Regulating sex work: subjectivity and stigma in Senegal

A Qualitative Phenomenological Study of the Lived Experiences of Female Sex Workers in a Bangladesh Brothel

AIM

The purpose of this study was to explore the lived experiences of female sex workers in the Kandapara Brothel in Tangail to build a better understanding of their lived perspective.

DESIGN

This qualitative study was based on the philosophical underpinnings of Giorgi's descriptive phenomenological philosophy.

METHODS

A purposive, convenience sample of 24 participants (N = 24) was recruited in the brothel, sufficient for data saturation. The inclusion criteria included (a) must work in the brothel and (b) must be ≥ 18 years old. In-depth interviews were conducted, and transcript data were reduced, managed and coded.

ETHICS

The university institutional review board and ethics committee approved the study, and participants provided written informed consent.

FINDINGS

A qualitative analysis of transcribed in-depth interviews revealed four major themes: (1) Early Trauma and Dysregulation, which reflects the trauma experienced by the women working in the brothel and being trafficked at a very early age; (2) Internal life describes the emotional experience and gratitude; the feelings of the sex workers in the brothel, (3) External life reflects the view of the greater Bangladeshi society of the sex workers and (4) The Brothel Life examines the relationships, competition, isolation, health concerns and workers' desire/uncertainty to leave the brothel. The four themes, while appearing separate, overlap with the other themes.

CONCLUSIONS

This phenomenological study illustrates the complexity of brothel workers' lived experiences. Understanding sex workers' lived experiences through a caring lens promotes care that allows for self-determination, reflection, growth, acceptance and, most of all, healing.

'Change creates change' - older female sex workers' experiences through the early COVID-19 pandemic

COVID-19 and associated policy responses created unique social, economic and health risks for sex workers. Through semi-structured interviews we explored pre- and early COVID-19 experiences and work practices of ten cisgender female sex workers 50 years of age and older in Queensland, Australia, analysing the findings using a risk environment framework. Throughout early 2020, participants navigated a complex risk environment, managing economic needs, health and safety, occupational stigma and policing. Australia's policy responses altered the risks and opportunities available to participants. Half the participants continued sex work and half stopped sex work with some accessing economic support and withdrawing superannuation savings. Those who continued sex work drew on life and work experience to reassess changing health, stigma, and policing risks, and adapted their work strategies by increasing client screening and modifying services. Participants relied on information from peer networks and organisations to guide work practices but remained wary of contact tracing, police and the media. Decriminalisation of sex work and the strengthening of sex worker organisation and government partnerships are important in embedding equity in responses to ongoing and new public health threats.

Attitudes towards sex workers: a nationwide cross-sectional survey among German healthcare providers

Background

Worldwide, sex workers face stigmatization and discrimination, also within healthcare. Only few studies on healthcare providers' attitudes towards care of sex workers have been performed. This study assessed attitudes and knowledge of healthcare providers in Germany towards sex workers and their specific health risks.

Methods

German healthcare professionals and medical students were invited to participate in a nationwide cross-sectional study in 2022. The online survey used a German translation of the "Attitudes towards Prostitutes and Prostitution Scale" by Levin and Peled for assessment of attitudes towards sex work and workers, together with prevalence estimates of common mental and physical disorders.

Results

A total of 469 questionnaires were included into analysis. Older participants tended to regard sex work as less of a choice (p < 0.004) and sex workers as more victimized (p < 0.001). The frequency of professional contact to sex workers neither affected the perception of sex workers' status as victims vs. independent individuals, nor the perceived moral status. Moreover, healthcare professionals overestimated the prevalence of various disorders which was influenced by participants' attitudes towards sex workers.

Discussion

A comparison to a recent Allensbach survey demonstrated similar attitudes of healthcare providers and the general population towards sex workers. Our results suggest that German healthcare professionals are not free of prejudices against sex workers, as has been shown for other marginalized groups in society. Instead, they seem to be influenced by personal opinion rather than by objective facts which they should have acquired during their professional education. Future interventions (e.g., better training regarding marginal societal groups) are necessary to encounter these issues in order to improve healthcare for sex workers.

