Keywords

Sex work, better known as prostitution, has been viewed throughout American history as a moral, legal, and social problem as early as the temperance movement of the 1880s. Since 1910, pimps, customers, and women who sold sex could be punished under the Mann Act (Conant, 1996), thus solidifying sex work as a social and moral evil in the USA (Farley, 2004; Till & Gurin, 1992). This and other anti-prostitution laws drove prostitution underground, and arguably made conditions worse for persons who sell sex—particularly poor and vulnerable communities of color (Musheno & Seeley, 1987; Sanders, O’Neill, & Pitcher, 2009). Today, prostitution costs major metropolitan cities upwards of $6–9 million annually to criminalize buyers and sellers (Allard & Herbon, 2003; Ward, 2012).

The focus of this chapter is on adult prostitution, one of several types of commercial sexual exchanges. The chapter begins by defining sex work and the commercial sex industry. Next, attention is given to philosophical perspectives that shape modern notions of sex work and prostitution, and how this discourse has impacted public perceptions of sex work. An analysis is provided on the variations of sex work experiences, including the differences between sex work, sex trafficking, prostitution, and transactional sex. The chapter then details policy approaches to address prostitution: criminalization, legalization and decriminalization. The remainder of the chapter focuses on adult women engaged in street-based prostitution, as it is one of the more visible and highly criminalized types of commercial sexual exchanges. This part of the chapter begins by describing who are likely to enter street prostitution and why, what dangers are associated with street prostitution, and how women exit, or leave street prostitution. It concludes with a discussion of three intervention approaches designed to help women exit.

What Is Sex Work and the Sex Industry?

Broadly, any exchange of money or goods in return for a sexual service is considered sex work. Thus, “sex work” is a generic term referring to commercial sexual exchanges, whereas the “commercial sex industry ” refers to the organizations, managers, and workers involved in selling sexual exchanges or services (Weitzer, 2010). Sex work is further delineated by whether sexual exchanges involve direct or indirect contact (Sanders et al., 2009), a distinction that has implications on the illegality of sex acts and services in the USA. For example, indirect sex work—pornography, stripping, erotic massages, and phone sex—refers to the sale of sexual fantasies or erotic services without physical contact (Brents & Hausbeck, 2007). Indirect sex work is often legal in the USA and is somewhat more tolerated than direct sex work, which involves intimate, physical contact such as coitus or fellatio. Direct sex work is highly stigmatized in the USA and is illegal for both buyers and sellers; however, sellers, who are typically women, bear the brunt of legal consequences as they face higher fees and jail time in comparison to buyers (Day, 2008).

Direct sex work, in particular, is further separated by the location where it occurs, specifically, on or off-street venues. The main distinction between on and off-street sex work is whether the venue operates under the guise of a business or a recognized sex market (Sanders et al., 2009). For example, off-street sex work, sometimes referred to as indoor prostitution, includes sex exchanges from escorts or “call girls ” that happen in private homes, or brothel sex work, which are organized houses of prostitution where buyers can choose from several sellers and have sex on site. On-street sex work refers to prostitution that occurs mainly in outdoor public spaces (e.g., on the street, in cars, and in crack houses). On-street sex work is more likely to be pimp-controlled (Norton-Hawk, 2004; Williamson & Cluse-Tolar, 2002) and frequently far more dangerous that off-street sex work (Weitzer, 2005).

The Internet has recently emerged as an alternative form of off-street prostitution due to its ease of communication and promise of anonymity (Agresti, 2009; Bernstein, 2007; Ray, 2007). There are sites—such as the now defunct Casual Encounters section on Craig’s List—for sellers or buyers to post advertisements for paid sex. Other sites such as The Erotic Review, allow buyers to post reviews about women whom they paid for sex (Milrod & Monto, 2012). Similar sites exist for sellers to screen their clients (Ray, 2007). Newer sites promote “sugaring,” a kind of sexual arrangement promoted as a dating relationship (Dalla, 2006; O’Leary & Howard, 2001). “Sugar daddies ” who are typically rich, older men are matched with “sugar babies,” young women or men who offer affection and companionship in exchange for their daddies’ monetary or nonmonetary support , which may include dinner dates, all-expenses-paid travel, or other gifts (O’Leary & Howard, 2001). Most sugaring sites explicitly prohibit prostitution and may cancel memberships if such correspondence occurs through their site; hence, this type of sex work is more accurately described as transactional.

Philosophies and Variations of Prostitution and Sex Work

Philosophically, sex work is typically described from an empowerment or oppressive paradigm. For example, the empowerment paradigm, often supported by sex workers’ rights activists, largely paints sex work as a means for women to gain economic independence and control over their working conditions (Farley & Kelly, 2000; Weitzer, 2009). Direct sex work is a lucrative, mutually beneficial transaction, similar to any other economic exchange (Weitzer, 2005). Framing sex work as “work” normalizes it. Furthermore, in countries where prostitution is legalized, the government regulates and licenses workers, thereby making it “safer” for buyers and sellers (Vanwesenbeeck, 1994); hence, they seek to legalize sex work. Conversely, the oppressive paradigm frames sex work as “exploitation” and insists that all sex work is a form of gender-based violence (Lorber, 2001). Consequently, simply making prostitution safer or less coercive is not possible, and they seek to abolish sex work (Farley, 2004). In doing so, sex worker advocates criticize abolitionists for taking away a woman’s right to choose to engage in prostitution and for labeling prostitutes as victims needing to be rescued or as criminals needing to be punished (Davis, 2000). While the lively debate between sex work advocates and prostitution abolitionists has uncovered compelling arguments as to the consequences each perspective has on women’s health, safety, and status in society, it has obscured discussion regarding the varying degrees of victimization and agency (Weitzer, 2010).

