Participation In Sex Work Research Articles

Attitudes Toward Cisgender Women's Participation in Sex Work: Opportunity for Agency or Harmful Exchange?

Despite the stigmatization of sex work in society, little empirical research has examined attitudes toward sex work, especially its modern incarnations (e.g., sugar relationships, webcamming). Here, a sample of 298 US residents (Mage = 40.06years; 59.1% male, 40.9% female) was recruited through Amazon Mechanical Turk. Various theoretical predictors (e.g., right-wing authoritarianism [RWA]), sociosexuality) were set to predict the degree to which four sex work domains (prostitution, pornography, sugar relationships, webcamming) provide cisgender women agency (beneficial) or harm them (detrimental). We found that the domains of sex work were organized hierarchically, as theorized by the so-called "whorearchy," whereby the more "unfavorable" domains (e.g., prostitution) fall at the bottom, and the more "favorable" ones (e.g., webcamming) sit at the top. Additionally, multiple regression analyses revealed that RWA (negatively) and sociosexuality (positively) were the strongest predictors of sex work agency across various domains. In predicting harm, RWA, feminism, religiosity, and age were unique positive predictors, whereas sociosexuality and male (vs. female) self-identified sex were unique negative predictors, across the four domains of sex work. Moreover, individual differences (e.g., RWA) were often significantly stronger predictors of agency or harm among female than male participants. The results suggest that although sex work domains vary in agency and harm ratings, individual differences (most notably, RWA and sociosexuality) are important predictors across domains, especially for cisgender women. Given the growing prevalence of such online forms of sex work, along with growing evidence of sugar relationships, it will become increasingly important to track reactions as these forms of sex work evolve.

The negative health spillover effects of universal primary education policy: Ethnographic evidence from Uganda

ABSTRACT Scholars of global health have embraced universal education as a structural intervention to prevent HIV. Yet the costs of school, including fees and other ancillary costs, create an economic burden for students and their families, indicating both the challenge of realising the potential of education for preventing HIV and the ways in which the desire for education may produce vulnerabilities to HIV for those struggling to afford it. To explore this paradox, this article draws from collaborative, team-based ethnographic research conducted from June to August 2019 in the Rakai district of Uganda. Respondents reported that education is the most significant cost burden faced by Ugandan families, sometimes amounting to as much as 66% of yearly household budgets per student. Respondents further understood paying for children’s schooling as both a legal requirement and a valued social goal, and they pointed to men’s labour migrations to high HIV-prevalence communities and women’s participation in sex work as strategies to achieve that. Building from regional evidence showing young East African women participate in transactional, intergenerational sex to secure school fees for themselves, our findings point to the negative health spillover effects of Uganda’s universal schooling policies for the whole family.

Transgender Women in Dominican Republic: HIV, Stigma, Substances, and Sex Work.

Exposure to stigma, violence, sex work, and substance use are associated with increased HIV risk, but relationships between these factors have not been fully elucidated among transgender women whose data are often aggregated with men who have sex with men and other sexual and gender minorities. Considering this gap, we aimed to identify a serologically confirmed HIV estimate for transgender women and examine the relationships between stigma, sex work, substance use, and HIV among a national sample of transgender women in Dominican Republic. We analyzed biomarkers and self-report data from the third wave of Dominican Republic's Encuesta de Vigilancia y Comportamiento con Vinculación Serológica, employing logistic and negative binomial regression to estimate models (n = 307). HIV rate was 35.8%. Nearly 75% of respondents engaged in sex work. Over 20% reported experiencing violence; 61.6% reported being stigmatized. Participation in sex work was associated with higher levels of stigma [incidence rate ratio (IRR): 1.70, p < 0.05]. Respondents who experienced violence had over three times higher odds of living with HIV relative to respondents who had not been victimized [odds ratio (OR): 3.15, p < 0.05]. Marijuana users were less likely to experience stigma compared with cocaine users (IRR: 1.72, p < 0.05), and a higher risk of alcohol dependency was associated with higher odds of experiencing violence (OR: 1.17, p < 0.001). Findings illustrate the importance of disaggregating data collected from transgender women compared with other sexual and gender minorities to ascertain subpopulation-specific estimates and indicate an urgent need to implement structural interventions and policies to protect transgender women's health and their human rights.

