Prostitution: a critical review of the medical and social sciences
Melissa Farley and Vanessa Kelly
Women & Criminal Justice 2000, Vol 11 (4): 29-64.
Melissa Farley & Vanessa Kelly c 2000 All Rights Reserved.
ABSTRACT. In the recent literature on prostitution, there has been a focus on
HIV which has tended to exclude discussion of the physical and sexual
violence which precedes and which is intrinsic to prostitution. The
literature of two time periods (1980-84 and 1992-1996) is critically reviewed
in order to describe this trend.
The normalization of prostitution in the medical and social sciences
literature, the tendency to blame the victim of sexual exploitation, and the
ways in which racism and poverty are an inextricable part of prostitution are
discussed here. The social invisibility of prostitution, needs of women
escaping prostitution, and an overview of recent criminal justice responses
to prostitution are summarized.
Some laws in USA have been profoundly influenced by social science
research - for example, rape law and sexual harassment law. In an era of
changing attitudes toward prostitution, familiarity with recent research is
essential to those who are a part of the criminal justice system. As
psychologists, we hope to see a change in the health professions’ relative
silence regarding prostitution’s harm to women, as well as a change in the
perspective on prostitution held by the criminal justice system.
The social and medical sciences have been limited by a failure to
adequately address the harm of prostitution to women. Concerned about the
Melissa Farley, Ph.D. is at Kaiser Foundation Research Institute, Oakland,
Ca. and Prostitution Research & Education, a project of San Francisco Women’s
Box 16254, San Francisco CA 94116-0254
Vanessa Kelly, Psy.D. is Coordinator, University of California at San
Francisco Traumatic Stress Treatment Program, San Francisco General Hospital,
San Francisco, CA.
invisibility of prostitution’s harm in the health professions (in addition to
its invisibility in the culture at large), we reviewed the literature on
prostitution. The authors concur with Vanwesenbeeck (1994, page 33) who
wrote: "Researchers seem to identify more easily with clients than with
Much of what has been written about prostitution in the medical and
social sciences fails to address the sexual violence and psychological harm
which both precede and are intrinsic to prostitution. A few (see below) have
noted that prostitution involves a lifelong continuum of sexual exploitation
and violence which begins with sexual assault or prostitution in childhood.
Most authors between 1980 and 1998 failed to address the violence in
prostitution. Instead, there has been an almost exclusive focus on sexually
transmitted disease (STD), especially the human immunodeficiency virus (HIV)
in the recent social science and medical literature on prostitution. Although
HIV has certainly created a public health crisis, the violence and human
rights violations in prostitution have also resulted in health crises for
To describe this trend in more detail, we reviewed the MELVYL Medline
and PsycINFO on-line databases on prostitution for 2 time periods: 1980 -
1984, and 1992 - 1996 (MELVYL Medline and PsycINFO, 1980-84 and 1992-1996).
Medline lists citations and abstracts of articles in medical and life
sciences journals. PsycINFO lists citations and abstracts of articles in
During the decade 1980-1990, there was a pronounced trend in the social
sciences literature to view prostitution primarily as a means of HIV
transmission, from prostitute to john. We compared the percentages of
journal articles which focused primarily on STD and HIV to those articles
which addressed prostitution itself as a source of harm to the woman
We organized the literature into three content categories based on
themes that emerged from the databases in the two time periods. As seen in
Table 1, these three categories were: (1) STD/HIV, (2) other harmful
consequences of prostitution, (3) legal/demographic/psychoanalytic. The
first category, STD/HIV, included those references which discussed means of
transmission and infection rates of STD, and various approaches to HIV
prevention. The second category (other harm) included discussions of non-
HIV-related harm of prostitution. Citations included discussions of sexual
and physical violence in prostitution, and antecedent harm, such as juvenile
prostitution and childhood sexual assault. The third category included
demographic descriptions of those in prostitution (e.g. number of arrests,
gender differences), b) psychoanalytic theorizing about the origin of
prostitution behavior which did not discuss trauma, c) discussions of
legalization or decriminalization which did not discuss harm to those being
prostituted, and d) historical accounts of prostitution.
The first part of this paper describes the quantitative results of this
review. In the second part of the paper, we critically discuss why the
literature failed to address the harm of prostitution, and we present some
alternative perspectives which take into account the harm caused by
TABLE 1 GOES APPROXIMATELY HERE
A Quantitative Summary of Two Online Databases on Prostitution: 1980-1984 and
From 1980 through 1984, 119 references to prostitution appeared in the
Medline database. See Table 1. 68% (81) were discussions of STD. The
PsycINFO database during that same time period contained 41 references to
prostitution, of which 2% (1) focused on STD.
15% (18) of the Medline prostitution database, and 41% (21) of the
PsycINFO prostitution citations 1980-1984 addressed the harm of prostitution
other than STD. These included discussions of juvenile prostitution, child
pornography, child abuse, substance abuse, and physical violence in the lives
of those prostituted (Brown, 1980; Pierce,1984; Paperny & Deisher, 1983;
Coleman, 1982; Lamb & Grant, 1983). A third of the 1980-1984 PsycINFO
citations noted the relation between early sexual exploitation and entry into
prostitution (Silbert & Pines, 1983). Other discussions included gender
differences in post-arrest detention (Bernat, 1984); and how a functionalist
analysis of prostitution ignores its harm (Hawkesworth, 1984).
17% (20) of Medline and 57% (19) of the PsycINFO citations between
1980-1984 discussed legal/demographic/psychoanalytic aspects of prostitution.
Examples from the Medline database included a psychoanalytic view of the
“fallen woman,” where and how often men used prostitutes, sexual stress, a
description of how Jack the Ripper tortured prostitutes, and an iconography
of the sexualized woman (Meyer, 1984; Alzate, 1984; Mims, 1982; Gee, 1984;
Gilman, 1984). References from PsycINFO discussed CB radio prostitution
(Luxenburg & Klein, 1984); and assertiveness and hostility in prostitutes
In the early 1980’s, the work of Silbert and Pines was a remarkable
exception to the relative silence about the harm of prostitution. These
authors published a number of groundbreaking studies which documented the
role of child sexual abuse as an antecedent to prostitution (Silbert & Pines,
1981; 1983); documented sexual and other violence perpetrated against women
in prostitution (Silbert & Pines, 1983; Silbert, Pines, & Lynch, 1982); and
noted the role of pornography in the harm of prostitution (Silbert & Pines,
1984). Silbert and her colleagues further described a “psychological
paralysis” of prostituted women, characterized by immobility, acceptance of
victimization, hopelessness, and an inability to take the opportunity to
change, which resulted from the inescapable violence they encountered
throughout their lives (Silbert & Pines, 1982b).
By 1992, the content and emphasis of the two databases on prostitution
had shifted dramatically. See Table 1. There was an 18% increase in Medline
and 68% increase in PsycINFO citations focusing on HIV. This was accompanied
by a 13% decrease in Medline and 33% decrease in PsycINFO references to the
harm caused by prostitution, other than STD. The topic of HIV dominated the
1992-1996 medical literature on prostitution, with subcategories emphasizing
the comorbidity of alcohol/drug use.
From 1992-1996, we located 551 prostitution-related references in
Medline. 86% (476) of these made primary reference to HIV or STD, an
increase of 18% from the 1980-1984 database. Examples of the HIV focus
included a study of the HIV risk behaviors among Dominican women prostituting
in New York City, HIV education programs, and the coincidence of HIV disease
with lack of access to health care (Deren et al., 1996; Lim et al., 1995;
Singh & Malaviya, 1994). References to HIV and prostitution frequently
normalized prostitution as in “Healthy and Unhealthy Life Styles of Female
Brothel Workers and Call Girls in Sydney” (Perkins & Lovejoy, 1996), and
“Prostitutes Can Help Prevent the Transmission of HIV” (Donegan, 1996).
