Crossroads of Choice: A qualitative study of the factors influencing decisions to transition from sex work among women engaged in sex work in Southern Uganda

Background

Women Engaged in commercial Sex Work (WESW) are exposed to behavioral, biological, and structural factors that exacerbate their risk to HIV infection and other sexually transmitted infections. While commercial sex work may appear voluntary, WESW are more likely to be constrained to selling sex due to limited viable alternatives. To effectively support this vulnerable group of women, it is critical to understand factors that facilitate and impede their decisions to transition from sex work into other careers or jobs. The current study explored women's decision to transition from sex work into other careers or jobs.

Methods

Semi-structured in-depth interviews were conducted with 53 WESW aged 20-47 enrolled within a larger study-Kyaterekera study, a randomized clinical trial (N = 542) implemented in 19 HIV hotspots in the Southern region of Uganda. Participants were selected based on their intervention attendance (high/medium/low attendance). The interviews were conducted in Luganda the widely spoken language in the study area to explore the factors influencing women's decisions to from transition from sex work to other jobs or careers. The main interview question used for this study was, "What are some of the factors that may influence whether you would transition from sex work to other jobs or vocations?". All interviews were audio-recorded, transcribed verbatim and translated into English. Thematic analysis in Dedoose software was used to analyze the data.

Results

Participants reported three primary types of decisions, including considering leaving sex work, deciding to leave, and continuing sex work. The emerging themes from the interviews were categorized into individual and structural level facilitators and barriers to leave sex work. Individual level factors included issues of stigma, discrimination, and aging as factors that facilitated women's decision to leave sex work. At the structural level, factors which include interpersonal stigma and discrimination (from immediate family and community members), physical and sexual violence and income related factors were identified as facilitators and barriers to leaving sex work.

Conclusion

Our study highlights the complex decision-making processes among WESW as they navigate transitions to alternative jobs or careers. By advocating for multifaceted interventions and policies tailored to the diverse challenges faced by WESW, our study contributes to a more informed approach to supporting their transition out of sex work.

Prostitution in the shadow of life-long sexual abuse: Arab women's retrospective experiences

The present study uses the life-course and intersectionality perspectives to explore the meaning that aging Arab women attribute to their lived experiences of life-long sexual abuse in the shadow of engaging in prostitution. Interpretive phenomenological analysis was used to analyze the narratives of 10 older Arab women in Israel who were engaged in prostitution. Four themes emerged: experiencing childhood in the shadow of sexual abuse, becoming a prostitute, being entrapped in prostitution, and settling accounts with the native culture. Women aging in prostitution experience a harsh reality of abuse and loss. The present study points to multiple channels of abuse throughout the life course, from childhood until old age.

APPS-S: A Tool for Measuring the Attitudes Toward Prostitution and Women in Prostitution in the Spanish Population

This study was designed with the purpose of testing the psychometric properties of the Spanish version of the Attitudes toward Prostitution and Prostitutes Scale through three studies with different samples. The first one explores the test's dimensional structure or constructs validity through confirmatory factor analysis, as well as internal consistency and test-retest reliability. The second one focuses on discriminant and criteria validity. Finally, the third one examines the scale's convergent validity and its sensitivity to detecting changes. The results support two subscales with an optimal index of internal consistency, structural stability over time, and discriminative power between groups of participants. It is, therefore, an adequate tool for adults as well as young people and teenagers, and for detecting changes in the context of intervention or awareness workshops.

Access to Sexual Rights for People Living with Disabilities: Assumptions, Evidence, and Policy Outcomes

