Dr. Alexa Albert is a researcher on human sexuality issues. She is the author of the recently published "Brothel: Mustang Ranch and Its Women" (Random House, 2001), based on studies she conducted on condom use at a Nevada brothel. A graduate of Harvard Medical School, Albert is a pediatric resident at Children's Hospital and Regional Medical Center in Seattle.
I didn't go to learn, "What's a nice girl like you doing in a place like this?" But to learn, "What's a nice girl like you do in a place like this?" Do, that is, with condoms.
The place was Nevada's Mustang Ranch, the state's most famous legal brothel, and the "girls" were the licensed prostitutes who worked there. The time was the early 1990s, a period of acute public awareness about and fear of AIDS. After three years of lobbying, I had finally persuaded the Nevada Brothel Assn. to grant me permission to conduct a public health study at Mustang Ranch.
Nevada's legal brothels are a remarkable public health story. The only state in America to permit legalized brothel prostitution, Nevada requires its licensed prostitutes to undergo regular exams for sexually transmitted diseases, including monthly HIV tests. Since HIV testing began in 1986, no brothel prostitute has tested positive, and the incidence of other STDs has been negligible, according to the state. Nevada also requires customers to use condoms for all sexual activity.
Fully aware of how few outsiders had ever been allowed inside to research Nevada's brothels, I nervously left my home in Boston for Nevada. I wanted to learn exactly how prostitutes were using condoms. The fact the brothel workers were having sex with many different men each day, while maintaining impeccable health records, suggested that women were using condoms effectively. What could they teach the rest of us--especially us women who might assume there's not much to learn?
Before starting my study, I had to seek the cooperation of the prostitutes. "You want me to save the rubbers?" one woman asked, incredulous, when I asked her to collect her used condoms so I could examine them for breaks. Despite some resistance, everyone obliged. One brothel customer even insisted that his used condom be distinctive--it was tied up with a red ribbon.
Over the course of my three-week study, I learned a great deal from my interviews with the prostitutes about their condom use. For one, I confirmed that these licensed prostitutes were complying with Nevada law requiring condom use in brothels. And although the women used an average of six condoms a day, they experienced negligible breakage or slippage of the condoms. Studies have shown that the more experience a person has with using condoms, the less likely it is that a condom will fail from incorrect use.
Some of us have faced a partner who doesn't want to wear a condom; the Mustang Ranch women also encountered this. In fact, more than 65% of the women said that at least one of their customers had balked at wearing a condom during the previous month.
Some men tried the classic excuses: Condoms decreased sensation and prevented them from reaching orgasm. They used other tactics as well, such as telling the women "you'll have a better time" if they didn't use condoms, or promising to "pull out" before orgasm. A few offered the women extra money--as much as $1,000.
None of the women I interviewed said that she had caved and taken the money to have unprotected sex. Instead, the women said they used various verbal comebacks, both earnest ("I don't feel like playing Russian roulette today") and provocative ("Nothing against you personally, but I thought you'd want to know I didn't use condoms with the guy before"). When all else failed, they tried the blunt approach: "Honey, if you don't like it, the door is over there."
Women also turned the condom into an erotic accessory, incorporating it into foreplay. Nearly half of the women said they could sneak the condom on during fellatio, with some men not even noticing until after sex. Instead of being angry, the women said the men reacted with "awe" and "amazement" at their skillful use of condoms.
Clearly, the Mustang Ranch women had something going for them that some others don't: Nevada's condom law. More critical, perhaps, was these women's ability to transform condom use into a positive experience for their partners. They showed how women can take charge of the condom and still make sex pleasurable.
Despite the recent paucity of media attention on HIV and the availability of new treatment regimens, HIV remains a very serious public health problem. According to the federal Centers for Disease Control, the rate of HIV infection remains higher among ethnic and racial minorities, particularly their women and youths, than other groups. There is a need for continued promotion of ways to reduce the risk of infection.