The psychological literature on prostitution, even more clearly than
the medical literature, reflects this change in emphasis. The 1992 - 1996
PsycINFO database shifted from a discussion of the psychological and
demographic aspects of prostitution to a focus on HIV: 70% (146) of the
PsycINFO literature now made primary reference to HIV or other STD, a 68%
increase from 2% (1) in 1980-1984.
In contrast, the percentage of journal references addressing
prostitution-related harm other than STD significantly decreased in both
databases. Only 2% (10) of the Medline literature addressed the harm caused
by prostitution, a 13% decrease from 15% (18). References to prostitution-
related harm on PsychINFO decreased by 33% (from 41% (21) in 1980-1984 to 8%
(18) in 1992-1996). Several studies focused on childhood physical or sexual
abuse or neglect, as precursors to prostitution (Cunningham et al., 1994;
Marwitz & Hornle, 1992; Widom & Kuhns, 1996); one investigated the health of
Honduran street children (Wright et al., 1993). Other references from the
PsycINFO database noted violence against prostitutes; reported suicide
attempts among Brazilian prostitutes; defined and recognized prostitution as
a form of sadistic abuse; and noted that physical abuse was an antecedent to
prostitution (Miller & Schwartz, 1995; De Meis & De Vasconcellos, 1992;
Goodwin, 1993; Savin-Williams, 1994).
The number of articles with legal/demographic/psychoanalytic content
decreased in both databases. Medline references decreased 5%, from 17% (20) in
1980 – 1984, to 12% (65) in 1992 - 1996. Examples of these citations were:
sexuality in ancient Egypt; a literature review on adolescent female
prostitution; and discussions of decriminalization and legalization of
prostitution (Androutsos & Marketos, 1994; Jesson, 1993; Donovan & Harcourt,
Twenty-two percent (46)of the references in the 1992-1996 PsycINFO
database focused on legal/demographic/psychoanalytic aspects of prostitution,
a decrease of 35% from 1980-1984. Content of these references ranged from a
critique of feminist analyses of prostitution, to demographic variables
associated with prostitution by choice, to family economic obligation as a
factor which led to prostitution among Taiwanese women; and “Rational
Decision-Making Among Male Prostitutes,” (Shameem, 1993; Cates & Markley,
1992; McCaghy & Hou, 1994; Calhoun & Weaver, 1996).
Discussion and Analysis of the Content of the Medical and Social Science
In the discussion which follows, we discuss in more detail, research
which reflects the customer’s perspective that prostitution is both a
convenient sexual service as well as a source of anxiety about his physical
health. We also discuss the need for research and clinical interventions
which address the physical and emotional harm to the person in prostitution
herself. We briefly summarize diverse criminal justice responses to
prostitution, and conclude with some proposals for urgent and long-term
health care provision.
Controlling the transmission of HIV
Although at first glance, the public health attention to risk of HIV
infection includes the prostituted woman herself; on closer inspection, it
becomes apparent that the overarching concern is for the health of the
customer: to decrease his exposure to disease. In spite of extensive
documentation that HIV is overwhelmingly transmitted via male-to-female
vaginal and anal intercourse, not vice versa, one of the misogynist myths
about prostitution is that she is a vector of disease, that she is ultimately
the source of contamination of the ‘good wife’ through the husband’s weak
moment. The focus on HIV in the prostitution literature is a variant of this
prejudice against prostituted women.
These notions appear to form the basis of the HIV-focused research, with
the ultimate goal of making prostitution either governmentally regulated, or
decriminalized (Lancet, 1996). Many studies emphasized the education of
prostituted women regarding condom and safe needle use (Fajans et al., 1995;
Pyett et al., 1996; Wong et al., 1994).
Others investigated prostituted women’s perceptions of HIV risk (Graaf
et al., 1995; Gossop et al., 1995; Morrison et al., 1994). Graaf et al.
(1995) interviewed 127 prostituted women and 27 prostituted men. They found
that drug use (but not alcohol use) decreased condom use in the following
way: when women needed money for drugs, they were more willing to accede to
johns’ demands for unsafe sex. Graaf recommended methadone as a vehicle for
increasing condom use, and suggested that prostituted women needed to change
their “distinctively negative work-attitude.”
In much the same way that slave-owners discussed the inevitability of
slavery, and the improved care of slaves, there was an underlying assumption
in much of the research that prostitution is inevitable. Although education
efforts appeared well-intentioned, most HIV-focused authors minimized or
ignored the harm of prostitution as well as the option of escape. For
example, Karim et al. (1995) interviewed women who prostituted at a truck
stop in South Africa. The researchers found that women were at a higher risk
for physical violence when they attempted to insist on condom use with
customers, whose violence contributed to their relative powerlessness.
Ignoring their earlier finding that the women were at a higher risk for
violence if they insisted on condom use, the researchers recommended that
women in prostitution learn negotiation and communication skills to reduce
HIV risk. They failed to clarify how one would persuade a dominant customer
into using a condom when he does not want to.
After two decades of research on HIV, the World Health Organization
noted that women’s primary risk factor for HIV is violence (Piot, 1999). Aral
and Mann (1998) at the Centers for Disease Control, emphasized the importance
of addressing human rights issues in relation to communicable disease. They
noted that since most women enter prostitution as a result of poverty, rape,
infertility, or divorce, public health programs must address the social
factors which contribute to STD/HIV.
Globally, the incidence of HIV seropositivity among prostituted women
is devastating. 58% of prostituted women in Burkina Faso, West Africa; 52%
of Kenyan women in prostitution in one study, and 74% of prostituted Nairobi,
Kenyan women in another study tested positive for HIV (Lankoande et al, 1998;
Kaul et al., 1997; Kreis et al., 1992). 50% of prostituted women as compared
to 20% of women attending an antenatal clinic in KwaZulu-Natal, South Africa
tested positive for HIV (Ramjee et al., 1998; Kharsany et al., 1997)
In Cambodia, approximately 1 in 2 women in prostitution tested positive
for HIV, compared to 1 in 30 pregnant women, and 1 in 16 soldiers and police.
(World Health Organization, 1998). In Italy, a recent study noted a 16%
seroprevalence among prostituted women, which represented a significant
increase in the 1991-1995 rate (11%) over the 1988 to 1990 rate (2%) (Spina,
et al, 1998). Rates of HIV among US prostituted women vary, for example, 57%
in New Jersey; and in Atlanta, Georgia - 12% among women, 29% among men, and
68% among transgendered people in prostitution (Elifson et al., 1999).
The differential medical treatment of women compared to men resulted in
a lack of attention to early HIV infection in women (Allen et al., 1993;
Schoenbaum and Webber, 1993). Allen (1993) investigated HIV risk-assessments
in inner-city US women’s health clinics and found that despite the presence
of HIV infection across a broad age range for both sexes, early HIV infection
(not yet AIDS) was “completely unrecognized among all adolescent, young
adult, and older women.”
In Thailand, a study of brothel-based prostitution reported that 26% of
women nationwide and 34% in the northern provinces (where women migrated to
escape war or economic devastation) were HIV-positive (Kilmarx et al, 1998).
