Thus, in some situations, sex workers are powerless to insist on condoms for safer sex. Like many people in committed relationships, sex workers may find it difficult to discuss condoms or safer sex practices with their partner at home. The illegality of prostitution in the US drives the industry underground and engenders a strong distrust of both police and public health authorities among sex workers. This makes effective HIV prevention outreach difficult. Drug-addicted people may turn to prostitution to earn money to pay for the high cost of illegal drugs.
Many homeless youth have no training or means of support, and rely on prostitution for survival.
Attention to the more immediate concerns of food, housing and addiction often takes priority over future concerns of HIV infection. Some rural counties in Nevada have legal prostitution governed by the state Board of Health. The Board requires that condoms be used for all acts of sex and that sex workers must be licensed and undergo weekly STD tests and monthly HIV tests, at their own expense. Licensed prostitutes receive no sick leave or health insurance, and if they tested HIV-positive would be terminated without counseling or assistance. Outreach workers are former prostitutes who are trained in AIDS prevention.