The premise is Sonja Blue is the adopted persona of a young heiress who disappeared a couple of decades prior. Imprisoned inside a metal hospital, but only recently, she has a fascinating history the reader slowly discovers. Sonja is a "living" vampire who has managed to maintain most of her humanity upon her traumatic transition from rebellious teenage girl to vampire. Forced to work as a prostitute, eventually becoming a hunter of her own kind, Sonja must cope with the traumatic physical as well as psychological changes that have turned her from Denise Thorne to Sonja Blue. A vampire who struggles with a personified embodiment of psychopathia and hunger called "The Other" (who may be a demon or may be not).
The book's biggest selling point and what makes it interesting is it is a punk horror book, not a romance. It is about a young woman from a privileged background who survives a traumatic event (her literal rape accompanied by turning) before building herself back up on the margins of society. There's not a whiff of romance about being a vampire here and being the nicest vampire in the world means she's still a vicious hardcore killer. It's just most of her victims deserve it and she prefers to hunt on "Pretenders" (monsters living among us Muggles).
The punk themes are embodied by the primary villain being religious hypocrite and televangelist con woman, Catherine, exploiting her followers through the use of psychic powers. She has endured a life almost as horrifying as Sonja's but it has made her even more determined to be the boot rather the ant. Honestly, Catherine doesn't work that well as a villain because she seems fairly weak tea compared to Sonja's other opponents and her motivations are almost incidental to our heroine's problems. We also have Sonja's bisexual British Renfield and much time devoted to how society craps on women in general (which our heroine still suffers from because she needs money). Effectively, she just has our heroine imprisoned so she can keep bilking her parents but doesn't even know Sonja is a vampire for most of their relationship.
One thing I really liked about the characters is they all had surprisingly three-dimensional characterization and backstories which were all plausible. Claude is a pudgy ex-football player who gets caught up in circumstances beyond his control. Catherine is a "white trash" character who comes from an abusive fundamentalist background. Sonja's mother and father (or more precisely, Denise's) are both hit by her "death" differently. The book is incredibly violent and doesn't make any apologies about the fact vampires are monsters--incredibly dangerous ones at that. One of my favorite scenes in the book is when a convenience store clerk describes his encounter with a hold-up that Sonja "interrupts" and ends with a housewife finding the unfortunate stick-up artist dead in her trash cans. There was a kind of bleak humor that is found throughout.
I have to say that I have some criticisms about this book but I also feel kind of iffy about giving them. They're stylistic choices that probably explain why the book won a Stoker award versus a more generic format. This book is a anachronically ordered series of vignettes which are primarily concerned with how it feels to be a vampire as well as her life. Much of her history is told in flashbacks and exposition that still give a great sense of what a craptacular life she's lived. It switches from Claude's perspective to Sonja's to Catherine's to her minion's to Sonja again many times. Characters like Claude become irrelevant despite strong openings and are less important than the narrative implies they'll be. I felt this book hit me in the gut several times and I appreciate that but other readers may have issues with it. I confess, if I was the writer (which is always a dangerous thing to say), I would have gotten to Sonja's perspective and backstory earlier but I'm not a world-famous vampire writer.
In conclusion, this is an excellent Gothic Punk novel and perfectly fit the themes of books of the time period that laid the groundwork for what I liked about Vampire: The Masquerade and other dark fantasy fiction. It's violent, unapologetic, dark, and definitely of the horror genre--which is why it's awesome.