Sex work, gender transition, family rejection and depressive symptoms among transgender women in India

Background: Transgender women in India face unique stressors associated with minority experiences, such as experiences of gender transition and participation in sex work. However, the relationship between sex work, transition and mental health outcomes is understudied in this population. Aims: This article aims to examine the association between gender transition status, sex work, family rejection and depressive symptoms among transgender women in India. Methods: Data comes from a cross-sectional epidemiological study with transgender women from three states of India; Karnataka, Maharashtra and Tamil Nadu (N = 1366). Multivariate regressions were used to examine the association between sex work status and gender transition and how gender transition, and sex work are associated with depressive symptoms. Results: 70% of the sample reported being in sex work and over 82% endorsed taking some form of gender transition service. Those who reported being in sex work were significantly more likely to have undergone breast augmentation, hormonal therapy and gender affirming surgery. Those who reported ever being married were less likely to report gender affirming surgery and were more likely to report hormonal therapy. Additionally, being in sex work, undergoing transition, leaving home because of sexual orientation, and being married were significantly associated with depressive symptoms. Discussion: Community-led organizations and other service agencies must incorporate intersectional experiences and identities, including sex work and gender transition, in their programs to further social and health justice for transgender women in India. Policy and programmatic implications are discussed. Supplemental data for this article is available online at https://doi.org/10.1080/26895269.2021.1939220

The Feminist Ethic of Care: Mothering Among Sex Workers in Mumbai

The majority of sex workers are mothers. Although participation in sex work is primarily driven by the prioritization of their children’s needs over their own, mothers are stigmatized, subject to poorer health, and lack access to quality health care and social services. Interviews with 25 mothers in Mumbai, India, were analyzed using theory-driven coding to reexamine participation in sex work in context of Gilligan’s three-stage ethic of care, a feminist theory of moral reasoning. Stage 1 (decision making focused on self) themes were (a) sex work served as a means to survival and (b) exploitative and unfulfilling relationships required a focus on self. The transition from Stage 1 to 2 theme was language of selfishness versus responsibility. Stage 2 (selflessness is goodness) themes characterizing the majority of narratives were (a) sex work is justified, (b) duty to prioritize care of others, and (c) self-sacrifice to achieve aspirations for children. The transition from Stage 2 to 3 had one theme: consideration of self. While Stage 3 represents women taking holistic care of themselves and others, the data did not reflect this. Reframing mothers’ participation in sex work using the ethic of care framework may support destigmatization, decriminalization, and security of human rights.

Sex work, social support, and stigma: Experiences of transgender women in the Dominican Republic

Background: Transgender populations, and especially those in resource-limited settings, are at an elevated risk of experiencing stigma and discrimination.Aims: This study sought to examine the relationship between parental, familial, and other social support, experiences of stigma and discrimination, quality of life, and sex work in a national sample of transgender women in the Dominican Republic (n = 291).Methods: Descriptive analyses for the outcome variable, sex work, as well as for measures associated with socio-demographics, social support, stigma, quality of life, and experiences of abuse and violence were performed. Bivariate analysis examined differences between respondents involved in sex work and those not involved in sex work.Results: We found that participation in sex work was associated with low social support and quality of life and increased experiences of stigma, discrimination, and abuse. Specifically, Dominican transgender women involved in sex work received less social support than their non-sex working peers; they experienced heightened arguments and problems with non-parental family members, professors or bosses, classmates, and close friends, as well of loss of friendships. Involvement in sex work was also associated with higher levels of stigma and discrimination, lower quality of life, and experiences of sexual abuse, torture, and experiences of attempted murder on one’s life.Discussion: Transgender women participating in sex work require more rather than less social support from family members and loved ones, especially in areas where workplace discrimination policies that affect transgender individuals are nebulous, such as the Dominican Republic.

