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Prostitution in Vancouver: Violence and the Colonization of First Nations Women

July 2005
Transcultural Psychiatry 42(2):242-71

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Prostitution Research & Education, San Francisco CA USA

We interviewed 100 women prostituting in Vancouver, Canada. We found an extremely high prevalence of lifetime violence and post-traumatic stress disorder (PTSD). Fifty-two percent of our interviewees were women from Canada's First Nations, a significant overrepresentation in prostitution compared with their representation in Vancouver generally (1.7-7%). Eighty-two percent reported a history of childhood sexual abuse, by an average of four perpetrators. Seventy-two percent reported childhood physical abuse, 90% had been physically assaulted in prostitution, 78% had been raped in prostitution. Seventy-two percent met DSM-IV criteria for PTSD. Ninety-five percent said that they wanted to leave prostitution. Eighty-six percent reported current or past homelessness with housing as one of their most urgent needs. Eighty-two percent expressed a need for treatment for drug or alcohol addictions. Findings are discussed in terms of the legacy of colonialism, the intrinsically traumatizing nature of prostitution and prostitution's violations of basic human rights.

Comparison of First Nations and European-Canadian women: Childhood physical and sexual abuse, homelessness, and violence in prostitution

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Responses to 'What do you need?' asked of women in prostitution

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Transcultural Psychiatry

DOI: 10.1177/1363461505052667

2005; 42; 242 TRANSCULT PSYCHIATRY

Melissa Farley, Jacqueline Lynne and Ann J. Cotton

Women

Prostitution in Vancouver: Violence and the Colonization of First Nations

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Prostitution in Vancouver: Violence and the

Colonization of First Nations Women

MELISSA FARLEY

Prostitution Research and Education, San Francisco

JACQUELINE LYNNE

Vancouver, British Colombia

ANN J. COTTON

University of Washington, Seattle

Abstract We interviewed 100 women prostituting in Vancouver, Canada.

We found an extremely high prevalence of lifetime violence and post-

traumatic stress disorder (PTSD). Fifty-two percent of our interviewees

were women from Canada’s First Nations, a signiﬁcant overrepresentation

in prostitution compared with their representation in Vancouver generally

(1.7–7%). Eighty-two percent reported a history of childhood sexual abuse,

by an average of four perpetrators. Seventy-two percent reported childhood

physical abuse, 90% had been physically assaulted in prostitution, 78% had

been raped in prostitution. Seventy-two percent met DSM-IV criteria for

PTSD. Ninety-ﬁve percent said that they wanted to leave prostitution.

Eighty-six percent reported current or past homelessness with housing as

one of their most urgent needs. Eighty-two percent expressed a need for

treatment for drug or alcohol addictions. Findings are discussed in terms of

the legacy of colonialism, the intrinsically traumatizing nature of prosti-

tution and prostitution’s violations of basic human rights.

Vol 42(2): 242–271 DOI: 10.1177/1363461505052667 www.sagepublications.com

transcultural

psychiatry

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Key words colonization • First Nations • post-traumatic stress disorder •

prostitution • sexual assault

Prostitution is a gendered survival strategy that involves the assumption of

unreasonable risks by the person in it. A number of authors have docu-

mented and analyzed the sexual and physical violence that is the norma-

tive experience for women in prostitution (Baldwin, 1993, 1999; Barry,

1979, 1995; Boyer, Chapman, & Marshall, 1993; Dworkin, 1981, 1997;

Farley, Baral, Kiremire, & Sezgin, 1998; Giobbe, 1991, 1993; Hoigard &

Finstad, 1986; Leidholdt, 1993; MacKinnon, 1993, 2001; McKeganey &

Barnard, 1996; Miller, 1995; Silbert & Pines, 1982; Silbert, Pines & Lynch,

1982; Vanwesenbeeck, 1994; Weisberg, 1985). For example, Silbert and

Pines (1981, 1982) reported that 70% of women suffered rape in prosti-

tution, with 65% having been physically assaulted by customers, and 66%

assaulted by pimps. The foregoing authors include data from Burma,

Germany, Mexico, Philippines, the Netherlands, Norway, Scotland, South

Africa, Thailand, Turkey, USA and Zambia.

Most of those in prostitution began prostituting as adolescents. Nadon,

Koverola, and Schludermann (1998) found that 89% had begun prosti-

tution before the age of 16. Of 60 women prostituting in escort, street, strip

club, phone sex,

and massage parlors in Seattle, all began prostituting

between the ages of 12 and 14 (Boyer et al., 1993). In Canada, as elsewhere,

most women and men enter prostitution as adolescents (Lowman, 1993).

Fifty-two percent of 183 Vancouver women were ﬁrst prostituted when

they were younger than 16 years, and 70% ﬁrst prostituted before age 18

(Cunningham & Christensen, 2001). Children typically enter prostitution

subsequent to abusive treatment by caregivers (Lowman, 1993) and

subsequent to running away from dangerous home environments

(Federal/Provincial Territorial Working Group on Prostitution, 1998).

Most people in prostitution were sexually abused as children, usually by

several perpetrators. Farley and colleagues (2003) found an average of four

perpetrators of childhood sexual abuse against those in prostitution in

nine countries. Those in prostitution are often still children (Youth Dele-

gates of Out of the Shadows, 1998). Across nine countries on ﬁve conti-

nents, 47% of the people in prostitution entered it when they were less

than 18 years of age (Farley et al., 2003). One girl prostituting in Seattle

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,

p. 16)

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The most relevant paradigm currently available for understanding the

harm of prostitution is that of domestic violence. Physical coercion, rape

and violence by husband/partner/pimp and john are perpetrated against

women in prostitution (Currie, 1994; Lowman, 1993; Lowman & Fraser,

1995; Miller, 1995). Of 854 people in prostitution, 73% reported that they

had been physically assaulted in prostitution (Farley et al., 2003). In most

instances, women in prostitution are battered women. 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.

One survivor described prostitution as a ‘harrowing metamorphosis’

that included frequent physical assaults and which ultimately resulted in a

‘neutralization of the body’ (Jaget, 1980, p. 188) or somatic dissociation.

The physical and emotional violence of prostitution leads to somatic

dissociation which itself has been regularly associated with chronic health

problems (Kirkingen, 2001). In 1858, Sanger asked 2000 prostitutes in New

York about their health and concluded that ‘premature old age’ was the

invariable result of prostitution (cited in Benjamin & Masters, 1964).

Today we view the chronic ill health of those in prostitution as resulting

from physical abuse and neglect in childhood (Radomsky, 1995), sexual

assault (Golding, 1994), battering (Crowell & Burgess, 1996), untreated

health problems, and overwhelming stress and violence (Friedman &

Yehuda, 1995; Koss & Heslet, 1992; Southwick, Yehuda, & Morgan, 1995).

Sanger described conditions of despair, degradation, decline, and early

death among women in prostitution who survived, on average only 4 years

from entry into prostitution (Benjamin & Masters, 1964). Making the

same observation in the parlance of today’s global marketplace, an anony-

mous pimp commented on the ‘brief shelf life’ of a girl in prostitution.

Pheterson (1996) summarized the health problems of women in prosti-

tution: exhaustion, frequent viral illness, sexually transmitted diseases,

vaginal infections, backaches, sleeplessness, depression, headaches, stomach-

aches, and eating disorders. The longer women were in prostitution, the

more sexually transmitted diseases they reported (Parriott, 1994). Women

who were used by more customers in prostitution reported a range of

more severe physical symptoms (Vanwesenbeeck, 1994).

