How Do I Fit? Understanding Barriers and Facilitators to Social Services Among Women Involved in Commercial Sexual Exploitation

Background and Purpose: Sex trafficking and commercial sexual exploitation (CSE) can lead to devastating health and mental health consequences for women, such as elevated rates of substance use, trauma, posttraumatic stress disorder, and depression. Consequently, access to and engagement with services that address addiction, mental health, housing, and provide general advocacy are critically important to women’s increased safety, stabilization, and quality of life. The purpose of this study is to 1) understand how women involved in CSE identify their own experiences of sex trading and 2) identify barriers and facilitators to service access and engagement with social services among women involved in CSE.

Methods: This grounded theory study used a constructivist approach and partnered with an anti-trafficking coalition and a women’s substance use treatment center. Semi-structured, in-depth interview data were collected from 30 adult women who had traded sex as adults (through maximum variation and snowball sampling), as well as 20 service providers who come into contact with adult women who trade sex (through coalition-based purposive sampling and nominations sampling). The research team independently conducted open coding of de-identified transcripts to uncover preliminary themes. A coding schematic was created and discussed with the research team for focused coding. Emergent themes were continually compared and defined in the coding schematic. We enhanced the methodological and analytic rigor through collaboration with multiple key stakeholders, use of non-stigmatizing language in study materials, use of life calendar method with women, self-reflexivity processes, analytic memo-writing, and multi-phase member checking.

Results: Women held varied sex trading identities (typically as women who traded sex, independent prostitutes, or prostitutes with pimps) and had diverse experiences with trauma and substance use. Some women would be considered victims of sex trafficking but viewed it as the involvement of multiple underage girls in a trafficking ring, which did not resonate with their experiences as adults. Women experienced judgment when disclosing sex trading in social services. While some women saw disclosure as helpful in addressing the complex feelings stemming from sex trading and relating to other women in groups, they also identified risk of harm and multiple barriers to disclosure during intake meetings and individual sessions with providers as well as group sessions with providers and other clients. Women also experienced racial tensions in groups between White and African American women. African American women described experiences of racism and perceived preferential treatment for White clients. Providers also described a series of challenges in addressing racial tensions and racism. Finally, women who had attended groups focusing on privilege, oppression, and racism described the positive impact on themselves and their relationships with other women in treatment.

Conclusion and Implications: Relevant service providers should recognize the range of sex trading that occurs by providing information about CSE and sex trading identities as well as the fluidity and movement between them. Providers should respond to disclosures of sex trading with client-centered, mirrored language. Anti-oppression training for providers and groups with women to address racial tensions biases may be needed to help increase women’s engagement in services.