Prevalence and correlates of selling illicit cannabis among people who use drugs in Vancouver, Canada: A ten-year prospective cohort study

BackgroundThe illicit selling and use of cannabis is prevalent among marginalized people who use illicit drugs (PWUD). Given that participation in illicit drug markets has been previously associated with a range of health and social harms, we sought to examine the predictors of selling cannabis among PWUD in Vancouver, Canada, a setting with a de facto legalized cannabis market, on the eve of the planned implementation of legalized non-medical cannabis including measures to regulate the existing illicit market. MethodsMultivariable generalized estimating equations (GEE) logistic regression was used to analyze longitudinal factors associated with selling illicit cannabis among three prospective cohorts of PWUD between September 2005 and May 2015. ResultsAmong the 3258 participants included in this study, 328 (10.1%) reported selling illicit cannabis at baseline, and 46 (5.1%) initiated cannabis selling over the study period. In the multivariable analysis of the whole sample, factors significantly associated with selling cannabis included cannabis use (Adjusted Odds Ratio [AOR] = 4.05), dealing other drugs (AOR = 3.87), being male (AOR = 1.83), experiencing violence (AOR = 1.40), non-medical prescription opioid use (AOR = 1.32), non-custodial involvement in the criminal justice system (AOR = 1.31), being stopped by police (AOR = 1.30), crack use (AOR = 1.25), homelessness (AOR = 1.23), age (AOR = 0.96 per year) and participation in sex work (AOR = 0.67) (all p < 0.05). The subanalyses indicated that dealing drugs other than cannabis, cannabis use, and non-custodial involvement in the criminal justice system were the only factors significantly associated with selling cannabis in all four subgroups. ConclusionThese findings support existing evidence indicating that selling illicit cannabis is often a survival-driven strategy to support the basic needs and substance use of some PWUD. Our findings suggest jurisdictions with planned or impending cannabis legalization and regulation should consider the vulnerability of PWUD when seeking to eradicate illicit cannabis markets, for example, in setting criminal penalties for selling cannabis outside of regulatory frameworks.

Estimating the Prevalence of HIV and Sexual Behaviors Among the US Transgender Population: A Systematic Review and Meta-Analysis, 2006-2017.

Background. Transgender women (transwomen) in the United States have been shown to have high HIV risk with Black and Hispanic transwomen being particularly vulnerable. Growing research on transgender men (transmen) also shows increased HIV risk and burden, although not as much is known for this transgender population.Objectives. This systematic review estimates the prevalence of self-reported and laboratory-confirmed HIV infection, reported sexual and injection behaviors, and contextual factors associated with HIV risk of transgender persons living in the United States.Search Methods. We searched the HIV Prevention Research Synthesis database and MEDLINE, EMBASE, PsycINFO, CINAHL, and Sociological Abstracts databases from January 2006 to March 2017 and January 2006 to May 2017, respectively. Additional hand searches were conducted in December 2017 to obtain studies not found in the literature searches.Selection Criteria. Eligible reports were published US-based studies that included transgender persons and reported HIV status.Data collection and analysis. Data were double-coded and quality assessed. We used random-effects models employing the DerSimonian-Laird method to calculate overall prevalence of HIV infection, risk behaviors, and contextual factors for transwomen, transmen, and race/ethnicity subgroups.Main Results. We reviewed 88 studies, the majority of which were cross-sectional surveys. Overall laboratory-confirmed estimated prevalence of HIV infection was 9.2% (95% confidence interval [CI] = 6.0%, 13.7%; κ = 24). Among transwomen and transmen, HIV infection prevalence estimates were 14.1% (95% CI = 8.7%, 22.2%; κ = 13) and 3.2% (95% CI = 1.4%, 7.1%; κ = 8), respectively. Self-reported HIV infection was 16.1% (95% CI = 12.0%, 21.2%; κ = 44), 21.0% (95% CI = 15.9%, 27.2%; κ = 30), and 1.2% (95% CI = 0.4%, 3.1%; κ = 7) for overall, transwomen, and transmen, respectively. HIV infection estimates were highest among Blacks (44.2%; 95% CI = 23.2%, 67.5%; κ = 4). Overall, participation in sex work was 31.0% (95% CI = 23.9%, 39.0%; κ = 39). Transwomen (37.9%; 95% CI = 29.0%, 47.7%; κ = 29) reported higher participation in sex work than transmen (13.1%; 95% CI = 6.6%, 24.3%; κ = 10; P = .001). Most outcomes indicated high heterogeneity in the overall and subgroup analyses.Conclusions. The availability of more data allowed us to calculate estimates separately for transwomen and transmen. HIV prevalence estimates for US transwomen were lower than previous estimates, but estimates for HIV prevalence and participation in sex work were higher when compared with transmen. Evidence gaps remain for transmen and the syndemic relationship of HIV, risky behaviors, and contextual factors specific to the transgender experience.Public Health Implications. This study highlights gender disparities for HIV and risky sexual behavior, as well as evidence gaps that exist for transmen. Tailored programs and services for the transgender population need to be developed to encourage use of and access to HIV prevention services.