Prostitution can be lethal (Potterat et al., 2004). A Canadian

commission found that the death rate of women in prostitution was 40

times higher than that of the general population (Special Committee on

Pornography and Prostitution, 1985). A study of Vancouver prostitution

reported a 36% incidence of attempted murder (Cler-Cunningham &

Christenson, 2001).

Vancouver agencies serving women in prostitution have observed many

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First Nations women in prostitution. We use the words First Nations as a

term of respect for people whose ancestors were the ﬁrst nations of people

in North America. We use the term Aboriginal interchangeably with First

Nations.

In a number of communities across Canada, Aboriginal youth

comprise ‘90% of the visible sex trade’ (Save the Children Canada, 2000,

p. 7), suggesting the importance of placing prostitution in historical

context. Acknowledging the adverse effects of colonialism, Cler-Cunning-

ham and Christenson (2001) observed the ‘immense overrepresentation’

of Aboriginal women in Vancouver’s street-level sex trade.

The Royal Commission on Aboriginal Peoples (RCAP) documented

the perilous state of Aboriginal housing: 84% of Aboriginal households

on reserves did not have sufficient income to cover housing (RCAP,

1996). Housing instability results in reserve-to-urban migration, leaving

young women vulnerable to prostitution, in that homelessness has been

established as a primary risk factor for prostitution (Boyer et al., 1993;

Louie, Luu, & Tong, 1991; Silbert & Pines, 1983). When women in prosti-

tution are asked what they need, first on their list is housing (Farley et al,

1998).

Colonization and racism result in extensive and insidious trauma that

wears away its victims’ mental and physical health (Kelm, 1998; Root,

1996). Colonization of First Nations in Canada by the British and the

French resulted in well-documented health problems (Waldram, Herring

& Young, 2000). The combined effects of poverty, race discrimination and

cultural losses profoundly affect First Nations and are likely contributing

factors to high rates of interpersonal violence, depression, suicide and

substance abuse (Kirmayer, 1994).

Canada’s Royal Commission on Abor-

iginal Peoples referred to premature death as one of the consequences of

colonization:

Aboriginal people are more likely [than non-Aboriginal people] to face

inadequate nutrition, substandard housing and sanitation, unemployment

and poverty, discrimination and racism, violence, inappropriate or absent

services, and subsequent high rates of physical, social and emotional illness,

injury, disability and premature death. (RCAP, 1996, p. 107)

The suicide rate among First Nations people across Canada was three times

that of other Canadians and six times higher for those aged 15–24 years

(Bobet, 1990).

The prevalence of violence against Aboriginal women is extremely high.

The death rate of First Nations women from homicide is more than four

times greater than that of all Canadian women (Health Canada, Medical

Services Branch, unpublished tables, 1995, cited in RCAP, 1996, p 153).

Nahanee (1993) wrote of ‘the almost total victimization of [Aboriginal]

women and children’ and concluded ‘violence against Aboriginal women

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has reached epidemic proportions according to most studies conducted

over the past few years. This violence includes the victimization of women

and their children, both of whom are seen as property of their men

(husbands, lovers, fathers), or of the community in which they live’

(Nahanee, 1993, pp. 360–361). Similarly in the United States, 80% of

indigenous women seeking health care at one clinic reported having been

raped (Old Dog Cross, 1982).

First Nations gay men like First Nations women, are in double jeopardy.

Comparing Canadian Aboriginal and non-Aboriginal gay men,

researchers found that Aboriginal gay men were signiﬁcantly more likely

to be poor, unstably housed, more depressed, to have been sexually abused

as children, to have been raped, and to have been prostituted (Heath et al.,

1999).

The diagnosis of post-traumatic stress disorder (PTSD) describes

psychological symptoms resulting from overwhelmingly traumatic events

such as rape, war, and prostitution. PTSD can result when people have

experienced ‘extreme traumatic stressors involving direct personal experi-

ence of an event that involves actual or threatened death or serious injury;

or other threat to one’s personal integrity; or witnessing an event that

involves death, injury, or a threat to the physical integrity of another

person; or learning about unexpected or violent death, serious harm, or

threat of death or injury experienced by a family member or other close

associate’ (American Psychiatric Association, 1994). PTSD is characterized

by anxiety, depression, insomnia, irritability, ﬂashbacks, emotional

numbing, and hyperalertness. Symptoms are more severe and long lasting

when the stressor is of human design. PTSD is common among prostituted

women. Farley and colleagues (1998) found a PTSD prevalence rate of

67% among those in prostitution in ﬁve countries.

Cultural and social factors are known to have a causal role in PTSD

symptoms (U.S. Department of Health and Human Services, 2001).

Trauma history and PTSD vary by race/ethnicity and national origin with,

for example, refugees from South Asian countries experiencing high rates

of war-related traumatic events (Mollica et al., 1990) and indigenous

peoples in the United States suffering multiple and cumulative trauma

when compared with other groups (Robin, Chester, & Goldman, 1996). In

a study that included a majority of Alaska Native women, 70% of a sample

of pregnant women in substance abuse treatment had experienced child-

hood physical and sexual abuse (Brems & Namyniuk, 2002).

There are many anecdotal accounts and case studies of prostitution

(Farley & Kelly, 2000). We noted the need for quantitative data. This work

was an attempt to expand a quantitative database on prostitution, history

of violence and PTSD that now includes nine countries (Farley et al.,

2003). An analysis of the intersections of race, class and gender is crucial

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to an understanding of prostitution. In reviewing the literature regarding

colonialism, cultural alienation, and violence against First Nations, we

predicted that First Nations women, compared with non-First Nations

women in prostitution, would report increased rates of violence both

during prostitution and in their lives prior to prostitution. Given the

previous ﬁndings of extremely high rates of PTSD among those prosti-

tuted, we did not anticipate ﬁnding differences in PTSD between First

Nations women and white European-Canadian women in prostitution.

Method

Brief structured interviews of 100 prostituting women and children were

conducted in Vancouver, Canada. We contacted agencies working with

prostitutes and set up collaborative efforts where possible. The second

author was a board member of a Vancouver agency that provided services

to prostitutes and was familiar with locations where prostitution

commonly occurred in Vancouver. She was known to some of our inter-

viewees in her capacity as a social worker. Interviewers were screened for

the ability to establish an easygoing rapport on the street and in occasion-

ally dangerous locations.

The women we interviewed were from the Downtown Eastside,

Franklin, and Broadway/Fraser prostitution strolls in Vancouver, BC. We

attempted to contact any woman known to be prostituting, whether

indoor or outdoors. Using a snowball recruitment technique, we asked

women to let their friends who were prostituting elsewhere (e.g. in other

areas or indoors) know that we would return to a speciﬁc location at a

speciﬁc time the next day. Usually we had access only to people prostitut-

ing on the street. Only four women refused to participate; several appeared

to be in the process of approaching customers.

Informed consent included a summary of research goals and partici-

pants’ rights. Respondents’ copies of the consent form included names and

phone numbers of local agencies that could be contacted for support and

assistance and included the authors’ phone numbers and email addresses.

In all cases we offered to read the items to respondents. Most were able to

complete the questionnaire without assistance; however, a few were illiter-

ate.

