she replies.
The light bulb went on. “You’re a prostitute,” I say.
She nods. I look up to be sure the door is closed. “May I ask why?” I inquire.
“I’m saving for college tuition,” she states, also turning to check the door.
We settle in for the discussion.
She got accepted at a Brand Name University. You know the kind of school – may or may not be Ivy League, but very hot, suddenly impossible to get into. We’ll call it BNU. Dad cannot afford the high end tuition at BNU, but makes too much money for her to qualify for financial aid. He can only afford the local community college. Hence the freelance job.
She earns $1,000 a day, and has saved over $40,000 so far. When she gets enough, she’ll have finished her associates at SCC and will re-apply to BNU.
“Didn’t you talk to the financial aid office at BNU? Can’t you take out loans?” I suggest.
She doesn’t want to borrow money, and turns up her nose when I press the idea further. As for BNU’s financial aid office, they were mean, she says. Said “Just tell us if you’re coming, because if you’re not, we have a waiting list full of other applicants.”
I begin to get angry for her. “How can they be that way? Don’t they know how much their decisions affect people’s lives?”
I have an idea. “Let me call the Dean at BNU.” (Not that I even know who the Dean is, but when you get to be my age, you feel you have the right to talk to anyone, whoever they are. My tone conveys this conviction.) “If he knew this was what BNU’s high tuition has led to, I’m sure he’s get them to help you out.”
But she refuses to let me intervene. That’s okay, I still believe that I can work this angle for her, and I think perhaps I’ll just call that Dean anyway and feel him out. But in the meantime, I offer to refer her to a college counselor. No response.
I start running my rolodex through my head, trying to figure out who I can call to help this poor kid out. Then it occurs to me. She is not homeless, she is not starving, she is not a kid with no future. She is just a really bright kid whose only option right now is a local community college and not a Brand Name University. This is not such a terrible place to be. Certainly it can’t be bad enough to justify the risks of prostitution.
I tell her this. She seems to be listening, so I go on. I tell her that where she gets her degree does not define whether or not she will be a success in life. If she really is as good as student as it seems she is, she will learn what she needs to know just as well at SCC. She wants to go into business (no comments, please). “Do you really think they will teach you to put the debits on the credit side of the ledger at SCC?” I ask her. This elicits a smile.
I figure she still hasn’t tuned me out, so I tell her my story. How I didn’t even get an interview at the Hot Shot Medical School. How I ended up going to the Local University Medical School and Very Local Community Hospital Residency Program. And how my first job post-residency was on the faculty of that very same Hot Shot Medical School. Not bad for a low-end degree, huh? “Where you go to college does not determine your life,” I tell her. “You do.”
No go. Because as we talk further about the risks of her behavior, it becomes clear that the real problem is that she does not think what she is doing is at all stupid. After all, she uses condoms religiously. And what’s the risk, anyway, of getting HIV if you always use a condom? I’m not sure of that number when one has as many partners as she does, so instead I tell her a story about a patient who got HIV when the condom broke. I’m not sure she believes me.
“Besides”, she contends, “I’m not having anal sex, and I don’t swallow. And the condom has never broken.”
We talk more, juggling numbers, estimating risks, talking odds. Then it is clear she is finished the discussion.
So I wind it up, taking one final stab at my own argument. “Look”, I say. “Think of it this way. That degree from BNU is like a pair of Calvin Klein jeans. You can get just as cute a pair on sale at Old Navy. And you’ll still be alive to wear them.”
She smiles. “I love Calvin Klein.”
———————————————————————————————-
*This is a story I had posted and immediately pulled awhile back. (See this post about why.) I’m reposting it now because I asked for and obtained her permission to tell this story. Of couse, identifying details have been changed, personal information disguised, and HIPAA privacy rules maintained.
Category: Second Opinions
Excellent post. Well done.
I’m really glad you re-posted this article. There’s a customer at my business who needs to read it. It left me with a shiver down my spine and dropped jaw!
Gary Tijuana thoroughly enjoyed this post. Thanks for giving me an internal debate to entertain for a while.
I dont know how old this story is, but I thought about it when reading an article in the Dallas Morning News this morning. The article was about this 17 yo whos father cut him off from his college funds because his son is a democrat and the father said as long as he is against Bush he will have no money for college. This child refused to give up his beliefs and started a website , like that one kid who sold pixels for 1.00 a peice, to send himself to college. The point is , there are other ways to make money for college and this kid has already raised 30.000. It just takes initiative and creativity.
Wow. I was fascinated by your response, not that it was wrong, or bad, but just sort of unexpected that you’d use anecdotal evidence.
From what you’ve said here, it seems that your perception of the two schools is based on what she’ll learn, and her perception seems more based on the value added by the brand naming.