US Guidelines That Empower Women to Prevent HIV With Preexposure Prophylaxis.

EMPOWERING WOMEN TO PREVENT HIVSince the early days of the human immunodeficiency virus (HIV) epidemic, health care providers have sought methods of preventing HIV that empower women to protect their health.1,2 Now preexposure prophylaxis (PrEP), a daily pill that prevents HIV, can empower women wit

Intimate Partner Violence Among Transgender Youth: Associations with Intrapersonal and Structural Factors.

Intimate partner violence (IPV) is a serious public health problem, linked with a number of poor health outcomes. Some research demonstrates that transgender and gender nonconforming (TGNC) youth may experience IPV at similar rates to heterosexual cisgender women; however, there is a dearth of data examining the experiences of IPV among this population. The exclusion of TGNC youth in IPV research and public health interventions is problematic because it contributes to a traditional gender-based heterosexual model of IPV that ignores the specific needs of TGNC populations. Given the pervasiveness of transphobic stigma in the United States and the complexities of the lives of TGNC youth, it is important to understand how both structural and individual factors are associated with IPV among TGNC youth. Using data from a cross-sectional survey of 131 TGNC youth from 14 different cities in the United States representing various regions of the country, this study explores the associations between a range of structural and intrapersonal factors and experiences of IPV victimization among TGNC youth. Separate logistic regression models were fit to examine the relationships between structural and intrapersonal factors and IPV. Structural results found that TGNC youth experiencing extreme victimization, a history of incarceration, and participation in sex work were much more likely to report IPV. The only intrapersonal variable that was associated with IPV was depressive symptomatology; however, this relationship was strong, with participants being nearly eight times more likely to report IPV if they experienced symptoms of depression. Gaining a better understanding of the complexity of both structural and intrapersonal factors among TGNC youth will greatly inform the development of IPV prevention and services for TGNC youth experiencing this type of violence.

“Just being real”: A post-colonial critique on Amerasian engagement in Central Luzon’s sex industry

ABSTRACTThis paper explores the historical and social cultural factors that shape Filipino Amerasian women’s participation in sex work in the Olongapo red light district, adjacent to the former US Subic Bay Naval Base. The analysis shares terrain covered by other studies that examine the link between US militarism and Asian sex industries. In addition, this paper considers how racialized and sexualized power structures situate Amerasian women in specific ways in relation to sex work in the Philippines. A feminist post-colonial approach, including discourses on race, miscegenation and nationalism, provides a fresh perspective on how colonial and post-colonial structures and systems of power have shaped the sex industry as it is today, contributing to what may be an overrepresentation of Filipina Amerasians in sex work.

Transgender Women and the Sex Work Industry: Roots in Systemic, Institutional, and Interpersonal Discrimination

Because transgender people face discrimination on systemic, institutional, and interpersonal levels, the previous literature has supported that many transgender women view the sex work industry as their only viable career option. The current article reviews the literature on discrimination against transgender people, explores how discrimination influences their participation in sex work, and discusses how institutional discrimination against transgender women manifests within the criminal justice system. Furthermore, recommendations are provided for advocating for the rights of transgender people while promoting healthy behaviors and higher quality of life. Throughout the article, quotes from previous qualitative research are used to illustrate the experiences of transgender women through their own voices and perspectives.