The terms “sex work” and “prostitution” are often used interchangeably; however, doing so ignores important variations in mobility and experiences, particularly of violence associated with selling sex. Understanding that there are subgroups, or typologies of sex work has important implications on criminal behavior, criminal justice policy, and research. For example, conflation between terms has made it difficult to determine the prevalence of those involved in illegal sex work (see Vanwesenbeeck, 2001 and Weitzer, 2005 for critiques). Furthermore, there exists a status hierarchy among the subgroups of sex work (Weitzer, 2009) that can be situated on a continuum of increasing danger, illegality, and oppression/agency (Thaller & Cimino, 2016).

The following section describes four types of direct sex work—sex work, sex trafficking, street prostitution, transactional sex—and how they differ with respect to agency, illegality, sociodemographics, reasons for entry, and experiences of violence. Figure 1 summarizes some of the major differences between types of direct sexual exchanges. It is important to note, however, that these are merely examples presented to draw out the many nuances of sex work subgroups. Individual experiences will vary. Furthermore, evidence suggests that sellers are likely to engage in multiple types of sex work throughout their lifetime (Cimino et al., 2017).

Fig. 1
figure 1

Types of direct sex work exchanges. Copyright © 2015 A. N. Cimino All rights reserved

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Sex Work

In addition to being a generic term for commercial sex, “sex work” also refers to a typology of paid, direct sex wherein the seller is liberated and empowered by his or her decision to sell sex (Rabinovitch & Strega, 2004). Examples might include brothel workers, call girls , or independent sex workers, for whom sex work is a preferred career choice. Hence, this type of sex worker can be considered a laborer (not a victim) to acknowledge one’s agency and choice to enter or exit sex work. Sex work of this nature is typically found indoors, or in countries such as the Netherlands or New Zealand where it is legal to buy and sell sex. However, in the USA, high-profile cases involving Governor Eliot Spitzer, Senator David Vitter, or Reverend Ted Haggard involve this type of illegal sex work (Weitzer, 2010).

A defining characteristic of this type of sex worker, in comparison to street prostitutes or sex trafficking victims, is that workers have the freedom to work or not, are able to screen customers, and can keep most or all monies earned. The type and nature of sexual exchanges involved in sex work is also unique. For example, Lever and Dolnick’s (2000) comparative analysis of indoor sex workers versus street prostitutes found that sex workers spend significantly more time with clients than street-based prostitutes and provide more emotional labor (i.e., feigning desire and, at times, the illusion of intimacy), sometimes called “the girlfriend experience” (Milrod & Monto, 2012). Monto (2004) notes that most men believe sex workers enjoy their job, and that the women maintain this façade because “… customers want warmth, sexual passion, or a special connection … even if it is fleeting” (p. 180).

The only reliable estimate of indoor sex workers in the USA is in Nevada, where sex work is legal. According to Brents and Hausbeck (2007), about 500 women are legally licensed to work in Nevada; however, evidence suggests that about 3500 women still work illegally in Las Vegas and the surrounding area (Hausbeck, Brents, & Jackson, 2006). In terms of sociodemographics, this typology tends to attract White, well-educated women (Lever & Dolnick, 2000) who are technologically and business savvy (Bernstein, 2007). Hence, sex workers’ increased agency and mobility within and out of sex work. Evidence also suggests that women engaged in this type of sex work are slightly older (Sanders, 2006), and are more likely to enter commercial sex work as adults (Plumbridge & Abel, 2000), also conferring their empowerment and choice. This type of sex work is safer and under less police scrutiny than other types (Sanders et al., 2009). Plumbridge and Abel (2000) and Seib, Fischer, and Najman (2009) conducted studies comparing violent victimization between on and off-street sex workers and both found that off-street sex workers were less likely to experience client-initiated violence and forced sex in comparison to women engaged in street prostitution.

Sex Trafficking

Another type of sex work, “sex trafficking,” refers to persons who are forced or coerced into commercial sex, which can include on/off-street sex work markets, stripping, or pornography (Shared Hope International, 2015). Sex trafficking represents the extreme opposite of sex work, as those who are trafficked are considered victims who cannot or have not consented to commercial sex work. The United Nations’ Palermo Protocol (2000) defines sex trafficking victims as persons recruited, transported or harbored by force, coercion, abduction, fraud, deception, or the abuse of power for purposes of sexual exploitation. The US government further specifies that persons under the age of 18 cannot give consent to commercial sex acts (regardless of their choice or desire to do so) and are therefore considered sex trafficking victims (Trafficking Victims Protection Act [TVPA], 2000). Though there is federal legislation that seeks to protect, rather than incarcerate or penalize sex trafficking victims for unlawful acts committed as a direct result of being trafficked, most states continue to incarcerate children and adults for being sexually exploited. For example, in Las Vegas, Nevada, 150–200 children, including some as young as 11 years of age, are arrested for prostitution and related charges despite being too young to give consent (Kennedy, 2015); hence, demonstrating the need for criminal justice policy and practice to differentiate among subgroups of sex work.

