Abstract
It is well established in the literature that individuals who engage in sex work are more likely to experience sexual trauma/violence, but little research has examined experiences of sexual assault survivors who exchange sex from the survivor’s perspective. Sexual assault survivors and their informal support providers (SPs; e.g., family, friends, romantic partners) were interviewed separately about disclosure, social reactions, and help-seeking following assault. Sixteen survivors mentioned experiences exchanging sex, which comprise the sample for the current study as well as comments from twelve SPs. Qualitative analysis revealed several themes including violence experienced engaging in sex work, navigating stigma and the identity of both sexual assault survivor and sex worker, and how survivors’ social supports impact their recovery. Survivors endorsed their sex worker identities at varying levels, and others used their identity as a sexual assault survivor to explain why they engaged in sex work. Social work implications regarding service provision and advocacy work are discussed.
The connection between sexual violence and exchanging sex is present in the literature; however, the relationship between the two is often complex and multifaceted. Prior scholarship tends to seek samples of sex workers to better understand their experiences of sexual violence. Women who exchange sex are at risk of experiencing sexual trauma (Deering et al., 2014), and holding both of these identities (sex worker and sexual assault survivor) carries stigma in society. Miller (1993) found that street-based sex workers reported experiencing sexual assault (93%), assault from self-identified police (44%), and rape (75%) at particularly high rates. Given the high rates of sexual assault victimization among sex workers, it is possible that people identified as sexual assault survivors may have experiences exchanging sex; however, this positioning of the issue is rarely examined.
One study examining the link between sex work and assault victimization found that 23.5% of sexual assault survivors engaged in sex work following their assault (Campbell, Ahrens, Sefl, & Clark, 2003), suggesting that this is an important issue that warrants empirical exploration. It is important to understand both survivors’ assault experiences and experiences exchanging sex, as they may have unique treatment needs and also report wanting such tailored treatment (Patton, Snyder, & Glassman, 2013). Campbell, Ahrens, Sefl, and Clark (2003) found higher levels of physical distress and substance abuse among women who engaged in sex work after being sexually assaulted compared to those who had not engaged in sex work postassault. In addition, postassault sex work was related to receiving more negative social reactions from formal support sources (e.g., medical, legal), and 25% of their subsample linked their assault experience with entering the sex trade (Campbell et al., 2003). Engaging in sex work was related to regaining control over both their lives and bodies postassault. Child sexual abuse (CSA) and sexual assault in adolescence or adulthood may also serve as a pathway to engaging in sex work, through running away from abuse at home for young people (Dalla, 2006) and/or making it difficult to set boundaries and develop healthy sexuality later in life (Zerubavel & Messman-Moore, 2013). In addition, exploring how sexual assault survivors who exchange sex grapple with both of these identities and how their social supports may influence their recovery can have important implications for treatment and social work practice. This study will address how survivors conceptualize their identity as a sexual assault survivor who has exchanged sex and discuss responses from the survivors’ informal support network members (e.g., family, friend, romantic partner), with a sample of sexual assault survivors who reported exchanging sex. The following paragraphs will first describe literature on descriptive information about sex workers, primarily from sex worker samples, and sexual and physical violence experienced by sex workers. Next, directly tying to the focus of this article, we will detail literature on experiences with stigma of sex workers as well as the role of social support in their lives.
Correlates and Consequences of Engaging in Sex Work
Exchanging sex encompasses a broad category of activities including, but not limited to street-based sex work, escort services, call-in/call-out work, brothel work, stripping or exotic dancing, sex trades (for food, money, drugs, housing, etc.), bondage, discipline, sadomasochism, webcam, Internet/phone sex, and pornography (Cohan et al., 2006). Women exchange sex for a myriad of reasons including financial security, flexibility of hours, housing, and food security, to sustain a substance use habit, or because they are coerced or forced (Pitcher, 2018). Drug and/or alcohol use is linked with exchanging sex (Nuttbrock, Rosenblum, Magura, Villano, & Wallace, 2004; Spice, 2007) as is lack of housing (Kuhns, Heide, & Silverman, 1992). Research shows sex workers have higher rates of substance abuse compared to women who are not sex workers (Plant, 1990). A study of 203 African American female sex workers actively using crack cocaine found a similar reciprocal relationship between exchanging sex and drug use, suggesting that some women may exchange sex to support drug addiction but may also use drugs to cope with the stress of exchanging sex and associated trauma (Young, Boyd, & Hubbell, 2000). Substance use compounds the risk inherent in sex work; sexually transmitted infections (STIs) among sex workers were greater for those who drank more alcohol than those who drank less (Chen, Li, Shen, Zhou, & Tang, 2013). Research also suggests a link between sex work, substance use, and victimization while exchanging sex. A study of 106 street-based sex workers in New York City found women who injected drugs and/or used crack/cocaine were more likely to experience physical or sexual abuse from clients compared to nondrug users (El-Bassel, Witte, Wada, Gilbert, & Wallace, 2001). Briefly reviewing the behaviors associated with exchanging sex is important to contextualize how these can be linked to an increased risk of both physical and sexual violence.
Sexual and Physical Violence in Sex Workers
Women exchanging sex are more likely to have experienced some form of lifetime sexual trauma compared to women who have never exchanged sex (Church, Henderson, Barnard, & Hart, 2001; Wiechelt & Shdaimah, 2011). Risk of sexual assault and other forms of violence is high among sex workers (see Deering et al., 2014, for a review), with up to 54% of sex workers across studies experiencing sexual violence while engaged in sex work and up to 42% experiencing sexual violence by intimate or nonpaying partners. Additionally, scholarship examining the connection between early sexual trauma (sometimes called CSA) and engagement in sex work is varied. One study found that approximately 84% of participants who were street-based sex workers had reported CSA (Dalla, 2001). A study of street-based sex workers found that most had experienced early sexual trauma (74%) and physical violence while working (72%) while working, much of which was related to a parallel drug culture (Dalla, Xia, & Kennedy, 2003). Other studies of street-based sex workers found over half had been victims of violence from clients in the past year, one third in the past month, and that sex workers had more injuries than women who had not exchanged sex (Du Mont & McGregor, 2004; Kurtz, Surratt, Inciardi, & Kiley, 2004) as well as high rates of family/partner violence (53%) and violence when exchanging sex (36%; Cohan et al., 2006).