Vulnerability to sexual violence and participation in sex work among high-end entertainment centre workers in Hunan Province, China

China has seen a proliferation of entertainment centres that are frequented by business people. Employees at these centres often are young, female rural-to-urban migrants who may be vulnerable to sexual violence and exploitation. Data for this study were collected using a self-administered survey among male and female employees in two high-end entertainment centres in Changsha, Hunan Province, China. We used logistic regression to examine predictors of violent and potentially exploitative experiences (partner violence, forced sex and transactional sex). Predictors included gender, ever having a same-sex partner, migration variables and employment characteristics. Participants reported high levels of partner violence (16.0% ever and 9.0% in the past 3 months) and forced sex (13.9% ever and 5.5% in the past 3 months). Nineteen percent reported sex work in the past 3 months. In the multivariate regressions, ever having had a same-sex partner was associated with higher odds of ever having experienced partner violence (odds ratio (OR)=7.8, P<0.001), partner violence in the past 3 months (OR=9.0, P<0.001), ever having had transactional sex (OR=6.0, P<0.001) and transactional sex in the past 3 months (OR=5.2, P=0.001). After adjusting for transactional sex, the association between having had a same-sex partner and partner violence remained significant. Neither gender nor migration status was associated with any of the outcomes. High-end entertainment centre workers in China are at risk for sexual violence and should be targeted with employment-based interventions.

Participation in sex work: students' views

Increasing evidence points to student involvement in the sex industry. The current study comprised a cross-sectional sample of 315 undergraduates at a London university. Using a semi-structured questionnaire, data were gathered on students' financial and employment circumstances and their views on participation in sex work. Results suggested awareness of student sex work was widespread, and considered understandable by the majority. Students principally attributed participation in the sex industry to their financial situation. A relatively high proportion (16.5%) indicated that they would be willing to engage in sex work to pay for their education, with 11% indicating they would work as escorts. A model of willingness to undertake sex work was able to explain over one-quarter of the variance. These findings are explained in relation to the mainstreaming of sexual consumption, the supply routes of sexual labour from privileged socio-economic positions and the effects of student debt.

Female College Students Working in the Sex Industry: A Hidden Population

This study carefully examines the perceptions and experiences of several women who are part of an overlooked group—college students who work in the sex industry. Interviews were conducted with students working in strip clubs or pornography. The reasons why they choose such work and how this choice impacts them are explored. Findings reveal that the women clearly recognize the time and monetary benefits as a main motivating factor for their employment in the sex industry, and they downplay the threat of violence as the main cost. The women perceive the primary cost to be the stigma they faced and the cognitive dissonance it produces as they negotiate their student and sex worker identities. They employ a variety of coping strategies to manage the negative effects of stigma, including cognitively separating themselves from the norms of the industry, justifying why they do such work, focusing on other more positive roles, avoidance through substance use, and leaving the industry. These strategies help resolve the cognitive dissonance created by their participation in sex work. This paper will highlight the ways in which faculty and staff can assist student sex workers in developing healthy coping strategies, accessing help, and persisting in their college enrollment.

High Prevalence of Genetically Similar HIV-1 Recombinants among Infected Sex Workers in Nairobi, Kenya

HIV-1, a highly diverse infectious agent, shows the greatest sequence diversity in highly exposed individuals, including greater levels of recombination. HIV-1 diversity in Nairobi, Kenya was examined in 240 individuals, including both those with high and low exposure to HIV. Sequence analysis of a 590 nucleotide proviral region encompassing vpu and part of env revealed that most viruses were clade A1 (70%), while both clade D (9%) and clade C (6%) virus were also observed, as was recombinant virus (15%). Participation in sex work was significantly associated with clade: these subjects had a lower likelihood of infection with clade C virus and a higher likelihood of infection with a recombinant isolate (p = 0.038). Interestingly, most of the recombinants formed distinct groups based on shared recombination breakpoints between common clades (n = 33/37). This study shows the value of continued HIV sequence analysis to examine and monitor viral genetic variability.

