An Exploration of Sex Trading for Compensation and LGBTQ+ Inclusive Screening Practices: Perspectives of Young People who have Experienced Sex Trading and/or Homelessness

Abstract

Young people’s perspectives on social and healthcare providers’ assessments of sex trading for financial compensation are lacking. This is particularly important for LGBTQ+ youth who experience substantial barriers in navigating health and social services. Further, increased internet access (because of COVID-19 and other factors) has changed the landscape of the sex trades in ways that are not fully understood. Our study aimed to understand (1) how young people trade sex, and (2) provider strategies that increase youths’ comfort in disclosing sex trading and related risks. This community-based participatory research study surveyed currently or formerly homeless youth (ages 16–29). We co-created a cross sectional survey that explored youths’ perceptions of: (1) sex trading type, compensation, and meaning; and (2) practices to increase youths’ comfort in disclosing sex trading. Participants (N = 103; M_age = 22.9 [SD = 3.5]; 34% white, 55% ciswomen/21% trans; 51% queer) reported that “sex trading” signified multiple meanings, ranging from sex work/occupation to exploitation/trafficking, and included diverse in-person and virtual forms for varied compensation types. Youth reported being more comfortable disclosing when the provider indicated they would advocate for them if they are victims of discrimination. Compared to cisgender youth, trans youth reported feeling significantly more comfortable disclosing sexual activity when a service provider used gender/sexuality inclusive practices (e.g., pronoun pins). Findings suggest important implications for gender-inclusive practice strategies to ultimately reduce potential harms of sex trading and multi-item measures to assess the complexity of sex trading.

1. Introduction

Sex trading for financial compensation among youth is a public health concern (Gerassi et al., 2021; Krisch et al., 2019; Martin et al., 2020; Ulloa et al., 2016b). In the U.S., sex trading (or sex trade) typically refers to the exchange of any sexual act for any type of financial compensation and is used in many U.S. studies to determine prevalence and associations (Franchino-Olsen et al., 2021; Kaestle, 2012; Martin, 2013). Studies use this language with the intent to avoid judgment or stigma. These studies suggest that young people who trade sex are at increased risk for sexual risk behaviors/STIs, substance use, mental health disorders, sexual and physical victimization as well as sex trafficking (Bigelsen & Vuotto, 2013; Gerassi et al., 2021; Kaestle, 2012a; Krisch et al., 2019; Martin et al., 2020; Ulloa et al., 2016b). According to the U.S. federal definition, sex trafficking occurs when the person trading sex is (1) a minor, or (2) an adult (over the age of 18) who is induced to perform a commercial sex act (i.e., trade sex) through force, fraud, or coercion (Bigelsen & Vuotto, 2013; Farrell et al., 2014). Young adults (over the age of 18) may trade sex because of a range of reasons, commonly referred to as choice, circumstance, and/or coercion (Weber, 2020). Social oppressions and marginalization (e.g., transphobia, racism, etc.) may interact to reduce social protections, thereby contributing to possible circumstances under which sex trading is an option for young adults (Nichols, 2016). Therefore, health and social service providers can be essential in identifying and assessing youth who trade sex (including sex trafficked youth) and connecting them to critically important services. Although multiple studies have sought to evaluate assessment strategies from the perspectives of providers (Gerassi et al., 2018; Macy et al., 2021; Nichols & Cox, 2021), young people’s perspectives are critically understudied. This community-based participatory research (CBPR) study partnered with a group of young people with lived experiences (of sex trading, homelessness, and housing instability) to examine how young people trade sex as well as factors that increase youths’ comfort in discussing sex trading and related risk behaviors with service providers.

1.1. Background

Sex trading (also known as the sex trades) is a complex phenomenon that includes in-person or virtual sexual acts (e.g., prostitution, videoing/photos of stripping or masturbation) in exchange for financial compensation (e.g., money, drugs, housing). Approximately 5% of the U.S. population reports having ever exchanged sex for compensation, and were more likely to report past child abuse, STIs and HIV (Ulloa et al., 2016). People involved in the sex trade can include those who have been sex trafficked (e.g., minors, adults where a third party is involved) as well as those who engage in the sex trade by circumstance or choice.