There is less information about rates of violence among women who engage in off-street, or indoor, sex work. However, several studies from Canada suggest physical and sexual violence are less prevalent among indoor sex workers compared to those working outside or on the street (Benoit & Millar, 2001; Lowman & Fraser, 1995; O’Doherty, 2011). However, mixed findings were observed in U.S. samples, possibly due to the varying legal status of sex work across states (Brents & Hausbeck, 2005; Murphy & Venkatesh, 2006).
Experiences with Stigma
Women who exchange sex are likely to face stigma related to their identity as a sex worker (Sallmann, 2010). This stigmatization is often compounded by other identities that could also be stigmatized (e.g., drug user; Sallmann, 2010). Individuals who exchange sex can face challenges accessing necessary services, reporting violence, and seeking justice because of the stigma associated with their identity (see Benoit, Jansson, Smith, & Flagg, 2018, for a review). Beyond access to services, a sex workers’ efforts manage their stigmatized identity can impact their social relationships and support (Koken, 2012). Sex workers who completely conceal their identity report feeling isolated and lonely, whereas sex workers who selectively disclose report greater social support and more positive impacts on their social relationships (Koken, 2012). Beyond these impacts, stigmatization of sex workers can be dangerous. Women who are victimized while exchanging sex experience social stigma due to sex work’s criminalized status in most countries (Vanwesenbeeck, 2017). One Canadian researcher identified a “discourse of disposal” in media accounts of reported violence against sex workers, which had the effect of increasing violence against them (Lowman, 2000). Given that revealing their sex worker identity could affect several life outcomes (e.g., access to services), many have established ways to manage their stigmatized identity (Koken, 2012). Additionally, survivors of sexual assault also experience stigma regarding their identity as a survivor in the form of victim blaming, rape myths, internalized shame, and negative social reactions from formal and informal sources (see Kennedy & Prock, 2018, for a review). Because stigma exists for both sex workers and survivors of sexual assault, it is likely that survivors who exchange sex may experience stigma based on both of those identities. A study of college students found that attitudes were more negative and victim blaming scores were higher in a hypothetical rape of a sex worker versus a hypothetical rape of a non-sex worker (Sprankle, Bloomquist, Butcher, Gleason, & Schaefer, 2018), which speaks to the stigmatization unique at the intersections of these identities.
Social Support
The role of social supports has been discussed mostly in the literature examining experiences of exiting sex work (Dalla, 2006), and the role of various informal support sources has been examined in smaller qualitative studies of sex workers. For example, Hiller, Syverston, Lozada, and Ojeda (2013) reported that female sex workers who injected drugs received instrumental and emotional social support, which both positively and negatively influenced recovery efforts. Intimate partners and family provided both negative and positive support during women’s attempts to recover from substance abuse, with problematic support (i.e., well-intended support with unintended consequences) in strained family relationships that limited the positive effects of support. This mirrors the findings of research on social reactions to sexual assault survivors which are often mixed and therefore may both help and harm recovery (Lorenz et al., 2018). In sum, social supports are very relevant to survivors of sexual assault and sex workers alike; therefore, their involvement and participation in survivors’ lives who exchange sex may also be of particular relevance.
Current Study
Experiences with exchanging sex among sexual assault survivor samples are relatively understudied, and such studies may uncover a different range of experiences than traditional “sex worker” recruited samples. By examining the relationship between exchanging sex and sexual victimization from a sample of sexual assault survivors, we are able to potentially get at a more hidden group that may not necessarily self-identify as “sex workers” had we recruited a sample of “sex workers” to speak about their sexual assault victimization experiences. Additionally, how survivors who exchange sex discuss their identity was another aim of this study to draw implications for social work research and practice. The current study expands the literature by providing an in-depth exploration of sexual assault survivors’ experiences exchanging sex. The sexual assault literature highlights the importance of positive social support, but the presence of social support among survivors who also exchange sex is rather understudied. Yet social support among survivors who exchange sex can have important implications for recovery (Hiller, Syverston, Lozada, & Ojeda, 2013). Little research exists on how support providers (SPs) of this population of women appraise their experiences or navigate how to support survivors postassault. Therefore, we sought to address this gap by exploring women’s sexual assault disclosure experiences, where sex work may emerge as a topic as women seek support from others, including how survivors and their informal supporters talk about this behavior/context. For the current study, in the results and following discussion, we use “exchanging sex” versus “sex worker” or “sex work” so as not to attribute the identity of “sex worker” to any of the survivors who did not explicitly endorse that identity.
Several themes emerged from our analysis of the codes related to exchanging sex for money: (1) survivors’ motivations for exchanging sex, (2) women’s experiences surviving sexual assault and sex work, (3) issues of identity, and (4) the role of social support in survivors’ lives and their experiences exchanging sex.
Method
Participants
The sample of this study included adult female sexual assault survivors who disclosed their assault to an informal SP. Survivors had previously participated in a 3-year longitudinal survey (N = 1,863) regarding unwanted sexual experiences and the social reactions they received when disclosing these experiences (see Ullman & Peter-Hagene, 2016, for study description). Survivors who indicated interest in being contacted for an interview were also asked to provide contact information for a friend, family member, or significant other they told about an unwanted sexual experience. SPs were contacted later for a separate interview that focused on their experience helping the survivor. Separate interviews with survivors and SPs (N = 90) took place over 2 years, resulting in a total interview sample of N = 45 matched pairs of survivor and SP interviews. This total interview sample was further broken down into the current subsample for the study of survivors (N = 16) who mentioned their involvement in exchanging sex. Criteria for including survivors in this study was that they mentioned exchanging sex during their interview; therefore, some survivors were assaulted before exchanging sex, some were assaulted after exchanging sex, some were assaulted while exchanging sex, and some were assaulted on multiple occasions. SPs (not referring to the survivor’s matched pair unless otherwise stated; N = 12) who mentioned some knowledge of the survivor’s engagement in exchanging sex were included in the subsample for this study. Survivors and SPs included in this study are not matched pairs unless explicitly indicated in the results.
