Buying Sex- The Connection Between Buying Sex and Child Sex Abuse
"If I sexually molest her, will she become a prostitute later on?”
This is what one man, convicted of sexually abusing of a minor, wondered before he molested his stepdaughter (Pryor, 1996).
Of course, he was wrong to molest the little girl, but he was right to wonder about putting her at risk for prostitution.
Not only does research show that childhood sex abuse is a risk factor for engaging in sex work, but it also shows that children who are sexually abused may enter into sex work while they are still children. Purchasers of sex may be buying sex from children or from adult victims of child abuse.
Why is this important?
A commonly held belief is that buying sex acts is a legal, ethical practice that occurs between consenting adults.
When in fact research shows:
1. Many sex purchases involve children.
2. Many adult sex workers began their “careers” as children.
3. Many adult sex workers are victims of various forms of child abuse and are in need of healing.
4. Many sex workers are sex slaves who do not gain access to the proceeds of their work.
5. Many sex workers are sex slaves who are addicted to drugs and work to be paid in drugs to avoid withdrawal and may have no access to healthcare services for addiction treatment.
Sex work in the form of prostitution is commonly known as the oldest profession in the world. In-person sex work in the Unites States generates approximately $14 billion dollars annually (Sawicki et. al., 2019).
This amount of $14 billion is an economic indicator that represents the exchange of sex for money. It is a proxy measure for the prevalence of sex work. Fourteen BILLION dollars are 14 billion signs that point to the ubiquitousness of the sale of sex. According to a 2012 report there were approximately 40 million sex workers in the world, of those, 1-2 million were based in the United States (Sawicki et. al., 2019).
What is Sex Work?
Sex work is not widely accepted or even legal in many jurisdictions. How sex work is conceptualized can differ widely regionally, making it difficult to pinpoint a specific definition. Typically, sex work is thought of as prostitution; however, it can include other paid sexual acts such as pornographic film acting, exotic dancing, and escorting (Abramovich, 2005).
An organization that advocates for sex worker rights provides this definition, “Sex workers are adults who receive money or goods in exchange for consensual sexual services or erotic performances, either regularly or occasionally” (Open Society Foundations, 2019).
Survival sex also falls under the category of sex work because sex is traded either for tangible items such as money, food, other goods or for non-tangible items such as a place to sleep or physical protection (McMillan et. al., 2018).
Another form of sex work is nonconsensual or coerced sex work done by victims of sex trafficking.
Pros
Proponents of sex work argue that sex work results in economic income, better pay options, more flexible working conditions, and allows for exploration of and expression of sexuality (Open Society Foundations (2019).
Cons
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Research has shown that sex work puts individuals at risk for HIV and other sexually transmitted infections, unwanted pregnancy, physical abuse, psychological abuse, emotional abuse, mental health disorders, substance use issues, and an increased risk of becoming a victim of human trafficking (Loza et. al., 2010). Sex trafficking survivors are at significant risk for injury, depression, serious weight loss, post-traumatic stress disorder, and substance abuse (Varma et al., 2015).
Additionally, depending on the jurisdiction, some sex work activities are considered criminal and can result in legal repercussions including jail time (Grubesic, 2023). A criminal record can complicate future efforts to find work, housing and other opportunities. These are serious personal consequences for individual sex workers that, together, pose significant public health risks on a societal level.
Major Causes
Some factors associated with engaging in sex work have been identified; however, it is difficult to pinpoint actual causes due to the complex nature of human behavior. Factors significantly associated with engaging in sex work are: childhood physical abuse, sexual abuse, living in a home with care givers who abuse substance/s, minority status, runaway behavior, homelessness, low education/failure of educational system, and drug overuse or addiction (Kramer & Berg, 2003).
Despite a precise cause being difficult to identify, one very significant risk factor has been shown to be associated with sex work.
Review of the Evidence: The scientific studies below found an association between childhood sex abuse and sex work.