Youth participation in the sex trades is multifaceted. Youth often trade sex because view the sex trades as an alternate option to abuse and problems experienced at home. Therefore, youth homelessness and sex trades often go hand in hand (Morton et al., 2018). These dynamics are especially difficult for queer and trans youth who often experience identity-based rejection and abuse and seek safer options elsewhere (Hogan & Roe-Sepowitz, 2023). Consequently, queer and trans youth experience homelessness at significantly higher rates than their cisgender and heterosexual counterparts (Deal et al., 2023). Further, they are more likely to experience depression, suicidal attempts, sexual risk behaviors, and substance use (Cohen & Bosk, 2020; Deal et al., 2023; Rhoades et al., 2018). However, queer and trans youth who trade sex report creating fictive families among peer networks, which are often affirming and contrast from families of origin (Alessi et al., 2021; Curtis et al., 2008). Therefore, having a nuanced understanding of the challenges youth experience prior to and during homelessness is critical to advance the wellbeing of youth who experience homelessness and the sex trades, especially those who are queer and trans.

However, extant quantitative research on sex trading does not aways reflect these nuances. For instance, survey research that asks youth whether they have “traded sex” for financial compensation does not typically differentiate between circumstances, types of sex acts or compensation (Gerassi et al., 2023; Martin et al., 2020; Ulloa et al., 2016). It is likely that virtual transactions have increased due to the COVID-19 pandemic (Todres & Diaz, 2021), further underscoring the need for a better understanding of both virtual and in-person sex trading behaviors and trajectories. Increases in internet access have drastically changed the landscape of sex trading by: (1) altering how in-person sex trading is facilitated(Jones, 2015, 2020; Nayar, 2017; Upadhyay, 2021) (e.g., meeting potential clients online before meeting them in-person), and (2) increasing in virtual forms of sex trading(Jones, 2015, 2020; Nayar, 2017; Upadhyay, 2021; van Doorn & Velthuis, 2018) (e.g., webcamming, photos). Research understanding the behavioral consequences for people who trade virtual forms for compensation suggests that they experience in-person and cyber violence, harassment, stalking, doxing (Jones, 2015, 2020; Nayar, 2017; Upadhyay, 2021; van Doorn & Velthuis, 2018), and complex mental health consequences including substance use. However, we know very little about whether and how youth categorize virtual forms (e.g., videos, webcamming) as sex trading and whether such forms are ultimately safer (or not) than in-person forms.

Multiple recommendations indicate that providers who encounter sex trading, sex trafficking, homelessness, foster care, intimate partner or sexual violence should use inclusive visual cues and strategies (Acevedo-Polakovich et al., 2013; Nadal et al., 2016) to support young people of marginalized identities (Choi et al., 2015). It is important to note that any recommendations should be rooted in a sex positive perspective. This framework suggests that consensual sexual activity can be healthy, embraced, and enjoyed and serves as an important starting point for youth (Dodd, 2020). While the benefits and utility of sex positive frameworks have been more extensively studied, the perceived helpfulness of visual cues and strategies used to counteract social oppressions (e.g., racism, cissexism) is less understood. For example, youth of color and/or those who are lesbian, gay, bisexual, trans, and queer (LGBTQ+ ) are known to experience discrimination in health and behavioral health settings (Nadal et al., 2016; Rossman et al., 2017). Therefore, several recommendations suggest that providers should use inclusive visual cues (e.g., LGBTQ+/Pride flags) (Acevedo-Polakovich et al., 2013; Boswell et al., 2019) and/or verbal cues that actively challenge oppression and discrimination at the interpersonal and structural levels (Plaut et al., 2018). A long history of color-evasive (formerly referred to as colorblind) practices have dominated health and social services (Apfelbaum et al., 2008; Plaut et al., 2018). Such practices resulted in the lack of recognition of racism, which has detrimental effects for racially minoritized youth. Studies suggest people of color who are exposed to color-evasive messaging and low racial diversity in organizations can increase distrust (Plaut et al., 2018). Similarly, organizations that do not address sexual and gender diversity may also be problematic. However, the extent to which recommended inclusive practices can increase comfort among young people with marginalized identities in discussing sexual activity, including sex trading, remains unclear (Gerassi & Pederson, 2022; Hogan & Roe-Sepowitz, 2023).

1.2. Anti-Oppressive, critical theoretical framework

We used an anti-oppressive practice framework to guide this study, which was primarily influenced by intersectionality and queer theory. Intersectionality analyzes conditions of power across gender, race, sexuality, among other domains to expand knowledge and contribute to transformative change (Cho et al., 2013). Importantly, intersectionality can serve as a critical epistemology and structural analysis as well as a form of social justice activism (Moradi & Grzanka, 2017). Therefore, it is important to consider such power dynamics in this study (and others) and use findings to contribute to social change. Queer theory highlights the differential experiences LGBTQ+ individuals have within different contexts of power and challenges normative frameworks for organizing society (Dilley, 1999). Collectively, these theories inform this study’s anti-oppressive critical framework by situating differential experiences with service providers within varied contexts of power, privilege, and oppression to further social justice for youth who trade sex, particularly those who are singularly or multiply minoritized.