So why not go evidence-based with her, and see if her perception of added value is really valid?
Look up (or have her look up) information on [female] grads of BNU and of Local State U, and see what the data says about percentages with jobs after graduation, average salaries for graduates, grad school placements, and so forth.
(You or she can probably get this information with a few calls to the schools; talk to the departments that teach business related subjects, and to related student clubs. If you can’t get it there easily, check with the accredidation organization for the schools. But most schools use this sort of information in their recruiting, so have it available.)
Then look up long term information on local female business community leaders and see whether their backgrounds are from BNU or Local State U type schools.
I suspect you’ll find that her perception of added value isn’t totally wrong, but maybe the added value isn’t nearly what she thinks it is, and maybe that information can be part of her balancing the risks, opportunity costs, and so forth of her current decision?
Bardiac:
You make lots of good points, as usual.
So, OK, let’s do the math.*
Assume 0.5% of heterosexual males is infected with HIV in NYC (Data from NYC DOH)
Assume the risk of HIV from an infected male in a single act of unprotected intercourse is 1-2 per 1000 (based on data form discordant couples.) I’ll pick 1.5 because it is halfway.
Assume 0.8% condom breakage rate (the rate reported among sex workers in the Netherlands)
So the risk of HIV from a single act of protected intercourse with a NY male of unknown status is 0.005 x .0015 x 0.008 = .06 per million
Let’s say she make $150 per act (we’ll assume she provides middle range services, she’s only just started out there,I doubt she’s got a cushy high end clientele just yet). And let’s say she needs $40,000 annually for tuition and living expenses. (Based on actual numbers from BNU). That means she’ll need 300 partners to earn enough for 2 years.
So the risk our girl has of acquiring HIV is 300 x .000006 or 1.8 per 100,000. I don’t think she has plans for grad school yet, but you can do that math.
By the way, finding the right assumptions to do that calculation took me almost an hour of online research, which, in case you are wondering, is why I went for the anectodal (and true) story in my 15 minute office visit with my patient. Now that I have the number, I’ll be better prepared for the next hooking student who comes to see me in the middle of a busy morning asking for HIV testing.
It’s not too high a risk, I agree, but let’s compare that to the risk taken by a young women out there having unsafe sex with a guy they meet at a bar. That number is 0.005 x .0015 or .75 per 100,000. Three times would be 2.4 per 100,000, an equivalent risk to the one my patient is taking.
So a similar question might be – would you have unprotected sex with 3 different strangers in return for 2 years of college tuition? I wonder how she would have answered that one (probably in the affirmative…) Of course, lots of my patients do this for free, although the act is often made under the influence of alcohol, is usually regretted, and is often followed by 3 months of fear waiting for the negative result.
Finally, I won’t argue with you that a degree from the BNU’s of the world carry more weight in the job market, open more doors and in general make life a hell of a lot easier. But I don’t believe those degrees are worth the price she is paying. I can’t quantify that price, because I don’t know what number value to give to that which is lost by prostituting oneself.
* References available on request, this comment is long enough without a bibliography.
Instead of condom breakage rates, I could have used the oft quoted rate for condom effectiveness against HIV, which is about 95%. Using that number her overall risk for aquiring HIV would be about 1 in 10,000, a much higher number.
Does entering the military count as prostitution for tuition?
$150 per act? You must be joking. A college girl as cute as you described is pulling in a MINIMUM of $500 per hour. More likely closer to $750. Check out TER or any similar site to confirm the numbers. The fallacy in your assumption: an escort’s rates are less determined by how long she’s been in the business (and established a “cushy” clientele) and a lot more by 1) how pretty she is and 2) how young she is. And if she’s Brazilian, the sky is the limit.
Its the same reason that its impossible to “save” a stripper: they make a shedload of money. And trying to convince someone pulling down the equiv. of $300-$350K/yr. at 19 (!!!) that they are better off working at Starbucks for $10/hour because it is “safer” is going to be a really tough slog. I know that at 19 I was doing some pretty stupid, dangerous stuff, and giving me a rational explanation of why it was dangerous and stupid to drop acid and then drive a car would not have had much of an impact on the decision.
I also suspect that calling the Dean at the fancy branded college would be fruitless, and in my opinion misdirected. How students earn money to attend is ultimately not their responsiblity – very few take up protitution, but I’m sure some deal drugs, and maybe some parents are guilty of insider trading etc. to try and raise the cash. The school can’t be responsible for every stupid thing a potential student does to pay for it.
Finally…Not all hookers want to be saved… nor do all of them need to be. It is called the oldest profession for a reason, because its fairly easy, and its very lucrative.
Statistically speaking, the AIDS risk is too low to be an effective counter. Money is a much better motivator….
-Karl
Wow, impressive, and convincing numbers. Thanks for the explanation.