Despite a high level of condom use in Thailand, women in brothels, especially
the young, were not protected from HIV. The authors speculate that this may
be because men who use prostituted women are more likely to be HIV-infected
than other men. Another investigation of johns’ seropositivity in USA
reported an HIV+ rate of 37% among customers of men in prostitution and a
seropositivity rate of 3% among customers of women in prostitution (Elifson
et al., 1999)
Homeless children are at highest risk for HIV, for example in Romania
(Hamers et al., 1998) and Colombia (Spiwak, 1999). Piot (1999) noted that
half of new AIDS cases are in the under-25 age group, and that girls are
likely to become infected at a much younger age than boys, in part because of
the acceptance of violence perpetrated against girls and women in most
cultures. Men frequently seek out younger girls in prostitution and
elsewhere because it is assumed that they are less likely to have HIV.
STD and HIV have increased exponentially in the Ukraine and other
former Soviet Union states since 1995. Although data on seropositivity among
women in prostitution was not available, a 1998 review article speculated
that the increase in STD/HIV was a result of political restructuring,
poverty, collapse of healthcare systems, and a dramatic increase in
prostitution (Hamers et al., 1998).
Much of the health sciences literature assumed the normalcy of
prostitution as vocational choice for women (Deren et al. 1996; Farr et al.,
1996; Green et al 1993). It was often suggested that prostitution could be a
safe activity. However, this perspective seemed only to consider safety from
In 1988, the World Health Organization contributed to the normalizing
of prostitution by describing it as “dynamic and adaptive sex work, involving
a transaction between seller and buyer of a sexual service.” (cited in
Scambler & Scambler, 1995, page 18) Other researchers virtually instructed
women in prostitution to smile in the face of abuse and to proceed with the
job of servicing johns (Perkins & Lovejoy,1996; Graaf et al., 1995). Graaf et
al.(1995, page 45) recommended a “positive professional image.”
Wong et al. (1994) formulated a STD/HIV prevention program in Singapore
which ignored pervasive violence in prostitution. Role playing and use of
comic books were aimed at increasing condom use.
Pederson (1994) noted the coincidence of the HIV epidemic and the
concept of prostitution as vocational choice. Some have suggested that
prostituted women in the commercial sex industry are “simply another category
of workers with special problems and needs” (Bullough & Bullough, 1996, page
177). This perspective reflects the customer’s view that if prostitutes’
behavior can be controlled, perhaps HIV can also be controlled. An editorial
in Lancet (1996) suggested that decriminalization of prostitution would
decrease police harassment and assist prostituted women in finding safer
state licensed brothels in which to work, although the writer questioned
whether “herding” prostitutes into brothels would actually benefit their
health or safety. Other negative health consequences of prostitution were
Several authors assumed that the primary problem with prostitution was
its illegal status. Donegan (1996) suggested that because prostitution is
underground, young women suffer from social stigma. This perspective,
however, does not address the social stigma and enormous contempt aimed at
women in areas where prostitution is legal – for example, Nevada.
Subtle and blatant examples of blaming the victim of prostitution were
noted throughout the research reviewed here. Prostituted women were
sometimes described as “risk takers,” with the implication that they
deliberately provoked the violence and harassment aimed at them in
prostitution (Rosiello, 1993, Vanwesenbeeck et al, 1993).
The psychological literature of the 1980’s assumed an essential
masochism among battered women– a theoretical perspective which was later
rejected for lack of evidence (Koss et al, 1994). It is still assumed that
prostituted women have personality characteristics which lead to their
victimization. Rosiello (1993), for example, described the inherent masochism
of prostituted women as a “necessary ingredient” of their self-concept.
MacVicar and Dillon (1980) suggested that masochism plays a central role in
the acceptance of abuse by pimps. Psychoanalytic theories that prostituting
originates in maternal deprivation or from the anal desires of the child
–have been described by Weisberg (1985) and Bullough & Bullough (1996).
Vanwesenbeeck, et al (1993) identified three groups of prostituted
women as 1) those who had a positive, businesslike attitude and consistent
condom use, 2) those who had a negative attitude and occasional failure to
use condoms),and 3) “risk takers” who did not use condoms and who reported
feeling powerless. The “risk takers” reported fears of violence and despair
in situations where they were powerless. One woman stated that health
planning was not a priority when “your whole life’s a misery and pain”
(Vanwesenbeeck et al., 1993, page 87). The women in the “risk taker”
category reported the greatest financial pressure, and serviced the largest
number of johns.
It was assumed that “risk-taking” prostituted women willingly exposed
themselves to harm, although the histories of the “risk-takers” revealed that
they had been battered and raped significantly more often than the non-risk-
takers. Risk-taking behavior was rarely interpreted as trauma-based
repetition of childhood sexual abuse. Although some described risk-taking
behaviors as occurring in the context of childhood poverty, trauma, or
violence (Cunningham et al., 1994; Vanwesenbeeck et al., 1995), others
pejoratively implied intentional or callous risk-taking on the part of women
in prostitution (Faugier & Cranfield, 1995).
It would be more appropriate to view all prostituted women as at-risk.
It has been established that johns pressure women into unsafe sex (Farr et
al., 1996). Women were unable to prevent johns’ demands for unsafe sex, and
were often physically assaulted when they requested condoms (Ford &
Koetsawang, 1991; Karim, et al., 1995; Miller & Schwartz, 1995).
Drug addiction was often viewed as the only reason for prostituting.
The view that addicted prostitutes were the source of all health problems
which occur in prostitution was rarely challenged. Addicted prostitutes were
seen as the source of danger to the john, rather than the john’s posing a
threat to the woman in prostitution. Morrison et al.(1995) opined that women
in ‘high class’ prostitution did not need alcohol or drugs to cope with the
psychological trauma of their work, implying that only ‘lower class’ women
Women in prostitution were often assumed to have an underlying
personality disorder. De Schampheleire (1990) concluded that 61 prostituted
women had emotional difficulties that resulted first in addictions, and later
in prostitution, which was itself described as a “diversion” from other
Noting the utter vulnerability of intoxicated women on the street,
Morrison (1995) wrote:
“The most inebriated prostitutes on the street appear
to be the most successful at attracting clients.
Women who appear entirely powerless and incapable of
setting the boundaries of the sexual activity to take
place will attract men who may wish to legitimize an
act of sexual abuse by the payment of cash”(page 292-293).
In the authors’ experience, a significant percentage of women enter
prostitution with no previous drug or alcohol abuse. Some initiated or
increased drug or alcohol use to anesthetize the pain of physical injuries
and verbal abuse inflicted on them in prostitution.
Graaf et al. (1995) and Plant et al.(1989) found that women’s alcohol
use in prostitution was related to the psychological trauma of prostitution.
It permitted a chemical dissociation, as well as a means of anesthetizing
their physical aversion for johns. Green et al (1993) noted that some
Glasgow women were only able to prostitute under the influence of drugs or
“I have to be a little stoned before I go through with it. I have to
shove my emotions to the side.” Another woman said: “The whole thing is
sick. I cut out everything to do with feelings – it’s never, never okay.”
(Hoigard & Finstad, 1986, page 165)
Alegria et al.(1994) found that 70% of 127 Puerto Rican women in
prostitution had symptoms of depression which were associated with increased
risk behaviors for HIV. In most studies, however, psychological factors
motivating HIV risk-taking were not discussed.
The economic vulnerability and limited career options of poor women are
significant factors in their recruitment into prostitution. In the authors’
view, poverty is one precondition for prostitution, in addition to female
gender. Barrett & Beckett (1996) described poverty and childhood sexual abuse
as factors preceding entry into prostitution.
An editorial in Lancet (1996) referred to the economic needs that impel
women to prostitution, as opposed to the instincts which impel men to buy
prostitutes. Many authors assumed that women enter prostitution to get rich
(Carr, 1995; Lancet, 1996; McCaghy & Hou, 1994).