To our knowledge, this is the first study to explore the recommended practices that may contribute to facilitating sex trading disclosures in health or social service settings, from the perspectives of youth with lived experiences. This study aimed to examine:

1. How young people trade sex for financial compensation, and

2. Factors that increase young people’s comfort in disclosing sex trading and sexual risk behaviors to providers.

2. Methods

2.1. Design

Our study was informed by an intersectionality and anti-oppression framework, which underscored the importance of examining intersections of marginalization, as our sample size would allow, and using our study to advance social justice (Crenshaw, 1991). At the time of data collection, the authors consisted of a faculty researcher, one graduate student, and two undergraduate students. Collectively, we hold differing racial (white, Latinx), ethnic (Hispanic, Non-Hispanic), gender (transgender, cisgender), sexuality (queer, heterosexual) identities as well as differing experiences with prior housing stability. Though our perspectives and lived experiences differ, we share an anti-oppressive lens that influences our work as is appropriate with our roles on this project. In particular, the faculty researcher implements strategies to increase power sharing within the research team and in partnership with lived experience experts.

To begin, we met virtually with two youth leaders and another staff member of a national non-profit organization that aims to build resiliency of the youth services community. After preliminary discussions about the project, those youth leaders convened a larger youth leaders’ group (YLG) of six to 12 youth who held diverse identities across race, gender, and sexuality, and who work in leadership positions within youth services across the United States. YLG members were instrumental in crafting survey questions, disseminating the study to potential participants, and interpreting findings (particularly the qualitative responses). YLG participation included attending meetings to discuss the project aims, survey development, contextualizing quantitative results, analyzing coding schemes used in qualitative data, and discussion of how the results should be disseminated beyond manuscript publication. We additionally presented the results in mini pre-recorded videos embedded in anonymous surveys in case anything arose in the project that they did not feel comfortable stating in a group setting. YLG members were provided with gift cards for their time and expertise. Some directions that were proposed by the youth leaders are considered less methodologically rigorous by traditional social science methods, such as the anonymizing of the survey for mass distribution which precluded response rates. The first author provided recommendations for enhancing methodological rigor, but ultimately favored the perspectives of the youth leaders in accordance with a CBPR approach. Institutional Review Board approval was obtained by [university]. Data collection occurred from February to May 2021.

2.2. Survey

The survey included quantitative and qualitative questions that were developed with the YLG. The researcher first drew from evidence-based sex trading/sex trafficking screening tools (Macy et al., 2021) and recommendations for inclusive practices (Acevedo-Polakovich et al., 2013; Boswell et al., 2019). Then YLG assessed the relevance of these recommendations and added several more items that were not in the literature. First, the survey asked perceptions of sex trading among youth themselves and their friends by asking “What does sex trading mean to you? What are some of the reasons that young people trade sex for compensation?” Other questions asked participants to indicate compensation types and how exchanges occurred from a checklist of items. Second, questions assessed how inclusive practices (e.g., LGBTQ+ flag, pronoun pins) would increase youths’ comfort in disclosing sex trading (e.g., “would any of the following impact young people’s comfort in disclosing sexual activity?” [Likert scale]; for those who reported sex trading, “would any of the following impact your comfort in disclosing sex trading?”). We ended this section with an open-ended question, “What could a service provider do or say that would help young people talk about sex trading?” Third, we asked about demographics and life circumstances regarding homelessness (e.g., homelessness in middle school, high school). The research team and YLG extensively brainstormed possible inclusivity cues, which resulted in the addition of some that do not appear in the literature, such as pro-choice signs (see results for further specific items). The internal consistency of the comfort questions was strong (α = 0.88). All items were reviewed for clarity.

2.3. Data collection

Youth (ages 16–29) were eligible for the study if they answered affirmatively to one or both questions: (1) are you currently or have you ever lived outside, in a vehicle, shelter, transitional housing, and/or temporarily lived with a friend or a family member who was not your primary caregiver as a child?; (2) have you ever traded sex or sexual contact for food, clothing, shelter/housing, drugs, money, or something else of financial value? YLG members indicated that minors who were about to age out of some services as well as people in their late 20′s would have substantial insights. Potential participants reviewed the informed consent before answering screening questions in Qualtrics. The informed consent stated that the purpose of the survey was to understand the language, symbols, and practice strategies that providers can use to “increase people’s comfort in talking about sex trading.” Eligible participants were routed to the anonymous survey. Upon completion, participants were routed to another brief Qualtrics survey to receive $15 to their choice of Amazon, Walmart, or Target.