If respondents indicated that they were prostituting we asked them to

ﬁll out three questionnaires. We paid a small stipend ($10 Canadian) to

those who responded to the three questionnaires. The Prostitution Ques-

tionnaire (PQ), used in similar research in South Africa, Thailand, Turkey,

the USA and Zambia, consists of 32 items asking about physical and sexual

assault in prostitution, lifetime history of physical and sexual violence, and

the use of or making of pornography during prostitution (Farley et al.,

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1998). The questionnaire asked whether respondents wished to leave

prostitution and what they needed in order to leave. We asked if they had

been homeless, if they had physical health problems, and if they used drugs

or alcohol or both. Because of item heterogeneity, psychometrics on the

PQ are not available. Sample items include:

2. Since you’ve been in prostitution, have you been physically assaulted?

14a. When you were a child, were you ever hit or beaten by a parent or

caregiver until you had bruises on your body or were injured in some

other way by them?

16. Did you ever have pictures taken of you while you were working in

prostitution?

19. Have you ever been homeless?

Respondents also completed the PTSD Checklist (PCL), a 17-item scale

that assesses DSM-IV symptoms of PTSD (Weathers, Litz, Herman,

Huska, & Keane, 1993). Respondents were asked to rate the 17 symptoms

of PTSD (see Table 1) on a 5-point scale with 1 = not at all;2=a little bit;

3=moderately;4=quite a bit; and 5 = extremely. Weathers and colleagues

(1993) report PCL test–retest reliability of .96. Internal consistency as

measured by Cronbach’s alpha was .97 for all 17 items. Validity of the scale

is reﬂected in its strong correlations with the Mississippi PTSD Scale (.93),

the PK scale of the MMPI-2 (.77) and the Impact of Event Scale (.90). The

PCL has functioned comparably across ethnic subcultures in the USA

(Keane, Kaloupek, & Weathers, 1996).

Based on previous responses to open-ended questions about health

problems among prostituted women, we constructed a Chronic Health

Problems Questionnaire (CHPQ; Farley et al., 1998). The CHPQ is a

symptom checklist with dichotomous items. Interviewees were asked

whether or not they had symptoms or experienced events commonly

reported by women in prostitution. Sample items included joint pain, jaw

pain, loss of feeling on skin, pain in breasts and head injury. Scale mean

was 17.6, with SD = 8.6. Internal consistency as measured by Cronbach’s

alpha was .92 for 36 items.

Once it was apparent that we were interested in hearing about women’s

experiences during prostitution, many volunteered information regarding

what prostitution was like for them. Some of their observations are

included here. Whenever an interviewee wanted to talk with us, we

welcomed that and took notes. During this process, referrals were made to

substance abuse treatment centers, First Nations community centers and

medical clinics.

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Participants

We describe all of the 100 interviewees in this study as women, although

one respondent identiﬁed as transgendered. This person was included as a

woman with the rest of our respondents. Ages ranged from 13 to 49 years,

with a mean age of 28 years (SD = 7.8 years).

The youngest age at recruitment into prostitution was 10 years. Respon-

dents spent an average of 10 years in escort, massage, and street prostitution

(SD = 7 years). A few respondents had been in prostitution less than a year,

with 4 months being the least amount of time any of our interviewees spent

in prostitution. One woman had been prostituted for 31 years.

With respect to race/ethnicity, 52% were First Nations, 38% were white

European-Canadian, 5% were African-Canadian, and 5% left the question

unanswered. Ethnicity was self-reported. The majority of the 52 First

Nations women described themselves as Native (n = 24), First Nations

(n = 2) or Native Indian (n = 2). Next most often, they described them-

selves as Metis (n = 10), a French word that translates to English as ‘mixed

blood’ and is used to describe people who are of both First Nations and

European ancestries. Historically, the two major colonizers of First Nations

of Canada were the British and the French; therefore most of those called

Metis were First Nations/French or First Nations/British. In current use in

the Downtown Eastside of Vancouver, the word Metis refers to anyone who

is biracial or multiracial. We use the term Metis in its broadest sense and

not as a term that refers to legal status. The First Nations women also

categorized themselves as Cree or Cree Native (n = 3), Cree/French (n = 2),

Ojibwa (n = 2), Aboriginal (n = 2), Native/El Salvador (n = 2),

Blackfoot/Cree (n = 1), Cree/Metis/Mexican (n = 1), and Interior Salish

(n = 1). In order to make statistical comparisons, we collapsed all the fore-

going groups into the category ‘First Nations.’ Fewer than 10 women

identiﬁed themselves by nation, so we were unable to compare nations in

our analyses.

Results

Childhood Violence

Eighty-two percent of our respondents reported a history of childhood

sexual abuse, by an average of four perpetrators. This statistic (those

assaulted by an average of four perpetrators) did not include those who

responded to the question ‘If there was unwanted sexual touching or sexual

contact between you and an adult, how many people in all?’ with ‘tons’ or

‘I can’t count that high’ or ‘I was too young to remember.’ Seventy-two

percent reported that as children, they had been hit or beaten by a care-

giver until they had bruises or were injured.

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Eighty-six percent of these women in Vancouver prostitution reported

current or past homelessness.

Physical and Sexual Violence in Prostitution

Ninety percent of these women had been physically assaulted in prosti-

tution. Of those who reported physical assault, 82% of the perpetrators

were their customers. Eighty-nine percent had been physically threatened

while in prostitution and 67% had been physically threatened with a

weapon. Seventy-eight percent had been raped in prostitution, with 67%

of those raped having been raped more than ﬁve times. Seventy-six percent

of those who had been raped had been raped by customers.

Sixty-seven percent of our interviewees reported that pornography was

made of them in prostitution; and 64% had been upset by an attempt to

force them to perform an act that customers had seen in pornography.

Verbal and Emotional Abuse in Prostitution

Eighty-eight percent of the women responding to our questionnaires

reported that they had been verbally abused. One woman commented,‘lots

of [customers] are super-nice at ﬁrst. Then when the sex act starts, they

get real verbally abusive.’ Another told us that while legal prostitution

might make her feel safer from physical assaults, it would not change the

verbal abuse and harassment that she knew was intrinsic to prostitution.

Physical Health Problems

Sixty-three percent of these women in prostitution reported health

problems. Common symptoms were memory problems (66%), trouble

concentrating (66%), headaches (56%), dizziness (44%), vision problems

(45%), hearing problems (40%), balance problems (41%), aching muscles

(78%), joint pain (60%), jaw pain (38%), and swelling of limbs (33%).

Cardiovascular symptoms included chest pain (43%), pain/numbness in

hands/feet (49%), irregular heartbeat (33%) and shortness of breath

(60%). Sixty-one percent of these respondents had cold/ﬂu symptoms. In

addition, 35% reported allergies and 32% reported asthma. Twenty four

percent reported both painful menstruation and vaginal pain. Twenty

three percent had breast pain. In response to a general query about health,

30% of the women we interviewed reported hepatitis C. Some of the

cardiovascular, neurological and joint complaints may have been

symptoms of drug withdrawal.

Seventy-ﬁve percent of the women reported physical injuries from

violence in prostitution. Many reported stabbings and beatings,

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concussions and broken bones (broken jaws, ribs, collar bones, ﬁngers,

spinal injuries, and a fractured skull), as well as cuts, black eyes, and ‘fat

lips.’

Fifty percent of these women had head injuries resulting from

violent assaults with, for example, baseball bats and crowbars. Many had

their heads slammed against walls and against car dashboards. Customers

and pimps regularly subjected then to extreme violence when they refused

to perform a speciﬁc sex act.

Post-Traumatic Stress Disorder

PTSD consists of three types of symptoms: (1) persistent, intrusive re-

experiencing of trauma; (2) numbing of responsiveness and persistent

avoidance of stimuli associated with trauma; and (3) persistent autonomic

hyperarousal. A diagnosis of PTSD requires at least one intrusive

symptom, three numbing/avoidance symptoms, and two hyperarousal

symptoms, as well as having experienced a traumatic stressor (criterion A).

