From Exploitation to Industry: Definitions, Risks, and Consequences of Domestic Sexual Exploitation and Sex Work Among Women and Girls

Abstract

In the last 15 years, terms such as prostitution, sex trafficking, sexual exploitation, modern-day slavery, and sex work have elicited much confusion and debate as to their definitions. Consequently several challenges have emerged for both law enforcement in the prosecution of criminals and practitioners in service provision. This article reviews the state of the literature with regard to domestic, sexual exploitation among women and girls in the United States and seeks to (1) provide definitions and describe the complexity of all terms relating to domestic sexual exploitation of women and girls in the United States, (2) explore available national prevalence data according to the definitions provided, and (3) review the evidence of mental health, social, and structural risk factors at the micro-, mezzo-, and macrolevels.

INTRODUCTION

The Trafficking Victims Protection Act (TVPA) of 2000 defines a sex trafficking victim as a person induced to perform a commercial sex act through force, fraud, or coercion regardless of citizenship or national origin (22 U.S.C. §7102), and its reauthorization in 2005 focused on the recognition of as well as service provision for domestic victims. Numerous overlapping yet contrasting terms such as sex trafficking, prostitution, survival sex, sexual exploitation, and sex work provide much confusion and many challenges in victim identification, in large part because of the theoretical and philosophical perspectives influencing these concepts. Recent studies in the United States have focused on understanding the prevalence and risk factors of sexually exploited women and girls, yet there is still a dearth of information to comprehensively serve women and girls.

DEFINITIONS

In order to fully understand the complexity and breadth of sexual exploitation, relevant definitions are outlined here. Definitions continue to create confusion and controversy within the academic, legal, and popular literature as well as among researchers and social service providers (Jordan, Patel, & Rapp, 2013; Reid, 2010). Subsequently it is imperative to explore the different definitions pertaining to domestic sexual exploitation as well as the various criticisms of the terms as they apply.

Sexual Exploitation

On October 9, 2003, United Nations Secretary-General Kofi Annan issued a global bulletin defining and prohibiting sexual exploitation and setting the precedent for the world (Annan, 2003). Sexual exploitation broadly refers to “any actual or attempted abuse of a position of vulnerability, differential power, or trust for sexual purposes, including but not limited to profiting monetarily, socially, or politically from sexual exploitation.” At the time of this bulletin, the term referred to any individual, regardless of age, who was affected by sexual violence for political or social advancement. Although scholars and prominent world organizations, including the United Nations, currently utilize the term “sexual exploitation” to refer to sexualized, exploitative gender-based crimes against women and girls exclusively, U.S. law has used the term only to refer to treatment of minors.

Sex Trafficking: Trafficking Victims Protection Act

On October 28, 2000, U.S. Congress passed the Trafficking Victims Protection Act (TVPA), which would become the first comprehensive federal law to address trafficking in persons in the United States, and it has been reauthorized four times (2003, 2005, 2008, 2013; Trafficking Victims Protection Reauthorization Act, 2014). Sex trafficking is federally defined as “the recruitment, harboring, transportation, provision, or obtaining of a person for the purpose of a commercial sex act” (22 U.S.C. §7102). In its simplest form, the law indicates that this crime occurs when an adult is induced by force, fraud, or coercion to perform a sex act for money or anything of financial value (Human Trafficking, n.d.). A delineation was made to describe severe forms of trafficking, which occur when (a) sex trafficking in which a commercial sex act is induced by force, fraud, or coercion, or in which the person induced to perform such act has not attained 18 years of age; or (b) the recruitment, harboring, transportation, provision, or obtaining of a person for labor or services, through the use of force, fraud, or coercion for the purpose of subjection to involuntary servitude, peonage, debt bondage, or slavery (22 U.S.C. §7102).

There are several well-documented criticisms of this law to consider. First, the TVPA is based on a prosecutorial foundation, requiring victims to cooperate with the prosecution of the trafficker (Jordan et al., 2013). This becomes complicated when individuals are traumatized and unable to dictate their story in a narrative fashion required by court testimony. Second, the TVPA reflects an abolitionist perspective geared to eradicate all forms of commercial sex and thus does not allow for individuals who sell sex or sexually services voluntarily without force, fraud, or coercion (Musto, 2009). A woman selling sex may either be arrested for prostitution or implicate a trafficker who used force, fraud, or coercion to commit the crime against her.