Survey participants were recruited through convenience and snowball sampling techniques, which are considered methodologically rigorous approaches with hard-to-reach, hidden populations (Gerassi et al., 2016; Martin, 2013). The research team emailed recruitment materials to the YLG, who forwarded information to their personal and professional networks (e.g., youth advisory boards). The research team also contacted multiple organizations who work with this population, as well as other researchers who were known to use CBPR methods in their work, to disseminate study information. Several young leaders also disseminated the study using their social media accounts.

2.4. Analysis

Data analyses were conducted in SPSS. We used a rigorous process to validate anonymous survey responses and identify potential bots or spam participants(Kennedy et al., 2021). First, we included a reCAPTCHA question along with other multiple choice and open-ended required checks throughout the survey. Second, suspected spam participants were contacted to verify their email address and key demographic information (e.g., date of birth, age, state, location). Respondents were determined to be spam participants if (1) they provided non-sensical responses that matched word-for-word to another participant(s), (2) the contents of their verification email did not match the participant’s reported key information (e.g., date of birth and age did not match each other), and/or (3) their stated location did not match the IP address of the survey. The final sample included 103 valid responses; another 7,052 responses were determined to be invalid.

We conducted descriptive analyses of all quantitative questions and examined differences in participants’ responses by demographics and their own lived experiences of sex trading and homelessness as well as reports of their friends engaging in the sex trade. Research on stigmatized and criminalized behaviors among youth is known to be underreported. Therefore, we chose to include those whose “friends” participated in sex trading because (1) it is likely that some youth who trade sex would not disclose themselves but would indicate that their “friends” had participated, and (2) youth who have friends who trade sex may be knowledgeable of their friends’ sex trading experiences (Dank et al., 2015). Similarly, youth who experience homelessness and who do not report trading sex themselves are likely to know others who do. Since this study sought youths’ perceptions of discussing sex trading, we included all young people who completed our survey in our analysis.

To compare demographics, we first examined differences across race, gender, and sexuality. We also compared responses among those who endorsed (1) both homelessness and sex trading (n = 74), and (2) only homelessness (n = 29) (no participants endorsed sex trading only). For quantitative items, we conducted t-tests and one-way ANOVAs to compare means between relevant groups. When relevant, we conducted Kruskal-Wallis tests which allowed for uneven distributions to determine differences between identity groups and used the Bonferroni correction to determine differences between groups.

Qualitative responses were independently coded by two research team members and then checked by a third member. We compiled our preliminary coding scheme and sample (de-identified) codes and recorded videos discussing findings for YLG members. They completed questionnaires that provided analytic feedback and directions for qualitative codes, contexts for quantitative findings, and directions for dissemination of findings. We used individual surveys rather than community meetings to gain more insights from youth whose schedules conflicted with our prior meetings leading up to data collection. Given the subject matter, we also thought that individuals of minoritized identities could have differing reactions to the data and wanted to allow for privacy among the members. YLG members (n = 5) suggested that the findings were reflective of the scope of sex trading experiences and provider experiences. Three members expressed a strong desire for findings to be used to assist sex trafficking victims rather than criminalize adult sex workers, which is also the intent of the research team.

3. Results

3.1. Participants

Table 1 summarizes the demographics of the full sample (N = 103), those who reported both sex trading and homelessness (n = 74) and those who reported homelessness only (n = 29). More than half of participants identified as people of color, approximately one-fifth identified as trans/gender-expansive and over half identified their sexuality as queer.

Table 1.

Sample Demographics.