De Vries and Goggin (2018) conducted a systematic review of and meta-analysis of studies that looked at the impact of sexual, physical, and emotional abuse on the risk of commercial sexual exploitation of youth. The analysis had no geographical limits. The search for studies was conducted in 2017. The time period that the studies chosen were conducted ranged from 1992 to 2015. Studies that were not peer reviewed, published, and printed in English were excluded. Inclusion criteria for the meta-analysis were that studies were required to contain sufficient statistical data, address the impact of physical, sexual, or emotional abuse, and that the subjects were minors at the time of commercial sexual exploitation. Results indicated that children who were sexually abused were 2.5 times more likely to be commercially sexually exploited.
Slim et. al. (2020) conducted a case control study in Lebanon during an unspecified time period to study factors, including child abuse, associated with women engaging in sex work. The study used a sample of 120 incarcerated women, 60 of whom were sex workers, and a control group of 60 women who were not sex workers. To gather data on factors possibly associated with engaging in sex work, the researchers used a prison employee to administer face-to-face consultations. The consultation consisted of collecting demographic data and administering the Child Abuse Self Report Scale (CASRS), Composite Abuse Scale, the Hamilton Depression Rating Scale (HDRS), the Hamilton Anxiety Scale (HAM-A), and the Perceived Stress Scale (PSS). A set of logistic regressions was conducted, statistical significance, p= < 0.05, was found for child sexual abuse and sex work, with the group that was sexually abused being more likely to engage in sex work than those not sexually abused.
Silbert and Pines (1981) conducted a descriptive study to better understand the antecedents to prostitution in non-incarcerated females. The sample consisted of 200 former and current female prostitutes with an age range of 10 to 46 years old, thus revealing that 60% of the participants were children under the age of 16. Participants were recruited from the San Fransico community during an unspecified time period. Face to face interviews were conducted by specially trained interviewers who had previously been prostitutes. An instrument called the Sexual Assault Experiences Questionnaire was developed by the researchers for the purpose of collecting relevant data for the study. The data analysis revealed that 60% of the sample was sexually abused prior to age 16 and that 70% of the women reported that their sexual abuse affected their decision to enter into prostitution.
Widom and Kuhns (1996) conducted a longitudinal prospective cohort study to test the hypothesis that there is a direct relationship between early childhood victimization and subsequent promiscuity, prostitution, and teen pregnancy. The study followed a cohort of 1196 children from a metropolitan area in the Midwest United States. The intervention group was comprised of abused and neglected children and the control group was comprised of a non-abused/neglected cohort matched based on race, socioeconomic class, age, and sex. Both groups were children during the period of 1967-1971, abuse and neglect status was obtained from county court records. Both groups were interviewed as adults during the time period of 1989-1995. Two-hour double-blind interviews were conducted, consisting of a battery of structured and semi structured questions and rating scales, measures of IQ and reading ability, and a psychiatric assessment. Data between the two groups were then statistically analyzed, revealing a statistically significant result (p= <0.01) for the connection between childhood abuse and neglect and prostitution as compared to the control group.
Stoltz et. al. (2007) conducted a prospective cohort study in Vancouver Canada between September 2005 and June 2006. The purpose of the study was to evaluate how childhood sexual, physical, and emotional abuse might be associated with engagement in sex work. The sample included 361 “street-involved” youth. Interviews were conducted to determine socio-demographic variables including having sold sex for money or gifts. Data from the evidence-based instrument the Childhood Trauma Questionnaire was gathered to determine the abuse history status of participants. Data from these two sources were then statistically analyzed. After adjusting for demographic variables, multivariate logistic regression revealed a significant association between childhood sexual abuse and sex work. The p value for this association was p < 0.001.