Criterion A requires having experienced or witnessed an event or events

involving actual or threatened death or serious injury, or a threat to the

physical integrity of self or others, and reacting with intense fear, helpless-

ness, or horror to these events (American Psychiatric Association, 1994).

Attempted rape is commonly accepted as meeting criterion A for diagnosis

of PTSD (Avina & O’Donohue, 2002). Ninety percent of our respondents

had themselves been physically assaulted in prostitution. Based on

previous ﬁndings we concluded that all of our respondents met criterion

A by having experienced or witnessed serious injury.

We summed respondents’ ratings across the 17 items of the PCL, gener-

ating an overall measure of PTSD symptom severity that was previously

used by the scale’s authors. Mean PCL score for our respondents was 55.7

(SD = 15.6).

Using Weathers et al.’s (1993) formulation we considered a score of 3

(moderately), 4 (quite a bit) or 5 (extremely) on a PCL item to be a

symptom of PTSD. Eighty-nine percent of our respondents endorsed at

least one intrusive symptom of PTSD, 81% endorsed at least three

numbing and avoidance symptoms of PTSD, and 85% endorsed at least

two of the physiologic hyperarousal symptoms of PTSD. The mean scores

for these 100 women in prostitution were within the clinically symptom-

atic range (3 or greater) on two of the ﬁve intrusive symptoms, for all seven

of the numbing/avoidance symptoms, and all ﬁve of the hyperarousal

symptoms of PTSD. See Table 1 for mean scores of each of the 17 PCL

items. Seventy-two percent of our respondents met criteria for a PTSD

diagnosis.

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History of Violence and PTSD

We investigated four types of lifetime violence experienced by these inter-

viewees: childhood sexual assault, childhood physical assault, rape in adult

prostitution, and physical assault in adult prostitution. Eighty-nine

percent reported childhood sexual assault, 72% reported childhood

physical assault, 92% reported rape in adult prostitution, and 90%

reported physical assault in adult prostitution. Four percent of the sample

had experienced only one type of lifetime violence, 11% reported two

types, 23% reported three types, and 62% reported experiencing all four

types of lifetime violence.

PTSD diagnosis and severity were not related to number of types of

lifetime violence as would normally be expected. These respondents’

extremely high incidence of lifetime violence created a ceiling effect.

Because 85% of the sample experienced three or four types of lifetime

violence, there were not enough people in the group who experienced only

Transcultural Psychiatry 42(2)

252

TABLE 1

PTSD symptoms of 100 Vancouver women in prostitution

Percent

responding at

PTSD symptom

PTSD symptom Mean SD level (%)

Intrusive re-experiencing (B symptoms)

Memories of trauma from the past 3.1 1.3 64

Dreams of trauma from the past 2.8 1.4 54

Act/feel as if traumatic event were happening again 2.8 1.3 53

Very upset when reminded of trauma from past 3.5 1.2 76

Physical reactions to memories of past trauma 2.6 1.4 52

Numbing and avoidance (C symptoms)

Avoid thinking or feeling about past trauma 3.5 1.4 76

Avoid activities which remind you of past trauma 3.4 1.4 68

Trouble remembering parts of trauma from past 3.1 1.5 65

Loss of interest in activities you used to enjoy 3.8 1.3 78

Feeling distant or cut off from people 3.7 1.4 72

Emotionally numb; unable to have loving feelings 3.4 1.5 70

Feel as if future will be cut short 3.4 1.5 68

Hyperarousal (D symptoms)

Trouble falling or staying asleep 3.1 1.4 67

Feeling irritable or having angry outbursts 3.3 1.5 64

Difﬁculty concentrating 3.3 1.3 72

‘Superalert’ or watchful or on guard 3.6 1.3 81

Feeling jumpy or easily startled 3.3 1.5 66

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one or two forms of lifetime violence (15%) to determine whether there

was a relationship between PTSD severity and number of different types

of lifetime violence.

Current Needs of Interviewees

Ninety-ﬁve percent of these respondents stated that they wanted to leave

prostitution. Eighty-two percent expressed a need for drug or alcohol

addiction treatment. They voiced a need for job training (67%), a home

or safe place (66%), individual counseling (58%), self-defense training

(49%), health care (41%) and peer support (41%). Thirty-three percent

needed legal assistance, 32% wanted legalized prostitution, 12% needed

childcare, and 4% wanted physical protection from pimps.

Differences with Respect to Race/Ethnicity

We compared First Nations women with European-Canadian women in a

number of analyses. Table 2 summarizes these comparisons. Childhood

sexual abuse was reported signiﬁcantly more often by interviewees identi-

fying as First Nations than by those describing themselves as European

Canadian (χ

(1) = 5.2, p = .02). Of those First Nations women reporting

sexual abuse, relatives were speciﬁed as perpetrators 41% of the time, adult

friends or community members were speciﬁed as perpetrators 34% of the

time, and an older child was speciﬁed as perpetrator 25% of the time.

Signiﬁcantly more First Nations women than European-Canadian women

reported childhood physical abuse (χ

(1) = 5.6, p = .02).

Farley et al.: Prostitution in Vancouver

253

TABLE 2

Comparison of First Nations and European-Canadian women: Childhood

physical and sexual abuse, homelessness, and violence in prostitution

First Nations European-Canadian

% (n = 52) % (n = 38) χ

Childhood physical abuse* 81 (42) 58 (22) 5.6 .02

Childhood sexual abuse* 96 (50) 82 (31) 5.2 .02

Verbal abuse in prostitution 88 (45) 92 (35) 1.0 .30

Physical abuse in prostitution 88 (46) 89 (34) .02 .88

Raped in prostitution 92 (48) 92 (35) .00 .97

Threatened with a weapon 63 (33) 66 (25) .16 .69

Homelessness 83 (43) 87 (33) .43 .51

Upset by being forced to 69 (36) 58 (22) 1.2 .28

imitate pornography

Had pornography made of them 65 (34) 60 (23) .49 .48

*p < .05.

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There were ethnic differences in response to a needs assessment. See

Table 3. First Nations women indicated a signiﬁcantly greater need for self-

defense training (χ

(1) = 7.4, p = .006), a greater need for peer support

(χ

(1) = 6.3, p = .01), a greater need for job training (χ

(1) = 4.6, p = .03),

and for individual counseling (χ

(1) = 3.9, p = .05).

We found no race/ethnic differences in the frequency of health problems

endorsed on the Chronic Health Problems Questionnaire (F(1,82) = .06,

p = .81).

First Nations women in the sample were not more likely than European

Canadians to qualify for a diagnosis of PTSD (χ

(1) = .01, p = .92) nor

was there a signiﬁcant statistical relationship between PTSD severity, as

measured by the mean PCL sum score and First Nations heritage (Pearson

r = –.02, p = .86).

Discussion

The clinical expression ‘hypervigilance’ does not adequately describe the

physical terror and despair we witnessed in many of these women. Violence

seemed to be in the very air they breathed. Our ﬁndings document this

extreme level of sexual violence. One woman told us that she was continu-

ally raped in prostitution, explaining ‘what rape is to others, is normal to us.’

Another woman, aged 36, described a rape as the ‘deﬁning experience’ of her

life. At age 16 she was raped at knifepoint after which the rapist gave her a

gold chain in effect paying her for the rape and deﬁning her as a prostitute.

