Night Moves: A Qualitative Investigation of Street-Level Sex Work

Becoming a mother in the context of sex work: Women's experiences of bonding with their children

Many females engaged in sex work are mothers, often experiencing poverty, violence, marginalization, and psychological distress, factors also found to affect parental bonds. However, little is known about how this context impacts the bonding process. Given the ubiquity of sex work across geographical territories, understanding the relationship it has with mother-child bonding is an important international consideration in providing healthcare for sex working mothers and their children. Therefore, in this study we sought to explore women's experiences of bonding with their children in the context of sex work. We interviewed six women in the UK who were sex working during the first two years of their child's life about their bonding experiences and analyzed transcripts using Interpretative Phenomenological Analysis. We identified four themes were identified: (1) the complex process of bonding; (2) the role of powerlessness on bonding; (3) the powerful impact of receiving help, and (4) new perspectives of the body and sex work following motherhood. Findings contribute to the research literature on bonding by emphasizing the value of supportive care and the importance of social context, indicating specific factors to inform psychological support among sex working women.

Short-term interruptions to sex work among a prospective cohort of street-based cisgender female sex workers in Baltimore

BACKGROUND

Street-based female sex workers (FSW) often cycle in and out of sex work engagement. For many FSW, substance use plays a critical role in sex work entry, continuation, and interruptions. We examined individual, interpersonal, and structural correlates of short-term interruptions of sex work among street-based FSW in an urban environment.

METHODS

Data were from 205 FSW in Baltimore, MD, USA followed as part of an observational prospective cohort study between April 2016-Februrary 2018. The primary outcome was short-term interruptions of sex work (stopping sex work) over the past 3 months, asked every 3 months over a 12-month follow-up. We assessed the relationship between individual, structural, and interpersonal factors for each woman's prior visit and current visit with short-term sex work interruptions. We employed modified Poisson regression with Generalized Estimating Equations to identify correlates of short-term interruptions of sex work.

RESULTS

Eighty-two women (40%) reported stopping sex work over the past 3 months at least once during follow-up. Past drug treatment (adjusted incidence rate ratio [aIRR] 1.40; 95% CI: 1.06-1.86) and not having used drugs in the past 3 months (aIRR 2.70; 95% CI: 1.96-3.71) were positively associated with short-term interruption to sex work. Past intimate partner violence (IPV) (aIRR 0.52; 95% CI: 0.31-0.86) and current homelessness (aIRR 0.61; 95% CI: 0.41-0.91) were negatively associated with short-term interruption. Results were inconclusive for the association between recent prostitution arrest and short-term interruptions to sex work (IRR 0.86; 95% CI: 0.40-1.86).

CONCLUSION

The study suggests that similar to other professions, women leave sex work for numerous reasons. Substance use cessation and participation in drug treatment programs may contribute to short-term interruptions of sex work by reducing reliance on sex work for income among street-based FSW. Structural vulnerabilities including homelessness and IPV are driving continued street-based sex work, speaking to the need for holistic structural interventions.

Women in Sex Work and the Risk Environment: Agency, Risk Perception, and Management in the Sex Work Environments of Two Mexico-U.S. Border Cities

Sex work around the world takes place under conditions of structural violence and vulnerability. The México-U.S. border region is characterized by the presence of factors that increase the risk for health harms among female sex workers (FSW); located in this context, the risk environments of Tijuana and Ciudad Juárez have similar yet distinct characteristics that influence how risk is produced and experienced among FSWs. Exploring the ways in which FSWs enact agency in risk environments can illustrate how environmental characteristics shape perceived risks and the strategies that FSWs develop to manage them. This approach also identifies the limits that are placed by environmental characteristics over the capacity for harm reduction and prevention practices among FSWs. We analyzed the role of agency in the work environments of female sex workers and its relationship with risk perception and management in the cities of Tijuana and Cd. Juárez.