Ahrens et. al. (2012) conducted a longitudinal cohort study to evaluate the association between childhood sexual abuse and transactional sex in youth aging out of foster care in the Midwestern United States. The sample was comprised of 732 youth of whom data were gathered at age 17 and again at age 19. Data from a larger study (Midwest Evaluation of the Adult Functioning of Former Foster Youth) and in person interviews were statistically analyzed for association between exposure to childhood sex abuse and sex work. After adjusting for covariates, the analysis showed that subjects who did experience childhood sex abuse (sexual molestation and rape) were significantly more likely to engage in sex work than the subjects who did not experience childhood sex abuse. There was a strong association between molestation and sex work, with a p value of < 0.05. For those children who were raped the p value was <0.01, indicating an even stronger association between rape and engaging in sex work. Tyler et. al. (2000) conducted an interview study with path analysis on the relationship between childhood sexual abuse and other variables including engaging in trading sex for food or drugs. The sample size was 361 adolescent females that were considered homeless or runways from six agencies located in Missouri, Iowa, Nebraska, and Kansas. Subjects were interviewed by trained interviewers that conducted 90 minute interview sessions. Subjects were recruited from outreach programs and provided incentives of food and $15 cash. Data was collected via interview using questions the authors adapted from Whitbeck and Simons (Tyler et. al. 2000). The analysis found that females who were sexually abused were significantly (p value = <0.05) more likely to trade sex for drugs or food than those who were not sexually abused as children.
Diamond-Welch and Kosloski (2020) conducted a cross-sectional observational study with logistic regression analysis of data collected via an online survey to assess relationship between childhood sex abuse and commercial sex behaviors. Data collection instruments used were the evidence-based ACE instrument and a self-administered survey on demographics and sex buying/selling habits. The sample of 930 adults was recruited online to complete a web-based survey. The location of the study was not specified as the study was done virtually and not in person, although US citizen status was a factor for inclusion in the study. The study found a significant (p value = < 0.05) association between childhood sexual abuse and selling sex.
Halkett et. al. (2022) conducted a longitudinal exploratory study to study predictive factors for sex work. The study began in 1997, 1998 and 1999 in the San Fransisco Bay area. Follow ups took place 5, 10, and 16 years later. The sample consisted of 228 children, 140 children who were diagnosed with ADHD and 88 children who were not diagnosed with ADHD but matched by age, ethnicity and income. Data was collected by structured interviews and self-report measures. Measures included Background Information Questionnaire (BIQ) and the Family Information Profile (FIP). Child sex abuse occurring between the ages of 9-15 was found to be statistically significant predictor of sex work even after controlling for other variables, p = .007. (Please note that this study did not find a connection between ADHD and sex work, the study looked at the connection between sex abuse and sex work.)
McLachlan (2022) conducted a single subject exploratory case study in California in 2015 to assess the relationship between early childhood experiences and vulnerability of entering into prostitution. The sample was an individual girl who had entered into prostitution at age 11. The method of data collection for analysis were several in person interviews conducted by the clinician researcher. Psychological testing instruments were also administered, including, the House-Tree-Person, Kinetic Family Drawing, Roberts Apperception Test for Children-Second Edition, and a Sentence Completion Task. This data was then qualitatively analyzed for emerging themes which were then coded and organized. The major theme recognized was insecure attachment of the anxious ambivalent type that led to dysfunctional internal working models that made the subject susceptible to the traumatic bonding of a pimp/prostitute relationship.
The convicted sex offender who wondered if he might put his victim at risk for prostitution instinctively knew what scientific research has shown.
People who work with the population involved in sex work have noticed the relationship between child abuse and engaging in sex work. A common flow of events looks like this;
Do all sex workers begin working as adults?
Some studies reveal that for many children, sex work was a part of their childhood abuse, and for many adults, their involvement in sex work began as abuse during childhood.
In their investigative study Campagna and Poffenberger (1988) described methods in which adults who sexually abuse children at home then initiate abused children into “sex rings”, aka a group of “customers” curated by the abuser. These homegrown sex rings, often manifesting as parties or exclusive gatherings in a private setting, then serve as a segway into more commercial sex, including child pornography, (more accurately termed child sex abuse material).
This illustrates the tie between childhood sex abuse and sex work. It also demonstrates that many sex workers originate as child sex abuse victims.
It is also important to note that children should not be considered prostitutes as that implies an informed consensual process, which a child is not capable of making.
Any instance where a person under age 18 has exchanged a sexual act or performance in exchange for something of value is defined as child sex trafficking (NYC Administration for Children’s Services n.d.).
