Introduction

Commercial sexual exploitation of children (CSEC) is a serious and pervasive issue within the USA and globally. It involves the exploitation of minors in various forms of sexual abuse, including sex work or child pornography. All children are vulnerable to CSE. Youth with multiple marginalized identities, including sexual and gender minority youth, are at particularly high risk. This review article aims to explore the existing literature on the intersection of LGBTQ youth and CSEC, shedding light on the unique experiences of sexual minorities (SM) and youth identifying as transgender and gender diverse (TGD). This article will discuss the shortcomings of research and discourse that collapse the experiences of all sexual and gender minorities into the blanket “LGBTQ experience.” However, because of limitations in existing research and an understanding of some overlapping shared experiences, this article will at times also cite research on the larger LGBTQ youth community.

CSEC refers to the sexual abuse and exploitation of children for monetary or other gains. According to the Office of Juvenile Justice and Delinquency, CSEC consists of “crimes of a sexual nature committed against juvenile victims for financial or other economic reasons… These crimes include trafficking for sexual purposes, prostitution, sex tourism, mail-order-bride trade, early marriage, pornography, stripping and performing in sexual venues” [18]. This definition has grown to also include “survival sex” or the exchange of sexual activity for basic need [18].

CSE youth are an understudied population. While there is literature that aims to determine the prevalence of youth at risk for and involved in trafficking [18, 19•, 20•, 21, 23, 52], it is largely understood that given the hidden nature of this problem, the existing literature that does exist is largely an underrepresentation of the issue. There is even more limited information on gender distribution and background characteristics of trafficked youth, including information on sexual and gender identities [38].

When children lack basic social and economic support, they are at highest risk for exploitation. This includes youth who are homeless, either because they have run away or because they have been forced out by caregivers. Studies on the relationship between homelessness and sex trafficking suggest that between 19 and 41% of youth who experience homelessness also experience sex trafficking [28]. In one study done in California, researchers found that over half of the youth who have been abandoned or thrown out of their homes by their caregivers were involved in sex trafficking due to a lack of basic needs [4]. Additionally, children who have experienced maltreatment are at increased risk for CSE as are those who have been involved with child protective services [16,29]. Several studies have also looked at mental health and found an association with poor mental health and later victimization in CSEC [10,16,44]. Other risk factors that have been less well studied but warrant mentioning include conflict with parents prior to engagement in CSEC and difficulty in school [9].

It has been well documented that many of the risk factors for CSEC are disproportionately prevalent in the LGBTQ youth community. Some estimates find that while LGBTQ youth make up less than 10% of the population, they make up 40% of the homeless youth population and are at 120% higher risk of experiencing homelessness than their heterosexual, cisgender peers [8••, 11, 34, 41]. While more research is needed, in the studies that have looked at homeless LGBTQ youth, factors that result in homelessness include structural and interpersonal discrimination, family rejection, abuse, and marginalization by social services [11, 34]. In one study, 40% of LGBTQ homeless youth have been forced out of their homes due to prejudice, lack of understanding, or homophobic attitudes [49].

When turning to the literature on abuse, the trends are similar. LGBTQ youth are at higher risk of experiencing both physical and sexual abuse. Literature on TGD youth highlights how nearly 50% of TGD youth have experienced sexual abuse in their lifetime, and similar rates exist for annual experiences with emotional abuse [32, 39].

For a multitude of reasons, which are outside the scope of this article to explore, LGBTQ youth experience poor mental health at alarmingly high rates. Rates of suicide attempts or suicidal ideation are 4 times higher in LGBTQ populations compared to their heterosexual, cisgender peers [48]. When turning to the research on transgender individuals, studies have found as many as 40% of TGD individuals have attempted suicide in their lives [32, 45, 49].

This understanding of the risk factors for CSEC in combination with the increased prevalence of these factors among LGBTQ youth generated the aim of this review: to explore the existing literature on the intersection of LGBTQ youth and CSEC.