Agency and social constraint among victims of domestic minor sex trafficking: A method for measuring free will

Human agency has been a focus of philosophical and sociological concern from early debates about "free will" to recent themes in poststructuralism. Debates over the proper understanding of structure, agency, and constraint are hindered by the fact that few if any empirical measures of these concepts have been proposed. As sociologists have long recognized, the total results of the decisions of a group's members can be viewed as a distribution, and parameters can be fit to obtain a description of observed distributions. Here we propose the use of negative binomial curve to model population survival outcomes, and suggest that the parameters of such a curve represent reasonable surrogates for measures of agency, opportunity, and constraint when the decision process can be thought of as akin to a Bernoulli process. To provide an illustration of this approach, we discuss participation of legal minors in commercial sex (commonly referred to as victims of domestic minor sex trafficking (VDMST) or commercially sexually exploited children (CSEC)). In popular and advocacy-based accounts, considerable focus has been placed on the relative powerlessness of female VDMST. Using the proposed modeling technique, we test the extent to which male versus female VDMST appear to possess greater agency (or function under more limiting constraint) when deciding whether to remain in sex work or "leave the life". Contrary to existing literature, our results indicate that male and female underage sex workers are experiencing similar levels of agency, and differ mainly in opportunity, and constraint. Other individual circumstances are shown to contribute to varying levels of agency and constraint among sex workers, including street work status, community trouble, drug use, and the availability of an alternative income.

Exchange Sex and HIV Infection Among Women Who Inject Drugs-20 US Cities, 2009

BACKGROUND

Women who inject drugs and who also exchange sex are at increased risk for HIV infection, but data on this population in the United States remain sparse.

METHODS

This study assessed the prevalence of exchanging sex for money or drugs among women who inject drugs using data from the 2009 US National HIV Behavioral Surveillance (NHBS) system. Prevalence of being HIV-positive (testing positive in NHBS), HIV-positive-unaware (reporting being HIV-negative or unknown status but testing positive in NHBS), and risk behaviors and use of services were compared between women who did and did not exchange sex. The association between exchange sex and being HIV-positive-unaware of the infection was examined using multivariate Poisson models with robust standard errors.

RESULTS

Among 2305 women who inject drugs, 39% reported receiving things like money or drugs from ≥1 male partners in exchange for oral, vaginal, or anal sex in the previous 12 months. Women who exchanged sex were more likely to be unemployed, homeless, lack health insurance, have multiple condomless vaginal or anal sex partners, and receptively share syringes. In multivariate analysis, exchange sex was associated with being HIV-positive-unaware (adjusted prevalence ratio 1.97, 95% confidence intervals: 1.31 to 2.97).

CONCLUSIONS

Prevalence of exchange sex was high in this population. Women who exchange sex were more likely to be socially disadvantaged, report sexual and injection risk, and be HIV-positive-unaware. They represent an important group to reach with HIV prevention, testing, and care services.

Gender, Race, and Risk: Intersectional Risk Management in the Sale of Sex Online

Sex worker experience of risk (e.g., physical violence or rape) is shaped by race, gender, and context. For web-based sex workers, experience of risk is comparatively minimal; what is unclear is how web-based sex workers manage risk and if online advertising plays a role in risk management. Building on intersectionality theory and research exploring risk management in sex work, we content-analyzed 600 escort advertisements from Backpage.com ( http://www.backpage.com ) to explore risk management in web-based sex work. To guide our research we asked: Do advertisements contain risk management messages? Does the use of risk management messaging differ by sex worker race or gender? Which groups have the highest overall use of risk management messages? Through a multivariate analysis of covariance (MANCOVA) we found that advertisements contained risk management messages and that uses of these phrases varied by race and gender. Blacks, women, and transgender women drove the use of risk management messages. Black and White transgender women had the highest overall use of these phrases. We conclude that risk management is an intersectional practice and that the use of risk management messages is a venue-specific manifestation of broader risk management priorities found in all venues where sex is sold.

“You Just Give them what they Want and Pray they don't Kill You”

Using both qualitative (in-depth, personal interviews) and quantitative (self-report survey indices) techniques, data were collected from 43 women involved in streetwalking prostitution. The purpose of the investigation was to examine exposure to violence and victimization among a particularly vulnerable female population across the life span. A secondary goal was to apply stress theory as an organizing framework for examining personal resources (e.g., social support, locus of control) and coping behavior. Results from both data collection strategies are presented, and implications for intervention are described.

The Sexual Exploitation of Girls in the United States: The Role of Female Pimps

The role of women in the sex trafficking of minors in the United States has received limited research attention. Case study analysis of 49 female pimps from federal, state, and local cases were analyzed to explore whether there were differences in the penalties given to females when compared with their male co-defendants, and cross-case analysis was conducted to identify themes that represent female pimp typologies. Both prison sentence and probation sentences were significantly lower for female co-defendants when compared with their male co-defendants. Five discrete typologies were developed including Bottom, Madam/Business Partner, Family, Girilla, and Handler. Each of these had unique features regarding violence toward their minor victims, co-defendants, actions during the sexual exploitation of the minor, and sentencing outcomes. Implications for practice and future research were recommended.