If she’s business minded (and she sounds it), I think she’ll see that even on the most basic level, the risks outweigh the potential benefits of branding.
Maybe also remind her that once she’s not supported by her parents for a year, she should recheck her eligibility for financial aid, since self-supporting makes a huge difference.
I can’t stand when people say they don’t want to get loans … I don’t see the reasoning.
So smart yet so … I dont know the word I am looking for.
perhaps instead of scaring her with HIV, you can scare her with tales of abusive and violent clients… find percentages of hookers who’ve gotten beaten up, and if she’s had a couple of rough clients herself, she’ll be more inclined to listen, perhaps…
Heather B said…
I can’t stand when people say they don’t want to get loans … I don’t see the reasoning.
I’ve got recent student loans. I had to take them out because my parents were, like the subject of the post, deemed to have made too much money for me to recieve proper financial assistance. The average interest rate on these loans is around 5-6%apr and the total amound of the loans is approximately twice what I make in a professional financial industry after any bonuses and before taxes.
My monthly student loan payment is more than my rent and utilities combined and, as far as I can tell, I’ll be paying it for at least the next 5 years.
Because I have these loan payments to make every month, I lose the freedom and financial independance that people usually get with these jobs. I can’t travel, I can’t go out much, I can’t put away for retirement, I can’t buy a place, I can’t even afford a car.
So is sleeping with 300 strangers over the course of a year or two worth the 7-10 years of financial stability and freedom after school? If anything, I’m surprised more people in this situation don’t chose to do it.
I dunno. I knew a prostitute in college (she told my girlfriend, who then told me).
Was she better off for having gonr to a relatively BNU and sleeping with people?
I don’t feel I can make that decision for her. I can’t say I think she was wrong. Don’t forget, when you do your numbers, to account for the reality that poor people have increased health problems in general. You’re probably better off working as a prostitute and being able to afford health insurance, food, vitamins, and doctors, than the reverse.
I found this post from Grand Rounds at GeekNurse.
When I graduated from college in the late 80’s HIV wasn’t as big of a deal – but this was in NYC and so people were dying of AIDS. I attended a very expensive women’s only college and know there were a number of girls in my dorm working as prostitutes because it was such good money. I never knew any street walker types but there were plenty that worked on call meeting older wealthy business men in hotel rooms.
Obviously it isn’t something I’d advocate but I have to believe that college administrators at expensive urban schools are aware of the practice and what a premium smart, cute college students can make.
I’m afraid you misstated the calculation. If the chance of a “hit” for each trial is p, and there are n trials, the odds of (at least one) hit over n trials are not p*n, but 1-(1-p)^n.
In this particular case, the difference is lost in rounding to 2 significant digits. If the base chance or trials get much higher, it starts to show.
For example, figuring in even a small chance of being raped without protection (a common hazard for prostitutes) would probably give a much scarier number.
Oh, and a prostitute should probably be getting HIV tests at least monthly.
After what everyone has said – I’m still left with one word “wow.” That was a wonderfully written and very insightful post. And it got me thinking because I’m hoping I will make decisions about which grad school to attend soon (if I get offers) and finance is an issue but not so much of an issue because we will get funding through our supervisor.
I can understand why the girl might feel there is a need to do this – hmm but what if she made it to BNU but contracted HIV? Would she think this is worthwhile still? It feels to me that this is an issue of priority and frankly sometimes I have thought that if I were to get really sick again at grad school, would I want to choose an easier path and have less chance of being sick or be sick and fulfill my dreams to be at grad school? (I know this is not long term thinking…)
To Joe:
Hang in there – you’ll get the loans paid back. I graduated with over $100 k in student loans from med school. Like you, I didn’t ahve money to travel, I drove a used car till I was 35, we ate in instead of out. These things are not the end of the world. There are people out ther who are starving, people who are homeless. We forget how truly privileged we are when we live surrounded by such excesses.
I still don’t think these trappings of success in our society warrant prostituting one’s self.
Oh, and one piece of advice from someone whose been there. Don’t use student loans as a reason not to contribute to your retirement plan. I did that, and it was stupid, stupid, stupid. Especially if your employer matches your contributions. I know it seems like you don;t have the money, but please do waht it takes to make those contributions. You won’t regret it, I promise.
David Harmon: Oops – you’re right. Thanks for correcting me. And thanks everyone else for your comments and advice. This was a tough one…
OK, we’ve done the HIV risk-benefit analysis. I’m more interested in the non-quantifiable losses (re: tbtam’s earlier comment). A young woman – what happens to her sexuality? A BNU degree hardly seems worth selling one’s soul to the Devil
Stuart
http://news.yahoo.com/s/ap/20060316/ap_on_re_us/stanford_no_tuition
Please read the above article on how some big name schools are helping out families…
This post really affected me, and not in a “…I feels so sorry for her…” kind of way. This woman is a perfect example of the spoiled rotten 20 somethings that are emerging into the world today.