Sentidos Atribuídos à Satisfação Sexual por Trabalhadoras do Sexo

Objetivou-se compreender os sentidos atribuídos à satisfação sexual por mulheres que vivenciam o trabalho sexual. Trata-se de um estudo qualitativo, fundamentado nas abordagens fenomenológicas de Sartre e Heidegger. Foi realizado com 30 trabalhadoras sexuais da região do Alto Sertão Produtivo Baiano. Evidenciou-se que as mulheres têm os sentidos sobre satisfação sexual estruturados na dimensão financeira em interface à autoestima e ao ato sexual, explicadas a partir das experiências aprendidas, enquanto são/estão inseridas no serviço sexual. Esses sentidos revelam que o prazer em conexão ao dinheiro é a sobrevivência e subsistência. Já o orgasmo propriamente dito remete à autoestima e às emoções sentidas por quem nutre afeto. Essas nuances mostram que o serviço sexual é, além de ofício, o contexto que permite a elas ser/estar em um espaço com possibilidades de vivências multifacetadas, como a liberdade sexual, em uma temporalidade que é reflexo de subjetividades que extrapolam o determinismo natural.

Sex Workers' Everyday Security in the Netherlands and the Impact of COVID-19

Introduction

The COVID-19 pandemic has laid bare and exacerbates the existing insecurities of sex workers. This paper asks: What are sex workers' everyday experiences of (in)security? And: How has the COVID-19 pandemic influenced these?

Methods

We engage with these questions through collaborative research based on semi-structured interviews carried out in 2019 and 2020 with sex workers in The Hague, the Netherlands.

Results

Revealing a stark mismatch between the insecurities that sex workers' experience and the concerns enshrined in regulation, our analysis shows that sex workers' everyday insecurities involve diverse concerns regarding their occupational safety and health, highlighting that work insecurity is more multi-faceted than sexually transmitted infections (STIs). Widespread employment and income insecurities for sex workers are exacerbated for transwomen and male sex workers. Their legal liminality is enabled not only by the opaque legal status of sex work in the Netherlands, but also by the gendering of official regulation. The COVID-19 pandemic made visible how the sexual and gender norms that informally govern sex workers' working conditions intersect with hierarchies of citizenship, complicating access to COVID-19 support, particularly for migrant sex workers.

Conclusions

Sex work regulation in the Netherlands leaves workers in a limbo-not without obligations and surveillance, yet, without the full guarantee of their labour rights.

Policy Implications

To effectively address sex workers' insecurities, a shift in regulation from its current biopolitical focus to a labour approach is necessary. Besides, public policy and civil society actors alike need to address the sex industry's harmful social regulation through hierarchies of gender, sexuality and race.

COVID-19, Stigma, and the Ongoing Marginalization of Sex Workers and their Support Organizations

Primary or first-hand stigma, associated with sex work, sometimes disparagingly referred to as "prostitution" or "whore" stigma, was a fundamental cause of social inequities for sex workers before the COVID-19 pandemic. In addition, courtesy stigma, or stigma by association linked with involvement with a stigmatized group, has long limited the ability of sex worker organizations to secure adequate funds to meet the needs of sex workers in their communities. In reaction to the pandemic, sex worker organizations quickly responded and in a variety of ways have been helping to ease the impact of the pandemic on sex workers in their communities. In November 2020, we interviewed 10 members of sex worker organizations from seven different communities across Canada about how they have been dealing with the immediate and longer-term impacts of the COVID-19 pandemic in their communities. Three strategic actions stood out in the interviews: (1) challenging stigma to help sex workers access government emergency funding; (2) reorganizing and adapting services to provide outreach to sex workers in their communities; and (3) advocating for continuous organizational funding. The findings show that primary stigma and courtesy stigma have further marginalized sex worker organizations and their clients during the pandemic. We conclude with participants' recommendations to address avoidable harms of COVID-19 among sex workers and to better support sex worker organizations in Canada.

Social service responses to human trafficking: the making of a public health problem

Human trafficking has received considerable attention from policymakers, researchers and service providers globally, with resulting interventions often positioning trafficking as something that simply exists. Drawing on Bacchi's 'What's the Problem Represented to be?' approach, this article proposes that trafficking is continually made through efforts designed to eradicate it. We conducted 22 interviews with representatives from social service organisations funded by the government of Ontario, Canada, for anti-trafficking programming. These interviews provide insight into how trafficking is being represented and with what effects. Our findings suggest that organisational initiatives often rely on individualised health-related interventions, such as trauma-informed counselling and other mental health support, to address trafficking. In the process, various sex work activities are deemed 'symptoms' of trafficking, and perceived pathways to engaging in sex work (such as drug use/dependence, a history of trauma and low self-esteem) are produced as 'causes' or 'risk factors'. We contend that by pathologising sex work and sex workers, organisations are employing a contradictory neoliberal paternalism to advance a public health representation of human trafficking that simultaneously responsibilises and disenfranchises purported victims.

Editorial: Understanding Exploitation in Consensual Sex Work to Inform Occupational Health & Safety Regulation: Current Issues and Policy Implications

The impetus behind this Special Issue emerged from a quest to move beyond binary thinking in the contemporary period about people who sell sexual services, including recent disputes about “sex trafficking vs [...]