	Total Sample (N = 103)	Sex Trading & Homeless (n = 74)	Homeless/ No Sex Trading (n = 29)
Race
Black/African American	30% (31)	29% (22)	31% (9)
Hispanic/Latinx	4% (4)	3% (2)	7% (2)
Multiracial	26% (27)	23% (17)	34% (10)
Native/Indigenous	1% (1)	1% (1)	0
White	34% (35)	38% (28)	24% (7)
Gender Identity
Cisgender Man	17% (17)	16% (12)	17% (5)
Cisgender Woman	55% (57)	54% (40)	59% (17)
Trans/Gender Expansive	21% (22)	23% (17)	17% (5)
Sexual Orientation
Asexual	3% (3)	4% (3)	0
Heterosexual	39% (40)	36% (27)	45% (13)
Queer	51% (53)	53% (39)	48% (14)
Age
16–17	7% (7)	4% (3)	14% (4)
18–24	56% (58)	58% (43)	52% (15)
25–29	37% (38)	38% (28)	3% (1)
Homeless* - Middle School
Never	49% (50)	41% (30)	69% (20)
Rarely/Sometimes	40% (41)	47% (35)	21% (6)
Often/Always	9% (9)	9% (7)	7% (2)
Live with Friends/ Family Member - Middle School+
Never	30% (31)	22% (16)	52% (15)
Rarely/Sometimes	48% (49)	53% (39)	34% (10)
Often/Always	19% (19)	18% (13)	7% (2)
Homeless* - High School
Never	31% (32)	23% (17)	52% (15)
Rarely/Sometimes	45% (46)	51% (38)	28% (8)
Often/Always	21% (22)	23% (17)	17% (5)
Live with Friends/Family Member - High School+
Never	15% (15)	12% (9)	21% (6)
Rarely/Sometimes	50% (52)	54% (40)	41% (12)
Often/Always	30% (31)	28% (21)	34% (10)
Currently Homeless*
Yes	23% (24)	27% (20)	14% (4)
No	69% (71)	65% (48)	79% (23)

^*Defined as lived outside, in a vehicle, shelter or transitional housing.

⁺Defined as temporarily lived with friends or a family member who was not a primary caregiver.

3.2. Sex trading among young people

Table 2 summarizes youths’ perceptions of type of sex trading acts and compensation types, among themselves and their friends. Notably, over half of participants who reported personal sex trading and 90% who reported that their friends traded sex reported some type of online sex trading. The most common ways that youth reported meeting people who traded sex included social media and dating websites or apps. When asked about types of sex trading, in-person forms included intercourse, sexual activity, dates, and sugaring while virtual forms included sexual photos, videos, and sexting. Participants also reported selling personal items, such as panties.

Table 2.

Sex trading acts, compensation types, and facilitation mechanisms, from the perspectives of young people who report sex trading among themselves (n = 74) and their friends (n = 80).

	Personal Sex Trading (n = 74) % (n)	Friend Sex Trading (n = 80)% (n)
Sex Trading Forms
In-person only	17.6% (13)	10.8% (8)
Online and In-Person Acts	58.1% (43)	72.5% (58)
Online Only	9.5% (7)	17.5% (14)
Sex Exchange Facilitation
Social Media	40.5% (30)	67.5% (54)
Dating Websites/Apps	43.2% (32)	60.0% (48)
Companionship Websites	31.1% (23)	50.0% (40)
Personal Ads	17.6% (13)	18.8% (15)
Informal Chat Rooms	16.2% (12)	18.8% (15)
Other	1.4% (1)	5.0% (4)
Online Sex Trade
Compensation Type
Money	56.8% (42)	91.3% (73)
Safety	13.5% (10)	35% (28)
Food	36.5% (27)	58.8% (47)
Clothing	25.7% (19)	48.8% (39)
Alcohol	10.8% (8)	35% (28)
Drugs	18.9% (14)	53.8% (43)
Cell Phone	21.6% (16)	28.8% (23)
Place to Stay	29.7% (22)	51.3% (41)
Gifts (Amazon Wishlist, experiential gifts, material items)	5.4% (4)	21.3% (17)
Validation/Attention	5.4% (4)	7.5% (6)

Table 3 summarizes the diverse meanings of the term “sex trading” to our study’s participants, which ranged from a means of survival to an occupation to acts that are inherently exploitative. Sex trading was seen as a neutral term for most of our participants, but not all. For some, the term “sex trade” was inherently exploitative or connoted forms of work.

Table 3.

Thematic Analysis of the Term “Sex Trading,” from the Perspective of Young People with Lived Experiences (N = 103).

Sex Trading Meaning (% of responses)	Characteristics	Sample Quote
Survival (21%)	Sex acts occur for ‘survival’ or to meet basic needs	“Trading your body for survival”“Using sex (or like sexual related stud) to pay for food or shelter” “Trading any sort of sexual content or favors for basic needs.”
Occupation (11%)	Acts occur as part of a job or work	“Sex work, prostitution, pimping, ect” “Sex work/sex as a sort of income” “Selling of sex”
Exploitation (4%)	Acts occur through ‘exploitation’ or person is bought/sold for sex	“Is when young people are targets and sold into sex markets.” “I really do not like or agree with using that term but since this is the question that is asked I will answer. Being a victim of human trafficking means that at one point I was brought or sold for sex.” “It means to me exploiting your body to get money etc often to survive”
Sex trade/ Exchange (55%)	Acts occur in exchange for something of value with no other meaning	“Trading any sexual activity (sex acts, pictures, videos, text messages) and sexual-related labor (dates, emotional companionship) for anything of value to that person” “It’s just the act of exchanging any sexual act for anything that has real value. Some people want to put judgments on this, but it’s just a trade.”