The following demographic and background data come from the survey portion of the larger study. The average age of women in the subsample (who spoke about a history of exchanging sex during the interviews) was about 42 years old (N = 16). This subsample was mostly comprised of black women (75%), while about 19% identified as multiracial (one respondent did not report their race). Additionally, about 63% of the exchanging sex sample had children, 13% were employed at least part time, and 53% had attended some college. Participants in our study reported CSA at a rate of 75%, 38% reported an alcohol-facilitated sexual assault, and all participants reported multiple (>1) sexual assault experiences. They also had an average of seven unwanted sexual experiences, and all but one participant reported intimate partner violence (IPV). CSA and unwanted sexual experiences were measured with a modified version of the Sexual Experiences Survey (SES; Koss, Gidycz, & Wisniewski, 1987) created by Testa, VanZile-Tamsen, Livingston, and Koss (2004; SES–Revised [SES-R]). Women were asked to indicate no/yes for each question on the SES-R measure. These rates speak to experiences as shared by participants during their life thus far and therefore may or may not have overlapped with their exchanging sex.
The subsample of SPs (N = 12) was an average of 44 years old, ranging from ages 21 to 72 years. Gender was evenly split among SPs: 50% were female, and 50% were male. Fifty percent also had children. SPs varied racially with 36% black, 36% white, 18% multiracial, and 9% American Indian. Most had some or graduated from college (64%), although only 45% were currently employed. Two SPs were romantic partners of the survivor (both male), three were family members (two sons and one mother), and seven were friends.
Procedures
Written informed consent was obtained for all interviews immediately prior to the interview. All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the University of Illinois at Chicago Institutional Review Board.
Semi-structured face-to-face interviews were conducted by one of three trained interviewers on the research team. Interviews lasted an average of 1 hr but ranged from 30 min to 3 hr. Participants were compensated US$30 for the interview portion of the study. After each interview, interviewers created “summary” documents, which included interesting points, questions raised, final thoughts, and unanticipated feelings emerging from the interview. Interviews were audio-recorded, transcribed, and checked by other members of the research team. During the transcription process, brief summaries and identified patterns were added. Interviewers conducted a final review of their transcripts for accuracy. Interviewers and members of the research team met to discuss emerging themes and patterns following transcription, as an initial stage in developing the codebook.
Interview Protocol
The interview protocol for survivors and SPs focused on the survivor’s unwanted sexual experience(s), the disclosure of an unwanted sexual experience, social support provided/received, and appraisals of the survivor-SP relationship. The present study focused on sexual assault survivors’ disclosure of exchanging sex during the course of the interview. Survivors were not asked outright during the interview whether they had exchanged sex or whether their assault occurred during an exchange, though when describing their experiences, survivors spoke about their experiences exchanging sex, sometimes within the context of unwanted sexual experiences. Survivors spontaneously offered stories regarding their experiences exchanging sex, and therefore, the timing of sexual assault, early sexual trauma, and exchanging sex are unknown unless the survivor offered this information in her interview. Additionally, and also unprompted, several SPs also discussed their knowledge and thoughts on the survivor’s experience in exchanging sex and related unwanted sexual experiences. As such, in this article, we focus on the subsample of survivors and SPs who discussed survivor’s experiences exchanging sex during their interview. The data arose from the examination of two qualitative codes for both survivors and SPs: trauma-related sex work and trauma related to other stressful life events.
Data Analysis
Members of the research team summarized each interview transcript to identify patterns and themes, which were later discussed among the research team in a process similar to that of thematic analysis (Braun & Clarke, 2006). The research team conducted several trials of interview coding and refinement to develop a codebook that covered the content of individual interviews and themes reflecting the matched pair relationships. Coding trials resulted in several revisions of the codebook whereby codes were added, renamed, redefined, and/or combined. The codes were descriptive in nature and were used to summarize and describe the primary topic of the excerpt (Saldana, 2012). We examined the context of the codes by reviewing transcripts and interviewer summaries when identifying relevant interview excerpts (i.e., quotes).
We used Atlas.ti Version 7 qualitative analysis software for coding and analysis. We identified codes that made the most analytic sense of the data (termed “focused” coding; Charmaz, 2006) and used the identified codes to pair with segments of the transcript. Specifically, we selected codes that best represented what was happening in the interview text. We coded the data separately and compared our interpretations of the content with other members of the research team to achieve consensus (Eisikovits & Koren, 2010). This process took place in several stages. First, pairs of coders separately coded each interview matched pair using the codebook. Second, one coder in the pair then reviewed both coded transcripts to identify any inconsistencies in the assigned codes. Third, the coders discussed these disagreements until reaching a joint consensed version by both parties (Patton, 2009). In cases where agreement was not obtained, double coding (i.e., simultaneous coding; Saldana, 2009) was used as a compromise between the two codes. Fourth, the original interviewer reviewed the coded transcript for agreement with the assigned codes. The coders and interviewer discussed any disagreements and corrected the coded transcripts until consensus was reached between the three parties. During the coding process, researchers created memos within the transcripts to highlight any relationships or inconsistencies within and between the survivor and SP interviews or to capture unanticipated themes in the data (Charmaz, 2006). The inclusion of memos allowed coders to pay attention to the relationships between different matched pair interviews.
Analysis took place using an iterative process in several stages after coding was completed. We analyzed the interview at both the individual level and at the level of the matched pair (i.e., dyadic). First, we conducted queries in Atlas.ti software to identify the number of times each interviewee endorsed a particular code related to exchange sex, sex work, or trauma. We also noted the type of survivor-SP relationship (i.e., friend, family member, significant other). Second, like that of thematic analysis, members of the research team individually reviewed the quotes for each query in search of patterns and noteworthy findings (Braun & Clarke, 2006). Third, the team met several times to review the identified themes and patterns. During this process, we looked for similarities and contrasts within and between the 45 matched pairs. For the subsample we identified for this study, we repeated this iterative process to identify themes related to quotes from participants under the two codes used (trauma related to sex work and trauma related to other stressful life events). Due to our small sample of both survivors and SPs, themes were considered whether two or more individuals spoke to similar experiences. After these themes were developed and consensed by the research team, we developed the proposed research questions for the present study to help guide the results and subsequent analysis. It should also be mentioned that members of the research team are familiar with the fields of sex work and sexual assault. Members of the research team have experience writing, presenting, and publishing in these fields. Additionally, members of the research team also have experiences working directly with sex workers and sexual assault survivors in both advocacy and clinical realms.