Commercial Sex Exploitation of Children and Domestic Minor Sex Trafficking

Both of the terms commercial sex exploitation of children (CSEC) and domestic minor sex trafficking (DMST) are used interchangeably and generally refer to the sex trafficking of minors, stipulated to be individuals under the age of 18. Unlike the federal definition for adults, sexual exploitation and trafficking crimes against minors do not require any element of force, fraud, or coercion. This term also targets any parent, legal guardian, or person having custody or control of a minor who knowingly permits or assist a minor to engage in sexual acts for financial gain.

Modern-Day Slavery

Modern-day slavery is frequently used to describe sex trafficking in awareness campaigns, news reports, governmental releases, and even some academic literature (Hughes, 2005; Newton, Mulcahy, & Martin, 2014; Reichert & Sylwestrak, 2013; Smith, Vardaman, & Snow, 2009). Advocates of this term argue the word captures the violence and cruelty victims endure while evoking an image of people forced to do something against their will. Abolitionists argue that modern-day slavery and sex trafficking are indistinguishable because they both deny the dignity of victims (Venkatraman, 2003). However, critics contend that the comparison of which modern-day slavery lends itself to, the trans-Atlantic, black slave trade, is theoretically, structurally, and economically different from modern-day sex trafficking (Musto, 2009). They also contend that not all forms of commercial sex are involuntary, and therefore equating acts of commercial sex to modern-day slavery is extreme and inaccurate.

Prostitution

Although prostitution by willing adults is not considered to be a form of sex trafficking or sexual exploitation, it has become increasingly recognized that law enforcement may not recognize elements of force, fraud, or coercion when charging women with this crime (Potterat, Rothenberg, Muth, Darrow, & Phillips-Plummer, 2001). Thus, it is important to note both its definition and prevalence when discussing sexual exploitation. Prostitution is defined by law as (1) the unlawful promotion of or participation in sexual activities for profit, including attempts or the solicitation of customers or transport of persons for prostitution purposes, (2) the ownership, management, or operation of a dwelling or other establishment for the purpose of providing a place where prostitution is performed, or (3) the assisting or promoting of prostitution (U.S. Department of Justice, 2012). Prostitution is criminalized in the United States with the exception of some parts of Nevada, and so individuals providing sexual services for financial compensation may be prosecuted for providing the service themselves or for the management of the services provided by another.

Trading, Survival, and Transactional Sex

Throughout the literature, a series of studies refer to trading sex, survival sex, and transactional sex interchangeably and reference an exchange of a sexual favor for something of value such as food, clothing, or shelter (Tyler and Johnson, 2006). Engaging in survival sex in itself is a strong risk factor for “indoor” and “outdoor” (commercialized) forms of prostitution (Miller et al., 2011). This term is used mostly in describing the exchange of sexual services for financial value among youth and young women, often as a method of survival (Greene, Ennett, & Ringwalt, 1999; Tyler and Johnson, 2006).

Sex Work

Sex work refers to the exchange of sexual services, performances, or products for material compensation and can refer to direct physical contact between buyers and sellers as well as indirect sexual stimulation (e.g., pornography; Weitzer, 2000, p. 1). Advocates of this term argue that sex work provides a sense of professionalization and dignity similar to other professions, especially in comparison to the term “prostitution” (Russell & Garcia, 2014). The concept of choice and freedom of expression among sex workers is continually debated in academic and legal writings. While some academic literature refers to sex workers as people who exchange sex for money voluntarily, that is, free of coercion or control, much debate still arises as to the concept of choice and lack of someone else controlling these sexual exchanges (Alvarez & Alessi, 2012; Miller et al., 2011). As such, it is imperative to include this term along with other forms of sexual exchanges for money or an item of financial value.

PREVALENCE OF SEXUAL EXPLOITATION IN THE UNITED STATES

Statistics on sex trafficking of U.S. citizens specifically within the United States are scarce because few prevalence studies have been conducted on this issue (Clawson et al., 2009; Leidholdt, 2004). The covert nature of sexual exploitation in addition to the lack of a uniform system of data collection to identify victims increases the difficulty of obtaining accurate statistics (Macy & Graham, 2012). Of the studies that focus on sex trafficking and sexual exploitation, particular attention has traditionally been paid to minors. It is important to note that estimates described in this section are the most recent available at this time.