Transcultural Psychiatry 42(2)

254

TABLE 3

Responses to ‘What do you need?’ asked of women in prostitution

First Nations European-Canadian

Need % (n = 49) % (n = 36) χ

Drug or alcohol treatment 88 (43) 75 (27) 2.3 .13

Job training* 78 (38) 56 (20) 4.6 .03

Individual counseling* 67 (33) 44 (16) 3.9 .05

Self-defense training** 63 (31) 33 (12) 7.4 .006

Home or safe place 61 (30) 75 (27) 1.3 .25

Peer support* 53 (26) 25 (9) 6.3 .01

Medical or health care 41 (20) 36 (13) .2 .66

Legal assistance 33 (16) 28 (10) .2 .63

Legalized prostitution 24 (12) 36 (13) 1.3 .24

Childcare 16 (8) 8 (3) 1.2 .28

Physical protection from pimp 4 (2) 3 (1) .1 .75

Note. Five participants did not respond to these questions.

*p < .05; **p < .01.

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Most of our respondents had been physically assaulted (90%) or raped

(78%) in prostitution. A fear of men was pervasive. One woman told us

that being hit and bruised were ‘just your common aggressiveness from

men.’ In a separate study of Vancouver prostitution, 68% of women had

been recently raped, 72% had been kidnapped, and 89% had had

customers refuse condoms in the previous year (Cunningham & Christen-

son, 2001).

For many of our interviewees, accommodation to violence began in

childhood. Most women in this study (82%) reported sexual abuse as

children, usually with multiple perpetrators. Currie (1994) found a

comparable prevalence of childhood sexual abuse (73%) among 600

women prostituting in Vancouver. Benoit and Millar (2001) noted a 55%

incidence of childhood sexual abuse among 201 women prostituting in

Victoria, BC. A Toronto study noted that many women who were prosti-

tuting cited ‘persistent abuse’ as precipitating their drug use (Butters &

Erickson, 2003).

Cler-Cunningham and Christenson (2001) reported that 85% of 183

women in Vancouver prostitution had been verbally or physically harassed

more than once in the past year. The verbal abuse in prostitution is socially

invisible just as other sexual harassment in prostitution is normalized and

invisible. Yet it is pervasive: 88% of our respondents described verbal abuse

as intrinsic to prostitution. Customers’ verbal assaults in all types of prosti-

tution are likely to cause acute and long-term psychological symptoms. A

woman in another study explained this: ‘It is internally damaging. You

become in your own mind what these people do and say with you. You

wonder how could you let yourself do this and why do these people want

to do this to you?’ (Farley, 2003b). The verbal abuse against prostituted

women is reﬂected in the names that all women are called by violent men

during sexual assaults. The epithets seem intended ‘to humiliate, to eroti-

cize, and to satisfy an urge for self-justiﬁcation.’ (Baldwin, 1992, p. 60).

The 72% incidence of current PTSD in these women in prostitution is

among the highest reported in populations where PTSD has been studied,

including battered women, combat veterans, childhood trauma survivors,

rape survivors, and torture survivors (Bownes, O’Gorman, & Sayers, 1991;

Farley et al., 1998; Feeney, Zoellner, & Foa, 2000; Houskamp & Foy, 1991;

Kemp, Rawlings, & Green, 1991; Ramsay, Gorst-Unsworth, & Turner, 1993;

Weathers et al., 1993). Rates of PTSD among these prostituted women

from Canada did not differ signiﬁcantly from prostituted women in other

countries including South Africa, Thailand, Turkey, the USA and Zambia

(F(5,575) = .95, p = .45). The mean PCL score (56) of these prostituted

women was in the same range (51–56) as that of people in prostitution in

South Africa, Thailand, Turkey, the USA and Zambia (Farley et al., 1998)

and similar to the mean PTSD score (51) of treatment-seeking Vietnam

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veterans (Weathers et al., 1993) and much higher than means in studies of

Persian Gulf War veterans (35, Weathers et al., 1993), and women HMO

members with and without childhood physical and sexual abuse (24–37,

Farley & Patsalides, 2001).

When we compared European-Canadian women with First Nations

women we did not ﬁnd differences in PTSD. The pervasiveness and

severity of trauma exposure experienced by these women in prostitution

may have obscured differences in PTSD that would otherwise be expected

on the basis of race/ethnicity. Our ﬁndings are consistent with two studies

that failed to ﬁnd race differences in PTSD symptoms among combat

veterans (Beals et al., 2002; Monnier, Elhai, Frueh, Sauvageot, & Magruder,

2002). In these studies, combat (like prostitution) was the overwhelmingly

traumatic event that mitigated differences in PTSD based on race.

Our respondents appeared to be in a state of almost constant revictim-

ization. The assaults against these women in prostitution were part of a

lifetime surround of exploitation and abuse. Because of this pervasive

violence we cannot separate the effects of childhood and adult violence on

current PTSD symptoms. It is likely that experiences of violence over the

course of one’s lifetime have a cumulative effect on PTSD symptoms

(Follette, Polusny, Bechtle, & Naugle, 1996). Other research found that a

history of sexual assaults is a common precursor to prostitution. West,

Williams, and Siegel (2000) found that women were most likely to prosti-

tute if they had experienced both sexual abuse as children and were later

revictimized by rape as adults. One young woman told Silbert and Pines

(1982, p. 488), ‘I started turning tricks to show my father what he made

me.’ Dworkin (1997, p. 143) described incest as ‘boot camp’ for prosti-

tution.

Fifty-two percent of our respondents were First Nations women, a lower

percentage than the 70% of First Nations women in street prostitution in

another Vancouver study (Currie, 1994, reported in Federal/Provincial

Territorial Working Group, 1998). In population census estimates, 7% of

Vancouver’s people are First Nations (Vancouver/Richmond Health Board,

1999). The overrepresentation of First Nations women in prostitution, and

prostitution’s prevalence in an area of Vancouver with a high proportion

of First Nations residents reﬂects not only their poverty, but also their

marginalized and devalued status as Canadians. Others report similar

ﬁndings. For example 15% of women in escort prostitution in Victoria, BC

were First Nations although the First Nations population of Victoria has

been estimated at 2% (Benoit & Millar, 2001 p. 18).

In New Zealand, Plumridge and Abel (2001) observed that 7% of the

Christchurch population were Maori women but 19% of those in

Christchurch prostitution were Maori women. Maori in prostitution were

signiﬁcantly more likely than European-ancestry New Zealanders to have

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experienced homelessness and to have entered prostitution as children

(Farley, 2003a). As we did in Vancouver, New Zealand researchers sampled

from the poorest community in Auckland and reported that twice as many

Maori there were in prostitution (40%) compared with their represen-

tation in northern New Zealand generally (21%) (Saphira & Herbert,

2003). In the early 1990s, Atayal and other Aboriginal girls comprised 70%

of those in Taiwanese debt-bondage prostitution although they were only

1.8% of the total population (Hwang & Bedford, 2003). The researchers

noted that pathways into prostitution for Aboriginal Taiwanese adoles-

cents were similar to those pathways elsewhere: globalization of the

economy, social and cultural disruption, race/ethnic discrimination, and

extremely high levels of family violence.

For women, prostitution is intimately associated with poverty. Its First

Nations residents refer to Vancouver’s Downtown Eastside, one of the

poorest areas in North America, as the ‘urban reserve.’ Colonization left

many First Nations people in extreme poverty that has endured for gener-

ations (LaFramboise, Choney, James, & Running Wolf, 1995). Eighty-six

percent of our respondents were currently or previously homeless. First

Nations youth who leave their home communities for urban areas are

particularly vulnerable to sexual exploitation in that they are both

homeless and in an unfamiliar cultural environment (Federal/Provincial

Working Group, 1998). Although we do not yet have data to conﬁrm this,

we suspect that First Nations women are more likely to be overrepresented

in the poorest types of prostitution – street and massage – than in strip

club, phone sex, and Internet prostitution. The ﬁrst author observed that

in Mexico City, Mayan women were often sold in prostitution for the

lowest price and were made available for more violent sex acts, such as anal

rapes, that other women refused to perform.