Results
We recognize prior scholarly debates regarding sex work, prostitution, research approaches, and analysis with participants with these lived experiences. While this study was not explicitly designed to address these issues through an intersectional framework, intersections of oppression move to the foreground through the exploration and analysis of the participants’ experiences. In social work practice in particular, bringing a critical feminist reflection to research is of the utmost priority, so as to avoid replicating oppressive structures of power (Mattsson, 2014). This may be done through avoiding narratives that intentionally problematize sex work without taking into considerations the viewpoints of those who engage in sex work themselves. Additionally, anti-oppression work includes disentangling the practice of social work from the institutions that criminalize, and therefore endanger, those who exchange sex (Wahab & Panichelli, 2013). We recognize the complex dialogue among scholars of sex work, social work, and sexual assault. Our goal was to honor what was said by the participants without making assumptions about their positionality or motivations for behaviors unless specifically stated by survivors. By honoring survivors’ narratives, we can better understand the reality of their experiences without ascribing prescriptive and damaging narratives to them, which ultimately replicates oppression and marginalization (Sloan & Wahab, 2000).
The subsample of interviewed survivors (N = 16) who discussed exchanging sex described their experiences as occurring preassault, postassault, or during assault. Several SPs (N = 12) discussed the survivor’s engagement in exchanging sex during their interview. We present the results from this subsample of survivors and SPs organized by research questions and subthemes. In presenting quotes in the results, we use several abbreviations as noted here to indicate demographic characteristics and type of relationship in the following order: (S/SP relationship, gender, age, race/ethnicity). SO = significant other, F = family, FR = friend; M = male, F = female; B = African American, W = white, N = Native American, H = Hispanic, MR = multiracial, U = unknown.
What Were Survivors’ Reasons for Exchanging Sex?
First, we briefly present attitudes and experiences endorsed by survivors studied here that are well-documented in the literature (n = 11). Survivors discussed their reasons for exchanging sex (i.e., money, housing, substances). One survivor explained that she only exchanged sex when she needed money and her decision to do so depended on her “financial situation”: Every now and then, it depends on my financial situation. If I don’t have any money I go outside and trick off. (F, F, 49, H) What happened was in my divorce I lost everything when I got hooked on drugs…. And in order to take care of my drug habit I had to work the street. (SO, F, 44, B) I met him on a job, he was working in a store. And we became, I would date him, you know. Date him for money…When we met, like I said, we were both drinking and he was supporting my habit, you know, and then when I went into treatment and I stopped and all that, you know, he was supporting me more…even though the financial [support] right now, it’s more one sided. (SO, F, 45, B) I probably had the worst experiences with that because I was going online and trying to find opportunities I didn’t have. I had a supposed agent in the beginning that coerced me into doing stuff and said I had to do it to get this job or that job. He would tell me, “oh, you know, I’ll give you this much money,” and then when the time came, he would just say that he didn’t have it. I didn’t want to do it in the first place. (FR, F, 25, MR) …Now I don’t actually go on the streets and sell myself. I work by the phone. (FR, F, 52, B) I was on the streets, I might as well say I was homeless cause I was living with my mother and then I started living with an older man. He wasn’t physically abusive, but he was verbally abusive. Then I had to have sex with him when I wouldn’t want to. I was like, wow, this is never gonna end. But it did. (SO, F, 45, B)
Overall, survivors’ reasons for exchanging sex were multifaceted and often mirrored prior literature on this topic, specifically literature on substance use (Edwards, Halpern, & Wechsberg, 2006; Forney, Inciardi, & Lockwood, 1992). While these results are not new, there is value in noting the similarity across varying populations and, in particular, the similarities in this population of sexual assault survivors.
How Did Women Conceptualize Their Experiences of Surviving Sexual Assault and Sex Work?
Extending current literature, our sample of survivors who exchanged sex shared experiences of severe trauma that illuminate the lengths women are willing to go to survive trauma and build meaningful lives. Because exchanging sex is associated with several risk factors (e.g., experiencing violence, interactions with police, homelessness; Pitcher, 2018), several survivors (n = 6) shared experiences managing risk that were related to exchanging sex (e.g., self-defense, setting boundaries with clients). Survival was present in their reasons for sex work, as it relates to the sexual trauma that survivors experienced before exchanging sex as discussed in the subsection below.