Reinforcing the notion that women are in prostitution solely for the
money, Taiwanese women in one study were described as entrepreneurs, although
more than half entered prostitution because of family pressure (McCaghy &
Hou, 1994). Many of these women were sold into brothels, coerced into
prostitution, or were escaping violence in their homes. To consider these
human rights violations as the inevitable risks of entrepreneurship is a
cynical denial of harm.
Calhoun & Weaver (1996) described the “rational decision-making” of
boys who were prostituting, suggesting that quick and easy financial gain was
a primary motivation to prostitute. They describe one youth’s reasoning:
“To James …[prostitution] solves a financial need, and he has apparently
decided that the high monetary return for a minimal investment of time is
preferable to legitimate employment and that it also exceeds the negative
consequences of arrest” (page 218).
Most of the interviewees in the Calhoun study however, were under the age of
18 and had little education. This suggests that escape from family violence
and lack of sustainable job options may have led to prostitution.
Other articles we reviewed similarly emphasized lack of education as a
precursor to entering prostitution (Deren et al., 1996; Farr et al., 1996;
Karim et al., 1995). Chattopadhyay, et al.(1994) noted that 70% of the Indian
women they interviewed wanted to leave prostitution, but cultural factors
which channeled them into prostitution prevented their escape: a 6% literacy
rate, beatings, starvation, rape by family members, and sexual exploitation
at their jobs. The most frequent reason given by these women for leaving
their last job was that prostitution would provide “better pay for what they
had to do anyway” (Chattopadhyay et al., 1994, page 254). Women in most jobs
in West Bengal, India, were expected to permit sexual exploitation.
Scambler & Scambler (1995) noted that underemployment, unemployment and
poverty were principal reasons for entering prostitution. Of 475 people in
prostitution from 5 countries, 72% reported current or previous homelessness
(Farley et al., 1998). A California agency serving women in prostitution
reported that 67% of those requesting services were currently or formerly
homeless. (PROMISE, 1997)
Poverty alone does not explain the gender imbalance in prostitution.
For example, Booth et al.(1995) interviewed 383 addicts and found that women
were more likely to have prostituted to earn money than men. Female gender
and having been prostituted were the strongest predictors in Booth’s study
for low self-concept, depression, and anxiety. Exchanging sex for money or
drugs led to a profound sense of worthlessness and other psychological
problems. El Bassel et al. (1997) found that women who traded sex for drugs
were in more severe psychological distress than women who did not trade sex
for their drugs.
Racism in Prostitution
There was a deafening silence regarding racism in the literature
reviewed here. Women in prostitution are purchased for their appearance,
including skin color and characteristics based on ethnic stereotyping.
Throughout history, women have been enslaved and prostituted based on race
and ethnicity, as well as gender (Barry, 1995).
Root (1996) characterized racism as a form of insidious trauma which
continually wears away at people of color and makes them vulnerable to stress
disorders. Legal prostitution, such as strip clubs and stores which sell
pornography (that is, pictures of women in prostitution) tend to be zoned
into poor neighborhoods, which in many urban areas in the USA, tend also to
be neighborhoods of people of color. The presence of commercial sex
businesses creates a hostile environment in which girls and women are
continually harassed by pimps and johns. Women and girls are actively
recruited by pimps and are harassed by johns driving through their
neighborhoods. There is an essential sameness between the abduction into
prostitution of African women by slavers, on the one hand, and today’s
cruising of African American neighborhoods by white johns searching for Black
women to buy (Nelson, 1993).
In most cities in the US, women of color are overrepresented in
prostitution, compared to their numbers in the society as a whole. For
example, in Minneapolis, a city which is 96% white European-American, more
than 50% of women in strip club prostitution are women of color. (Dworkin,
personal communication, 1997). Especially vulnerable to violence from wars or
economic devastation, indigenous women are brutally exploited in prostitution
- Mayan women in Mexico City, Hmong women in Minneapolis, Karen women in
Thailand, or First Nations women in Vancouver.
African American women are arrested in prostitution at a higher rate
than others charged with this crime (Nelson, 1993, MacKinnon & Dworkin,
Once in prostitution, women of color face barriers to escape. Among
these is an absence of culturally-sensitive advocacy services. Other barriers
faced by all women escaping prostitution are a lack of services which address
emergency needs (shelters, drug/alcohol detoxification, and treatment of
acute posttraumatic stress disorder or PTSD) and long-term needs (treatment
of depression and chronic PTSD, vocational training, and longterm housing).
Violence precedes entry into prostitution
Research and clinical reports have documented the prevalence of
childhood sexual abuse and chronic traumatization among prostituted women
(Belton, 1992; Burgess,et al., 1987; Giobbe et al., 1990; James & Meyerding,
1977; Paperny & Deisher, 1983; Silbert & Pines, 1981, 1982a; 1983; Simons &
Whitbeck, 1991; Widom & Kuhns, 1996). From 60% to 90% of those in
prostitution were sexually assaulted in childhood (Harlan, Rodgers &
Slattery, 1981, Murphy, 1993; Silbert & Pines, 1983). One young woman told
Silbert and Pines (1982a, page 488): “I started turning tricks to show my
father what he made me.” Many of the adolescents interviewed by Weisberg
(1985) reported that they began prostituting before running away from home.
Multiple perpetrators of sexual abuse were common, as was physical abuse
in childhood (Farley et al., 1998). Sixty-two percent of women in
prostitution reported a history of physical abuse as children (Bagley &
Young, 1987; Silbert & Pines, 1981, 1983). In another study, 90% of the women
had been physically battered in childhood; 74% were sexually abused in their
families- with 50% also having been sexually abused by someone outside the
family (Giobbe, 1991; Giobbe et al., 1990). Of 123 survivors of prostitution
at the Council for Prostitution Alternatives in Portland - 85% reported a
history of incest, 90% a history of physical abuse, and 98% a history of
emotional abuse (Hunter, 1994). One woman in prostitution said:
We’ve all been molested. Over and over, and raped.
We were all molested and sexually abused as children,
don’t you know that? We ran to get away. They didn’t
want us in the house anymore. We were thrown out, thrown
away. We’ve been on the street since we were 12, 13, 14.
(Boyer et al, 1993, page 16)
Child sexual abuse was a precursor to prostitution among 50% of 150
Nigerian prostituted teenagers (Adedoyin & Adegoke, 1995). Widom and Ames
(1994) noted that child sexual abuse survivors were more likely than child
physical abuse survivors to be arrested for prostitution as adults. 30% of a
sample of women in San Francisco entered prostitution at the age of 15 or
younger, and described themselves as runaways (PROMISE, 1997).
Women who experienced early sexual abuse were at risk for a later
recurrence of sexual and physical trauma (Browne & Finkelhor, 1986; Wyatt &
Powell, 1988), but these behaviors were based in trauma, and were not the
result of an innate risk-taking personality. Trauma researchers have
described the complexity of repetitive behaviors found in survivors of
chronic trauma (Herman, 1992; Terr, 1991). Traumatic reenactments occur along
with psychobiological dysfunction, including self-destructive thoughts and
behaviors, self-contempt, feelings of shame and worthlessness, substance
abuse, eating disorders, and sexual aversions or compulsions (Herman, 1992;
Incest, rape, and prostitution may be seen as points on a continuum of
sexual exploitation and abuse. Some described the emotional distancing
necessary to survive rape and prostitution as the same technique used to
endure familial sexual assault (Giobbe, 1991; Miller, 1986). Dworkin (1997a)
described incest as “boot camp” for prostitution.