The last criminal justice report issued in April 2011 reported 2,065 suspected incidents of U.S. sex trafficking incidents that were investigated by law enforcement between 2008 and 2010 (Banks & Kyckelhahn, 2011). The most commonly reported study stated that as many as 325,000 children remain at risk for sexual exploitation in the United States dates from 2001 (Estes & Weiner, 2001) and is commonly referenced in government reports (Clawson et al., 2009; Reichert & Sylwestrak, 2013) and academic research studies (Clarke, Clarke, Roe-Sepowitz, & Fey, 2012; Jordan et al., 2013). This study also indicates that a third of runaway or throwaway youth are recruited into prostitution within 48 hours of leaving home. In addition to the fact that this report was published 13 years ago, critics have argued that the methodological formula by which this estimation was calculated is flawed and inaccurate (Musto, 2009). The average age of entry into prostitution is estimated to be 12 to 14 for girls, and the average age of which victims come into contact with first responders is 15 years old, creating many challenges in the prevention of sexual exploitation (Smith et al., 2009).

In response to the lack of national data and prevalence estimates, two main initiatives were launched to provide information and referral services and collect prevalence data. First, the National Center for Missing & Exploited Children (NCMEC) in conjunction with the Federal Bureau of Investigation (FBI) and the U.S. Department of Justice’s Child Exploitation and Obscenity Section formed the Innocence Lost Initiative to address the growing problem of domestic child sexual trafficking. As the name suggests, this collaboration targets child sex trafficking only and estimates that one in seven endangered runaways are likely sex trafficking victims (National Center for Missing & Exploited Children, 2013). Since its founding in 2003, the NCMEC has received and reported more than 2.3 million reports of suspected child sexual exploitation to law enforcement and analyzed more than 108 million images and videos depicting apparent child pornography.

Second, the National Human Trafficking Resource Center (NHTRC) was launched in 2008 with the establishment of a hotline service to report suspected trafficking cases. Since then, the number of hotline calls has increased 259% and resulted in 25,269 substantive calls (excluding hang ups, wrong numbers, and missing calls) regarding 20,400 individual cases in 2013 alone (NHTRC, 2014). There were 5,214 cases reported that were considered to have “high” or “moderate” levels of critical information and key indicators relevant to identifying a human trafficking situation. Of these, more than 69% (n = 3,609) involved sex trafficking and approximately 77% (n = 3,997) involved females. Almost 61% (n = 3180) involved adults and approximately 31% (n = 1,638) involved minors.

More extensive data are available regarding prostitution charges than sex trafficking. Although it is impossible to ascertain which of these cases involved elements of trafficking or exploitation, it is probable that at least some of these cases were misidentified as prostitution (Prostitution and Human Trafficking: A Paradigm Shift, 2013). In 2011, 44,090 individuals nationwide were charged with prostitution and commercial vice crimes. Almost 69% (n = 30,407) of individuals charged were identified as female. Of the 42,779 individuals charged as adults, 46.8% (n = 20,013) ranged in ages between 18 and 29 with an additional 760 individuals charged as minors. Almost two-thirds (n = 483) of charged minors identified as black compared to 35.3% (n = 268) white and 1.2% (n = 9) as other races. Among adults charged with prostitution, however, the racial demographic picture changed, as 43.3% (n = 18,744) identified as black compared to 53.7% (n = 23,287) identified as white.

MICROLEVEL: RISKS AND CONSEQUENCES OF SEXUAL EXPLOITATION

The risks and consequences to sexually exploited women and girls are numerous and challenging to consider in understanding the problem. The dense complexity of terminology described previously adds a distinct challenge in this field, especially in understanding the risks and consequences of the problem. In light of this added complication to the field, the discussions of specific studies described here utilize the terms for women and girls chosen by the authors. For example, a study examining the mental health risks of sex workers will be described as such and refer to them as “prostitutes” or any other label. The relationship between the most commonly identified individual risk factors, mental health issues (including consequences of trauma, posttraumatic stress disorder, and depression) and substance abuse, is multifaceted regardless of the label assigned to sample subjects.

Mental Health

Victims or survivors of sexual exploitation and trafficking maintain increased rates of mental health issues such as depression and posttraumatic stress disorder (PTSD) and have elevated rates of trauma (Muftic & Finn, 2013; Pierce, 2012; Reid, 2011; Twill, Green, & Traylor, 2010; Wells & Mitchell, 2007). These are important risks and consequences of sexual exploitation because they profoundly affect individuals’ experiences during sexual exploitation and any assistance they may subsequently seek. A victim’s mental health may be further complicated by the cyclical nature of trauma, substance abuse, PTSD, and other mental health issues as well as the length of time and intensity of the sexual exploitation.

