Survival sex: Sexual agency and consent in a state of deprivation? A scoping review

Abstract

Survival sex is the exchange of sex for material goods required for survival (i.e., shelter, food, drugs). Because this exchange occurs under conditions of deprivation, there is a power imbalance that limits the ability to freely consent to sex or to exercise sexual agency. This review aimed to examine the consent and sexual agency implications of survival sex and to identify which factors push people into greater levels of deprivation and vulnerability to engage in survival sex. We searched six databases and included 21 articles that discussed the sexual consent or sexual agency implications of survival sex and synthesized the study findings via qualitative analysis. We identified three themes as they relate to the consent or sexual agency implications of survival sex—power, coercion, and sexual agency—and five themes we called push factors into greater vulnerability to survival sex—hunger, patriarchy, poverty, substance use, and insecure housing. Each factor has the effect of limiting people’s capacity to consent to sex by creating a coercive environment that limits their power to exercise sexual agency. We found that women are at particular risk to be coerced into survival sex by other people or circumstances of deprivation. Our findings suggest that survival sex is often nonconsensual sex. In contrast to traditional approaches that consider survival sex a risk factor for sexual health, we discuss policy and advocacy efforts and apply a human rights perspective that considers how survival sex is a violation of personhood and autonomy.