Pervasive violence in prostitution
A number of authors have documented and analyzed the sexual and
physical violence which is the normative experience for women in
prostitution, including Baldwin (1993), Chesler (1993), Dworkin (1981;
1997a), Farley et al.(1998), Hunter (1994), Jeffreys, (1997), Karim, et al.,
(1995), MacKinnon (1993), McKeganey & Barnard (1996), Miller (1995),
Silbert & Pines (1982a, 1982b) Weisberg (1985), and Vanwesenbeeck (1994).
Silbert & Pines (1981, 1982b) reported that 70% of women suffered rape in
prostitution, with 65% of prostitutes having been physically assaulted by
customers; and 66% assaulted by pimps. Vanwesenbeeck (1994) reported that
60% of prostituted women in the Netherlands suffered physical assaults; 70%
experienced verbal threats of physical assault; 40% reported sexual violence;
and 40% reported having been forced into prostitution and/or sexual abuse by
acquaintances (Vanwesenbeeck, 1994). After reviewing a number of studies,
Weisberg (1985) concluded that most juvenile prostitutes had been abused or
beaten by both pimps and customers.
85% of women interviewed by Parriott (1994) had been raped in
prostitution. Of 475 people in prostitution who were interviewed in 5
countries, Farley et al (1998) reported that 73% had experienced physical
assaults in prostitution, and 62% had been raped in prostitution. The Council
for Prostitution Alternatives in Portland, Oregon, reported that prostituted
women were raped an average of once a week (Hunter, 1994).
Women in prostitution are battered women. Prostitution, like battering,
is a form of domestic violence. Giobbe (1993) compared pimps and batterers
and found similarities in their use of enforced social isolation,
minimization and denial, threats, intimidation, verbal and sexual abuse,
attitude of ownership, and extreme physical violence to control women. The
techniques of physical violence used by pimps are often the same as those
used by torturers. Gray (1973, cited in Weisberg, 1985) reported that one
teenager was beaten with a 6-foot bullwhip and another was tied to a car and
forced to run behind it. It has been reasonably estimated that prostitution
is 80% to 90% pimp-controlled (Giobbe & Gamache, 1990; Hunter, 1994).
The primary concern of prostituted women in Glasgow was violence from
customers (Green et al., 1993). Rape was common. The women in Glasgow were
physically abused as part of the job of prostitution. They were whipped and
beaten up, with payment at times received “per individual blow” (Green et
al., 1993, page 328). Prostituted women described a minority of johns as
extremely dangerous. These men were likely to assault or murder women in
prostitution for pleasure. They used fists, feet, baseball bats, knives, or
guns in their assaults on the women. One man inserted a shotgun into at least
one woman’s vagina and mouth.
87% of prostituted women interviewed by Miller (1995) were physically
assaulted in prostitution, with 31% having been stabbed, and 25% being hit
with an object. 37% of her sample had been held captive. Prostituted women
were often assaulted and robbed (Green et al, 1993; Hardesty & Greif, 1994;
Miller & Schwartz (1995) found that 94% of those in street
prostitution had experienced some form of sexual assault; 75% had been raped
by one or more johns. In spite of this, there was a widespread belief that
the concept of rape did not apply to prostitutes. If rape of a prostituting
woman occurs, some have considered the rape to be “theft” or “breach of
contract” rather than rape. Many people assumed that when a prostituted woman
was raped, it was part of her job and that she deserved or even asked for the
rape. In an example of this bias, a California judge overturned a jury’s
decision to charge a customer with rape, saying that “a woman who goes out on
the street and makes a whore out of herself opens herself up to anybody.”
One juror interpreted the judge’s decision as a refusal to give rights to
prostitutes (Arax, 1986). Because of the difficulty in obtaining testimony
from those who are addicted or homeless, and because of bias against those in
prostitution, district attorneys and police tend to place a low priority on
prosecution of those who rape prostitutes (Gross, 1990).
Symptoms of psychological trauma in women in prostitution
Describing the trauma of prostitution, and its consequences, one
fourteen year old stated: “You feel like a piece of hamburger meat – all
chopped up and barely holding together” (Weisberg, 1985, page 112).
Dissociation is the psychological process of banishing traumatic events
from consciousness (Herman, 1992). It is an emotional shutting-down which
occurs during extreme stress among prisoners of war who are being tortured,
among children who are being sexually assaulted, and among women being
battered or raped or prostituted.
Vanwesenbeeck (1994) considered dissociation in those prostituted to be
a consequence of both childhood violence and adult violence in prostitution.
She noted that a proficiency in dissociation, perhaps learned in order to
survive sexual abuse as a child, was required in prostitution. Vanwesenbeeck
et al. (1995) found that the more severe the victimization in childhood, the
more frequently dissociation and denial were used in adulthood.
Ross et al.(1990) noted dissociative symptoms in women in strip club
prostitution. Belton (1998) reported that depression as well as dissociative
disorders were common among prostituted women. One prostituted teenager
“I left my body. Very seldom was I ever there.
I had a good technique for leaving. I knew where
I was at, I mean I knew what they were doing, but
it was like I have no feeling…it was my survival.
That was a way of knowing that they might have
my body, but they’re not going to get me.”
(Giobbe, 1992, page 125)
People in prostitution suffer from posttraumatic stress disorder (PTSD).
Symptoms are anxiety, depression, insomnia, irritability, flashbacks,
emotional numbing, and hyperalertness. Farley et al., (1998) interviewed 475
prostituted people in 5 countries (South Africa, Thailand, Turkey, USA, and
Zambia) and found that 67% met diagnostic criteria for PTSD, suggesting that
the traumatic sequelae of prostitution were similar across different
The following are three examples of PTSD:
Many years after escaping from prostitution, an Okinawan woman who had
been purchased by US military personnel during the Vietnam war became
extremely agitated and had visions of sexual abuse and persecution on the
15th and 30th of each month, those days which were GI paydays (Sturdevant &
Another woman described how her symptoms of PTSD were ignored by her
counselor: "I wonder why I keep going to therapists and telling them I can't
sleep, and I have nightmares. They pass right over the fact that I was a
prostitute and I was beaten with two-by-four boards, I had my fingers and
toes broken by a pimp, and I was raped more than 30 times. Why do they
ignore that?" (Farley & Barkan, 1998, page 46).
An observant john noted of the woman he was raping: “…maybe she was
undergoing a slight nightmare or something like confusion.” (Hite, 1981, page
The violence of prostitution, the constant humiliation, the social
indignity and misogyny result in personality changes which have been
described by Herman (1992) as complex posttraumatic stress disorder (CPTSD).
Symptoms of CPTSD include changes in consciousness and self-concept, changes
in the ability to regulate emotions, changes in systems of meaning, such as
loss of faith, and an unremitting sense of despair. Once out of prostitution,
76% of a group of women interviewed by Parriott (1994) reported that they had
great difficulty with intimate relationships. Not only were sexual feelings
destroyed in prostitution, but the emotional part of the self was eroded.