Using the term “child prostitute” perpetuates harm to children as it normalizes the sale of children for sex.
Trafficking Misconception
Many people think that sex trafficking is some sort of well organized operation that transports people across state lines for sex or from other countries for sex. While this certainly does happen, these scenarios are examples of sex trafficking, they are not the definition.
The definition is more broad and it does not require transportation of any kind.
Even though the word trafficking implies movement of people through transportation, that is not a prerequisite requirement for trafficking. What constitutes trafficking is the exchange of sex acts for something of value.
With adults there must be an element of coercion involved in the sex exchange in order to be considered trafficking, without coercion of some kind, the exchange would be considered prostitution.
Whereas with children, there need not be any element of coercion due to the vulnerable and dependent nature of children.
Again, there need not be any transport of the child. Sex trafficking includes an instances where a child/children never leave their own homes but are offered by their own parents/caregivers for sex in exchange for money, drugs, food, or other services. In these cases although the children do not travel outside their homes they are still being trafficked.
Any sex act involving a child, including child pornography, that is traded for something of value is sex trafficking. There is no such thing as child prostitution, only child sex trafficking.
It is important to note that while coercion is not required to meet the definition of child sex trafficking, that doesn’t mean coercion doesn’t actually happen. Child grooming for sex abuse/sale by adults is a form of coercion. The process of grooming has been cultivated, refined and developed collectively by various child abusing communities. There are books, leaflets, magazine articles, online chats, forums and groups dedicated to the practice of grooming children for sex abuse.
Many perpetrators understand that a systematic set of actions and behaviors directed towards turning an innocent child into a sexualized object for use by adults, will produce a “successful” outcome. These individuals have shared tips, posted information online, provided in person mentorship and instruction, created communities in which to develop networks dedicated to abusing children for sexual gratification.
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Prevalence and Incidence
Usually, a discussion of a public health problem starts out with noting the prevalence and incidence of the problem, meaning what is the data on how widespread the problem is? What are the statistics on who is affected? What percentages of which populations?
This is difficult for this topic. It is like trying to discuss data on local cocaine sales.
You don’t really have accurate information because the information is being actively and purposely concealed and suppressed. We are talking about the illegal and immoral sale of innocent children for sex.
Of course we will not have up to date, accurate numbers reflecting what is actually going on. What can we do? Ignore it? Say we don’t have good data therefore we cannot know the problem exists, therefore we do nothing?
No. We can look at other ways to determine that the problem exists. We can look at arrests or reports of sex trafficking. The national clearinghouse Polaris maintains data on this as well as the International Labour organization.
But what about the cases that go unreported?
Especially when we are talking about children. Kids have limited authority and agency in their own lives, many are not capable of making a report and worse, many are not believed even when they are able to make a request for help.
One thing to look at are proxies, something that represents the problem indirectly. In this case, money. As previously stated, sex work generates 14 billion dollars in the U.S. annually. First, we must recognize that this number does not account for children or adults being covertly sold for sex in underground black markets. So we can recognize $14 billion as being the low end of a range of income that likely goes much higher than $14 billion.
We all know that the movie industry is extremely lucrative, Hollywood celebrities are among some of the most idolized and wealthy people in the U.S. Yet in 2022, only $6.54 billion was spent by U.S. consumers on movie tickets (Statista, 2023).
Yes, Americans spent more than double the amount of money on sex than on movie tickets.
We do not know what percentage of sex workers that generate $14 billion are children, but the research clearly shows that some of them are in fact children.
Child sex abuse (including sex trafficking and child pornography) is a tremendous public health problem.
The annual cost is estimated to be $9.34 billion (Letourneau et al., 2018). Over $9 billion per year is spent on medical/health treatment, child welfare services, special education services and other expenses. This $9 billion includes expenses for non-fatal cases of child sex abuse as well as productivity loss for fatal cases.
It is important to not overlook the fatal cases of child sex abuse, death resulting from a child being raped to death, dying from a drug overdose (children are often drugged for transport and sex abuse to make them less combative/less likely to run away) or they commit suicide.