There are no credible estimates of the size of sex trafficking due, in part, to speculative methodologies and reports that lump sex and labor trafficking under the umbrella term “human trafficking.” For example, reports estimate that 600,000–800,000 persons are internationally trafficked, whereas 2–4 million victims are trafficked domestically, with as many as 70% of whom are forced into the sex industry (US Department of State, 2004). These figures are in stark contrast to the nearly 3700 sex trafficking victims the National Human Trafficking Resource Center (NHTRC) identified in 2015 (33% of whom were minors). Additionally, a recent report by the Bureau of Justice Statistics identified 2000 sex trafficking victims in a two-and-a-half-year period between 2008 and 2010 (Banks & Tracey, 2011). Although the exact prevalence is hotly contested, research has well established that sex trafficking victims come from all races and genders (i.e., female, male, and transgendered; NHTRC, 2015), yet African American (Banks & Tracey, 2011) and female domestic minor sex trafficking victims are most frequently identified by law enforcement and social service agencies (Kennedy & Jordan, 2014; Reichert & Sylwestrzak, 2013).

Unfortunately, the accessibility of technology has also contributed to the commercial sexual exploitation and trafficking of vulnerable women and children (Godoy, Sadwick, & Baca, 2016). Traffickers and buyers use the Internet to contact, groom, and facilitate the purchase/sale of sex acts from vulnerable persons domestically and abroad. As anti-sex trafficking stakeholders become aware of tactics employed by exploiters, public–private and multidisciplinary entities have pushed to develop technological tools to prevent and combat sex trafficking.

Prostitution

Prostitution, like sex work , is a generic term to refer to any commercial sexual exchange. However, “prostitution” as a typology more accurately refers to sex work that is oppressive, namely street-based sex work, because it lies at the intersection of extreme poverty, violence, and criminality; hence, prostitutes are viewed as both victims and criminals. For example, a majority of street-based prostitutes enter sex work because they face homelessness, extreme poverty, and lack alternative employment opportunities (Cronley, Cimino, Hohn, Davis, & Madden, 2016; Edlund & Korn, 2002). Many engage in “survival sex” wherein they trade sex for housing, food, or drugs (Dalla, 2006). Thus, they enter street-based prostitution because it represents the best “choice” given their impoverished circumstances (Davis, 2000).

Although street prostitutes can work independently, between 42% and 80% of women engaged in street prostitution were at some time in pimp-controlled prostitution (Norton-Hawk, 2004; Williamson & Cluse-Tolar, 2002). Pimps are persons who live off the earnings of the prostitute. Many use subtle and/or overt strategies, such as physical violence, to control most aspects of these women’s lives, including their continued prostitution (Kennedy, Klein, Bristowe, Cooper, & Yuille, 2007; Williamson & Cluse-Tolar, 2002); however, some women consider pimps their romantic partners (Cimino, 2013; May, Harocopus, & Hough, 2000).

Research has well established that this type of sex work is heavily policed. For instance, street prostitutes comprise 90% of those arrested for prostitution (Lucas, 1995), but are estimated to make up less than 15% of all persons in sex work (Flowers, 1998). High arrest rates among street prostitutes are due, in part, to the fact that this type of sex work is more publically visible than indoor sex work, thus the public tends to associate it with crime and deviance (Weitzer, 2010). Although many persons involved in street-based prostitution have criminal histories that include shoplifting, burglary, fraud, and drug charges, this may reflect the harsh reality of surviving a street-based lifestyle rather than an innate criminal propensity. For example, a study by May et al. (2000) showed that pimped prostitutes averaged 50 sex work-related arrests, whereas non-pimped prostitutes, many of whom were homeless, averaged 22 arrests as young as age 12 (average age was 16).

Some estimates on the prevalence of street-based prostitution exist . The Federal Bureau of Investigation (FBI) reported an annual average of nearly 70,000 persons arrested for prostitution (Office of Juvenile Justice and Delinquency Prevention [OJJDP], 2014), though the number is likely to be much higher as arrests do not capture the entirety. Furthermore, federal arrest data does not delineate between sellers and buyers, and some prostitutes, particularly juveniles, may also be categorized as sex trafficking victims (Banks & Tracey, 2011). One outdated but rigorous study based on capture–recapture data in Colorado estimated 23 full-time prostitutes per 100,000 populations in the USA (Potterat, Woodhouse, Muth, & Muth, 1990).

In terms of sociodemographics , street sex workers tend to be poor, uneducated, underemployed, or unemployed (Edlund & Korn, 2002). Many have histories of child maltreatment (e.g., physical and sexual abuse, neglect) that persists into adulthood (Cusick, 2002; Nadon, Koverola, & Schludermann, 1998; Silbert & Pines, 1982). In fact, this type of sex work frequently results in serious threats to health and safety: As many as 52–81% of street-based prostitutes experience physical and sexual violence (Plumbridge & Abel, 2000; Raphael & Shapiro, 2004; Seib et al., 2009; Surratt, Inciardi, Kurtz, & Kiley, 2004).Some are murdered (Salfati, James & Ferguson, 2008).