(Hoigard & Finstad,1986; Giobbe, 1991, 1992)
One of the longer-lasting effects of CPTSD involves changes in relations
with other people, including changes in perception of the perpetrator of
abuse. Unless human behavior under conditions of captivity is understood, the
emotional bond between those prostituted and pimps is difficult to
comprehend. The terror created in the prostituted woman by the pimp causes a
sense of helplessness and dependence. This emotional bonding to an abuser
under conditions of captivity has been described as the Stockholm Syndrome
(Graham et al., 1994). Attitudes and behaviors which are part of this
syndrome include: 1) intense gratefulness for small favors when the captor
holds life and death power over the captive; 2) denial of the extent of
violence and harm which the captor has inflicted or is obviously capable of
inflicting; 3) hypervigilance with respect to the pimp's needs and
identification with the pimp's perspective on the world (an example of this
was Patty Hearst's identification with her captors' ideology); 4) perception
of those trying to assist in escape as enemies and perception of captors as
friends; 5) extreme difficulty leaving one's captor/pimp, even after physical
release has occurred. Paradoxically, women in prostitution may feel that
they owe their lives to pimps.
Physical Health Problems
A focus on the spread of HIV shifted attention away from the
inaccessibility of health care for women in prostitution in USA (Lawless,
Kippax & Crawford, 1996; Pederson, 1994; Sacks, 1996). This same trend has
been observed in non-dominant countries. Moses (1996) noted that the lack of
access to health services resulted in unsuccessful implementation of large-
scale STD prevention programs in Asia and Africa.
A lack of attention to women’s experiences of violence and sexual abuse
has resulted in repeated failures of the health care system for women (Dean-
Patterson, 1999). Those in prostitution lacked access to social and medical
services which were available to others (Scambler & Scambler, 1995). Fear of
arrest and social contempt made it difficult for prostituted women to seek
shelter or medical treatment (Weiner, 1996).
Some research addressed non-HIV-related health problems of women in
prostitution. Prostituted women had an increased risk of cervical cancer and
chronic hepatitis (Chattopadhyay et al., 1994; de Sanjose et al., 1993;
Pelzer et al., 1992; Nakashima et al., 1996). Incidence of abnormal Pap
screens was several times higher than the state average in a Minnesota study
of prostituted women’s health (Parriott, 1994). Childhood rape was associated
with increased incidence of cervical dysplasia in a study of women prisoners
(Coker et al., 1998).
Half of the women interviewed in San Francisco by Farley & Barkan
(1998) reported physical health problems, including joint pain,
cardiovascular symptoms, respiratory symptoms, neurological problems, and HIV
(8%). 17% stated that, if it were accessible, they would request immediate
hospital admission for drug addiction or emotional problems. Some acute and
chronic problems were directly related to violence. One woman said about her
“I’ve had three broken arms, nose broken twice,
[and] I’m partially deaf in one ear….I have a small
fragment of a bone floating in my head that gives me
migraines. I’ve had a fractured skull. My legs ain’t
worth shit no more; my toes have been broken. My feet,
bottom of my feet, have been burned; they've been
whopped with a hot iron and clothes hanger… the hair on
my pussy had been burned off at one time…I have scars.
I’ve been cut with a knife, beat with guns, two by fours.
There hasn’t been a place on my body that hasn’t been
bruised somehow, some way, some big, some small.”
(Giobbe, 1992, page 126).
70% of 100 prostituted girls and women in Bogota reported physical
health problems. In addition to STD, their diseases were those of poverty and
despair: allergies, respiratory problems and blindness caused by glue
sniffing, migraines, symptoms of premature aging, dental problems, and
complications of abortion (Spiwak, 1999). Adolescent girls and boys in
prostitution surveyed by Weisberg (1985) reported STD, hepatitis,
pregnancies, sore throats, flu, and repeated suicide attempts.
Women who serviced more customers in prostitution reported more severe
physical symptoms (Vanwesenbeeck,1994). The longer women were in
prostitution, the more STD reported (Parriott, 1994).
We found no study to date of the chronic nature of the health problems
suffered by women in prostitution, although it has been well documented that
chronic health problems result from physical abuse and neglect in childhood
(Radomsky, 1995), sexual assault (Golding, 1994), battering (Crowell &
Burgess, 1996), untreated health problems and overwhelming stress (Friedman &
Yehuda,1995; Koss & Heslet, 1992; Southwick et al. 1995). Prostituted women
suffer from all of the foregoing. Many of the chronic physical symptoms of
women in prostitution were similar to the physical sequelae of torture
The death rate of those in prostitution was 40 times higher than that
of the general population (Special Committee on Pornography and Prostitution,
1985; cited in Baldwin, 1992).
Pornography and prostitution
Barry (1995) defined pornography as the presentation of prostitution
sex. Pornography is a specific type of prostitution, in which prostitution
occurs and, among other things, is documented. The women whose prostitution
appears in pornography are prostituted women.
The harm of prostitution is made to disappear in pornography.
Pornography has been used as recruitment into childhood sexual assault as
well as recruitment into prostitution (MacKinnon & Dworkin, 1997).
Pornography which normalizes prostitution is used by pimps to teach girls
what acts to perform in prostitution (Silbert & Pines, 1984). Women in
prostitution have described pornography’s role in their being coerced by
pimps or customers to enact specific scenes (Silbert & Pines, 1984; MacKinnon
& Dworkin, 1997; Farley & Barkan, 1998). Customers show women pornography to
illustrate what they want. Strip clubs show video pornography to promote
49% of 130 people in one study reported that pornography was made of
them while they were in prostitution; and 32% had been upset by an attempt to
coerce them into performing what customers had seen in pornography (Farley &
Barkan, 1998). 56% of those in prostitution in South Africa, 48% in Thailand,
and 47% in Zambia reported being upset at attempts to coerce them into acts
seen in pornography (Farley et al., 1998). 38% of 200 prostituted women
interviewed by Silbert & Pines (1984) reported that pornography had been made
of them as children. 27% of the adolescent boys interviewed by Weisberg
(1985) reported that pornography had been made of them. Even after women
escaped prostitution, they continued to be traumatized by the knowledge that
customers look at pornography which documented what was done to them in
prostitution (MacKinnon & Dworkin, 1997).
Needs of women escaping prostitution
In order to offer genuine choices to people in prostitution, programs
which claim to offer assistance must offer more than condoms and safer sex
negotiation skills. These are not only insufficient, but they have been
shown to result in increased violence against prostituted women. It is
necessary to look at the vast array of social conditions in women's lives
which eliminate meaningful choices. In order to understand prostitution, it
is necessary to also understand 1) incest and other childhood sexual assault;
2) poverty and homelessness; 3) the ways in which racism is inextricably
connected with sexism in prostitution; 4) domestic violence; 5) posttraumatic
stress disorder, mood and dissociative disorders as sequelae of prostitution;
6) chemical dependence; 7) the need for culturally-relevant treatment; and 8)
the fact that the global nature of the commercial sex industry involves
interstate and inter-country trafficking as a necessary part of its
The most urgent need of girls and women escaping prostitution was
housing (Boyer et al, 1993; Commercial Sexual Exploitation Resource
Institute, 1998; El Bassel et al., 1997; Farley et al, 1998; Serre et al,
1996; Weisberg, 1985). Both transitional and longterm housing was needed.
Serre et al. (1996) found that 50% of the 355 women in prostitution
were in unsafe living conditions, and that 33% had been physically assaulted
during the prior 5 months. 92% of 475 people in prostitution stated that
they wanted to escape. When asked about their needs, 73% told the researchers
that they needed a home or place of asylum; 70% needed job training; 59%
needed health care, including treatment for drug or alcohol addiction (Farley
et al., 1998).
As part of intake assessments, health service providers should not only
inquire about history of sexual assault, violence, and addictions. Belton
(1992) and Goodman & Fallot (1998) have discussed the need for routine
inquiry regarding prostitution history. The questions “have you ever
exchanged sex for money or clothes, food, housing, or drugs?” and “have you
ever worked in the commercial sex industry: dancing, escort, massage,
prostitution, pornography, phone sex?” have been used in the first author’s
Emergency services used by women in prostitution, such as crisis lines,
emergency housing, medical and psychological treatment, substance abuse
treatment, and outreach programs rarely if ever addressed the sexual trauma
of women in prostitution (Boyer et al, 1993). Often, medical and social
service providers were disrespectful to women in prostitution.