Street Level Prostitution: A Systematic Literature Review

The aim of this study was to synthesize research on female street level prostitutes for application in mental health practice and identification of future research needs. The data were from reports conducted in Westernized countries on female street level prostitutes between the years 2000 and 2014. Street level prostitutes are at high risk for HIV/STIs, chronic and acute physical/mental health problems, and violence, but there is a paucity of research on resilience and coping skills. We conclude that street level prostitutes suffer severe health disparities, yet they do not seek health care on a consistent basis. It is important for mental healthcare providers to offer women a safe, non-judgmental environment while providing assessment and referral. Future research on mental health consequences as well as resilience and coping skills would support effective interventions that address the women holistically.

Never Innocent Victims

Over the past decade, street sex workers and their families garnered considerable media attention through extensive coverage of disappeared and murdered women in Western Canada. The research presented here examines whether recent media accounts differ from past coverage given that families and friends of disappeared and unaccounted for women inserted themselves into media discussions and circulated alternative readings of their stories. We found that coverage was dominated by two discourses: Vermin-victim discourse demonstrates the tensions between historically dominant conceptualizations and more recent ideas promulgated by families; and risky lifestyle discourse is related to neo-liberal ideologies about personal choice and responsibility.

The mothering experiences of sex-trafficked women: between here and there

This qualitative study focuses on the mothering experiences of women from the former Soviet Union (FSU) who were sex-trafficked to Israel. In-depth interviews were conducted with 8 women who gave birth either in the FSU or in Israel. The women's stories reflect 3 experiential spheres, those of "the good mother," "the sacrificing mother," and "the mother who wants for herself." These mothering spheres were found to exist against the backdrop of a life between 2 countries, where the women's mothering is split between "here" and "there." Furthermore, it was found that the women's sex-trafficking experience continually threatened to invade the 3 mothering spheres and destabilize the balance among them. The splits and conflicts among the mothering spheres are examined from a gendered perspective with emphasis on mother-daughter relationships and on the social constructions of mothering and prostitution.

Violence against women in sex work and HIV risk implications differ qualitatively by perpetrator

Background

Physical and sexual violence heighten STI/HIV risk for women in sex work. Against this backdrop, we describe the nature of abuse against women in sex work, and its STI/HIV implications, across perpetrators.

Methods

Adult women involved in sex work (n = 35) in Baltimore, MD participated in an in-depth interview and brief survey.

Results

Physical and sexual violence were prevalent, with 43% reporting past-month abuse. Clients were the primary perpetrators; their violence was severe, compromised women’s condom and sexual negotiation, and included forced and coerced anal intercourse. Sex work was a factor in intimate partner violence. Police abuse was largely an exploitation of power imbalances for coerced sex.

Conclusions

Findings affirm the need to address physical and sexual violence, particularly that perpetrated by clients, as a social determinant of health for women in sex work, as well as a threat to safety and wellbeing, and a contextual barrier to HIV risk reduction.

A Predictive Theory of Intentions to Exit Street-Level Prostitution

Street-level prostitution is notoriously difficult to escape and rarely do women exit prostitution on their first attempt or without experiencing serious negative consequences to their physical or mental health. Unfortunately, few theories exist that explain the exiting process and those that do exist are difficult to test quantitatively. This article applies the integrative model of behavioral prediction to examine intentions to exit prostitution through attitudes, norms, and self-efficacy beliefs that underlie a woman’s intention to exit prostitution. Constructs unique prostitution—agency and societal context—enhance the model. This theory may explain and predict an exit from street-level prostitution.