Trauma

Literature in this area of study addresses trauma, which both precedes and occurs simultaneously with the exploitation. Well-documented literature and evidence show that a single traumatic event may and often does cause psychological harm; however, when an individual experiences repeated and prolonged abuse, the effect is much more complex (Herman, 1992). Sexually exploited women are yet another population of women who experience this type of repeated and prolonged abuse.

Although consistent empirical evidence shows an association between previous child sexual abuse histories and sexual exploitation as well as prostitution (Ahrens, Katon, McCarty, Richardson, & Courtney, 2012a; Clawson et al. &, 2009; Fong & Berger Cardoso, 2010; Simons & Whitbeck, 1991; Vranceanu, Hobfoll, & Johnson, 2007), the prevalence rates of trauma reported in these studies range widely from 33% to 84% (Clawson et al., 2009). In addition to child sexual abuse, nascent research focusing on the impact of adult sexual assault on prostitution and exploitation also shows an important association to consider. One study of 102 survivos of adult sexual assault showed that 23.5% had engaged in prostitution, of which 75% indicated a relationship between the assault and prostitution (Campbell, Ahrens, & Clark, 2003).

In conjunction with sexual abuse and assault, other forms of nonsexual trauma, such as physical and emotional abuse, are also important risk factors to consider. One study of 278 sex workers in Miami found that 51% of their sample had experienced physical abuse and 65% had experienced emotional abuse, in addition to 53% who had experienced sexual abuse (Surratt, Kurtz, Weaver, & Inciardi, 2005). Childhood emotional abuse is also significantly associated with commercial sexual exploitation and may contribute to a younger age of entry into prostitution (Roe-Sepowitz, 2012).

Subsequent to victims’ trauma and abuse previously experienced before exploitation, research also supports that victims of sexual exploitation endure several forms of victimization during or in addition to ongoing sexual exploitation. One study examining health outcomes among domestic, sexually trafficked victims found that most victims had experienced physical violence (88.9%), sexual violence (83.3%), and psychological violence (100%) during sexual exploitation (Muftic & Finn, 2013). Additionally, a sexually exploited girl or woman will have a greater likelihood of exposure to violence and abuse from a pimp and/or someone purchasing sex from them. The additional control and coercion of sexual exploitation by a pimp also promulgates additional exposure to threatened or actualized assault or other forms of trauma. Of the 71 women controlled by a pimp in a Chicago study, 21% were threatened to be raped and more than half reported to have been sexually assaulted (Raphael, Reichert, & Powers, 2010).

PTSD and Depression

Exposure to various forms of violence is empirically linked to levels of PTSD and depression. Two multicountry studies examined issues of depression and PTSD among sex trafficking victims and found significant associations between these mental health issues and trafficking. Hossain and her research team (2010) found that more than half of the 204 trafficking victims interviewed across 12 countries met criteria for depression, and 77% had symptoms of PTSD. Although this well-known study was not conducted in the United States, it is frequently referenced in domestic literature and must be addressed accordingly. The second study found a 68% (n = 562) rate of PTSD across all sexually trafficked participants from nine countries and 69% (n = 87) among U.S. victims (Farley et al., 2004).

On a smaller scale, several domestic studies have found similar associations and prevalence rates of PTSD among sexually exploited women. Several studies of 100 participants or fewer showed that female victims of sexual exploitation experience rates of PTSD ranging from 27% (Wells & Mitchell, 2007) to 50% (Twill et al., 2010). Similarly, these types of studies showed depression rates of up to 60% (Roe-Sepowitz, 2012). Given the extreme trauma that victims of sexual exploitation face and the empirical link between trauma and PTSD as well as depression, high rates of mental health consequences unfortunately are expected in this population.

Substance Abuse

Often linked to mental health, sexual exploitation of women and girls is empirically linked to substance abuse, and victims are generally more likely to use drugs than alcohol (Heilemann & Santhiveeran, 2011; Macy & Graham, 2012). For example, 75% of respondents in one study indicated having used drugs as compared to only 26% who had used alcohol (Farley et al., 2004). Another study of 255 sex workers showed that 78% of participants had injected drugs. Female, homeless, and runaway youth are also particularly at higher risk for exchanging sex for drugs and general survival (Chen, Tyler, Whitbeck, & Hoyt, 2004; Lankenau, Clatts, Welle, Goldsamt, & Gwadz, 2004).