Although it is commonly assumed that street prostitution is the most
dangerous type of prostitution, Boyer observed that women in non-street
prostitution, such as strip clubs, massage brothels and pornography, had less
control over the conditions of their lives and probably faced greater risks
of exploitation, enslavement, and physical harm, than women prostituting on
the street. Her report on the needs of prostituted women in the Seattle area
recommended increased outreach to women in non-street prostitution. Training
for service providers was recommended, as were peer support groups where
women could speak openly with others about their experiences of sexual
exploitation. Chemical dependence treatment specifically for commercial sex
industry survivors was also proposed (Boyer et al, 1993).
The vocational needs of women escaping prostitution are complex and
long-term. Women leaving prostitution in their twenties and thirties may
have been in prostitution since they were very young, and may never have had
a job other than prostitution. Vocational counselors should be able to
articulate the impact of prostitution on a woman’s vocational identity.
Vocational rehabilitation counselors must be expert in labor market issues,
federal and state laws regarding disability, and they must be skilled at
using psychiatric diagnoses in disability applications (Murphy, 1993).
Asthana and Oostvogels (1996) predicted that programs to assist those
in prostitution would continue to fail unless significant changes were made
to systems which keep women in a position of subordination and exploitation.
In one particular instance of this, women drug users were prostituted far
more frequently than men drug users, were at greater risk for HIV than men,
had lower self-concepts than did men drug users, and had fewer employment
opportunities, legal or illegal, than did men drug users (Booth et al.,
Weisberg (1985) noted the importance of prostitution prevention
programs for children. The Commercial Sexual Exploitation Resource Institute
(1998) offered multilingual curricula for prostitution prevention in junior
and high schools, a legal services clinic, and a program which placed
survivors of prostitution into host families in the community.
Criminal Justice Responses to Prostitution
It is beyond the scope of this paper to critique the history of legal
approaches to prostitution in the USA. Feminist attorneys Margaret Baldwin,
Dorchen Leidholdt, and Catharine MacKinnon have begun discussions of a range
of legal responses to prostitution (Baldwin, 1993; Leidholdt, 1993;
In most parts of the USA, prostitution is a criminal act. Yet there has
been a hugely disparate arrest rate of women in prostitution, compared to
arrests of johns. The law enforcement focus on the woman in prostitution
rather than on predatory behaviors of pimps and johns, reflects the emphasis
of the social sciences literature reviewed here. The demand side of
prostitution has been largely ignored. For example, The Seattle Women’s
Commission (1995) reported that in 1993, there were 1,210 arrests of women on
prostitution-related charges. Of those arrested, 62% were charged and 42%
convicted. During the same time period, 228 men were arrested for
patronizing a prostitute. Of those men, 98% were charged and only 8%
convicted. Arrests of women in prostitution and the simultaneous failure to
arrest customers comprised unfair and discriminatory practices (Davis, 1993).
It is commonly assumed that the greater the legal tolerance of
prostitution, the easier it is to control public health (Green et al, 1993).
“Public health” in this context refers primarily to STD in johns, rather than
to the mental and physical health of prostituted women. Legalized
prostitution involves state, county, or city ordinances which regulate
prostitution, for example, requiring STD tests and collecting taxes. In
Nevada, regulations determine geographic location and size of brothels, as
well as activities of women outside the brothel. Prostituted women are only
allowed into nearby towns from 1-4pm, are restricted to certain locations,
and are even prohibited from talking to certain persons (Miller et al.,
The HIV epidemic has brought with it the advocacy of another legal
approach to prostitution: decriminalization, or the cessation of enforcement
of all laws against prostitution. Decriminalization of prostitution has been
promoted by the commercial sex industry as a means of removing the social
stigma associated with prostitution. The likely result of decriminalization
would be to make men’s access to women and children in prostitution far
easier than when prostitution is illegal. Decriminalization would normalize
commercial sex but it would not reduce the trauma and the humiliation of
being prostituted. Respondents in South Africa and Zambia were asked whether
they thought they would be safer from sexual and physical assault if
prostitution were legal. A significant majority (68%) said “no” (Farley et
al., 1998). The implication was that regardless of the legal status of
prostitution, those in it knew that they would continue to experience
Dworkin proposed decriminalization of prostitution for the prostitute
and recognition of the pimp or john as criminal (1988). In Norway,
criminologists Finstad and Hoigard proposed “unilateral criminalization of
customers” (1993, page 222). Stating that “prostitution is not a desirable
social phenomenon” (Ministry of Labour, Sweden, 1998,page 3), the Swedish
government in 1999 criminalized the buying of sexual services but not the
selling of sexual services. Noting that “…it is not reasonable to punish the
person who sells a sexual service. In the majority of cases… this person is a
weaker partner who is exploited,” (Ministry of Labour, Sweden, 1998, page 4)
the Swedish government allocated social welfare monies to “motivate
prostitutes to seek help to leave their way of life” (Ministry of Labour,
Sweden, 1998, page 3). These social interventionist approaches reflect the
state’s interest in counteracting the spread of the commercial sex industry
(Mansson and Hedin, in press). As Finstad and Hoigard wrote in 1993:
“If any sort of criminal law must exist, it should be directed against
‘normal’ people’s harmful behavior, such as being the customer of a
prostitute. This suggestion… rests on the objective consequences of
customers’ actions, the long-term effects suffered by women. Many
customers are in the kind of social situation in which the threat of a
criminal conviction would be effective…” (page 222).
Another criminal justice approach to prostitution is the diversion
program which focuses on educating arrested johns (Monto, 1998). The Sexual
Exploitation Education Program (SEEP), in Portland, Oregon, operated in
conjunction with the Council for Prostitution Alternatives. Goals of SEEP’s
interventions with johns were: 1) to reframe the definition of prostitution
from a “victimless crime” to a system of violence against women; 2) to
deconstruct male sexual identity in order to clarify how men’s socialization
led to a propensity for commiting violence against women; and 3) to stress
the choice and responsibility which men have to create egalitarian
relationships without coercion or violence. (cited in Monto, 1998).
In the United Kingdom, the Kerb Crawlers Rehabilitation Programme
operates as part of the Research Centre on Violence, Abuse, and Gender
Relations. Like SEEP, the Kerb Crawlers (an expression which refers to
johns) program attempts remedial social education by shifting the focus from
the woman in prostitution to the john. The Programme was designed to
challenge misconceptions about prostitution, about male sexuality, about the
consequences of child abuse, and to address the reasons why people enter
prostitution (Bindel, 1998).
Although the johns’ education programs report significantly reduced
recidivism, a trial treatment program for arrested pimps in Nova Scotia
resulted in 100% recidivism (McGrath, 1998). Pimps are significantly more
dangerous perpetrators than most customers of prostitutes.
Other legal approaches to prostitution include confiscation of the cars
of arrested johns. A number of states and municipalities, including
California, Minnesota, Illinois, Pennsylvania, New York, and Wisconsin have
enacted such laws. Monies from such confiscations should be used exclusively
to develop services for women escaping prostitution.
The social invisibility of prostitution
The social and legal refusal to acknowledge the harm of prostitution is
stunning. Libertarian ideology obfuscates the harm of prostitution, defining
it as a form of sex. The statement that prostitution is "just a job which
can be difficult at times, like any other job" - is far from the truth.