Analyzing the effects of racism is central to an understanding of prosti-

tution. Racism has a profound effect on health (Williams, Lavizzo-Mourey,

& Warren, 1994; Turner & Kramer, 1995). For example a U.S. report

located more than 175 studies documenting race/ethnic disparities in

diagnosis and treatment of medical conditions (Institute of Medicine,

2002). Reﬂecting poverty, malnutrition, chronic stress and inadequate

health care, premature aging is commonplace in the Downtown Eastside

where one neighborhood center categorizes anyone over age 40 as a senior.

The vulnerabilities of race, class and gender have been recognized as multi-

plicative risk factors for HIV (Osmond et al., 1993), and we think that they

are also multiplicative risk factors for prostitution. In Canada, the triple

force of race, class and sex discrimination disparately impacts First Nations

women. Prostitution of Aboriginal women occurs globally in epidemic

numbers with indigenous women at the bottom of a racialized sexual hier-

archy in prostitution itself. This phenomenon has been observed by others

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(Grant, Grabosky, & David, 1999; Ministry of Foreign Affairs and Trade,

2001; UNICEF, 2004).

For many, the experience of prostitution stems from the historical

trauma of colonization. Imposing a sexist and racist regime on First

Nations women, colonization simultaneously elevated male power within

the colonized community (Fiske, 1995). Today, many First Nations women

are dominated by a ‘newly evolved state of traditional governance’ that

replaced more egalitarian systems (Brunen, 2000). The cultural destruc-

tion of positive roles for First Nations men and their subsequent identiﬁ-

cation with supremacist attitudes have had disastrous consequences for

First Nations women, with astronomical rates of incest, rape and husband

violence.

Freire (1994) described the colonial destruction of positive roles for

men as resulting in ‘adhesion to the oppressor’ (p. 27). Dworkin also

discussed the harm inﬂicted on women by colonized men:

The stigma of the prostitute allows the violent, the angry, the socially and

politically impoverished male to nurse a grudge against all women, includ-

ing prostituted women; this is aggressive bias, made rawer and more danger-

ous by the need to counter one’s own presumed inferiority. (Dworkin, 2000,

p. 325)

Sexual violence and other family violence are major social problems in

First Nations communities. A Dene woman described communities in

which the entire female population had been sexually assaulted by men.

She had been threatened with further violence if she spoke out against this

(Lynne, 1998, p. 43). Consistent with others’ reports, First Nations women

in our study were signiﬁcantly more likely than non-First Nations to report

childhood physical and sexual abuse.

There is an urgent need for further exploration of these connections

between gender, race/ethnicity, and class in prostitution not only in

Canada but elsewhere (Bourgeault, 1989). Prostitution is one speciﬁc

legacy of colonization although it is infrequently analyzed as such (Lynne,

1998; Scully, 2001). A perspective that understands prostitution to be

colonization of First Nations women by both First Nations and non-First

Nations men may be helpful in addressing the problem.

The RCAP report suggested that a general health strategy for First

Nations should involve equitable access to health services, holistic

approaches to treatment, Aboriginal control of services, and diverse

approaches that respond to cultural priorities and community needs

(RCAP, 1996). These four strategies are applicable to the healing of women

escaping prostitution. Models for healing of First Nations women in

prostitution would include a decolonizing perspective that analyzes

historical trauma, violent crimes, family violence, child abuse and neglect,

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discrimination, unresolved grief and mourning. Cultural moderators of

these traumatic experiences that would promote healing include

family/community support, traditional spiritual practices and medicine,

and a positive indigenous identity (Walters, Simoni, & Evans-Campbell,

2002). A study of the needs of Vancouver prostituted women underscores

these recommendations (Benoit, Carroll, & Chaudhry, 2002). A Toronto

study of 30 prostituting women emphasized their need for mental health

services, including drop-in crisis centers open at night as well as hotlines

staffed by peers (Butters & Erickson, 2003). Access to alternative employ-

ment that would generate sustainable income is necessary in order to

remove the economic motivation for prostitution.

In our opinion, western medical treatment of PTSD is best combined

with traditional healing for First Nations women who want to escape

prostitution. The Peguis First Nation community in Manitoba found that

a combination of traditional and western healing approaches was

especially effective for those who suffer from emotional problems, includ-

ing those related to alcohol and drug abuse, violence and suicide (Cohen,

cited in RCAP, 1996).

Women in prostitution self-medicate for depression and PTSD with

drugs and alcohol.

An urgent need for treatment of drug and alcohol

addiction was voiced by 82% of those we interviewed. An approach that

simultaneously treats substance abuse and PTSD has proven more effec-

tive than treatment that only treats substance abuse and fails to address

PTSD (Epstein, Saunders, Kilpatrick, & Resnick, 1998; Najavits, Weiss,

Shaw, & Muenz, 1998; Ouimette, Kimerling, Shaw, & Moos, 2000). Women

in prostitution who are dealing with addictions are not likely to beneﬁt

from treatment in mixed-gender groups. It is unsafe for them to discuss

prostitution in the traditional 12-step setting, because men regularly

proposition them as soon as the women are known to have prostituted.

Furthermore, conﬁdentiality is a concern in communities where everyone

is either related or knows one another (Rees, 2001).

Any intervention for those in prostitution must ﬁrst acknowledge prosti-

tution as a form of violence. As with battered women, physical safety is a

critical concern. In order to address the harm of prostitution it is necessary

to use education, prevention and intervention strategies similar to those

dedicated to other forms of gender-based abuse such as rape and intimate

partner violence. This understanding of prostitution as violence against

women must then become a part of public policy and it must be struc-

turally implemented in public health care, mental health services, homeless

shelters, rape crisis centers and battered women’s shelters (Stark &

Hodgson, 2003). The healthcare provider must become not only culturally

competent regarding differences between nations in culture and language

but also acquainted with community services and anti-violence resources

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(Polacca, 2003). In the United States there is the additional complexity of

jurisdictional confusion. Tribal courts may lack the means and the will for

strong prosecution of perpetrators of violence. Tribal jurisdiction some-

times conﬂicts with federal law enforcement, and perpetrators may be

aware that there are minimal consequences for violence against women

(National Sexual Violence Resource Center, 2000; Polacca, 2003).

Caution is warranted in interpreting these results because we ran

multiple post-hoc analyses on this data, which has not been statistically

corrected for the increased probability of ﬁnding signiﬁcant results when

multiple analyses are performed. Nonetheless, we are conﬁdent that the

trends we have described are accurate and that they warrant further

investigation.

Because of the ongoing trauma of prostitution and homelessness it is

likely that some of these women minimized childhood violence. To review

a history of trauma while in the midst of ongoing abuse was likely to have

been too painful for some. Some of these women did not categorize

juvenile prostitution as childhood sexual abuse.

Others minimized

violence they had experienced by comparing it with that suffered by

friends. One woman told us that since she had no broken bones and had

not been assaulted with a weapon, therefore her rape and strangulation by

a john did not count as much. Thus we assume that the reporting of

trauma history among our respondents is conservative and that the actual

prevalence of traumatic events, health symptoms, and PTSD symptoms is

likely to be higher than reported here. Some women we interviewed were

obviously intoxicated. This does not decrease our conﬁdence in the

accuracy of these results. Along with others we have noted that addicts

report life events with as much accuracy as non-addicts do (Bonito, Nurco,

& Shaffer, 1976).