Understanding the social and economic contexts surrounding women engaged in street-level prostitution

Prostitution involves the exchange of sexual services for economic compensation. Due to the sexual promiscuity surrounding prostitution, women involved in prostitution constitute a high-risk group for contracting and transmitting STDs, including HIV. Prostitution is not only a public health concern, but also an economic one. Cities throughout the United States spent an average of $7.5 to $16 million per year enforcing prostitution laws and addressing negative outcomes associated with prostitution. Thus, women involved in prostitution are a cause for concern from both public health and economic perspectives. However, little is known about why women remain in this type of behavior given the risks prostitution presents, and even less is known about how to intervene and interrupt the complex cycle of prostitution. Thus, the purpose of this study was to understand what factors contribute to a woman's decision to remain in prostitution. A series of interviews were conducted with 12 women engaged in street-level prostitution. Results of the study revealed that drug use not only spurs entry into prostitution, but also contributes to the tenure of prostitution. Further, social support and economic stability are plausible reasons for women remaining in prostitution. These findings lead us to recommendations for policy and program development. Women involved in prostitution are a highly marginalized population, rarely recognized as individuals with life histories. Understanding why women remain in prostitution is important, because until these determinants are known, intervention programs designed to interrupt the cycle, and ultimately prevent prostitution, cannot be formulated.

Exiting Prostitution: An Integrated Model

Exiting street-level prostitution is a complex, convoluted process. Few studies have described this process within any formal conceptual framework. This article reviews two general models and two prostitution-specific models and their applicability to the exiting process. Barriers encountered as women attempt to leave the streets are identified. Based on the four models, the barriers, the prostitution literature, and the authors’ experience with prostituted women, a new integrated six-stage model that is comprehensive in scope and sensitive to women’s attempts to exit prostitution is offered as a foundation for continued research on the process of women leaving the streets.

Rapid assessment of HIV risk behavior in drug using sex workers in three cities in South Africa

A rapid assessment was undertaken with drug using commercial sex workers (CSWs) to investigate practices putting them at risk for contracting HIV. It included key informant (KI) (N = 67) and focus group (N = 10) interviews in locations with a high prevalence of drug use in Cape Town, Durban and Pretoria, South Africa. HIV testing of KIs was conducted. Cocaine, Ecstasy, heroin and methaqualone are used by CSWs prior to, during and after sex. Drugs enhance the sexual experience and prolong sex sessions. Interviews revealed inconsistent condom use among CSWs together with other risky sexual practices such as needle sharing. Among CSWs who agreed to HIV testing, 34% tested positive. Barriers to accessing drug treatment and HIV treatment and preventive services were identified. Interventions recognizing the role of drug abuse in HIV transmission should be prioritized, and issues of access to services, stigma and power relations must be considered.

Correlates and predictors of women's sex trading over time among a sample of out-of-treatment drugs abusers

This research addressed two research questions: (a) controlling for crack use, what are the factors associated with women's engagement in ever having traded sex? and (b) controlling for crack use, what are the factors associated with women's engagement in sex trading in the past 90 days? The sample included 149 sexually active, crack using women selected from a subsample of participants in the Kentucky NIDA AIDS Cooperative Agreement. Bivariate analyses indicated that in addition to the pattern of crack use, 13 of the candidate variables were significantly related to sex trading, ever and 11 related to sex trading in the past 90 days. The multivariate models accounted for more than 40% of the variance in sex trading, ever and almost 59% of the variance in sex trading over the past 90 days. Suggestions for HIV/AIDS prevention and intervention among drug-involved women are discussed; implications for future research are suggested.

Street smarts and urban myths: women, sex work, and the role of storytelling in risk reduction and rationalization

Storytelling has a strong tradition in inner-city American communities. In this article, we examine patterns of storytelling among a sample of drug-using women from New York City who engage in street-based sex work. We consider two particular formats of storytelling for analysis: "street smarts" and "urban myths." Street smarts are stories of survival, and urban myths are compilations of street legends spread by word of mouth. The narratives are filled with tales of extreme risk across situations. The women used the stories to delineate the boundaries of risk as well as to rationalize risks they deemed to be inevitable but temporary in their lives. Few of the women capitalized on the greater instructive quality of the stories toward increased risk reduction, which may relate to the women's distance from an identity of "sex worker." If properly harnessed, the strength of storytelling suggests new avenues for risk-reduction interventions.

The role of the bar context and social behaviors on women's risk for aggression

The present study is an initial examination of the extent to which the environmental characteristics of bars and social behaviors that women engage in when drinking in this setting are associated with bar-related aggression. As expected, several environmental characteristics (e.g., young patrons, pool playing) and social behaviors (e.g., alcohol consumption, leaving the bar with strangers) were associated with more severe bar-related aggression experienced by women during the past year. These results shed light on the significant problem of bar-related aggression against women and can potentially be used to develop prevention and educational programs.