Methods

A comprehensive literature search with narrative methods was used to identify relevant articles that addressed the intersection of CSEC and LGBTQ youth populations. A narrative review was conducted with a goal to identify gaps in current literature to inform future research.

The following databases were searched in July 2023: PubMed, MEDLINE, EMBASE, Web of Science, and ProQuest. The following terms were searched within each database: lgbtq OR gay OR bisexual OR transgender OR lesbian OR “men who have sex with men” OR msm OR “women who have sex with women” OR wsw OR “sexual minority” OR “gender non-conforming” OR “gender diversity” OR “gender nonbinary” OR “gender expansive” OR “two-spirit” AND “sexual exploitation of children” OR “child sexual exploitation” OR dmst OR “human trafficking” OR “sex trafficking” OR prostitution OR “sex work” OR “survival sex” OR “transactional sex” AND child OR adolescents OR youth OR teen OR juvenile OR girls OR boys.

Eligibility criteria included articles published in English, studies published between January 2018 and July 2023, articles that focused on youth under age 18 years old, and articles focused on sexual exploitation. Exclusion criteria included articles that did not collect gender and sexuality data or did not include subanalysis based on participant sexual or gender identities.

All abstracts meeting inclusion criteria were evaluated by the study author for relevance. Abstracts were deemed relevant if they addressed the intersection of CSEC and LGBTQ identities. Full-text articles were then reviewed by the study author to ensure they met inclusion criteria. If studies did not meet the criteria, they were removed.

Results

A total of 370 studies were captured across databases using the search terms above. Three hundred twenty-three of these studies were excluded after review of the title and abstracts. A total of 10 of these studies were excluded because they were duplicates. A total of 36 full texts were screened. Of these texts, 15 studies were excluded as they did not capture information on sexual or gender identity or they focused on cisgender heterosexual females and did not complete any subanalysis based of sexual or gender identity [3, 5, 6, 7, 12•, 14, 17, 30, 31, 35, 36•, 37, 40•, 42, 43]. Five studies were excluded as they did not focus on CSEC [13, 24,25,26,27]. Six studies were excluded as they served more as an overview of CSEC and therefore only dedicated a small portion of their discussion LGBTQ groups [19•, 20•, 21, 23, 33, 47•, 54]. One study was excluded because while it did capture sexual and gender identities, it did not include a discussion based on various sexual or gender identities [37]. See Fig. 1.

Fig. 1
figure 1

Identification of studies via databases

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A total of 8 studies were included in the final review as they focused on the intersection of CSEC and LGBTQ youth. Of these, 2 studies focused on TGD youth [22, 50], and the remaining 6 studies focused most broadly on LGBTQ youth [1••, 2••, 8••, 51••, 53••]. See Table 1.

Table 1 Final review article summaries
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Discussion

This review adds to a very small area of research that focuses on LGBTQ youth and CSE. The research available highlights how an intersectional approach to this topic yields nuanced and practical insights both in addressing risk factors and potential future interventions and preventative programs.

An Intersectional Understanding of Risk Factors

While youth independent of their sexual and gender identities may experience homelessness, LGBTQ youth are overrepresented; 40% of homeless youth identify as LGBTQ compared to ~10% of the general population [8]. From the literature review, multiple studies highlight how LGBTQ youth are more likely to run away or be kicked out of their homes because of rejection of their gender or sexual identities [1••, 8••].