3.3. Factors that increase young people’s comfort in disclosing sexual activity (including sex trading)

In the overall sample, the factor that was most associated with comfort disclosing was if the provider indicated that they would advocate for youths who are victims of discrimination (M = 3.9, SD = 1.0). This factor was significantly different when comparing queer youth (M = 4.3, SD = 7) to heterosexual youth (M = 3.5, SD = 1.2). Table 4 summarizes the factors that increase comfort in discussing sex trading or sexual activity with a service provider for the overall sample by gender. Compared to cismen and ciswomen, trans and gender expansive youth reported feeling significantly more comfortable disclosing sexual activity when a service provider presented gender/sexuality inclusive indicators (e.g., pride/pronoun pins) and used gender-inclusive best practices. These results were similar for queer participants (regarding pronoun use, asking about sexuality/gender identification, discrimination, and discussion of sexual or romantic attraction taking away from the issues that youth want to discuss).

Table 4.

Youth people’s perspectives on factors that would increase comfort for the overall sample and by gender (Likert-type scale 1–5, 1 = Strongly Decrease Comfort to 5 = Strongly Increase Comfort).

	Overall (n = 103)M (SD)	Cisgender Men (n = 17)M (SD)	Cisgender Women (n = 57)M (SD)	Gender Expansive (n = 22)M (SD)	SS - Between Groups	SS - Within Groups	MS - Between Groups	MS - Within Groups	F
Service provider has/wears…
pride flag/pin	3.6(1.1)	3.5(1.1)	3.4(1.0)	4.1(1.0)	6.7	100.9	3.4	1.1	3.1***
pronoun pin	3.7(1.0)	3.7(1.0)	3.4(1.0)	4.1(0.8)	7.7	90.5	3.9	1.0	4.0***
trans flag/pin	3.6(1.1)	3.6(1.1)	3.3(1.1)	4.3(0.8)	15.4	103.6	7.7	1.1	6.9**
Black Lives Matter sign/pin	3.7(1.1)	3.7(1.0)	3.6(1.1)	4.0(1.0)	3.1	97.6	1.5	1.0	1.5
Defund the Police sign/pin	3.7(1.1)	3.8(1.1)	3.5(1.1)	4.1(1.2)	4.8	113.0	2.4	1.2	2.0
Pro-Choice sign/pin	3.7(1.1)	3.6(1.1)	3.5(1.1)	4.2(0.9)	8.4	106.2	4.2	1.1	3.7**
Service provider discusses/uses…
what pronouns they use	3.8(1.0)	3.8(0.7)	3.6(1.0)	4.2(0.9)	6.4	80.1	3.2	0.9	3.7**
pronouns based on how they dress, without asking	2.6(1.3)	2.9(1.3)	2.6(1.1)	1.9(1.4)	11.9	140.0	6.0	1.5	4.0**
pronouns to refer to their partner, without asking	3.1(1.6)	3.4(1.3)	3.4(1.6)	2.2(1.5)	21.4	210.7	10.7	2.3	4.7**
what pronouns their partner uses	3.6(1.0)	3.6(1.1)	3.5(1.0)	4.2(0.8)	9.1	88.2	4.6	0.9	4.8**
how they identify their sexuality, sexual orientation, and gender identity	3.6(1.0)	3.7(1.2)	3.5(1.0)	3.9(1.1)	2.6	101.9	1.3	1.1	1.2
how they identify their race or ethnicity	3.4(1.0)	3.5(1.1)	3.4(1.0)	3.3(1.2)	0.7	104.5	0.3	1.1	0.3
with same race/culture brings up how race/culture can impact their relationship	3.6(1.0)	3.5(1.1)	3.61.0)	3.6(1.1)	0.2	97.6	0.1	1.0	0.1
with different race/culture brings up how this difference can impact the relationship	3.2(1.1)	3.5(0.9)	3.1(1.1)	2.9(1.0)	3.6	107.4	1.8	1.2	1.5
that they will advocate for young person if they are the victim of discrimination	3.9(1.0)	4.2(1.0)	3.8(1.1)	4.1(0.9)	3.1	96.5	1.5	1.0	1.5
race and takes away from other pressing issues young people want to talk about	2.8(1.2)	3.1(1.3)	2.8(1.1)	2.4(1.3)	5.2	128.7	2.6	1.3	1.9
sexual/romantic attraction and takes away from other pressing issues young people want to talk about	2.8(1.2)	3.1(1.2)	2.8(1.1)	2.2(1.3)	9.5	125.9	4.7	1.4	3.5***

Notes:

^*p <.001;

^**p <.01;

^***p <.05.