Sex work and students: an exploratory study

Available evidence suggests that changes in the funding of higher education have led to some students entering the sex industry in order to make ends meet. The current study comprises a sample of undergraduates (N = 130) in the south of England, who completed a cross‐sectional survey of their financial circumstances, health, psychological well‐being, substance use and lifestyle. A response rate of 74% was obtained. Data indicated that over 10% of all respondents knew of students engaged in sex work (defined as prostitution, escorting, lap dancing or stripping) in order to support themselves financially. Poor psychological well‐being, drinking problems and financial circumstances were associated with sex work, and although no direct evidence was found linking this to an earlier history of sexual abuse, there was an indirect relationship through the impact of abuse on mental health. A logistic regression model incorporating General Health Questionnaire scores, alcohol problems and hours worked outside of study strongly predicted whether respondents knew of students engaged in sex work. For lap dancing in particular the model was very strong. This study provides further evidence of students' participation in sex work and its association with economic circumstances. Further longitudinal work is required to clarify the nature of these relationships.

Sex Work in Cambodia: Beyond the Voluntary/Forced Dichotomy

This paper looks at the dominant voluntary/forced dichotomy shaping understandings of sex work internationally. It argues that the distinction between forced and voluntary participation in sex work cannot account for or help explain the multiple and contradictory subjectivities some women embrace and the constrained agency they exhibit in sex work. Based on ethnographic research and interviews with sex workers in Sihanoukville, Cambodia, this paper shows how elements of individual choice and coercion are intricately intertwined in women's experiences.

Attachment style, childhood adversity, and behavioral risk among young men who have sex with men

Purpose To examine relationships among childhood adversity, attachment style (one's core beliefs regarding the self and others), and the following risk behaviors and contexts among young men who have sex with men (YMSM): homelessness, daily substance use, participation in sex work, involvement in the criminal justice system, and being out of school or work. Methods Using a targeted sampling approach, we recruited 569 YMSM aged 17–28 years from natural venues in New York City including bars, clubs, parks, and bus stations. Youth completed a structured interview assessing lifetime and current risk and protective contexts and behavior. Data were analyzed using univariate and multivariate statistical methods, including hierarchical logistic regression. Results After controlling for demographic characteristics and childhood adversity, YMSM with a fearful attachment style were more likely to have been homeless (OR 2.93, 95% CI 1.65–5.18), to have participated in sex work (OR 2.35, 95% CI 1.44–3.85), to use substances daily (OR 2.79, 95% CI 1.29–6.03), to have been involved in the criminal justice system (OR 2.04, 95% CI 1.38–3.01), and to be out of school/work (OR 2.47, 95% CI 1.47–4.15). Three subgroups were particularly vulnerable: YMSM who identified as heterosexual, or bisexual, and/or transgender. Conclusions A fearful attachment style contributes to some YMSM remaining outside of the protective systems of family, school, and work, and is associated with risky contexts where they are less likely to encounter prosocial peers and adults. Further, it is associated with risk behavior. Although gay-identified youth are generally found to have poor outcomes when compared with the general population of adolescents, in the present report, YMSM who identified as heterosexual were at particular risk. Attachment theory can guide interventions by informing how individuals experience relationships and manage developmental transitions.

Gay and Bisexual Male Escorts Who Advertise on the Internet: Understanding Reasons for and Effects of Involvement in Commercial Sex

The growing research on male commercial sex work has primarily concentrated on adolescent hustlers and street-based workers. Few studies have addressed the specific characteristics of adult male gay or bisexually identified escorts who work independently. We explored qualitatively reasons for and effects of sex work among 46 gay and bisexual male escorts in New York City who use the Internet to advertise their services. Participants completed quantitative measures and a semi-structured qualitative interview. A manual search of themes in the transcribed interviews identified three main reasons for participation in sex work—monetary benefits, positive impact on the self, and sexual pleasure. Participants also reported various changes to their personality and sexuality because of their involvement in commercial sex work. Internetbased male escorts represent a unique population of commercial sex workers, different from male sex workers who work on the streets, and have their own specific health needs.