Predictors of Traumatic Stress Among Adult Sex Workers in Canada and the United States

Background/Purpose: This study aimed to better understand traumatic stress and factors that influence the level of distress experienced by sex workers in Canada and the United States. Recently implemented policies in the United States and Canada regarding the sex industry (including the criminalization of clients in Canada in 2014, and the US criminalization of online advertising of sexual services in 2018), as well as criticisms of these policies voiced by sex workers’ rights advocates, practitioners, and researchers, are largely premised on assumptions regarding the prevalence and causes of traumatic stress experienced by sex workers. To contribute to the evidence informing this debate, we measured relationships between symptoms of PTSD and client-related and work-related factors. Studied factors included: sex work stigma, social cohesion among workers, client motivations, worker control over working conditions, client perceived adherence to hegemonic masculinity norms, client sense of sexual entitlement, and scores on a “bad clients” scale measuring 8 non-violent negative behaviors and characteristics of clients (for example “bad personal hygiene” and “being rude or disrespectful”).  Other variables included worker demographics (age, length of time in the industry, racial/ethnic identity), and sites of finding and serving clients.    

Methods: An online Qualtrics survey was conducted with sex workers who advertised online in January 2018, resulting in a convenience sample of 339 respondents. The survey consisted of validated measures (social cohesion, sex work stigma, prevalence of violence, burnout exhaustion) and measures that were especially developed for this study (clients’ perceived adherence to hegemonic masculinity norms, clients sense of sexual entitlement, the bad clients scale, client motivations). The outcome variable, symptoms of PTSD, was measured using the PCL DSM IV scale.      

Results: A multiple regression analysis was conducted to examine predictors of PTSD. The model was significant F(12,180) = 12.32  R square = .451. PTSD was predicted by greater perceived clients’ adherence to hegemonic masculinity norms (𝛽 =.356) greater sex work stigma (𝛽 =.275) less control over working conditions (𝛽 = -.243) and racialized identity (𝛽 =.210).  

Conclusions and Implications:

The findings of this study suggest that levels of traumatic stress among sex workers are partially explained by a combination of clients’ adherence to hegemonic masculinity norms, sex work stigma, control over working conditions, and racial/ethnic identity. These findings support, on the one hand, the view underpinning the criminalization of clients’ model according to which the purchase of sexual services is especially traumatizing to those providing the services when it is strongly associated with the norms and gender practices termed hegemonic masculinity. On the other hand, this study also shows that sex work stigma and worker control over working conditions (as well as the structural conditions and life trajectories to which racial/ethnic identity may be seen as a proxy) are factors of almost equal importance. This is noteworthy given sex workers’ rights advocates ongoing concern about the adverse unintentional consequences of policies and interventions that result in reducing workers’ control over their conditions and the perpetuation and entrenchment of sex work stigma.