Violence and Threats of Violence Experienced While Exchanging Sex
Some survivors shared their experiences with violence while exchanging sex (n = 4) in the context of attempting to set limits with clients. Survivors described setting boundaries for themselves on what sex acts they would or would not do when they exchanged sex. However, survivors were not always successful in setting boundaries with those who were purchasing sex. Two survivors were attacked or threatened when they attempted to set a boundary and changed their minds about the sex acts, or the situations went awry and became violent. One survivor recalled: Another time I was turning a date with this guy, doing the oral sex and I’m like “what’s wrong with you?” It’s taking so long…10 more minutes, 15, 20. And I’m like “Uh-uh, this is it.” So, I got out the car, started running…We was on a one way street and the guy, he backed his car all the way back to catch me, parked, got out, and started hitting me. “Give me my money back.” I was trying to give it back, but he actually had the money in my coat and he wouldn’t let me go. (F, F, 49, B) I was shooting cocaine and my ex-boyfriend was gone at the time. I had this stranger come in my house and tricked him out of some cocaine, as we shot some cocaine but not as much as he paid for. As he was leaving, he wanted sex for it. I was trying to get something for nothing. I walked by to have him leave and he grabbed my collar, had a knife and had me go in the back room. I convinced him to put the knife down. Then he had me mount him and was telling me, get into it, get into it. I remember I just stopped and said you’re going to have to kill me, I’m not going to finish. It shocked him a little, so I ended up getting him out of my house. (SO, F, 45, U) I hopped in the car with 2 white boys and I was in the truck and I thought I was gonna do it but then I thought about my unborn baby and I’m like “I can’t do it.” What if they got something? What if they give it to my baby? and then I changed my mind and one them said “We outta kill her. Let’s kill her…” (F, F, 46, B) I’ve had other bad situations with drugs, like situations cause I used to hustle, I used to prostitute back in the day twenty years ago. I been in some bad situations but those were the ones that stand out where it was taken from me like with a weapon but I’m kind of numb to it. You know when you do a lot of drugs and you drink…(SO, F, 45, U) Sometimes they try to get outta control with you. (laughs) Yeah once or twice, I’ve been lucky though…(I) defend myself, like I’m gonna kill them or something…I have to defend myself, what other choice do I have, this man is getting ready to, (sigh) you know. It’s like a repeat thing. This man is getting ready to do the same shit to me that these other people did, right? (F, F, 49, B)
Experiences with law enforcement
Exchanging sex puts individuals at risk of having encounters with law enforcement (Sallmann, 2010). Two survivors had positive/neutral encounters with law enforcement during their time exchanging sex (n = 2). One survivor recalled an experience where a law enforcement officer found her on the street and brought her home. The survivor describes her experience in varying ways, sometimes as “sex trafficking” and sometimes as “prostitution.” During this experience, the survivor was underage and had been taken by a man, given illicit substances, and told to exchange sex: Finally, I guess some lady saw me and she called the police and at the time I was in (state) so when they brought me back they took me to the doctor and asked me questions and stuff like that. So, I go, make it back to my mom. (F, F, 38, B) …the good thing about that is, one incident happened to me and as soon as it happened I saw the police and I flagged the police down and they caught him. (FR, F, 51, B) I had a police man also do that to me…but that was wrong but I think he felt bad after that so he used to see me all the time and I would see him. It seemed like when I would be in tight spots like with jobs and he would lock them up or get them away from me, so he tried to rectify the situation. It’s all sick (laughs). (FR, F, 51, B)
How Did Sexual Assault Survivors Who Exchange Sex Discuss Identity?
Some survivors highlighted how they conceptualized their identity in relation to their exchanging sex involvement (n = 7). While “stigma” related to the assault was never explicitly named as such by participants (nor would we expect it to be), survivors who discussed their identity often reported social reactions from others that the researchers perceived to be the result of stigma. As a way to navigate this stigma, survivors displayed and reported different levels of endorsement of or distancing themselves from a sex worker identity. While many survivors were open during the interview about their exchanging sex experiences, some only used the words “prostitution” or “sex work” to talk about how they rejected those labels to avoid the stigma and subsequent mistreatment of those identities (n = 4). One survivor did not disclose this identity to her husband: We just getting high, I don’t want him to touch me and he thinking well, “you can do it…,”…he never really knew for sure what I was doing, I didn’t never say, “I’m a hooker.” But it was like he was treating me like that too and I didn’t wanna. (F, F, 49, B) The reason that I wanted to share that with him mostly was because I knew basically friends and stuff that messed with drugs and that were sex workers and stuff like that, and I didn’t want him to think that he that I was getting ready to be one of them ones…He was like oh nah you…I wouldn’t treat you like that I wouldn’t treat you like that but it was a lie. It came to pass and he started trying to treat me like that. (FR, F, 46, B) I wasn’t dressed like this, but I didn’t wear miniskirts and stuff either. I just was who I was because I thought that the main thing for me was not to attract too much attention. So, I customarily was at bus stops and act like I’m waiting for the bus, and buses would go by and I never get on because I’m waiting for somebody to come and do that, so what I’m saying is I didn’t look the role, that’s what I’m trying to say. (FR, F, 55, MR) For me the pain was prostitution, or being with a guy, even though I really like the guy and want him to date me and love me, I still charged him money cause I knew deep down inside in my mind that he didn’t want me for a girlfriend. It’s all for sex. (FR, F, 43, B) I just been I guess would say punishing myself and I just figured I’m not gunna give anybody anything free. I got that in the back of my mind because for so many years I was abused. So I figured if a guy is gunna get something from me I want to get the money for it. I’m not just gunna have a relationship. If you’re in a relationship, a guy might take you to dinner or the movies, but you just don’t outright ask him for money. (FR, F, 52, B) Where you’re so into [it], practically almost do anything for some—disgusting. The part about the streets of getting in and out of cars is kinda disgusting too. (FR, F, 51, MR) That’s my life and I ain’t proud of it, why would you be proud to be a drug addict and a hooker, that’s what I was. I wish I could change it and do it different but I’m not ashamed of it and in a way I’m kind of proud of it because I got through it…(SO, F, 45, U) Same time I lost my virginity was right around when I was experimenting with marijuana and alcohol…The boy who had sex with me paid me…So that’s how the whole prostitution thing kicked in, at a very young age, the mentality. (F, F, 49, B)
What Role Do Social Supports Play in Survivors’ Lives and Their Experiences Exchanging Sex?
For survivors of sexual assault and those who engage in sex work, social support is vital for healing and recovery outcomes (Hiller et al., 2013; Ullman, 2010). In our sample, many discussed the role of their social supports in various life outcomes (e.g., health, substance abuse, family relationships) postassault. Seven survivors spoke about family members (noninterviewed SPs) from their perspective, and 12 interviewed SPs discussed their experiences providing social support to survivors with regard to the survivor’s experiences exchanging sex. In particular, the social supports for survivors were discussed as either being particularly helpful or retraumatizing.
Trauma and Familial Networks
While some survivors did speak about family members in a positive way, many (n = 7) spoke about their negative experiences with family members. These family members were not the designated SPs but were family members brought up by the survivor during the interviews. One survivor shared that she was put at risk because her mom “put her (me) out”. She described how she was then trafficked: When I was eleven, my mom had put me out and I didn’t know where to go. I went to the bus station and met a man. I got caught up in sex trafficking and stayed away from home. I didn’t know what it was or where I was, as he was taking me to different states. He beat me, he introduced me to drugs. It was terrible things. It was hell (sniffles)…I stayed there in sex trafficking for four years. (F, F, 38, B) …but she [mother] would look down on it like it’s not something to be proud of even. (SO, F, 45, U) I was ten until 12 years old, he didn’t physical (unclear) inside me, but he began to suck on my vagina, and it kind of messed me up, because in the process of him doing that, he was giving me money to do it to me and I’m only ten years old. (F, F, 44, B) Also, a brother that…you know, at the time when I was in the menace just…really tricked me…You know, ‘I’ll give you this if you just let me rub’…(FR, F, 51, MR)
The severity of experiences with family members were varied, as described by the survivors above. The survivors that described transactions with family members for sex illuminate a unique and understudied subset of the sample that may suggest the need to inquire about the phenomenon more specifically.