Transactional Sex

Transactional sex refers to any “sex-for-things exchanges” wherein individuals exchange sex for material goods, housing, protection, or other favors with a paying customer or casual/steady partner (Benoit et al., 2013; Dunkle et al., 2007; Dunlap, Golub, Johnson, & Wesley, 2002). As mentioned earlier, “sugaring” refers to a type of transactional sex arrangement; however, transactional sex can include any dating relationship and sexual exchange that blurs the artificial division between commercial and noncommercial exchanges (Thaller & Cimino, 2016). The women appear to be consenting adults who enter transactional sex relationships after coming to the reality that the female body can be used as currency in any sexual relationship. Because these relationships are within the confines of socially acceptable behavior, women engaged in transactional sex are unlikely to be identified as sex workers or prostitutes despite considerable overlap between the phenomena (Boyle et al., 1997; Dunkle, Wingood, Camp, & DiClemente, 2010).

Although this is an understudied phenomenon in the USA, one study by Dunkle et al. (2010) estimated that 33% of African American and White women in the US engage in noncommercial, transactional sexual exchanges, whereas 4% participate in commercial exchanges (i.e., prostitution). The authors defined noncommercial sexual exchanges as broadly as staying in a relationship longer than one wanted to because of economic considerations. They found that African American women were more likely than White women to engage in transactional sex (21.6% vs. 10.5%), and were more likely to trade sex with a nonregular partner (13.1% vs. 2.9%). Dunkle et al. (2010) found that sex trading was associated with a lack of education, difficulty meeting basic needs (e.g., food, clothing, and shelter), and the need to care for dependents, which reflect situations that also compel street prostitutes to engage in survival sex.

It is not known how much violence exists in transactional sex relationships. Most of the research in this area involves sex workers outside of the USA who financially depend on nonpaying intimate partners; hence, these women are involved in a combination of prostitution and transactional sex, and likely do not reflect transactional sex relationships in the USA. For example, one study of female sex workers in Kenya reported similar rates of physical/sexual violence and financial support from both paying and nonpaying partners (Benoit et al., 2013).

Policy Approaches to Address Prostitution

As the above analysis demonstrated, sex workers experience varying degrees of empowerment and oppression. Framing sex work as “work” ignores gender-based violence and crimes against women, yet framing it as “exploitation” overshadows women who earn living wages and feel empowered by sex work. It is hard to dispute that sex work is a business. The very nature of sex work is embedded in capitalism: an exchange between two individuals (seller and buyer) who decide on a mutually agreeable exchange of goods (money, drugs, food, or place to stay) for services (sex, intimacy), with the desire to maximize profit (the number of interactions) and minimize loss (money versus time spent per exchange). It is also difficult to ignore the reality that the illegal sex trade, particularly sex trafficking, is linked with organized crime (Farley, 2009), and severe forms of violence against women.

Policies to address prostitution struggle with the same issues—is prostitution a form of employment or a criminal activity? Criminalization, legalization, and decriminalization represent three approaches to address prostitution; however, none are completely free from critique (Day, 2008; Farley, 2004, 2009). Below presents a description of each of the three approaches and an analysis of critiques from sex workers’ rights advocates and abolitionists.

Criminalization

In America’s national infancy, brothel-based sex work was common and somewhat acceptable, only becoming a target of reform in the temperance movement of the 1880s (Sloan & Wahab, 2000). Progressive Era reformers observed that more young, single women were working out of necessity, inevitably leading some to prostitution, which they viewed as immoral (Abramovitz, 1996). Operating under the belief that prostitution could be eliminated through harsh and rigorously enforced laws, criminalization was the first US policy adopted to deal with prostitution. Anti-prostitution specialty courts, prisons and vice squads began to appear as early as the Mann Act in 1910 (Conant, 1996; Musheno & Seeley, 1987). Radical feminists and activists in the 1970s continued to argue for the criminalization of prostitution, asserting that prostitution is always about control of women and that these criminal sanctions may help reduce violence against women (Lorber, 2001; Lucas, 1995).

Today, prostitution continues to be illegal in most of the USA; however, decades of criminal sanctions have done little to decrease the number of women who enter sex work (Norton-Hawk, 2001). Furthermore, because street prostitution is more publically visible than indoor prostitution, criminalization policies have unfairly targeted on-street sellers. Hence, some have argued that anti-prostitution laws have driven the more dangerous forms of sex work (i.e., street prostitution) deeper underground, magnifying the problem and making sex workers vulnerable to exploitation from customers, pimps, and brothel owners (Musheno & Seeley, 1987; Norton-Hawk, 2001; Weitzer, 1991). For example, to reduce their visibility, street prostitutes take customers to remote or unfamiliar places where rape or abuse can occur unnoticed (Marcus, Oellermann, & Levin, 1995; Pauw & Brener, 1997). They also spend less time screening clients or engage in riskier acts at a higher price (i.e., unprotected sex, anal sex) to make more money quickly (Alexander, 1998). Pimps also capitalize on women’s fear of arrest. One way a pimp can convince a prostitute to work for him is through offering protection from violent customers or by posting bail when a prostitute gets arrested while working. Some pimps legitimately offer help and protection, but many are exploitative (e.g., take profits, force drug use, demand quotas) and use violence to control their prostitutes (Kennedy et al., 2007; Williamson & Cluse-Tolar, 2002).

Another unintended consequence of the criminalization of prostitution is that it makes exiting sex work much more difficult. For example, in instances where prostitution is a felony, women with criminal records are prohibited from some types of legitimate employment, essentially trapping them in prostitution (Norton-Hawk, 2001; Sanders et al., 2009). Furthermore, Høigård and Finstad (1992) observed that some prostitutes had to sell themselves to pay court fees because they had no other source of income. In sum, the deterrent affect of criminalization appears lost, as the plethora of arrests and incarcerations indicate that these policies did little to stop women from prostituting.