No study of prostitution can claim a representative or random sample,

given the illegality of prostitution in most locations. ‘There is quite simply

no such thing as a representative sample of women selling sex’ (McKeganey

& Barnard, 1996). We interviewed those people to whom we had access. In

most cases we and other researchers have access only to people prostitut-

ing on the street. That said, we made every attempt to contact any woman

known to be prostituting, indoors or outdoors. We did this by asking

women to tell friends who were prostituting elsewhere (e.g. in other areas

or from their homes or clubs) that we would return to a certain location

at a speciﬁc time the next day. Interviewees often reported involvement in

prostitution across multiple locations, for example, strip club, escort and

massage parlors as well as street prostitution.

As shown in these ﬁndings, prostitution is a sexually exploitive often-

violent economic option most often entered into by those with a lengthy

history of sexual, racial and economic victimization. Prostitution is only

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now beginning to be understood as violence against women and children.

It has rarely been included in discussions of sexual violence against First

Nations.

It is crucial to understand the sexual exploitation of First Nations

women in prostitution today in a historical context of colonial violence

against nations (Frideres, 1993; Ryser, 1995; Waldram, 1997). Today, the

continued displacement of women who are poor, rural and indigenous

may be understood as trafﬁcking in which women are moved from the

reserve to the city for the purpose of prostitution (Lynne, 1998).

Just as wife beating was historically viewed as having been provoked by

the victim, prostitution is still viewed by some as a job choice to which the

victim ‘consents.’ Ninety-ﬁve percent of our interviewees said that they

wanted to escape prostitution, while also telling us that they did not feel

that they had other options for survival. Another report found that 90%

of women in prostitution wanted to leave prostitution but could not

(Elizabeth Fry Society of Toronto, 1987). Social scientists have begun to

address the harms of incest, rape and family violence. We hope to see more

research that examines prostitution as part of the surround of violence

against women, speciﬁcally including First Nations women. We also hope

to see investigations of interventions that promote healing from prosti-

tution.

Acknowledgements

Thanks to Rudolph Ryser, PhD, Center for World Indigenous Studies, Olympia,

Washington, for invaluable information about colonization and geopolitics.

Notes

1. In phone sex, a person verbally provides explicit sex talk for pay for a

customer who typically masturbates during the call. It can include what in

other settings would be verbal sexual harassment, as well as sexist and racist

epithets and other verbal abuse. Commonly, women who engage in phone

sex, like women in strip clubs, also prostitute in other ways.

2. British Colombia surveys found the average age of entry into prostitution to

be 14–15.5 years, and a Vancouver survey found average age of entry into

prostitution to be 16.3 for girls and 15.6 for boys (Lowman & Fraser, 1989).

3. Aboriginal and First Nations, are words used to refer to indigenous peoples

of Canada. No doubt some will disagree with our choice of terms. We are not

using terminology that refers to a person’s legal status. Instead, we are

attempting to use respectful words as spoken by both insiders and outsiders

in the Downtown Eastside community of Vancouver. When an author in a

cited work uses the term Aboriginal, we use the word Aboriginal in connec-

tion with their work. However, we prefer not to use the term Aboriginal

because the Oxford Dictionary currently lists a second descriptor for the word

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Aboriginal as ‘primitive.’ We use the term First Nations interchangeably with

Aboriginal throughout the article, as Brunen does in her 2000 article on the

marginalization of Aboriginal women with addictions in the Canadian

healthcare system.

4. Similar health consequences of colonialism on indigenous people are seen in

health data from the United States. American Indians and Alaska Natives have

the second highest infant mortality rate in USA, and the suicide rate of

American Indians is 50% higher than the national rate (U.S. Dept of Health

and Human Services, 2001, p. 82; U.S. Dept of Health and Human Services,

2001a, p. 17).

5. Other descriptions of violence included:

[I have a] long history of physical abuse. I was beaten by my mother’s

boyfriend, ran away from home to a pimp who beat me, I left him for

a man who beat me up, and so on....

A 13-year-old told us she had: ‘disalignment in my neck, cuts, and

scratches, bruises caused by bad dates. Also deafness.’

A stalker hit me with his car on purpose.

Date tried to assault me with steel-toed boots because I wouldn’t do

something he wanted.

A bad date hit my head on a wall.

I was beaten with stones by a couple of women.

[A pimp] locked me in a room and beat me 30 times with baseball bat.

My boyfriend pushed me downstairs and broke my arm, [I’ve had]

multiple beatings by various boyfriends, broken kneecaps, broken

limbs. I’m scared of men.

Two years ago, I was beat and raped for 45 minutes.

6. Wayne Christian, Director of the First Nations Round Lake Treatment Centre

in Armstrong noted that most of his clients have used drugs and alcohol to

‘deaden’ the pain of emotional and physical trauma. ‘Up to 95% of clients at

Round Lake reported a history of some kind of trauma, personal trauma,

whether it was residential school, sexual abuse, physical violence, abandon-

ment – those types of issues . . .’ (Rees, 2001).

7. One woman at ﬁrst answered ‘no’ to the question, ‘before you were 18 years

old, did you experience any unwanted sexual touching or any sexual contact

between you and a grown up?’ Then she thought about it brieﬂy and asked

(without interviewer prompt): ‘does this question mean for when I was

prostituting underage?’ After the interviewer said yes, the young woman said

‘every time a john touches me, it’s unwanted.’ She started prostituting at

age 12.

8. Although there is a common misconception that street prostitution is the

most harmful type of prostitution, there is no research evidence for this. In

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fact, women have told us that they felt safer in street prostitution compared

with legal brothels or massage parlors where they were not permitted to reject

customers for any reason. Others commented that on the street they could

refuse dangerous-appearing or intoxicated customers. Some told us that they

considered it a deterrent to violence when a friend made a show of writing

down the john’s car license plate number. Raphael and Shapiro (2002) noted

that women in Chicago reported the same frequency of rape in escort and in

street prostitution. Although more physical violence was reported in street

compared with brothel prostitution in South Africa – there was no difference

in the incidence of PTSD in these two types of prostitution, suggesting that

the experience of prostitution is intrinsically traumatizing (Farley et al.,

1998). A Canadian study comparing strip club and street prostitution found

that women prostituting in strip clubs had signiﬁcantly higher rates of disso-

ciative and other psychiatric symptoms than those in street prostitution

(Ross, Anderson, Heber, & Norton, 1990). Strip club/massage, brothel and

street prostitution were compared in Mexico. There were no differences in the

incidence of physical assault and rape in prostitution, childhood sexual abuse

or symptoms of PTSD, and no differences in the percentages of women in

brothel, street, or strip club/massage prostitution who wanted to escape

prostitution (Farley et al., 2003).

We have begun inquiry about different locations where prostitution

occurs. A checklist rather than open-ended questions about location of

prostitution is recommended. In a 2003 study, Farley used the following list

of categories of prostitution, asking each participant regardless of the location

of the current interview, to check off each kind of prostitution she had previ-

ously been in. Types of prostitution included: escort, massage, phone sex,

street, Internet, brothel, prostitution as a child under age 18, strip club, bar,

table dance club, peep show, prostitution associated with a military base,

trafﬁcked (moved) from another country to New Zealand for prostitution,

trafﬁcked (moved) from one part of New Zealand to another for prostitution,

and other. Kramer (2003) found a range of street, escort and strip club prosti-

tution experiences among interviewees in southwestern USA. Across these

three types of prostitution, 90% of Kramer’s respondents described the

experience of prostitution as negative or traumatic. We suggest that any study

of prostitution report the length of time in prostitution and the number of

customers seen by respondents. These factors, more than the physical location

of the prostitution, are correlated with harm (Parriott, 1994; Vanwesenbeeck,

1994).

