Disclosing Sex Trading Histories to Providers: Barriers and Facilitators to Navigation of Social Services Among Women Impacted by Commercial Sexual Exploitation

Sex trafficking vulnerabilities in context: An analysis of 1,264 case files of adult survivors of commercial sexual exploitation

PURPOSE

Commercial sexual exploitation occurs when anything of value is given in exchange for a sex act. Sex trafficking involves the commercial sexual exploitation of individuals by means of force, fraud, or coercion. Due to the illegal nature of commercial sexual exploitation, there is a profound dearth in the literature. To develop a deeper understanding of the experiences of adult survivors of commercial sexual exploitation, investigators analyzed 1,264 unique case files collected between 2011 and 2021.

METHODS

Key predictors included mental health diagnoses, childhood sexual abuse, and educational achievement, while relevant outcomes included age of entry into sexual exploitation, length of exploitation, number of arrests, cycling into and out of commercial sexual exploitation, and program placement outcomes. Regression analyses (e.g., linear, binomial, or zero-inflated Poisson) were conducted.

RESULTS

Results suggest that educational achievement is a potential protective factor against exploitation. Higher number of arrest and higher number of children had a bidirectional relationship with longer experiences of exploitation. Further, diagnoses of bipolar disorder and neurodevelopmental disorders were related to higher rates of cycling (i.e., repeated attempts to exit exploitation), and neurodevelopmental disorders and schizophrenia spectrum disorders were related to poorer placement outcomes.

CONCLUSIONS

The findings provide a more authentic portrait of contextual influences on commercial sexual exploitation across a lifespan, informing services, interventions, and policy and supporting survivors in their promising futures.

Including the issue of receiving payment for sex in intervention for substance use disorder: Professionals' intentions and interventions

BACKGROUND

Studies have shown that a high percentage of individuals with substance use disorder (SUD) are involved in receiving payment for sex (RPS). The stigma associated with RPS may lead to non-disclosure of RPS in drug treatment services thus preventing fully benefitting from SUD treatment. Research on RPS in the context of SUD interventions is scarce. The current study examined the extent to which social workers believe they should attend to the issue of RPS as part of the treatment of addictions and the extent of their self-reported work with RPS, as associated with comfort in discussing sexual issues in treatment (CDSIT), professional self-efficacy, attitudes towards people who engage in RPS, and attitudes towards social justice.

METHOD

A sample of 171 social workers who had worked with individuals with SUD in addiction treatment centers completed an online questionnaire. The main analyses were only conducted on participants who completed the full questionnaire (n = 124).

RESULTS

Most social workers believe in the importance of addressing RPS issues in treatment of individuals with SUD, but mostly did not translate their beliefs into practice. Attitudes toward social justice and toward people who engage in RPS, and the interaction between self-efficacy and CDSIT were associated with the belief in the importance of addressing RPS in treatment. The main factor that contributed to the self-reported work with RPS was CDSIT.

CONCLUSION

Policy-makers should promote specific training for professionals in the addiction field to address the issue of RPS when working with individuals with SUD, and increase levels of CDSIT.

Crystal methamphetamine use subgroups and associated addiction care access and overdose risk in a Canadian urban setting

OBJECTIVES

Methamphetamine use is rising globally and we have limited treatments for this. Subgroups within the diverse methamphetamine-using population may have distinct treatment needs. Among a community-recruited sample of people who use crystal methamphetamine, we aimed to identify subgroups and characterize their overdose risk and access to addiction care.

METHODS

Data from prospective cohorts of people who use drugs in Vancouver, Canada from 2014 to 2018 were used to conduct a repeated measures latent class analysis among participants who used crystal methamphetamine. Multivariable generalized estimating equations models were fit to determine the associated factors.

RESULTS

Among 824 eligible participants, a five-class model was identified as the best fit: (1) primary stimulant use (15.7%); (2) women engaged in sex work and opioid use (21.4%); (3) street income generation and opioid use (31.6%); (4) opioid agonist therapy (OAT) patients (22.3%); and (5) men who have sex with men (9.0%). In multivariable analyses, compared to the primary stimulant use group, non-fatal overdose was positively associated with street income generation (adjusted odds ratio [AOR] = 1.49, 95% confidence interval [95% CI]=1.30-1.71), sex work (AOR = 1.38, 95% CI=1.20-1.59) and OAT (AOR = 1.22, 95% CI=1.06-1.41) subgroups; engagement in non-OAT addiction care was negatively associated with street income generation (AOR = 0.81, 95% CI=0.68-0.97) and sex work (AOR = 0.78, 95% CI=0.63-0.98) subgroups.