Believing that prostitution is inevitable, some policy makers and activists have proposed legislation that either legalizes or decriminalizes sex work. Underlying both efforts are empowerment paradigm assumptions that prostitution is an occupational choice that is not exploitative; any harms associated with prostitution (i.e., physical health and safety risks) are actually lessened via legalization or decriminalization (Day, 2008; Vanwesenbeeck, 1994). Evidence of the success of legalization or decriminalization in the USA or abroad is mixed (Sanders et al., 2009). An examination of both policies is explained below.

Legalization

Legalization of prostitution is state-regulated sex work through licensing and regulation (West, 2000). Such regulations often include registration and licensing requirements, mandatory health examinations, taxes to generate revenue, or specially zoned geographic areas where prostitution can take place (Sanders et al., 2009; Weitzer, 1991). Commonly cited reasons to legalize prostitution include public health concerns such as safer working conditions (i.e., mandated condom use and testing), control over when and where to work, and increased safeguards and barriers to prevent child sexual exploitation (Farley, 2004; Sanders et al., 2009; Vanwesenbeeck, 1994). Others believe that legalized prostitution would guarantee protection of sex workers’ rights; for example, when they need legal recourse for on-the-job physical or sexual assault, violation of labor laws, or allowing sex workers to unionize. Furthermore, legalizing prostitution could save millions of dollars in law enforcement and criminal justice costs, and prostitution could even be a source of revenue, as in the Netherlands where 5% of the gross domestic product is from prostitution (Daley, 2001).

Sex workers themselves have voiced poignant critiques against legalization. To some sex workers, the concept of state-controlled prostitution is exploitative. For example, states acting out of economic interests would earn revenue from prostitution, which they feel is no different than working for a pimp (O’Connell Davidson, 1998; West, 2000). Ultimately, the state, pimps, and brothel owners—who view laws against pimping as barriers to business—would benefit the most from legalization because they, not sex workers, would be in a position to control competition (West, 2000), demand, and surplus (O’Connell Davidson, 1998).

Furthermore, sex workers’ rights activists feel that some regulations violate civil rights (Weitzer, 1991; West, 2000) and would perpetuate social stigmas already heavily associated with prostitution (Weitzer, 1991). For example, registering as a “card-carrying prostitute” is stigmatizing and would cause sex workers to lose their anonymity (Farley, 2004). Sex workers who refuse to get licensed would face penalties and fines, essentially pressuring sex workers to register as a prostitute or enter third party-controlled prostitution (i.e., brothels) (O’Connell Davidson, 1998). Other critics find the compulsory health examinations are a violation of privacy (Sanders et al., 2009; Weitzer, 1991; West, 2000).

As described above, prostitution is heavily associated with crime and deviance (Weitzer, 2010), thus legalizing prostitution can be unpopular as politicians and their constituents worry that state-condoned prostitution would lead to the proliferation of prostitution (Weitzer, 1999). Few, if any neighborhoods want the sex trade in their backyard. Rather, areas zoned exclusively for sex work would likely be on the periphery of a town and physically isolated, thus reinforcing the social rejection and stigmatization of sex work (Farley, 2004).

Evidence suggests that legalization has not increased the safety of sellers, and in some cases has increased illegal prostitution and trafficking. For example, sex workers have reported that mandatory tests have not benefited their health, particularly since only sellers—not buyers, are tested (Day, 2008; Farley, 2004). Furthermore, a recent study examining data from 149 countries where prostitution is legalized indicated that legalization has not increased protection of sex workers, and in some cases was detrimental to victims of forced prostitution and human trafficking (Cho, 2015). Last, it is a misconception to assume that legalized prostitution would get rid of illegal prostitution. Those who are pushed out of the legal market because they do not want or cannot be licensed may be forced to operate illicitly, particularly if they engage in survival sex (Weitzer, 1999).

Decriminalization

Some sex workers’ rights advocates feel that decriminalization of prostitution is a fairer and more balanced approach to the drawbacks of criminalization and legalization. Unfortunately, there is little public support for decriminalization, and most policy makers oppose it (Weitzer, 1999). Two forms of decriminalization exist: (a) formal decriminalization wherein criminal sanctions prohibiting prostitution are removed from the law or the severity of the sanctions is reduced (Musheno & Seeley, 1987; Sanders et al., 2009); (b) “de facto decriminalization” in which police are encouraged to ignore or selectively enforce prostitution laws; however, the laws prohibiting sex work still exist. It is well known that prostitution enforcement is costly (Norton-Hawk, 2001; Pearl, 1987) and that criminal convictions can prevent women from legitimate employment, thus trapping sex workers in prostitution (Sanders et al., 2009). Decriminalized prostitution is intended to alleviate some of these risks.

COYOTE—an acronym for “Call Off Your Old Tired Ethics”—is one group that has challenged legalization efforts and advocated for the repeal of anti-prostitution laws (Jenness, 1990; Weitzer, 1991). Their argument is that prostitution is not a social or moral evil, but rather a means for women to gain economic independence, a matter or sexual self-expression, and an occupational choice (Jenness, 1990; Weitzer, 1991). They further argue that the creation of prostitution-free zones associated with legalization of prostitution would perpetuate the assumption that prostitution is always visible. This depiction erroneously conflates sex work with class status, rather than representing the full continuum of sex work, which also includes high-paid escorts and independent sex workers who solicit clientele via the Internet and meet at private residences. Another justification for decriminalization is that prostituted women would have more legal redress if they are raped or beaten (Farley, 2004). Hence, decriminalization advocates assume social and moral stigmas would cease once criminal sanctions are removed.