9. Not only has there been a lack of attention to prostitution as a form of

violence against First Nations women, but the RCAP report has been

generally criticized for its failure to take into account the viewpoint of Abor-

iginal women (Frideres, 1996). Frideres in the same article also comments

that two-thirds of the presenters at the RCAP hearings were male (Note 18,

p. 264).

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Full-text available

Dec 2024

Purpose: When individuals under the age of 18 are victimized by sex trafficking, it is termed commercial sexual exploitation of children (CSEC) in the United States. It is suggested that a history of engagement with the foster care system is one of the leading risk factors for CSEC. However, it is possible that it is the very factors that facilitate engagement with the foster care system (e.g., neglect, abuse, etc.) that establish vulnerability for CSEC victimization rather than the foster care system itself and that the foster care system serves a protective role for such victims. The purpose of this investigation is to examine the relationship between risk factors within the family of origin, foster care experiences, and outcomes for CSEC victims. Methods: Between 2014 and 2023, data were collected on minor victims of CSEC (n = 884) via the Child and Adolescent Needs and Strengths Assessment for Commercial Sexual Exploitation (CANS-CSE). Investigators conducted regression analyses to examine the relationship between family risk and foster care engagement (Aim 1). Foster care engagement (Aim 2) and number of foster care placements (Aim 3) are tested as moderators of associations between family risk factors and outcomes for youth. Results: Family risk is significantly associated with negative outcomes. Foster care placement and number of foster care placements do not moderate the link between family risk factors and negative outcomes for victims of CSEC. Conclusions: Results suggest that foster care does not protect against risks associated with families of origin and negative outcomes, a finding that may be unique for CSEC victims. Therefore, specialized, trauma-informed services should be implemented with CSEC victims who are engaged in the foster care system. In doing so, foster care could begin to serve a protective role in supporting young victims of CSEC and producing more positive outcomes.

Legal Prostitution: A Crime Against Humanity?

Article

Full-text available

Mar 2025
HARVARD INT LAW J

Close case readings focusing on the ICC support the theory that legal prostitution be recognized as a crime against humanity. Extensive social science research documents the coercion and damage attendant and endemic to the sex industry. Countries following the Swedish (now “Nordic/Equality”) prostitution model law, which penalizes buyers and third parties while supporting prostituted persons to escape, have decreased prostitution’s incidence, while countries in which prostitution is legalized have seen trafficking and other violative abuses metastasize. This article analyzes in depth the prospect of holding authoritative actors accountable for legalized prostitution under the international legal rubric of crimes against humanity. It documents that legalized and fully decriminalized prostitution release a tsunami of crimes against humanity for which these policies guarantee domestic impunity. Empirical evidence marshaled shows that legal prostitution exponentially increases “widespread” and “systematic attacks” against prostituted persons, including “rape, enforced prostitution, enslavement, human trafficking, sexual slavery,” and other atrocities enumerated under international law and the Rome Statute of the International Criminal Court (ICC).

Re-thinking vulnerability: Research fraud and bureaucratic harm in community-engaged online research

Article

Dec 2024
Qual Res

Vulnerability – understood broadly as susceptibility to harm – factors into many social science research projects, including those that are qualitative, involve collaborations between scholars and members of the group under study, and engage with online research techniques and technologies. However, guidance for how researchers and communities may understand, navigate, and mitigate vulnerability in such projects is often scattered across disciplines, making it difficult for researchers to discern relevant best practices. To further understandings of vulnerability here, we reflect in this article on our experience with a mixed-method project, where we partnered with sex workers across the United States to study their experiences with the online platforms they use to facilitate and conduct their work. Based on our encounters with university bureaucracies and research fraud over the course of this project, we argue broadly that vulnerability is not a fixed, inherent attribute of certain research participants; instead, it emerges through various relations and events in the field, and all parties involved in a research project may experience it. To illustrate this argument, we demonstrate how university bureaucratic practices and research fraud may variously harm both participants and researchers by undermining community collaborations, data collection, and researcher safety and well-being. In conclusion we suggest best practices for online research and for universities, so they may better protect researchers and the integrity of such studies.

Prevalence of Gender-Based Violence among Sex Workers in Bangui, Central African Republic (CAR)

Article

Jan 2024

Motivationen für den Verkauf von Sex

Chapter

Mar 2024

Kontextuelle Faktoren: Stressquellen und wie Frauen damit umgehen

Chapter

Mar 2024

Systems of Prostitution and Pornography: Harm, Health, and Gendered Inequalities

Chapter

Aug 2022

Systems of Prostitution and Pornography: Harm, Health, and Gendered Inequalities

Chapter

Dec 2021

Connections Between Racism and Mental Health

Chapter

Jan 1995

American Indian women and psychology.

Chapter

Jan 1995

Lost Voices: Women, Chronic Pain, and Abuse

Book

May 2014

Nellie A. Radomsky

Psychological Distress Among the Cree of James Bay

Article

Mar 2000
Transcult Psychiatr

The object of this study was to identify potential risk and protective factors associated with psychological distress among the Cree of James Bay, through a secondary analysis of data on 1136 Cree (aged 15–85) from a random general population health survey in 1991. In multiple linear regression models, factors significantly associated with reporting more distress in the past week included: younger age, female gender, early loss of a parent or close relative, more life events in the year before the survey, a serious illness or drinking problem in the past year, ever having used cannabis, having more than elementary education, having fewer than five close friends/relatives and residing in an isolated or inland region. Having a good relationship with others in the community and spending more time in the bush were both associated with less dis- tress. The relative importance of these factors varied across age/gender cohorts. We conclude that gender and generational differences should be considered when planning mental health promotion strategies for this population. In addition to more conventional approaches to reduce alcohol abuse, improve coping with loss and increase social support, tar- geted programs should be developed addressing the impact of edu- cation and role strain for women.

An analysis of individual, institutional, and cultural pimping

Article

Jan 1993

E. Giobbe

Clinical studies of neurotransmitter alterations in post-traumatic stress disorder

Article

Jan 1995

Prostitution and civil rights

Article

Jan 1993

C.A. MacKinnon

Sister Oppressions: A Comparison of Wife Battering and Prostitution

Article

Jan 2003

Political Status of Native Indian Women: Contradictory Implications of Canadian State Policy

Article

Jan 1995
Am Indian Cult Res J

Jo-Anne Fiske

Etude de la nature contradictoire et ambigue du statut politique des femmes indigenes vis-a-vis des hommes dans les processus politiques internes des communautes de reserves indiennes canadiennes depuis 1990. L'analyse du lien entre l'economie, l'organisation domestique et les processus politiques d'une part et les relations entre les femmes indiennes et l'Etat d'autre part montre que la position ambivalente des femmes s'explique en grande partie par les resultats contradictoires des pratiques de l'Etat-providence qui diminue le pouvoir de la parentele des hommes en limitant leur controle sur l'acces des femmes aux moyens d'existence et par des politiques patriarchales des strategies assimilationnistes

Women of color and traumatic stress in "domestic captivity": Gender and race as disempowering statuses

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Jan 1996

Maria P. Root

Prostitution in Vancouver: Violence and the Colonization of First Nations Women

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