There are, however, different pathways in which sexually exploited women and girls become addicted to substances. Drugs are used as a form of control and intimidation; however, many women and girls have survived violence by using drugs (de Chesnay, 2013). Some may enter prostitution as substance abusers, while others have been deliberately addicted by their pimps or are forced or coerced into exchanging money for drugs. Some evidence suggests that patterns of drug use in conjunction with sexual exploitation may be further impacted by the age at which the individual is first exploited or begins to trade sex. Young women who trade sex are especially vulnerable to higher rates of drug use (Miller et al., 2011). A study conducted in Minneapolis of prostituted women found that adult women who began trading sex as adults were more likely to abuse substances before trading sex for money, whereas adult women who began trading sex for money as minors were more likely to abuse substances after they began trading sex (Martin et al., 2010).

The consequences of substance abuse may involve arrests or convictions because sexually exploited women are most often arrested for crimes related to either prostitution or illegal substances (Schauer, 2006; Wilson & Dalton, 2008). Drug-related crimes are frequently committed for a pimp or to maintain one’s addiction. Women in criminal justice systems are more likely to experience both substance abuse and child sexual trauma. In a study of 100 female inmates, 98% reported high rates of trauma and 75% reported issues of substance abuse (Green, 2005). These studies and many more point to varied complexity of health, mental health, and judicial consequences for sexually exploited women.

Housing Instability

Several studies among runaway, throwaway, and homeless youth have shown an association between housing instability and sexual exploitation. Homeless youth experience increased risk for trading sex for food, money, or drugs (Hudson & Nandy, 2012; Kidd & Kral, 2002; Lankenau et al., 2004; Tyler et al., 2004), thereby increasing this population of youth’s risky sexual behavior. In a study of 372 homeless youth, females were more than four times more likely to engage in survival sex with a friend (Tyler et al., 2004). More than 98% of suspected or confirmed child victims of domestic sex trafficking taken in by National Center for Missing and Exploited Children (NCMEC) nationwide from 2004 to 2010 were classified as Endangered Runaways (National Center for Missing & Exploited Children, 2013). In a qualitative study of four Midwestern states, more than one-third of the homeless youth interviewed described experiences of trading sex for food, money, or shelter, and many discussed the coerced or manipulated nature of this exchange (Tyler & Johnson, 2006). Housing instability remains a critical risk factor to or consequence of sexual exploitation to consider with this population of female youth.

Evidence also exists of empirical associations between homeless, adult women and sexual exploitation as well as prostitution. A study of 81 pregnant women in Baltimore indicated that women who had recently experienced homelessness were more than four times more likely to have traded sex than women who had not been homeless (Brown, Cavanaugh, Penniman, & Latimer, 2012). Several studies have found associations between homelessness and prostitution (Cobbina & Oselin, 2011). Farley’s research team found that 75% (n = 571) across nine countries and 84% (n = 130) of the U.S. sample had been homeless at one point in their lives (Farley et al., 2004). The need for shelter or residential living facilities continues to be one of the most commonly qualitatively reported needs of sexually exploited and prostituting women (Kurtz, Surratt, Kiley, & Inciardi, 2005; Miller et al., 2011; Reid, 2010).

Complexity of Interactions Between Risk Factors and Vulnerabilities

Individual risk factors and vulnerabilities are additionally compounded by various studies showing that mental health, substance abuse, and housing instability issues may all precede sexual exploitation or become comorbid conditions of the exploitation. For example, many studies address the association between childhood trauma and sexual exploitation (Clawson et al., 2009; Fong & Berger Cardoso, 2010; Hossain et al., 2010; Macy & Graham, 2012; Newton et al., 2014), yet the trauma of the sexual exploitation itself increasingly intensifies and exacerbates a victim’s experiences. In another instance, runaway and throwaway youth or adults with unstable homes are at great risk of sexual exploitation (Estes & Weiner, 2001; Tyler and Johnson, 2006); however, sexual exploitation may create a path to homelessness and limited subsequent options. This area of research should be further developed in the exploration of any emerging patterns among sexually trafficked women and the relationship between the various microlevel risk factors and consequences.

MEZZOLEVEL: RISKS AND CONSEQUENCES OF SEX TRAFFICKING

Along with microlevel risks and consequences of sexual exploitation, multiple systems play a distinctive role in a victim’s exploitation as well as in her potential identification as a victim and connection to services. Although some victims do not know their exploiter before being kidnapped into sexual exploitation or trafficking, women and girls are often exploited by someone they love, usually a family member or intimate partner. Other they are exploited while they are the responsibility of the foster care system. This section will review the context and systems impacting the pathway into sexual exploitation for many women and girls.