Critics argue that decriminalization does little to protect against violence that seems inevitable in prostitution or to prevent psychological harm, such as stigma, depression and PTSD commonly associated with engaging in prostitution (Farley, 2004). In fact, some sex workers have not organized in support of decriminalization for fear of being arrested or stigmatized by their community or families (Sanders et al., 2009; Weitzer, 1991). Moreover, decriminalization may normalize gender inequality. For example, Conant (1996) supports decriminalized prostitution to meet basic male biological needs for sex, particularly for men who cannot attract unpaid sex partners. Married men also benefit from satisfaction and “adventure” that paid sex provides. These claims reflect and reinforce cultural notions of male privilege.

Decriminalization is not a panacea, particularly in countries that have de facto policies that outlaw buying, but not selling, sexual exchanges. For example, in Canada selling sex is legal; however, buying sex and most of the activities associated with selling sex, such as pimping, driving escorts to meet customers, and pimping, are criminalized (Van der Meulen, 2011). Sex workers in Canada have reported that because clients are fearful of soliciting in public places, the workers have less time to screen clients, which increases their chances of encountering a dangerous client. Other critics note that Canadian sex workers are prohibited from social services agencies, including healthcare, affordable housing, and police protection.

Focus on Adult Street Prostitution

As demonstrated throughout this chapter, women who engage in street-based prostitution represent a subgroup of sex workers situated at the end of a continuum of increasing danger, illegality, and oppression. Compared to other types of sex workers, street prostitutes lie at the intersection of extreme violence, poverty, and criminality . Failed efforts to eradicate prostitution through criminal sanctions give weight to the notion that prostitution continues to thrive because the larger economic system allows such “opportunities” to exist. It is difficult to ignore that women, particularly women of color, have fewer employment options and higher unemployment rates than men, regardless of education and skills, and that women are more likely to be poor than men (Abramovitz, 1996; Day, 2008). Taking economic and gender inequalities into consideration, it becomes clearer that women’s motivation to enter street-based prostitution may be out of necessity, rather than a “voluntary” exchange. In the following section, we explore in greater detail how women enter and exit street prostitution.

Who Are Street Prostitutes?

Women engaged in prostitution are not homogenous in terms of demographics or experiences. The persons most at risk for entering street prostitution, however, are girls and young women of color who disproportionately experience poverty and have unequal educational and occupational opportunities (Davis, 2000; Lucas, 1995). On average, girls begin street prostitution careers as early as 12–14 years of age, whereas adult women begin around age 18 (May et al., 2000; Norton-Hawk, 2004; Saphira & Herbert, 2004; Silbert & Pines, 1981). It is well documented that many street prostitutes have histories of maltreatment as children (i.e., physical/sexual abuse and neglect; Kramer & Berg, 2003; McClanahan, McClelland, Abram, & Teplin, 1999; Nadon et al., 1998; Silbert & Pines, 1982); however, child maltreatment is a correlate, not a cause of prostitution. Experiencing childhood victimization, however, does make one especially vulnerable to prostitution. Furthermore, the prostitutes’ families of origin are rarely pillars of stability. In a study of 200 adult and child prostitutes, 67% reported having a parent missing from their home; 19% of fathers and 11% of mother were convicted of a crime; 51% witnessed their father violently hit their mother, and 22% saw their mother violently hit their father (Silbert & Pines, 1982). Another study of 50 incarcerated female prostitutes found that close to 60% had one or both parents addicted to alcohol or drugs (Norton-Hawk, 2001).

Why Do Women and Young Girls Enter Street Prostitution?

Though individual reasons for entering street prostitution vary, poverty and the desire for financial independence consistently underlie the motivation to enter street prostitution (Edlund & Korn, 2002; Weitzer, 2009; Williamson & Folaron, 2003). Most women engaged in street prostitution lack education or job skills and see prostitution as their only option to make money (Mitchell, Finkelhor, & Wolak, 2010; Saphira & Herbert, 2004). Prostitution becomes an attractive option because it represents a job earning quick money with few skills or time commitments, and often exceeds earnings possible through legitimate employment (Edlund & Korn, 2002). The media often report that prostitutes earn thousands of dollars a day, serving to recruit women to the trade—the reality is that most of their endeavors are not lucrative, nor are they steady (Høigård & Finstad, 1992). In Vancouver, Canada, the median weekly income for street prostitutes under age 25 was $300, which decreased to $200 for women 25 and older (Deering, Shoveller, Tyndall, Montaner, & Shannon, 2011). Street prostitutes in Los Angeles averaged $458 per week in 1991 (Edlund & Korn, 2002).

Although sex work can be a sexual choice and lucrative business venture, it seems more likely that street prostitutes are victims of their social location, exploited by the promise of financial independence. For example, young girls or women fleeing abuse from their parents/caregivers or a romantic partner may first engage in survival sex for housing, food, or drugs, then never leave prostitution (Dalla, 2006). Some are coerced or forced into street prostitution by their friends, partners, or other exploiters who promise to keep them safe on the street (Kennedy et al., 2007; Silbert & Pines, 1982).