Sexuality scholars have historically understudied the link between disability, sexual exclusion, and social justice, including equal rights for people living with disabilities (PLWD) to enjoy a sexual and intimate life in adulthood. There have been some recent efforts to rectify this situation, with studies emerging concerning strategies for promoting their sexual rights. Our Target Article explores one contentious service option-the possibility of "sexual assistance" for PLWD, which ranges in meaning across countries from sex surrogacy to physical contact with paid sexual assistants. We conducted a knowledge synthesis using a scoping review methodology to identify the breadth of the academic scholarship available and assess its alignment with current ethical and moral debates and recent policies and practices surrounding the sexual scripts of PLWD as they relate to sexual assistance. We categorized the relevant articles in our scoping review into two broad classes: those that support sex-negative perspectives (i.e., framing sexuality as risky, adversarial, etc.) and those that support sex-positive perspectives (i.e., framing sexuality as normative, consensual, etc.). Our results show that sex-negative cultural scripts call for limitations of the sexual rights of PLWD due to their inherent vulnerability as having disabled sexualities and/or due to their heightened risk of exploiting sexual partners, especially cis women who sell sexual services. The sex-positive cultural scripts understand PLWD as having the same rights to sexual citizenship as non-disabled individuals and that to achieve this, equitable access to sexual health services in decriminalized and regulated service environments is needed. We conclude with limitations of our investigation and recommendations for further research on this understudied topic, including the possible integration of positive disabled sexuality and abuse prevention.

Are Anti-Prostitution Advertising Campaigns Effective? An Experimental Study

Many governments invest public funds in communication interventions and campaigns against prostitution and sexual exploitation in an attempt to change attitudes toward prostitution and eventually decrease its consumption. Despite the considerable investment that public institutions have made in campaigns against prostitution and sexual slavery, no known empirical studies have evaluated the effectiveness of such campaigns on attitudes and behavioral change. The messages of these campaigns usually center on one of two thematic focuses: Prostituted women who suffer exploitation and male consumers of prostitution. The present study examines the impact of different anti-prostitution advertisements on attitudes among male participants (N = 155 male participants). Specifically, the experiment aims to test the differential effect of these two focuses, compared to a no-advertisement control condition, on social support for prostitution, negative and incorrect beliefs about prostitutes, and family values related to prostitution. The results show that compared with the no-advertisement control condition, advertisements focused on men who use prostitutes have a significant effect on social support toward prostitution and incorrect beliefs about prostitutes, whereas advertisements focused on female prostitutes have no effect. The results have practical implications for governments and councils regarding the efficacy of this kind of public communication campaign against prostitution consumption.

The Marketing of Female Escorts: A Gendered Perspective of Online Companionship Advertisements

Advancement of technology has broadened possibilities for people working in the sex industry. Specifically, sex workers' use of online classified advertisement websites to market companionship and escort services has increased in recent years, yet research has lagged behind these developments. This study addresses the gap in research by examining female companionship advertisements on one of the most popular websites: Backpage.com. The lead author qualitatively analyzed over 1,500 advertisements to identify common themes and patterns in how escort companions were described. This study explores the type of identity claims escort companions make and how they formulate advertisements to appeal to a broad client base. Research on gendered stereotypes is used to interpret escort companions' use of language, symbols, and photography, through covert and overt messaging. Study results revealed that women offering companion services promoted and reinforced traditional gendered stereotypes through their online advertisements. Findings may be used to understand the context of sex work.

"This Is Me, This Is What I Am, I Am a Man": The Masculinities of Men Who Pay for Sex with Women

This paper draws on theories of masculinity to explore men's motivations for beginning and continuing to pay for sex with women. Based on in-depth interviews with 35 male clients of female sex workers in the UK during 2007/2008, our findings suggest that a desire to pay for sex is often entrenched in notions of hegemonic masculinity such as sex as a drive, or need for a variety of experiences and partners and is rationalized as an economic exchange. Yet, the men interviewed also expressed a need for intimacy, female friendship and conversation in a controlled environment, which challenged dominant masculine ideals. For participants, there was often an overlap between various motivational factors, and accounts were complicated by the anxieties and disappointments the men expressed about their non-commercial relationships and the intimacy and emotion frequently attached to encounters with sex workers. The pathologization of men who engage with paid sexual services fails to account for participants' complex, diverse motivations, which should be understood in the context of other relationships and gender relations rather than as a distinct type of interaction. We find that the theory of hegemonic masculinity provides a useful but partial account of the range of behaviors and characteristics expressed in paid-for sex, which participants use to negotiate the expectations, ambivalences and disappointments of everyday life and relationships.

"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.