Awakening as a change process among women at risk for HIV who engage in survival sex.

Women who exchange sex for survival requirements risk exposure to the human immunodeficiency virus (HIV). This grounded theory study was conducted to better understand these women's concerns, attitudes, and behaviors related to HIV, with the goal of informing prevention research. Interviews with 11 women engaged in survival sex were analyzed. Women described sliding into survival sex as a result of economic crises. Survival sex exposed women to violence, drug use, sexually transmitted infections, and HIV. Mitigating these risks is a process of awakening in which women reconstruct risk and survival and make changes in their behavior. These findings highlight the complexity of the problem of survival sex and suggest interventions to help women protect themselves against HIV.