Research also suggests that some women enter prostitution to support their drugs habit (Edlund & Korn, 2002). However, other evidence suggests that women turn to drugs after their initiation into prostitution as a way to self-medicate and cope with violence, stigma, and guilt associated with selling sex (Williamson & Folaron, 2003; Young, Boyd, & Hubbell, 2000). Kennedy et al. (2007) reported instances where drug dealers pimped out young women in a type of debt-servitude focused on getting another “fix.”

What Dangers Are Associated with Street-Level Prostitution

The occupational hazards of street-based sex work are unique: exploitation, violence, rape, and murder . The damaging effects that street prostitution has on women’s emotional and physical health is undeniable. Between 33% and 85% of street prostitutes report having been threatened with weapons, physically assaulted, or forced to have sex while prostituting (Farley & Kelly, 2000; Surratt et al., 2004). Though studies vary, about 60% of prostitutes have suffered abuse from customers (Pearl, 1987). Prostituted women, especially when under the influence of drugs, are at increased risk for violence, robbery, and forced sex (Sanders et al., 2009). Around 60% of pimps are physically or mentally abusive (Giobbe, 1993; Silbert & Pines, 1982). Although clients and pimps are the main source of violence against prostitutes, there are reports of police officers raping prostitutes (Pearl, 1987; Williamson, Baker, Jenkins, & Cluse-Tolar, 2007) or demanding free sex for police protection (Pauw & Brener, 1997). Furthermore, prostitutes encounter a murder rate 18 times higher than the general population (Potterat et al., 2004). Customers are responsible for 57–100% of prostitute homicides throughout urban cities in the USA (Brewer et al., 2006).

Women engaged in street prostitution face a number of physical health consequences such as increased risk of contracting human immunodeficiency virus (HIV) and other sexually transmitted infections (STI; Farley & Kelly, 2000; Vanwesenbeeck, 1994). Performing sex repeatedly leads to repetitive stress injuries from hand jobs and fellatio, feet problems from walking long hours in high heels, and chronic urinary tract infections (Alexander, 1998). Being homeless and living on the streets, as well as illicit drug use, can further diminish the prostitute’s physical health (Farley & Kelly, 2000; Williamson & Folaron, 2003).

Street prostitutes are likely to experience some form of mental health problems, particularly posttraumatic stress disorder (PTSD). For example, in a study of prostitutes in nine countries, 68% met the criteria for PTSD (Farley & Barkan, 1998). Stressors such as trying to avoid arrest, fear of violence from customers and abusive pimps, as well as the expected stigma associated with prostituting, exacerbate mental and physical health problems (Williamson & Folaron, 2003). In a study of over 1600 women, a prostitute’s odds of attempting suicide was 1.44 times higher than nonprostitutes after adjusting for age and abuse (Burnette et al., 2008).

How Do Women Leave Street Prostitution?

There is a limited but growing body of literature on the street-based prostitution exiting process (Baker et al., 2010; Cimino, 2012, 2013; Hedin & Masson, 2004; Oselin, 2010; Sanders, 2007). Most scholars agree that exiting street-based sex work is more complex than deciding to stop selling sex. More accurately, exiting is a process by which women come to the realization and take steps to disengage from prostitution. Theories on exiting describe it is a result of a complex interplay of factors that come together facilitating one’s ability to leave prostitution: structural (e.g., employment, welfare), relational (e.g., family, friends), and individual (i.e., shifting attitudes, belief in personal change). Some women experience catalysts such as witnessing and experiencing violence (Oselin, 2010), being burnt out (Vanwesenbeeck, 1994, 2005), facing incarceration (Sander, 2007), and/or coming to terms with declining economic viability (Dalla, 2006). Others experience a shift from glamorization to disillusionment with prostitution (Williamson & Folaron, 2003). Sometimes a subtler transition occurs from a “visceral” and “conscious awareness” about leaving prostitution (Baker, Dalla, & Williamson, 2010, p. 591). While success often hinges on access to supports and resources (Sanders, 2004), women also possess an “internal desire” to change (Baker et al., 2010, p. 591). In other words, women must want or intend to leave prostitution (Cimino, 2012, 2013, in preparation).

Unfortunately, dropping out of exiting programs and returning to sex work is the more likely outcome. For example, in Benoit and Millar’s (2001) study of 201 Canadian sex workers, 70% attempted to exit sex work at least once, while over half exited three or more times. Women who successfully exited made an average of 5.6 attempts. Similarly, in a study of brothel sex workers in Thailand, 60% (N = 42) quit and reentered sex work at least once (Manopaiboon et al., 2003). While 16 of these women successfully left prostitution (38%), nearly a quarter said they would return to prostitution if their situation made it necessary. Studies by Davis (2000; N = 291), Saphira and Herbert (2004; N = 47), and Dalla (2006; N = 18) suggest that about 20–25% of women in programs successfully leave prostitution.

These studies reinforce just how difficult it is to exit street prostitution and stress the need to examine barriers to exiting (see Baker et al., 2010 for a review). Some common structural barriers include economic inequalities, lack of affordable housing, and reductions to welfare (Farley & Kelly, 2000; Mayhew & Mossman, 2007; Sanders, 2004). Gendered shame and social stigma have also been liked to women’s diminished ability to exit prostitution (Baker, Dalla & Williamson, 2010) as well as increased dropout rates for women attending a program to help them leave sex work (Roe-Sepowitz, Hickle, & Cimino, 2012). Evidence shows that specialized treatment for trauma and underlying mental health issues can alleviate stigma and shame (Arnold, Stewart, & McNeece, 2000; Davis, 2000). Relearning how to trust has also been linked to successful exits (Preble, 2015; Rabinovitch & Strega, 2004).