Family Members’ Complicity in Survivor’s Exploitation
Sometimes, other family members knew about this transactional exploitation by family members but chose not to address it. A survivor was assaulted by her grandfather in front of her father and her brother. Her brother tried to attack the grandfather and questioned their father about why the grandfather was assaulting the survivor. The father then responded with a justification: We went to see my grandfather, me and my brother. He was drunk and sat next to me and started to feel up my breasts, and said, I can do this cuz you’re my granddaughter. My younger brother stood up, knocked him out, and turned to my father saying how can you allow your father to do that to your daughter? He says, don’t worry, you’re gonna be compensated when he dies, you’re gonna inherit all his money. (SO, F, 44, B) His mom had sold me for 20 dollars to an old man. She said “help him with his bags.” I said ok, as it was a house across the yard in the projects. I helped him to the house with his bags. He turned around and was standing there and had pulled his pants down. I’m like “What’s wrong with you?” and he said “Come up, I want you to.” I was like “what?? I was supposed to help you with your bags.” He tried grabbing, I pushed him down and he got a hold of his gun. At the time I was pregnant and I’m trying to get back to the house. He’s shooting a 22’ at me, could have killed me, and I’m like “why is he shooting at me?” Cause he mad, cause I got his money. “You pimped me out to this man and I didn’t know nothing about it? You could’ve got me killed.” It was just heart-breaking and I was just ready to get out of there. (F, F, 46, B)
The role of the SP
While not all dyads mentioned the SP’s knowledge of survivors’ exchanging sex, some SPs were aware of it and showed empathy for the survivor. Regardless of their knowledge of exchanging sex, our entire sample of SPs was understanding of the survivor’s past trauma and showed empathy (n = 12). One SP was aware of how and why the survivor began to exchange sex and how the behavior was deeply connected to the survivor’s identity of survivor: I believe the assaults all started with some kind of exchange for drugs. (SO, M, 55, W) She said she went home and took a bath for that, she bathed and bathed, trying to bathe the feeling that she felt because even for women that prostitute themselves, rape or violent sexual or unwanted advance is traumatic emotionally traumatic. (FR, F, 55, MR) She told me about this experience where she had filmed a porno with some company that didn’t disclose exactly what was going to happen, and she felt totally exploited afterwards on several different dimensions. Because the way that the pornography was marketed was really fucked up and part of the initial interaction. Also, since that film was made and released, she had experienced a lot of cyberbullying about what had occurred. She came up to me to try to solve a situation…(FR, M, 25, N) She tried to mess herself up when she was younger. She had ran away from her father’s home and said she was standing in the river, trying to get safe and she end up, she was going sell herself to these two men, was trying to get some money at home, and something crazy, I remember the story vividly. She said to the two guys that got upset cause she was pregnant with me at the time and she was going to sleep with them but then she changed her mind and so they got mad, one of them was going to kill her and the other guy was like no let’s drop her off by the hospital, so they dropped her off at the hospital and it was like, man this is risky business. (F, M, 46, B) She told me she ended up having like, not a relationship with him because she wasn’t dating him, but it was a sexual relationship. Based off of “Hey, I need a place to stay”…It wasn’t like verbally agreed upon, but it was like, “Okay, you want sex and I want a place to stay.” (FR, F, 21, H) When it initially came up, I noticed that she was particularly melancholy and asked her about it and she burst into tears. I waited to see if she wanted to say what was wrong and she told me she was thinking about some of the experiences she had when she was on the streets in prostitution situations and some of the horrible things she had experienced. I just basically tried to listen and make her as comfortable as I could. I actually started praying for God to use me to help her, whatever way I could. (FR, F, 58, B) It is hard sometimes, because I never experienced prostitution, a lot of the things that she has, but I think we all have different degrees of sickness, you know, degradation or whatever and maybe different rates of recovery too. I have experienced some things that just made me just want to…I just always remember saying God if I ever make it out of this I want to help somebody and I was just so grateful that she chose me to try and help her. You know. So that was the way I felt. (FR, F, 58, B) She said like when it got to gang related, she be like oh well, certain gangs that did this to me or certain gangs that involved me in this transaction. (F, M, 21, B) …we’ve been like hanging out for a while and her mom has a really bad drinking problem. So she told me that her mom had been calling her drunk and trying to prostitute her to other men…(FR, F, 26, W) I do too, we also went into sex working…I think that was a way of trying to escape…I think everything has some type of connection in some way. I just think from mine and her experience having been raped and other things, sex work played a big part in it too. I guess we just in a way felt we were robbed of our dignity, of our sanity, of our respect, not for ourselves, but for everybody else cuz now we are kind of like in this little bottle of we don’t want nobody to come in and destroy it again. So, I hope she’s at a point where she can better understand it and accept it for herself, to move on. (FR, F, 26, H)
Discussion
This qualitative interview study of survivors and their informal supports revealed information that is well-documented in the literature as well as additional specific experiences of survivors that have yet to be reported to our knowledge. Few studies of sexual assault survivors have examined their experiences exchanging sex, and more research is needed on sexual assault survivors who exchange sex to further capture their unique experiences (Campbell et al., 2003). The women in our sample reported exchanging sex or sexual acts for money, housing, and substances. This is similar to past research regarding the motivations of people who engage in forms of exchanging sex (Kuhns et al., 1992; Pitcher, 2018). Past research shows that living a lifestyle that includes exchanging sex can sometimes lead women to use more substances (Potterat, Rothenberg, Muth, Darrow, & Phillips-Plummer, 1998). We found that some women in our sample began exchanging sex for substances in order to support an addiction and then used more substances to cope with the trauma they experienced during sex work. However, there were a few women who reported that the onset of exchanging sex and substance use coincided. In addition, it should be noted that the survivors’ struggles with substance use may in fact be gendered and class related, given the demographics of our subsample. While survivors in our study did not speak to this directly, more scholarship is needed to tease apart the relationship between substance use, race, class, and gender in the context of substance use treatment (Tiger, 2017). The relationship between exchanging sex and substance use has important implications for revictimization risk and should be explored further to determine how to increase safety for women in the milieu of drug-related sex exchange.