Dysfunctional Family Dynamics

Dysfunctional family dynamics add extensive risk factors to victims in a number of different ways. First, a youth may witness detrimental and even life-threatening events such as intimate partner violence (IPV), addictions, or other mental health problems in the home (Raphael & Shapiro, 2004). A study exploring 174 women who were exploited when they were children found associations between factors in the home such as familial IPV and drug use, as well as lack of supervision, food, medical care, and love (Reid, 2011). Failures of these particular social institutions, such as the family, serve as contributing factors toward the pathway into prostitution (Kramer & Berg, 2003). Additionally, family members who may know of a girl or woman’s relationship with a potential trafficker or pimp may blame her for choosing or staying in that particular relationship (Stark & Hodgson, 2004). These family dynamics may impact her options over the course of the exploitation as well as her ability to access outside support.

Second, pimps, traffickers, or exploiters are often family members or family friends themselves (Jordan et al., 2013). One study exploring the relationship between pimps and sexually trafficked women and girls found that 16% individuals who recruited the sample into prostitution were family members (Raphael et al., 2010). This is consistent with U.S. Department of Justice report’s finding that 14% of sex trafficking cases involved family members (Newton et al., 2014). Exploited women and girls may be forced, coerced, or pressured into commercial sex industry to support themselves or their family members (Farley, 2004). In these cases, family members may restrict her movement from the home or control her contact with individuals outside the family (Reid, 2011).

Foster Care

Many domestic victims of sexual exploitation are vulnerable youth who are already involved in the foster care system (Fong & Berger Cardoso, 2010). Involvement in the foster care system may stem from child abuse and neglect (Miller et al., 2011) or from the loss of a parent through death, divorce, or abandonment (Clawson et al., 2009). Youth who are considered to live in “out of home” placements—including youth shelters, group homes, and foster care—are at greater risk of becoming victims of sexual exploitation (Rafferty, 2013). Qualitatively, many sexually exploited women and girls report themes of isolation and lack of connection and resources, often stemming from the child welfare system, foster care placements, and abandonment (Farley, 2004; Rabinovitch, 2008; Ugarte, Zarate, & Farley, 2003).

Despite efforts to intervene at a younger age, adults aging out of a foster care that have a history of sexual abuse continue to be more likely to have transactional sex (Ahrens et al., 2012) and remain at increased risk for prostitution. A study of prostituted adolescent girls showed that a third of their respective samples had a deceased mother (Raphael & Shapiro, 2002). Another study of 47 women in prostitution showed that 64% had been involved in the child welfare system, and 78% of those had lived in foster care or group homes (Nixon, Tutty, Downe, Gorkoff, & Ursel, 2002). The foster care system also serves as a direct consequence for many sexually exploited minors, because child victims often present without parental or legal guardianship and subsequently enter the foster care system (Fong & Berger Cardoso, 2010).

Intimate Partner Violence (IPV)

Evidence has emerged indicating that women and girls are often sexually exploited by someone they consider to be a romantic or intimate partner. In 2008 the National Opinion Research Center conducted a study of congressional mandates issued to identify victims of domestic trafficking through law enforcement and explore the differences between sex trafficking and unlawful commercial sex. Qualitatively many law enforcement respondents reported that the (generally older) boyfriends of teens and young adults would eventually become their pimp (Newton et al., 2014). In a study of 100 women controlled by pimps at that time in Chicago, 64 women viewed their pimp’s current relationship as a boyfriend, and of the 71 women recruited into prostitution by a pimp, 23 of them indicated their partner or boyfriend served as their primary recruiter (Raphael et al., 2010). Yet another study indicates that young people may agree to sell sex as a favor to their boyfriend or girlfriend and that this is completely socially acceptable under these circumstances (Anderson, Coyle, Johnson, & Denner, 2014). These studies support an intersection between a woman’s (abusive) intimate partner and her trafficker.

In a call for further research, experts recommended that sex trafficking should be conceptually understood through a similar framework as IPV because of both the overlapping methods of power and control and the significant number of women exploited by an intimate partner (Busch, Fong, & Williamson, 2004; Lutya & Lanier, 2012). This is evident from the stages of exploitation some victims endure, which often mirror IPV. The “honeymoon phase,” as it is most commonly referred to, is used in IPV work to describe the process by which the abusive partner will show affection and love toward a partner before inflicting acts of violence and abuse (Gomez, 2010). For many victims of sexual exploitation, the process is identical. With this showing of love and bonding with an abuser or exploiter, women would be more likely to defend their abusers in court or to the police, as is often the case with sex trafficking victims (Wasco, 2003; Watts & Zimmerman, 2002).