HIV infection risk and condom use among sex workers in Senegal: evidence from the list experiment method

Social desirability bias, which is the tendency to under-report socially undesirable health behaviours, significantly distorts information on sensitive behaviours that is gained from self-reports. As a result, self-reported condom use among high-risk populations is thought to be systematically over-reported, and it is impossible to identify the determinants of condom use. The main objective of the article is to elicit unbiased information on condom use among female sex workers (FSWs) using the double list experiment method to analyse the role of HIV infection and exposure to HIV prevention methods in condom use. More specifically, the difference in levels of condom use between HIV-positive and HIV-negative FSWs is estimated. In addition, the role of FSWs' registration and participation in a pre-exposure prophylaxis (PrEP) demonstration project in condom use is considered. A list experiment was designed to elicit condom use information from 786 FSWs in Senegal who were surveyed in 2015 and 2017. Using the list experiment method, participants were randomly assigned to one of two groups (treatment or control) and were asked to report the number of statements they agreed with. Respondents assigned to the control group were presented with three non-sensitive items, whereas those allocated to the treatment group were presented with the same three statements plus the sensitive item (e.g. 'I used a condom during my last intercourse with a client'). Comparing the average number of sentences that were agreed with in both groups provides an estimation of the condom use rate in the treatment group and estimating such prevalence for several sub-groups allows the role of HIV infection risk in condom use to be identified. The percentage of FSWs using condoms in their last sexual intercourse with a client was 80% in 2015 and 78% in 2017, which was significantly lower than the 97% obtained in the face-to-face surveys in both waves. When estimating condom use among sub-groups with the list experiment method, we found that condom use among HIV-positive FSWs was only 34%, which was 47 percentage points lower than condom use among HIV-negative FSWs. We also found that registered FSWs are more likely to use condoms than clandestine FSWs. However, we did not find any difference in condom use between FSWs who were enrolled in the PrEP demonstration project and those who were not enrolled. Health policies should therefore aim to increase condom use among HIV-positive FSWs.

'I dodged the stigma bullet': Canadian sex workers' situated responses to occupational stigma

Stigma attached to sex workers' occupation, sometimes disparagingly referred to as 'prostitution' or 'whore' stigma, is a fundamental challenge for people in sex work. Yet sex workers are not powerless when confronting occupational stigma. We employed thematic analysis with data from in-person interviews conducted in 2012-13 with a diverse sample of 218 adult sex workers in Canada. Our participants perceived a high degree of occupational stigma, which they responded to and managed using four main strategies. First, some participants internalised negative discourses about their sex work and accepted their discredited status. Second, many controlled access to information about themselves, consciously keeping knowledge of their occupation from most people while sharing it with trusted others. Third, some participants rejected society's negative view of their occupation. Finally, some attempted to reduce the personal impact of stigma by reframing sex work to emphasise its positive and empowering elements. Participants often strategically responded to stigma contingent on the situated contexts of their work and personal life. We discuss these findings in relation to the existing knowledge base about stigma attached to sex workers' occupation as well as how these findings may direct future research on stigma strategies.

"The Prostitution Problem": Claims, Evidence, and Policy Outcomes

Prostitution, payment for the exchange of sexual services, is deemed a major social problem in most countries around the world today, with little to no consensus on how to address it. In this Target Article, we unpack what we discern as the two primary positions that undergird academic thinking about the relationship between inequality and prostitution: (1) prostitution is principally an institution of hierarchal gender relations that legitimizes the sexual exploitation of women by men, and (2) prostitution is a form of exploited labor where multiple forms of social inequality (including class, gender, and race) intersect in neoliberal capitalist societies. Our main aims are to: (a) examine the key claims and empirical evidence available to support or refute each perspective; (b) outline the policy responses associated with each perspective; and (c) evaluate which responses have been the most effective in reducing social exclusion of sex workers in societal institutions and everyday practices. While the overall trend globally has been to accept the first perspective on the "prostitution problem" and enact repressive policies that aim to protect prostituted women, punish male buyers, and marginalize the sex sector, we argue that the strongest empirical evidence is for adoption of the second perspective that aims to develop integrative policies that reduce the intersecting social inequalities sex workers face in their struggle to make a living and be included as equals. We conclude with a call for more robust empirical studies that use strategic comparisons of the sex sector within and across regions and between sex work and other precarious occupations.