While most survivors in our study engaged in street-based sex exchange, some survivors engaged in “off-street” work via video and/or phone exchanged sex. One survivor in particular recalled her experience doing video work and encountering issues with payment, which is consistent with the literature (Benoit & Millar, 2001). Additionally, the survivor also experienced other forms of exploitation by way of engaging in video work, which may also echo prior literature on the nuanced risk of “off-street” work and the false sense of security (Murphy & Venkatesh, 2006). Future research should look at the nuanced experiences of sexual assault survivors who engage in “off-street” exchange sex to better understand the risks associated with all types of exchange sex. In particular, the idea of “underestimating risk” may be a useful avenue for researchers to examine risk management strategies with this particular population.
Only two survivors reported encountering police while exchanging sex, but their experiences are noteworthy. The two survivors had varying experiences with law enforcement and were either harmed directly by police while exchanging sex or were assisted by law enforcement. In addition, one survivor details the challenge she had reporting her assault to law enforcement, as she was aware of the stigma of being a sex worker having been to various law enforcement agencies in the past as an arrestee, not as a victim. These results help to illuminate the inherent obstacles for people who exchange sex to reporting sexual assault, as they are more vulnerable to police mistreatment due to the criminalized and stigmatized nature of their work. Survivors with histories of exchanging sex, especially if known to law enforcement, are not guaranteed they will be safe when reporting assaults or that their claims will be taken seriously. Because only two of our participants spoke about their experiences with law enforcement in the context of exchanging sex, more scholarship is needed to draw stronger connections between police and the mistreatment of survivors who exchange sex (Footer et al., 2018; Klambauer, 2018).
Some survivors experienced violence while exchanging sex, including threats and attempts of more severe forms of violence, such as sexual assault and homicide. For the women in this sample, risk of severe bodily harm occurred in situations when the woman tried to end an interaction or terminate an exchange. The women used various self-defense tactics, as there were no bystanders available in these situations. Researchers should explore factors contributing to homicide and rape risk for those exchanging sex and how to mitigate risk through policy, practice, advocacy, and strengthening community response to harm.
Some survivors also distanced themselves from the identity of a sex worker, which is important for understanding how they constructed their identities and are appraised by those close to them. Women who engage in exchanging sex often experience severe stigma, which can be further compounded by other stigmatized identities (e.g., drug user, CSA history, HIV diagnosis; Patton et al., 2013; Sallmann, 2010). Social support is related to better recovery from sexual assault (Ullman, 2010). Given that stigma and identity conceptualization related to either exchanging sex, experiencing sexual assault, or both in our sample, social support is likely to be even more important for victims engaged in exchanging sex (Hiller et al., 2013). However, having a stigmatized identity may serve as an obstacle to receiving needed social support, leading survivors to distance themselves from this identity in order to reduce potential stigma by their informal SPs. Future research should investigate these multiple stigmatized intersecting identities, and their impacts on recovery, treatment, and relationship outcomes.
Social support was important to this sample of sexual assault survivors, reflecting previous research (Hiller et al., 2013). Some survivors shared negative experiences with their familial networks (people who were discussed but were not the person’s designated SP for the study), while their experiences with SPs were more positive (even if the SP was family). This makes sense given that survivors would be more likely to choose positive SPs for the study. Survivors who were trafficked or exploited in the context of exchanging sex, surprisingly, often experienced this in the context of their family. The family’s involvement could vary; some family members were complicit in the survivor’s exploitation, other family members knew about it and justified what happened to survivors, or family members were victimizing the survivor and “paying” her in money or gifts. To our knowledge, the latter incidences have not been documented in the literature. Additionally, the phenomenon of family members paying survivors for sex is not adequately described by the CSA literature to our knowledge. Paying family members for sex could have marginalized the survivor, enabling her to be treated as an object rather than someone deserving of autonomy. We distinguish this from grooming because compensation occurred after the abuse began. Some survivors explicitly described their experiences as being trafficked but that was less common. More literature is needed to establish the behavior of paying minors for sexual acts. Additionally, there may be direct connections between the survivor’s social support, exchanging sex, and recovery outcomes. Because social support is vital for recovery, it is likely that experiences with family members play a critical role in facilitating or thwarting recovery. While this study does not speak to this directly, future research should seek to examine these connections in relation to other intersections of gender and class.
While not all SPs discussed the survivor’s experiences exchanging sex, the ones who did are poignant. In our subsample, half of the SPs were male and varied in relationship to the survivor (i.e., romantic partner, son, friend). Most SPs who mentioned the survivor’s experiences exchanging sex were quite empathetic and understanding, indicating a level of respect for what the survivor had gone through in her life. Similarly, many SPs mentioned how important the survivor’s healing was to them, as opposed to being judgmental of their experiences. We found that SP’s empathetic responses to survivors of particular importance, given how relevant social support and reactions can be for healing from trauma (Lorenz et al., 2018). In addition, the number of male SPs who expressed clear understanding and empathy for survivor’s exchanging sex experiences were of interest and should be examined more in future scholarship. Interestingly, one SP mentioned herself and the survivor going into “sex working,” but this decision was connected to both their past traumas. Future research should explore the role SPs play in the recovery of sexual assault survivors who also exchange sex.
Lastly, the intersecting identities of participants uniquely situated them in their respective life circumstances and trajectories of healing. Most survivors in the subsample were black or multiracial, had children, and all survivors were female-identified. These intersections of race, class, and gender speak to the unique struggles and experiences these women faced as both survivors of sexual assault and women who exchange sex, especially with regard to associated stigma and risk of violence. Future research with survivors of sexual assault who have also exchanged sex would benefit from using a theoretical framework that examines the intersections of race, class, and gender. Survivors who exchange sex are uniquely marginalized and oppressed, and therefore, research that seeks to understand these populations should appropriately respect and honor their narratives through ethical and participatory research methods.