MACROLEVEL: RISKS AND CONSEQUENCES OF SEXUAL EXPLOITATION

In tandem with individual and systemic vulnerabilities, many social and cultural factors influence the path into sexual exploitation, as well as the subsequent course of action and service access. It is impossible to provide a comprehensive analysis of sexual exploitation without addressing the societal structures and social factors that allow sexual exploitation to exist and that contribute to the effects of exploitation on the individual level.

Economic Costs

Sex trafficking has become one of the world’s fastest growing criminal industries, eliciting annual profits as high as $32 billion (International Labour Organization, 2008). Much of the current literature exploring the macroeconomic cost of sex trafficking frames exploitation as an issue rooted in national development and global power differentials between countries (Koettl, 2009; Schauer, 2006). There is a dearth of figures relating to profits gained and economic costs of sex trafficking in the United States beyond foreign-born and immigration-related proceedings. National and state reports on economic cost often focus on the cost of trafficking visas, asylum hearings, and other legal ramifications available for foreign-born women and girls who have been trafficked into this country. The U.S. government spends approximately $28.6 million annually on domestic programs to combat human trafficking, yet most of this funding aids international trafficking victims requiring immigration visas (Wyler & Siskin, 2012) and residential shelters for both international and domestic victims (Reichert & Sylwestrak, 2013).

However, some estimates have been calculated as to the unknown or unreported revenue of sex trafficking. For example, a medium-sized brothel’s in the United States is estimated to have profits of $1,168,000 per year (Hughes, 2005). This estimate accounts for four women with five customers at $160 a session ($160/session × 5 customers × 4 women = $3200/day × 365 days = $1,168,000) and is adjusted accordingly to the size of the brothel. Unfortunately, no estimate is available as to how many illegal brothels exist specifically in the United States. In a specific instance in Oakland California, a large prostitution ring identified 218 minors who were actively prostituted by 155 pimps in 2002. Each girl had a quota of approximately $500 a day, which was given to the pimp. A calculation of the pimps’ profits was determined: 218 girls multiplied by 300 days a year at $500/day amounts to revenue of approximately $32,700,000 a year. Only a small percentage of this income is usually reported to the government. To date, other related legal costs of criminal and civil proceedings have not been estimated.

Hospital- and health-care–related costs are another important societal cost of sex trafficking. Sexual exploitation and sex trafficking result in many physical injuries such as fractures, gastrointestinal disorders, infections, dental problems, malnutrition, pregnancy, and many gynecological complications and disorders (de Chesnay, 2013, p. 132). This population also struggles with elevated rates of physical and sexual assaults (Burnette et al., 2008; Clawson et al., 2009) as well as clinical disorders and diseases requiring treatment (Hossain et al., 2010; Medrano, Hatch, Zule, & Desmond, 2003). Although extant data do not focus specifically on health costs of sexually exploited women, health cost estimates are available for women with IPV who have also experienced similarly elevated rates of trauma and abuse. One study of IPV survivors found that women with a history of IPV expended an average of $1700 more in health care costs than women without a history of IPV (Jones et al., 2006). Annual costs for women with a history of abuse are estimated to be 19% higher than women without this type of history (Rivara et al., 2007). As identification of victims becomes clearer, financial estimates specifically regarding sexually exploited victims will be easier to calculate.

Social Norms Condoning Gender-Based Violence

Violence against women is a widespread and global epidemic. Like all forms of gender-based violence, sexual exploitation of women and girls would not exist without tacit and explicit structures that uphold male privilege and dominance. Despite legal and social progress made in this area, the institutionalized and cultural forms of violence against women have remained normative in U.S. and global cultures and continue to impact the pathway of sexual exploitation among women and girls (Heise, Ellsberg, & Gottmoeller, 2002; Hughes, 2005; Reed, Raj, Miller, & Silverman, 2010).

Institutionalized Discrimination

It would be impossible to examine the impact of sexism on sexual exploitation of women and girls without also considering the additional ramifications of racism, classism, and other forms of discrimination. The experiences of violence and abuse in addition to help seeking and service provision are greatly altered by added layers of discrimination for various identities (Kasturirangan, Krishnan, & Riger, 2004). Exploited women and girls of color are frequently confronted with an option of choosing their race or their sex in reporting any type of sexual violence, especially when perpetrated by a person of color (Sokoloff & Dupont, 2005). Images of sex trafficking victims often include young, often white, women with severe physical abuse who are chained and unable to escape (Lutya & Lanier, 2012); however, those are not necessarily the most common cases of trafficking victims seen in the United States (Clawson et al., 2009).