Institutions such as slavery and prostitution which have existed for
thousands of years are so deeply embedded in cultures that they become
invisible. In Mauritania, for example, there are 90,000 Africans enslaved by
Arabs. Human rights activists travel to Mauritania to report on slavery, but
because they don’t observe their stereotyped notion of what slavery looks
like – if they don’t see bidding for shackled people on auction blocks - they
conclude that the Africans working in the fields in front of them are
voluntary laborers who are receiving food and shelter as salary (Burkett,
Similarly, if observers don’t see exactly what their stereotype of
“harmful” prostitution is – for example, if they don’t see a gun pointed at
the head of a girl being trafficked from one state to another, if all they
see is a smiling streetwise teenager who says ‘I like this job, I’m getting
rich’ – then they don’t see the harm. Prostitution tourists go to
Amsterdam’s, New York’s, or Bangkok’s prostitution zones and see smiling
girls waving at them from glass cages or clubs. The customers decide that
prostitution is a free choice.
In prostitution, a necessary part of the role is to look happy: to ask
for the rape, to say she enjoyed the rape. Women who escape prostitution have
reported that saying these words of pleasure to those who are torturing them
was a nightmare.
The language recently used to describe prostitution has contributed to
confusion regarding whether or not prostitution is a form of violence against
women. Some words which refer to prostitution cover up its cruelty. The
term "sex work" implies vocational choice. Accepting prostituted women as
"commercial sex workers" brings with it an acceptance of what in any other
context would be described as sexual harassment, sexual exploitation, or
sexual abuse. If prostitution becomes "sex work," then the brutal
exploitation of those prostituted by pimps becomes an employer-employee
relationship. And the predatory, pedophiliac purchase of a human being by
the john becomes just one more business transaction.
Women who have survived prostitution and who have gotten out, have
asked that they not be transformed into the object/noun, "prostitute." The
word “prostitute” eliminates the human being in prostitution. Just as we
avoid referring to a battered woman as a “batteree,” someone who has actually
evolved into being the thing that was done to her, we can avoid turning the
woman in prostitution into that which was inflicted on her. We are invited
instead to use the adjective, verb, or prepositional phrase: "prostituted,"
"prostituting," or "person in prostitution."
One of the myths about prostitution is that "high-class" call-girl
prostitution is vastly different, and much safer than street prostitution.
This has not been verified by research. One study reported that there was no
difference in the incidence of posttraumatic stress disorder experienced by
those prostituting on the street and those prostituting in “high-class
brothels.” (Farley et al., 1998). Parriott (1994) found no differences in
health problems reported by women in massage brothels, escort services, strip
clubs, bars, and street prostitution. Boyer et al (1993) reported that women
in all forms of prostitution (escort, strip club, street, phone sex, and
massage brothel) were subject to sexual violence. One customer said: “With
all of this sexual harassment stuff going around these days, men need
somewhere to go where they can say and act like they want…I think that going
to a [strip] club is a release” (Frank, 1999, page 20). All mutations of the
commercial sex industry were unpredictable and dangerous for women.
Furthermore, most women in prostitution participate in several different
kinds of prostitution.
Sexual exploitation seems to happen with the "consent" of those
involved. But doesn't consent involve the option to make other choices? If
prostitution is a choice, why are those with the fewest options the ones in
it? (MacKinnon, 1993). The greatest obstacle to seeing prostitution as abuse
and exploitation is the notion of prostitution as “free will” (Finstad &
Hoigard, 1993, page 213). One woman described prostitution as "volunteer
slavery," clearly articulating both the appearance of choice and the
overwhelming coercion behind that choice. (Vanwesenbeeck, 1994, page 149).
Most of those in prostitution have few or no other options for the
necessities of life.
The commercial sex industry is a multibillion dollar global market which
includes strip clubs, massage brothels, phone sex, adult and child
pornography, street, brothel, and escort prostitution. One’s political
perspective will determine whether prostitution is viewed primarily as a
public health issue, as an issue of zoning and property values (which parts
of town should house strip clubs and pornography stores?), as vocational
choice, as sexual liberation, as petty crime, as domestic violence, or as
human rights violation.
For the vast majority of the world’s prostituted women, prostitution is
the experience of being hunted, dominated, harassed, assaulted, and battered.
Intrinsic to prostitution are numerous violations of human rights: sexual
harassment, economic servitude, educational deprivation, job discrimination,
domestic violence, racism, classism, vulnerability to frequent physical and
sexual assault, and being subjected to body invasions which are equivalent to
In prostitution, demand creates supply. Because men want to buy sex,
prostitution is assumed to be inevitable, therefore 'normal.' Men’s
ambivalence about the purchase of women, however, is reflected in the
relative scarcity of research interviews with johns, and their desire to
remain hidden. In a series of interviews with johns conducted by women
employed by massage brothels, Plumridge noted that on the one hand, they
believed that commercial sex was a mutually pleasurable exchange, and on the
other hand, they asserted that payment of money removed all social and
ethical obligations (1997). One john said: “It’s like going to have your car
done, you tell them what you want done, they don’t ask, you tell them you
want so and so done…” (McKeganey & Barnard, 1996, page 53).
The cultural context of sexism and racism must be understood in order
to offer real choices to women who are at risk for prostitution (Alegria et
al., 1994; Karim et al., 1995; Hardesty & Greif, 1994; Silbert and Pines
1983). The study of violence against women suggests that in order to predict
sexually aggressive behavior, we must take into account multiple variables
which connect the individual and cultural nature of sexual violence (Crowell
& Burgess, 1996). Pornography, for example, is a form of cultural propaganda
which reifies the notion that women are prostitutes. One man said “I am a
firm believer that all women… are prostitutes at one time or another” (Hite,
1981, page 760). To the extent that any woman is assumed to have freely
chosen prostitution, then it follows that enjoyment of domination and rape
are in her nature, that is to say, she is a prostitute (Dworkin, 1981).
Discussing his experience in a strip club, one man said, “This is the
part of me that can still go hunting” (Frank, 1999, page 22). Violent
behaviors against women have been associated with attitudes which promote
men’s beliefs that they are entitled to sexual access to women, that they are
superior to women, and that they are licensed as sexual aggressors (White &
Koss, 1993). Prostitution myths are a crucial component of attitudes which
normalize sexual violence. Monto (1999) found that johns’ acceptance of
commodified sexuality was strongly related to their acceptance of rape
myths, violent sex, and less frequent use of condoms with women in
prostitution. Arrested johns’ level of acceptance of prostitution myths was
the same as college men’s and women’s acceptance of prostitution myths
(Farley et al, 1998).
Prostitution must be exposed for what it really is: a particularly
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Table 1 Change in Content of References to Prostitution, 1980-199
1980 – 1984 1992 – 1996 Perc
Medline PsycINFO Medline PsycINFO Medline
% (N) % (N) % (N) % (N) ______% ______%___
1) STD/HIV 68% (81) 2% (1) 86% (476) 70% (146) +18%
2) Other Harmful
Consequences 15% (18) 41% (21) 2% (10) 8% (18) -%13
Psychoanalytic 17% (20) 57% (19) 12% (65) 22% (46) -5%
Total 100%(119) 100%(41) 100%(551) 100%(210)
1) STD/HIV: studies of at-risk sexual behaviors and drug-using practices
2) Other Harmful Consequences of Prostitution: studies of non-HIV-related harm, such as
physical and sexual violence, antecedent childhood sexual assault
3) Legal/Demographic/Psychoanalytic: studies which focus on the psychology, sociology or
legalization of prostitution, without an emphasis on harmful consequences