Use and Acceptability of HIV Self-Testing Among First-Time Testers at Risk for HIV in Senegal

HIV Self-Testing (HIVST) aims to increase HIV testing coverage and can facilitate reaching the UNAIDS 90-90-90 targets. In Senegal, key populations bear a disproportionate burden of HIV and report limited uptake of HIV testing given pervasive stigma and criminalization. In these contexts, HIVST may represent a complementary approach to reach populations reporting barriers to engagement with existing and routine HIV testing services. In this study, 1839 HIVST kits were distributed in Senegal, with 1149 individuals participating in a pre-test questionnaire and 817 participating in a post-test questionnaire. Overall, 46.9% (536/1144) were first-time testers and 26.2% (300/1144) had tested within the last year; 94.3% (768/814) reported using the HIVST, and 2.9% (19/651) reported a reactive result which was associated with first-time testers (p = 0.024). HIVST represents an approach that reached first-time testers and those who had not tested recently. Implementation indicators suggest the importance of leveraging existing community structures and programs for distribution.

Canadian Sex Workers Weigh the Costs and Benefits of Disclosing Their Occupational Status to Health Providers

Prostitution stigma has been shown to negatively affect the work, personal lives, and health of sex workers. Research also shows that sex workers have much higher unmet health care needs than the general population. Less is known about how stigma obstructs their health-seeking behaviors. For our thematic analysis, we explored Canadian sex workers' accounts (N = 218) of accessing health care services for work-related health concerns. Results show that participants had mixed feelings about revealing their work status in health care encounters. Those who decided not to disclose were fearful of negative treatment or expressed confidentiality concerns or lack of relevancy. Those who divulged their occupational status to a health provider mainly described benefits, including nonjudgment, relationship building, and comprehensive care, while a minority experienced costs that included judgment, stigma, and inappropriate health care. Overall, health professionals in Canada appear to be doing a good job relating to sex workers who come forward for care. There is still a need for some providers to learn how to better converse with, diagnose, and care for people in sex work jobs that take into account the heavy costs associated with prostitution stigma.

Prostitution Stigma and Its Effect on the Working Conditions, Personal Lives, and Health of Sex Workers

Researchers have shown that stigma is a fundamental determinant of behavior, well-being, and health for many marginalized groups, but sex workers are notably absent from their analyses. This article aims to fill the empirical research gap on sex workers by reviewing the mounting evidence of stigmatization attached to sex workers' occupation, often referred to as "prostitution" or "whore" stigma. We give special attention to its negative effect on the working conditions, personal lives, and health of sex workers. The article first draws attention to the problem of terminology related to the subject area and makes the case for consideration of prostitution stigmatization as a fundamental cause of social inequality. We then examined the sources of prostitution stigma at macro, meso, and micro levels. The third section focuses on tactics sex workers employ to manage, reframe, or resist occupational stigma. We conclude with a call for more comparative studies of stigma related to sex work to contribute to the general stigma literature, as well as social policy and law reform.

Sex work and three dimensions of self-esteem: self-worth, authenticity and self-efficacy

Sex work is assumed to have a negative effect on self-esteem, nearly exclusively expressed as low self-worth, due to its social unacceptability and despite the diversity of persons, positions and roles within the sex industry. In this study, we asked a heterogeneous sample of 218 Canadian sex workers delivering services in various venues about how their work affected their sense of self. Using thematic analysis based on a three-dimensional conception of self-esteem - self-worth (viewing oneself in a favourable light), authenticity (being one's true self) and self-efficacy (competency) - we shed light on the relationship between involvement in sex work and self-esteem. Findings demonstrate that the relationship between sex work and self-esteem is complex: the majority of participants discussed multiple dimensions of self-esteem and often spoke of how sex work had both positive and negative effects on their sense of self. Social background factors, work location and life events and experiences also had an effect on self-esteem. Future research should take a more complex approach to understanding these issues by considering elements beyond self-worth, such as authenticity and self-efficacy, and examining how sex workers' backgrounds and individual motivations intersect with these three dimensions.

'Whore stigma' as a transformative experience: altered cognitive expectations among Jewish-Israeli street-based sex workers

While the scholarship on sex work is substantial, it neglects to explore whether sex work and associated stigma affect sex workers' cognitive expectations. Drawing on observations of street-based sex work as well as in-depth interviews with Jewish-Israeli sex workers, this study suggests that because stigma is a moral experience that threatens and often destroys what really matters to stigmatised individuals, it leads to recurrent disappointments, which, in turn, may alter sex workers' cognitive expectations. Sex workers learn to see certain life goals, including maintaining healthy social relationships and a workspace free of violence and humiliation, as unobtainable. However, they also begin to see other aspects of their lives, such as economic autonomy, as achievable through sex work. Tracing how whore stigma becomes a transformative experience allows us to add another layer to the heretofore suggested link between the structural, cultural and individual aspects of stigmatisation.