What Interventions Are Available?

Street-level prostitution, more so than other types of sex work, has garnered attention from scholars, law enforcement, and social service providers (Weitzer, 2009) with the shared goal of helping women exit prostitution. As a result, a number of intervention approaches have been designed to help women leave prostitution, if they desire to. Broadly, three types of interventions exist: (1) diversion and law enforcement-based initiatives, (2) formal exiting programs, and (3) harm-reduction approaches (see Mueller, 2012 for examples). Generally, diversion and formal exiting programs are designed for women who wish to never return to sex work and offer services designed to stabilize, treat, and rehabilitate women. Harm-reduction approaches seek to mitigate exposure to violence, diseases, and other harm, without the assumption that they will exit. A discussion of these approaches follows.

Diversion and Law Enforcement-Based Initiatives

Diversion programs operate similar to drug-court models whereby persons convicted of prostitution are mandated to obtain court-supervised treatment, which may include case management, mental health and substance abuse treatment, or other supportive services. The level of law-enforcement involvement varies, but in many cases diversion is offered in lieu of criminal charges (Wiechelt & Shdaimah, 2011). For example, Project ROSE coordinates undercover sweeps in high prostitution areas. Street prostitutes who are arrested, if eligible, are offered a six-month diversion program, which includes access to social services, addiction treatment, and counseling (Roe-Sepowitz, Gallagher, Hickle, Perez-Loubert, & Tutelman, 2014). Upon successful completion of the program, charges are dropped. Prostitutes who decline to enroll or who are not eligible for the program, however, face prosecution and jail time, which has led to harsh criticisms of this program (Wahab & Panichelli, 2013). Other diversion programs, such as the Prostitution Diversion Initiative in Dallas, TX, set up a mobile court and triage center where prostitutes access services if they choose to exit (Fenili et al., 2011).

The participants’ desire to change and willingness to sustain a prostitution-free life are critical to the goals of most diversion programs (Fenili et al., 2011; Roe-Sepowitz, Hickle, Loubert, & Egan, 2011). However, a major limitation of diversion programs (as opposed to voluntarily entering a program) is that some sex workers only choose treatment to avoid criminal charges. Hence, though women have entered a program, they may not be “ready” or motivated to exit prostitution, leading to recidivism rates as high as 84% (Fenili et al., 2011).

Formal Exiting Programs

Formal prostitution-exiting programs are designed to address the causes and consequences of why women entered prostitution (Preble, Peatorius, & Cimino, 2015). Few states in the USA have prostitution-exiting programs, and some of them are offered as part of diversion programs (Wahab, 2006). One example is Standing Against Global Exploitation (SAGE), which provides prostitution offender remediation along with counseling, case management, and street outreach (Preble et al., 2015). Though specific interventions can vary, most exiting programs offer supportive services to address immediate health and safety concerns, emotional and sexual traumas, and may provide substance abuse treatment, housing and life skills education, or opportunities for gainful employment (Arnold et al., 2000; Davis, 2000; Mayhew & Mossman, 2007).

As mentioned earlier, about 20–25% of women involved in formal exiting programs have successfully left prostitution. It is important to note, however, that empirical data on the effectiveness of these interventions is limited due to methodological issues regarding sampling (Weitzer, 2005), lack of adequate assessments (Cimino, 2012; Gerassi, 2015), and inconsistent definitions of a successful exit (Davis, 2000; Mayhew & Mossman, 2007).

Harm-Reduction Programs

Interventions that focus on reducing the harm associated with sex work are intended to address public health concerns such as the spread of HIV/AIDS and the prevention of violence (Cusick, 2006; Rekart, 2005). The goals of harm-reduction programs are to safeguard sex workers and stop the spread of disease (Rekart, 2005). As such, harm-reduction programs typically operate from a public health model that focuses on physical and sexual health needs. Harm-reduction services can include education, peer outreach, access to clean needles and condoms, medical treatment, and safety tips (Mayhew & Mossman, 2007; Rekart, 2005). Harm-reduction approaches have been effective in reducing HIV and STIs and violence against sex workers (Jana, Rojanapithayakorn, & Steen, 2006). For example, Thailand’s condom use policy enabled sex workers to insist condom use, which reduced STI rates (Hanenberg, Rojanapithayakorn, Kunasol, & Sokal, 1994).

Conclusion

This chapter demonstrated how philosophical perspectives that frame sex work as “work” versus “exploitation” shape our criminal justice policies. Poignant differences among sex work , sex trafficking, prostitution, and transactional sex were identified. Specifically, variation among these typologies of sex work was due to sex workers’ socioeconomic background (e.g., poverty, education), venue (i.e., off/on-street), working conditions (e.g., when/how often to work, condom use, access to technology to facilitate exchanges [e.g., websites, credit cards]), reasons for entry, and how issues related to visibility/stigma (e.g., inability to hide on-street sex work) lead to policies that target adult women in street prostitution. The latter half of the chapter focused on how women enter and exit street-based prostitution and discussed intervention programs designed to help women leave prostitution.