Many studies of trading sex, survival sex, sexual exploitation, and domestic sex trafficking report higher rates of violence against women of color, primarily African American women, than whites (Hudson & Nandy, 2012; Macy & Graham, 2012; Martin et al., 2010; Tyler and Johnson, 2006). However, certain marginalized racial groups, such as Native American/American Indians, require more expansive research. One study in Minnesota of 105 Native American prostituted women revealed not only extensive rates of sexual and physical assault, but also that racism was an emotionally damaging source of ongoing stress in their experiences of prostitution, sexual assault, and mental and physical health needs (Farley et al., 2011). To date, this is the only study conducted with Native American and American Indian sexually trafficked women and/or girls.

Related to institutionalized racism, discrimination based on poverty and social class is interconnected in a web of structural barriers. Women and girls are made vulnerable to sex trading and sexual exploitation because of a lack of other economic options (Anderson et al., 2014; Cobbina & Oselin, 2011; Tyler and Johson, 2006). Some believe they are obtaining a form of formal or informal employment (i.e. stripping, dancing, modeling) and are exploited through deception and fraud (Jordan et al., 2013). People of color are also disproportionately affected by poverty, thus contributing to any existing vulnerabilities to sexual exploitation (Clawson et al., 2009; Farley et al., 2011). Factors such as racism, sexism, and classism become structural barriers that continually oppress those who are politically, economically, or culturally disadvantaged, primarily women and girls who are oppressed by their race and class in addition to their sex (Kurtz et al., 2005).

Demand for Sexual Exploitation

There are three main, identified components to the demand for sexual exploitation: (1) the men who buy commercial sex acts, (2) the exploiters who make up the sex industry, and (3) the culture that tolerates or promotes sexual exploitation (Hughes, 2005). High levels of men who purchase sex have fueled a demand for women to supply it, which has subsequently led to exploiters forcing or coercing women into sexual exploitation. A study in Pennsylvania reported there to be so much demand in a popular truck stop that women would make $1000 per night and would have little trouble paying the $418 fine upon arrest (Wilson & Dalton, 2008). Traffickers and exploiters are easily able to take advantage of this economic opportunity coupled with the individual risk factors and systemic vulnerabilities.

Furthermore, the glamorization of pimping and prostitution has also contributed to the normalization and tolerance for this type of exploitation and violence against women. Explicit and exploitive song lyrics, “pimp and ho” parties and verbal expressions, as well as video games and TV shows such as “Pimp My Ride” all provide a social context for the acceptance of sexual exploitation against women and girls who are objectified for sex (de Chesnay, 2013, p. 118). The Academy Award–winning song “It’s Hard Out Here for a Pimp,” from the film Hustle & Flow, sparked major criticism for its “disdain for women [that was] integral to the fantasy … of pimping” (Scott, 2005, p. 1). Moreover, many of these media images include women of color, adding increased normalization to the objectification of women, particularly nonwhite women.

In 2013 the Chicago Alliance Against Sexual Exploitation (CAASE) conducted an analysis of online networks for buyers of sex in Illinois (Janson, Durchslag, & Mann, 2013). An instrumental finding of this study was the use of the “USA Sex Guide,” which provided descriptions of women and prices paid for sex. Descriptions ranged from objective and descriptive information of women sold or sex acts provided (e.g., “COF—Cum on Face,” “BSW—Black Street Walker”) to subjective rating systems (based on “looks, attitudes and service”) and reviews (e.g., “ROB—Rip Off Bitch”). According to the analysis of Janson and colleagues, buyers of sex consistently justified purchasing sex and violence exerted against women through male entitlement and overt assumptions that prostituted women were considered to be “meat.” Despite the importance of the empirical literature focusing on risk factors of sexually exploited women and girls, the elements of structural- and gender-based violence greatly contribute to the pathway for sexual exploitation and merit further scholarly exploration.

CONCLUSION

Sexual exploitation of women and girls is a vastly complex issue in terminology as well as its individual, systemic, and societal risks and consequences. The much debated terminology initiates a divided framework in understanding empirical evidence as it relates to prostitutes and prostituted women, sex workers and traders, and sexually trafficked and exploited women and girls. Federal and state laws related to trafficking and prostitution also present additional complications in the understanding of sexual exploitation and the determination of crimes committed. Finally, the inability to provide accurate prevalence rates as well as controversies over extant data is well documented (Clawson et al., 2009; Greene et al., 1999; Macy & Graham, 2012) and increases the contextual confusion of the problem.