"They Started Sharing [...] That It Was Actually Possible": Peer Support in Women's Prostitution-Exiting Trajectories

Background and Purpose: A growing body of research demonstrates that peer support can facilitate drug use and mental health recovery and reduce health care costs. However, with the notable exception of Shdaimah and Leon (2016), peer support has not been studied in the context of street prostitution, despite the fact that this vulnerable population could potentially benefit from peer-based interventions. This paper fills this gap by examining the influence of peer support on substance-use involved women who are exiting street prostitution.

Methods: This qualitative study draws on interviews with 29 cisgender women formerly engaged in street prostitution and substance use. These women were exiting prostitution voluntarily, most of them without the coercive intervention of the criminal justice system. The women were recruited with the assistance of program directors from five different programs and transitional homes for women with substance abuse disorder in the greater Philadelphia region. The sample was of mixed racial background (48% identified as Black, 35% as White, 3% as Latina, 14% as mixed). Their age ranged from 24 to 61, and they had desisted from drugs and prostitution for periods ranging between 2 months and 7 years after being involved in both for 2 to 35 years. In-depth, semi-structured interviews lasted between 65 and 170 minutes and were recorded and transcribed verbatim. Interviews were coded and analyzed in two cycles (initial and focused coding) using ATLAS.ti 8 qualitative software.

Findings: Women interviewed pointed to peer support as an important factor in their exiting. The analysis revealed that connections with peers who have had similar lived experiences served multiple purposes that were important to their recovery efforts. First, interaction with peers allayed women’s feelings of isolation and helped to normalize their own lived experiences. Secondly, peers served as role models; interacting with peers who were on a successful trajectory (for example, have desisted from drugs and prostitution for many years) improved their self-worth. Thirdly, women were able to take advice from peers who went through similar experiences that they would not have necessarily accepted from professional treatment providers who lack this experience. Lastly, the presence of peer support also allowed women to talk in a non-judgmental setting about prostitution-related issues that they often did not address in therapeutic settings, even though it was an important part of their recovery efforts.

Conclusion and Implications: This research expands our theoretical understanding of the role of peer support in the context of prostitution and its importance for women’s exiting trajectories. It opens the “black box” of peer support in a way which may be relevant to other areas where peer support has been implemented, such as prison reentry. The findings highlight the need to incorporate peer support in programs assisting women exiting prostitution, either in group or one-on-one settings. Training and hiring of women with lived prostitution experiences should be a priority to programs wishing to assist women exiting prostitution. The findings also highlight the need to provide a safe, non-judgmental space for women to address their past in prostitution.