Results include overall sample means, and one-way ANOVA. The degrees of freedom between groups for all items was 2; within groups for all items was 93.

Open-ended responses to the item asking what else providers could do or say to help young people talk about sex trading were coded as follows: provide resources such as education, financial help, and support groups (n = 23), approach the situation nonjudgmentally and work to destigmatize sex trading (n = 18), build trust through confidentiality procedures and transparency (n = 14), provider shares information of potential harms (n = 9), provides empathy and understanding of the complexity of sex trading (n = 7), provides confidential resources for disclosures (n = 7), and provides connections to peers with similar situations (n = 7).

4. Discussion

This CBPR study elucidated the perspectives of sex trading and relevant practice considerations, from the perspective of people with lived experiences. These findings are in line with prior qualitative work. A strength of this study is its representation of diverse participants across race, gender, and sexuality. Our findings suggest some important implications for practice, policy, and research.

4.1. Toward a nuanced understanding of sex trading

Our study reveals new insights about the nuances of sex trading: young people exchange diverse forms of (virtual and in-person) sexual acts for multiple compensation types and for diverse reasons. While most youth described compensations that held a monetary value, it is important to note that a small proportion of youth perceived “attention” as a form of compensation. This finding could be attributed to the way items were worded, or differences in how youth view financial or material compensations. “Sex trading” has been used in both research and practice as a neutral term in contrast to terms that signify chosen profession (e.g., sex work) or victimization (e.g., trafficking). However, our findings suggest that some young people may not actually view “sex trading” as neutral at all. It is also possible that some youth chose not to participate because our survey materials used that terminology. As such, the complexity of sex trading is likely not yet adequately captured in studies that use a single question to assess a complex behavior (Gerassi et al., 2023; Gerassi et al., 2021; Martin et al., 2020; Ulloa et al., 2016a), nor in many tools used to assess for sex trading and sex trafficking risk in practice (Chisolm-Straker et al., 2019; Macy et al., 2021). It is possible that grounding questions in specific acts (e.g., “sexual photos” or “in-person sex”) may elicit more endorsements than a broad question about sex trading. Using qualitative interviewing remains a helpful tool to advance understanding and capture nuance. Further, qualitative methods to adapt and develop multi-item measures across populations of young people who trade sex is critical. New research, using qualitative, cognitive interview methods, has sought to adapt and develop a multi-item measure to identify university students who trade sex (Gerassi et al., 2023). However, more work is needed to revise and test measures in other subpopulations of young people. Doing so holds the potential to identify the types of sex acts exchanged, compensation forms, and ways that sex trade is facilitated across multiple contexts thereby enhancing our understanding of current day sex trade involvement among young people and better informing interventions and policies.

It is also likely that the COVID-19 pandemic has increased the types of connections that occur virtually (Todres & Diaz, 2020), further underscoring the need to ask young people specifically about online sex trading in both research and practice. Our findings suggest that young people who trade sex connect with consumers through multiple online websites, e.g., social media, personal ads, dating and companionship websites. This adds to prior work suggesting that young people may find alternatives to engage with consumers virtually (Blunt & Wolf, 2020), despite legislation to reduce online transactions (e.g., FOSTA-SESTA). We did not ask participants about when their sex trading activities occurred, so it is possible some transactions occurred before the enactment of such acts in 2018. However, our findings may contribute to a growing body of work suggesting that U.S. policies should focus on ways to enhance digital security practices to reduce harm in the sex trade rather than to attempt to shut down online transactions entirely (Blunt & Wolf, 2020). Furthermore, providers can use harm reduction strategies when working with youth to help increase their safety online, such as using VPN, protecting one’s identity online, etc. Groups such as the National Survivor Network have issued calls to use a radical harm reduction approach, which could potentially involve moving in-person work to online forms that can, possibly, be safer. Though caution is needed, effort should be made to evaluate these efforts as a possible strategy to reduce harm.