DISCUSSION

Socioeconomically marginalized subgroups with opioid and crystal methamphetamine co-use were at highest risk of non-fatal overdose and had poorer access to addiction care, highlighting the need for tailored interventions.

Prevalence and associated characteristics of youth who trade sex in a representative sample of high school students

INTRODUCTION

Our understanding of youths' sex trading predominantly stems from non-representative studies with high-risk populations (e.g. homeless/runaway youth). The purpose of this study is to identify the prevalence and associated characteristics of youth who report sex trading (compared to those who do not) in a representative sample of high school students.

METHODS

Data comes from the 2018 Youth Assessment, a cross-sectional survey administered to 9th through 12th graders across 24 high schools in Dane County, a predominantly urban area in Wisconsin, U.S.A. All youth who answered the question, "have you ever had sexual contact in order to stay safe or to get something like a place to stay, money, gifts, alcohol or drugs?" were included for secondary data analysis (n = 13,714). Participants were 70% White, 50% female/47% male, and 90% minors. Chi-square tests and logistic regression analyses were conducted.

RESULTS

2.47% of youth reported sex trading, of whom 91% were minors. Bivariate analysis revealed significant differences across demographics, economic instability, behavioral health and substance use, delinquency, and romantic/sexual behaviors. Multivariate results suggested that students who reported substance use, cutting class, 3 or more out-of-school suspensions, knowing a friend involved in a gang, dating violence, foster care involvement, or identifying as LGBTQ+ were more likely to report sex trading.

CONCLUSIONS

Although the causal order of characteristics analyzed in relation to the sex trading is not known, these findings have important implications for sex trading prevention, assessments, and intervention, particularly among youth with marginalized identities and adverse experiences.

Healthcare providers' perspectives on the relevance and utility of recommended sex trafficking indicators: A qualitative study

AIMS

The aims of this study were to (1) explore the barriers and challenges of sex trafficking identification and (2) understand how sex trafficking indicators are perceived (i.e. relevance and utility) by healthcare providers at five sites of a large sexual health care organization in a Midwestern state within the United States.

DESIGN

A qualitative, collective case study was conducted.

METHOD

In-depth, semi-structured interviews were conducted with 23 healthcare staff (e.g. medical assistants, nurse practitioners) who provided sexual and reproductive healthcare between fall 2018 and spring 2020.

RESULTS

Findings suggest that providers perceived behavioural and verbal sex trafficking indicators (e.g. patients appearing nervous or being unable to answer questions) as relevant, particularly with a female patient accompanied by a 'controlling' male. Medical and physical indicators (e.g. repeat STIs, bruises and tattoos) were perceived as generally lacking clinical utility or irrelevant. Some indicators were only perceived as relevant when combined or only later, upon reflection (e.g. older, female adult accompanying one or more female patients).

CONCLUSION

Healthcare providers may be aware of sex trafficking indicators conducive to identifying female patients, in relationships with older men, who are at risk of sex trafficking. Our study finds that healthcare providers may not be aware of all recommended sex trafficking indicators and the nuances of how patients present.

IMPACT

Provider trainings on sex trafficking dynamics and nuanced clinical presentations should include observing ST indicators in simulated interviews, assessing and safety planning (including using harm reduction strategies) with seemingly ambiguous cases. In addition, we recommend that trainings emphasize the relationship between the continuum of agency and victimization in sex trafficking and patient presentations.

Toward Affirming Therapy: What Sex Workers Want and Need From Mental Health Providers

Within the field of psychology, the development of a culture of competency both in training programs and, more specifically, related to working with historically underrepresented and underserved populations has been making significant progress. One group who has been neglected, however, consists of individuals who consensually work in the commercial sex trade industry (i.e., sex workers). The current Delphi study begins to address this gap. Using responses from eight sex workers to explore factors affecting disclosure of occupation to therapists, barriers and facilitators to receiving mental health care, and areas for educational growth among mental health professionals, the results reveal participants’ preference for therapists who take an affirming approach regarding their occupation (e.g., respecting the hard work, skill, and emotional labor) and do not assume that they are in therapy because of their work. Broadly, this article highlights the knowledge, skills, and attitudes sex workers believe comprise critical areas of competency for therapists working with this often-stigmatized population. Ultimately, these results can be used to advance competent, just, and effective therapy with this population.