The entitlement attitude of today is (to use an overstated term) pandemic. Focus on name brand, high style stuff is extrordinary, and the youth of today want it all NOW and honestly think that they deserve it. Hell, my own 9 year old is saving for a $200 iPod – Lord knows I won’t buy it for him.
So much of society today is shaped by the “fabulous” lives that are ever-present in the media. Jessica Simpson makes the Yahoo! headlines when she goes shopping, and shouldn’t every young girl get a $30,000 LV trunk? Afterall Jessica just sings, right?
Your patient’s closing remark about really liking Calvin Klein sealed the deal for me. She wants everything, and doesn’t care about what it takes to get there – however damaging to herself. After all, she deserves the big name school and all the stuff to go with it, right? She is ambitious, I’ll give her that, but damn the consequences. What she is doing for the sake of entitlement is putting herself in danger physically, emotionally, and legally. But she wants money fast and easy, and so this is the road to get there.
Am I being judgemental? You bet. I find it reprehensible that someone will eventually wind up in the kind of trouble that is dire, and more or less knows it along the way. We all pay for those who don’t contribute positively in society.
I like my stuff, and I have worked really hard to have what I have. I have longed for the free-gift and easy outs, but I have never EXPECTED it. I hope some day that the entitlement attitude goes away, and that young people don’t shy away from work so easily. Liklihood? Next to nothing…and I don’t even think I need to calculate those odds!
Wow, this is an amzing post and possibly matched by the comments! It leads me to think which job is tougher, prostitution or being a doctor.
If this were my world men would barely be able to weigh in with comments insinuating that one’s fee is high the work is easy. Try bending over six times a day and buying enough lube to convince your john that you want him.
Someone in my family was a prostute and I will never forget her words, “Easy money comes at a great cost.”
But prostitution is not about sex or merely about money. And HIV is not the only awful disease you can contract by having multiple anonymous sexual encounters.
If said patient feels this is her only option it sounds to me like it’s the one she likes best. I knew the risks of sex work and chose years of working and work study and loans I continued to pay well into my 30’s. I didn’t go to the school that charged more for one year than all my parents made cumulatively.
Thank you for the piece, sharing your experience and hers. Thank you for reminding us all that life is complicated.
Oy, me, that’s no good at all… I’m going to a BNU, but I don’t think I EVER would have considered prostituting myself… the life-ending student loans are worth being alive to pay.
Given correct and consistent use of condoms, prostitution carries virtually no STD risks. Check out the statistics from the legal brothels in Nevada where the women are tested weekly.
In illegal prostitution, the risk of falling victim to violence is however considerable. You should have talked to her about her protection. Does she have a driver? Does the agency do background checks? Does she work in-call only?
Schruggling’s complaints about her “entitlement attitude” are hard to understand. This woman has set her mind to a goal and works very hard for it. I don’t think anybody can deny that prostitution is extremely taxing work, both physically and mentally.
Some people in this discussion appear to be constructing rationally looking arguments because they deep down believe the woman’s choice to be “immoral”. Well, it is not. Few professions are as noble as the direct provision of pleasure to another human being.
Great post, interesting comment. As an adolescent medicine physician at an inner-city clinic, I've had the privilege of working with many girls who are "in the life". For the most part, they know their risk. That's not the issue. Educating them about it is not helpful. The reason why I don't prostitute myself is less about the risk of contracting a disease than about respecting myself. I learned that from somewhere (many places), it is my "normal". Was she ever raped, that ubiquitous but silent experience shared by so many woman and men (girls and boys)? What is her relationship with her father- is she using this as a misguided proxy for love (see the film "Very Young Girls")? What does she feel after these encounters, and how does she manage those emotions? How much work is it for her to ignore those negative feelings?
She likely won't stop selling her body, as it is really lucrative and she's already allowed herself to be disrespected- what is she going to gain by stopping the behavior now? If she was in my office (and she has been), I would ask her about her past. About what she thinks of shame, and strength, and love. Did she see herself having children? Does she have a little sister? That's the way to make it tangible for her- it calls into question her sense of self, not the risks she's taking.
She seems like she's pre-contemplative. I like the stages of change method of asking, on a scale of 1 to 10, what is your likelihood of changing your behavior, and then asking why it's not lower than that. For example, if she says "only a 3", then illicit from her why it's not 1. That will give her room to feel what she's learned so well to bury in order for her to do this work- and the reason why others, like us, could never envision placing ourselves in this position.
Dr Silva –
Thanks so much for this thoughtful comment.
Peggy