4.2. Improving screening and assessments for sex trading and sex trafficking

This study provides important practice considerations for providers to normalize the range of reasons why young people engage in the sex trade (Chisolm-Straker et al., 2019; Gerassi & Pederson, 2021). Importantly, providers should introduce questions by also including reasons like “to support oneself” or “as a form of work” rather than only focusing on survival or because the person does not have any other options. Importantly, these assessments should never be done to force young people to disclose sex trading (Gerassi & Pederson, 2022; Stoklosa & Ash, 2021), but rather to provide non-judgmental, inclusive opportunities to discuss any concerns, including sex trading and/or sex trafficking, and provide them options to reduce potential harms.

Finally, efforts to explicitly incorporate inclusive visual and verbal cues may help young people feel more comfortable in discussing sexual activity, including sex trading, and may be an essential component to reducing harm. These cues may be particularly important for those in subpopulations who experience disproportionate discrimination and risk of sex trafficking, e.g., trans and queer participants who reported that LGBTQ+ visual indicators would help them feel more comfortable. Such visual and verbal cues must also be paired with efforts to continually increase knowledge and improve inclusive and affirming practices and policies for those with marginalized identities (Nadal et al., 2016; Sue et al., 2007). To help trans and queer young people who trade sex feel more comfortable with disclosing, providers should educate themselves on the distinct challenges trans and queer young people may be facing (e.g., leaving or being kicked out of their homes due to family reactions to the young peoples’ identities) (Côté & Blais, 2021). Providers should additionally provide these young people with trauma-informed care and support them in finding needed services and resources that will be affirming of their identities (McCormick et al., 2018).

Organizations that encounter young people who trade sex (and their funders) should prioritize advocacy components, and these providers should directly state whether and how they can advocate for youth who have experienced discrimination. Providers who cannot provide advocacy services should proactively discuss other organizations that may be able to help the young person address any discrimination. This may help the youth who are being unfairly charged with a crime or may not be believed if they were the victim of one (or both). Our study did not assess the specific types of discrimination that would be most relevant for youth and future work should explore this point. These findings may also underscore the need for organizations to include policy advocacy in their scope of work and provide statements describing their position, e.g., advocating against recent anti-trans legislation that has been issued in several states. Connecting organizations’ macro-level advocacy to micro-level practice and policies may be crucial to building rapport, particularly for those who experience discrimination based on race, gender, and/or sexuality. Failure to advocate for inclusive policies that directly impact young people who trade sex and who experience social minoritization may only further perpetuate social oppression and cater white cisgender people. Organizations may require public statements and commitments to socially just practices and policies, including (publicly) recognizing and welcoming people of all genders and sexualities, advocating for socially just policies (e.g., gender affirming care), and using gender inclusive language (e.g., reproductive and sexual health providers referring to “pregnant people” rather than women).

4.3. Strengths and limitations

This study should be taken within the context of its strengths and limitations. A strength of this study is its CBPR approach, particularly within the context of the COVID-19 pandemic, which resulted in a more community-led understanding that centered youths’ perspectives. Further, this study highlighted the experiences of queer and trans participants, who are often not centered or included in studies on sex trading and in other fields (Franchino-Olsen et al., 2021; Heasley, 2021). One limitation of this study is that the use of anonymous surveys precludes us from knowing responses rates as well as generalizing our findings. Anonymous surveys also result in spam responses, but the number of responses is in line with other work using anonymous surveys (Kennedy et al., 2021). Though we implemented rigorous systems to address this limitation in line with best practices, it is possible that a spam participant passed all the checks and was coded as a true participant. Second, community leaders felt strongly that it was important to provide response options in many of the questions that allowed for a “not sure” or “prefer not to answer,” given the personal and sensitive nature of the survey questions. Consequently, our analyses were limited by those responses as well as sample size. Questions that focused on past experiences, particularly in middle or high school, are subject to potential recall bias. We also did not include questions regarding participants’ ability status, which is an important area of future research.

5. Conclusions

Our study sought to gain a nuanced understanding of sex trading and the ways in which sex trading and sex trafficking assessments can be improved, from the perspectives of young people with lived experiences. While beneficial for all youth, gender diverse youth may be parituclarly well positioned to benefit from implementing strategies as suggested by these findings and others (Gerassi & Pederson, 2022; Hogan & Roe-Sepowitz, 2023). Our findings add to current literature suggesting that these strategies should not be used to force disclosures (Stoklosa & Ash, 2021) but rather to guide providers in assessing sex trafficking risk and reducing potential harm. Future research should develop and test a multi-item measure that assesses the complex range of sex trading experiences to further elucidate the complexity of sex trading as well as the nuanced ways in which providers can meet the needs of young people who trade sex.

Data availability

The authors do not have permission to share data.