When we turn to services aimed at getting youth off the streets, we see in the literature one area where this intersectional approach focused on LGBTQ youth is key. Multiple studies discussed how LGBTQ youth experience discrimination from staff or other youth in shelters because of their sexual or gender identities [1••, 18]. This results in more LGBTQ youth being on the streets compared to being unhoused but in a shelter [12•]. However, even within the LGBTQ community, there are vastly different experiences with discrimination. In Alessi et al. [1••], they interviewed individuals with varied sexual and gender identities. One gay, Black male articulated how “the homeless shelter is not gay friendly.” A solution to this experience might be the creation of LGBTQ shelters. However, these still may cater to the majority, minority group (gay and lesbians) as is highlighted by the narrative of a bisexual, West Indian woman who reflected on an LGBTQ shelter, stating “They only accept gay and lesbian. That’s what pissed me off, because I was like… if it supposed to be LGBTQ then, why is it that [no bisexual women] can come in, because they do like girls, as well.” When we turn to insights gained by research focused on TGD youth, we see discrimination on both the individual and policy levels. Transgender participants in the Alessi et al. [1••] study highlight how TGD youth have to contend with cisgender normative policies with restrictions on what units in shelters they can be a part of that are not gender-affirming. A transgender female may be forced to live among males, which can be unsafe. Furthermore, TGD youth who potentially left homes because of rejection of their gender identity are again not given a viable housing option if they cannot live their authentic selves in all shelters.

Discrimination is not limited to housing, especially for TGD youth. Alessi et al. [1••] capture this in the narrative of a transgender male, “I just don’t want to quit being trans and like… it’s the only thing that’s holding me like from getting a real job.” This compounding effect of discrimination leaves many TGD youth with no option other than CSE to meet their basic needs. Additionally, as is documented in both literature on youth and adult TGD individuals, there is an added basic need of accessing GAC [1••, 8••, 15, 22••, 50]. Lack of employment options with health insurance in combination with cost for GAC has been documented to be a motivating factor in exchange sex for adult and youth TGD. Even when individuals are able to secure other employment, these jobs may not pay well enough for TGD individuals to pay for their necessary and lifesaving GAC [15], an added risk factor not experienced by cisgender peers.

Prevention, Education, and Resilience

While there is a dearth of research on prevention of CSEC, the literature is significantly lacking on prevention and education focused specifically on sexual and/or gender minority youth. While the study done by Van Ouytsel and colleagues [51••] was not specifically focused on prevention strategies, their findings are relevant to a discussion of education and prevention. They looked at transactional sexting in youth and found that sexual minority boys are at the highest risk of transactional sexting, especially transactional sexting that involved the use of a webcam. While safe Internet practices and education on CSE risks would benefit all youth, this study demonstrates that if we parse out variations within LGBTQ youth, it may be possible to provide more targeted education as a form of secondary prevention.

Greenfield and colleagues [22••] explored areas of resilience within TGD youth who had a history of sexual exploitation. They found that youth identified access to gender-affirming providers and healthcare as a source of strength. One transgender male expressed in reference to gender-affirming care with a supportive provider that “It’s awesome, I love it, I feel free. I feel like I can be me, like I don’t have to fake I’m something I’m not.” This offers the possibility that increasing access to LGBTQ friendly providers who offer GAC may be a way for society to help LGBTQ build resilience, which may combat vulnerability to CSEC. While this study offered great insights into the perspectives of TGD youth and young adults, more research on prevention and resiliency is needed for this subset of youth that the literature shows are at increased risk for CSE.

Conclusion

Despite the commercial exploitation of children being a pervasive human rights violation, it is a largely under research issue. Not only is there an overall need for more funding and research related to CSEC; there also needs to be an expansion of research on LGBTQ youth. While this review highlights a handful of studies that attempt to gain insight into the characteristics, including sources of resilience, for subsets of the larger LGBTQ population, most of the population-based research of LGBTQ youth combines sexual and gender minorities together in analysis. This is in part due to a myriad of practical reasons (e.g., small sample sizes and aggregated data in available population-based data sources). But in some cases, this is also partially due to the fact that the LGBTQ community is often regarded by researchers and the broader society as a monolith. While at times this may be appropriate, in research, it is important for us to think critically and be intentional when we collapse all sexual and gender minority individuals into a single group. As is highlighted by the literature that does exist, with additional, more granular knowledge, we can better serve these vulnerable and uniquely resilient youth.