An additional $5.4 billion is spent annually to incarcerate adults in the U.S. convicted of sex crimes against children (Blackburn, 2022).
You might say, Wow, that’s almost $15 billion dollars are being spent as a result of child sex abuse each year, this is crazy! Surely our tax dollars must be working equally as hard to PREVENT child sex abuse?…
No not equally. As a matter of fact, not even half as much. Not even a quarter.
Up until a few years ago ZERO dollars were being spent on child sex abuse prevention.
Yes you read that right, NO money spent to prevent kids from being abused. After much pressure from child welfare advocates, 2020 was the first year the U.S. government allocated money for child sex abuse prevention research.
In 2022 the budget for funding for child sexual abuse prevention was $2 million dollars (Blackburn, 2022).
Two million for helping protect kids is great, but for comparison consider the following.
In 2022 there was an $8 million budget to combat the trafficking of wildlife animals. And an $11 million budget to develop a fertility control vaccine for wild horses and burros. (Amundson, S., 2021).
Nothing against animals, they deserve protection too, but let’s be clear. The U.S. government prioritizes the prevention of trafficking wild animals over innocent children.
They spend 300% more money on preventing the trafficking of wild animals than they spend for preventing the trafficking of children.
Survivor voices are extremely important in understanding the problem of child sex abuse and child sex trafficking. Listening to the experiences of the people who have survived the horrors of child sexual abuse sheds light on the problem from the very heart of the issue.
Improving Screening for Sex Trafficking
Peterson et al. (2022) note the widespread problem of child sex trafficking. They conducted a study to improve screening for victims of child sex trafficking noting that victims do not typically ask for help by telling healthcare providers about their exploitative situation. For a variety of reasons, (being unaware, lacking terminology, shame, fear, distrust) kids do not disclose that they are being trafficked.
The researchers suggest better screening methods to detect children that are being trafficked. They state that the vast majority of child sex trafficking victims seek medical care from either a pediatrician or hospital emergency department around the time that they are being trafficked.
Many of the children present with a chronic medical condition, suicidal ideation or pelvic inflammatory disease.
Over 75% of a sample of sexually exploited teens in New York City reported seeking medical care within the past 6 months. Common reasons for seeking care include sexually transmitted infections, physical/sexual assault injury, untreated chronic disease, suicide attempt, drug ingestion, assistance with contraception, abortion or pregnancy complications (Varma et al., 2015).
The American Academy of Pediatrics Policy Statement on Global Human Trafficking and Child
Victimization (2017) states that in a study of cities that had human trafficking task forces, 55% of sex trafficking victims were younger than 18 years old. They identify the following risk factors for children being sex trafficked: children who identify as gay, lesbian, queer, bisexual, transgender, American Indian girls, history of abuse or neglect, substance misuse, homelessness, involvement with foster care, history of involvement with child protective services, family financial crisis or interpersonal violence. They also state there is a lack of research into the topic of child sex trafficking despite it being such a serious public health problem.
The Office of Juvenile Justice and Delinquency Prevention identifies lack of public awareness as an obstacle in identifying victims of child sexual exploitation and trafficking.
“The degree of traumatization experienced by CSEC victims is well documented. Sexually exploited persons suffer from high rates of posttraumatic stress disorder (PTSD), Stockholm Syndrome, memory loss, aggression, fear, depression, anxiety, hostility, anger issues, sexually transmitted disease/infection (STD/STI), physical trauma from beatings, and emotional and psychological trauma from engaging in unwanted sex (Greenbaum 2014; Cohen, Edberg, and Gies 2011; Raymond and Hughes 2001; Hughes 1999). Furthermore, minors exploited through prostitution are 70-90 percent more likely than nonexploited youth to have been victims of child abuse and they are also 28 times more likely to be arrested for prostitution in their lifetime (Goodman and Laurence N.d.). CSEC victims often suffer extreme shame about their experiences and they may face the stigma associated with being “sexually promiscuous” (Walker N.d.).”.
References
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