Limitations
There are limitations to this study that should be noted. First, this study was a volunteer, convenience sample of survivors and their primary SPs. Data obtained regarding survivors’ experiences with exchanging sex related to their sexual assault experiences were unprompted and obtained only when survivors or SPs volunteered this information. Thus, there may be survivors who engaged in exchanging sex related to their sexual assault but did not divulge this information during the interview. In addition, survivors may have only spoken about the most extreme experiences or not all of their experiences with exchanging sex, potentially biasing the results and limiting generalizability. This study could have benefited strongly from a participatory action methodology (PAR), so future work with this population should make this method a priority, as it may add to the richness of the data and more accurately describe these unique experiences. Because we did not explicitly ask survivors about their experiences exchanging sex during the interview, PAR would have been of particular use in terms of member checking our interpretations and analysis of their experiences. Additionally, actions and efforts directly developed from the research would be of particular use for this sample given the unique and sometimes hidden nature of this sample. Future studies collecting information about exchanging sex experiences among sexual assault survivors should obtain a broader range of information with greater depth.
Second, this study is limited by the retrospective design. Time elapsed since the assault could have influenced what survivors and SPs recalled about the survivors’ experiences with exchanging sex. On average, the survivors in the larger sample had experienced sexual assault 14 years prior to being involved in the study (SD = 12.22; Median = 11). Some survivors may have been involved in exchanging sex but did not remember or choose to discuss it as part of their story during interviews. However, the retrospective study design may have also allowed participants to gain perspective on their postassault experiences including experiences of sex work. Despite these limitations, this study provides valuable data on survivors’ experiences with exchanging sex postassault or related to assault from both survivor and SP perspectives.
Implications for Social Work Policy and Practice
The criminalization of sex work often places women who exchange sex into particularly vulnerable positions within society that preclude them from legal protections. Removing barriers to services could be greatly aided by reforming the current state of sex work criminalization (Amnesty International, 2016). Most women did not report the violence they experienced while exchanging sex perhaps due to the stigmatized and criminalized nature of sex work. We must advocate for decriminalization and for comprehensive services and safety nets for people who exchange sex (Vanwesenbeeck, 2017). Efforts are needed to reduce stigma associated with exchanging sex, particularly among police, including increased police accountability for committing violence against sex workers (Page, 2008). Staggeringly, almost half of police officers adhere to rape myths including not believing sex workers claiming rape (Page, 2008), which impacts their assessment of victim status and credibility. This belief may be compounded for survivors of color engaging in sex work. Rape myth acceptance reinforces the stigmatized identity of sex workers, creates additional barriers to legal justice and/or services, and contributes to revictimization of survivors reporting to police. According to Armstrong (2017), decriminalizing sex work has created more positive interactions between sex workers and police in New Zealand. Specifically, sex workers indicated feeling safer reporting violence while working in a decriminalized setting as compared to a criminalized setting. While sex workers indicate that the relationship isn’t perfect due to the history of carceral power the police possessed over sex workers, most feel that they are treated better by police after decriminalization. This indicates that regardless of the legal status of sex work, additional training, policy, and/or hiring processes promoting an organizational culture of believing all survivors is needed to better the lives of those who exchange sex (e.g., Start by Believing campaign, character-based hiring processes).
Clinicians can help women to recover in therapy by providing safe spaces in individual or group counseling contexts where they are free to talk about both sexual assault and exchanging sex experiences including helping them to assess risk while also healing from traumatic impacts of both experiences. The research suggests the need to evaluate survivors for experiences exchanging sex in order to meet their needs more effectively. Because survivors tended to openly speak about both their experiences exchanging sex and their sexual assault experiences, we should seek to better strengthen supports for both stigmatized identities in the context of therapy and institutional supports. In this study, the most valuable supports came from individuals who not only knew about the survivor’s past trauma and exchange sex but actively understood and empathized with the survivor’s experiences. Lastly, supports that bridge gaps in services in terms of housing, substance use treatment, and therapy may be most helpful for survivors who also exchange sex due to the multifaceted needs of this population. Social workers are uniquely situated to not only provide services but also to advocate for survivors and those who exchange sex alike. Survivors in our broader study discussed a myriad of concerns and needs for services as a result of their identity and experiences. Specifically, some had issues with financial insecurity, substance use, history of violent victimization, and racialized experiences of violence and oppression. Additionally, most interventions for human trafficking do not include housing services, financial support services, or health care without interactions with law enforcement or law enforcement adjacent agencies. Consequently, the continued criminalization of sex work often directs people, victims of trafficking included, to the criminal legal system rather than to apparatuses of service and assistance (Villacampa & Torres, 2019). Being connected to law enforcement and other criminalizing agencies creates further barriers to services and prevents survivors and those who engage in sex work alike from adequately accessing services they need. Social work professionals and settings should seek to better understand these intersections of need and help to make resources available to survivors. Resources should address these unique needs through financial assistance, job placement services, substance use treatment, and therapy settings that are intentional about their fight for equity of marginalized and oppressed peoples. Given the participants’ experiences, we are in agreement with Sloan and Wahab’s (2000) recommendations for social work practice including: prosecution of those who exploit and harm sex workers, promotion of economic opportunities for sex workers, and addressing stigma of sex workers in order to create an equitable environment that addresses tangible needs and healing, as well as supports those choosing to exit sex work.
The needs of this particular population are unique and often intertwined, reflected in struggles for housing, social services, medical assistance, law enforcement advocacy, counseling services, and substance use treatment. Increasing awareness and scholarship about the clinically applicable nuances of both sexual assault survivors and those who exchange sex are necessary if we are to improve quality of social services and referral networks within community programs.
Footnotes
Acknowledgments
This study was supported by a grant from the National Institute on Alcohol Abuse and Alcoholism (AA #17429) to Sarah E. Ullman, Principal Investigator. The authors thank Mark Relyea, Amanda Vasquez, Rannveig Sigurvinsdottir, Liana Peter-Hagene, Meghna Bhat, Cynthia Najdowski, Saloni Shah, Susan Zimmerman, Rene Bayley, Farnaz Mohammad-Ali, Shana Dubinsky, Diana Acosta, Brittany Tolar, and Gabriela Lopez for assistance with data collection, and Amanda Vasquez for helpful comments on an earlier version of this article.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: National Institute on Alcohol Abuse and Alcoholism (Grant AA #17429).
