Form 40 - AFFIDAVIT Rules of Civil Procedure (Rule 4.06) 14221

07-CV-329807PD1

ONTARIO SUPERIOR COURT OF JUSTICE

BETWEEN:

TERRI JEAN BEDFORD, AMY LEBOVITCH, VALERIE SCOTT

Applicants

and

ATTORNEY GENERAL OF CANADA

Respondent

AFFIDAVIT OF DR.

I, Melissa Farley, of the City of San Francisco, in the State of California, United States, make oath and say:

OVERVIEW OF MY AFFIDAVIT

1. The purpose of my affidavit is to describe, on the basis of my 40 years of research and practice as a clinical psychologist, the conclusions that I have reached on the harmful effects that has on the physical and psychological health of women that are engaged in it. 14222 - 2 -

OVERVIEW OF MY EXPERTISE

2. I have worked as a research and clinical psychologist in practice for 40 years. From 1993-2000, I was a principal investigator on research grants at a large health care system in the US where I collaborated with a team of researchers studying the long term effects of on their health and how that violence impacts preventive health care for women. Several peer-reviewed publications have resulted from this work. Attached to this my affidavit as Exhibit "A" is a copy of my curriculum vitae

3. My opinion is based on my years in practice as a research and clinical psychologist, on study of and expert testimony on the topic of sexual exploitation, posttraumatic stress disorder ("PTSD"), and prostitution. I have consulted with and presented workshops and seminars for universities, governmental agencies, and community groups addressing prostitution.

4. My opinion is based on approximately 900 interviews with women, girls, men, boys, and transgendered people in prostitution in 10 countries. My opinion is also based on several hundred interviews with johns. Most of what I have learned about prostitution is a result of talking with these people in depth about their experiences.

5. I am currently on the editorial board of the Journal of Psychological Trauma.

I also review articles on prostitution and trafficking for governmental and i nongovernmental agencies. I review articles submitted for publication on the topic of prostitution and trafficking for other peer reviewed journals such as Violence against Women, Interpersonal Violence, AIDS Care, Women and Criminal Justice, and British Medical Journal. 14223 - - 3 - 6. I am an associate scholar with the Center for World Indigenous Studies, - located just south of Vancouver in Olympia, Washington.

7. Since 1995, my work has focused on research which has contributed to a greater knowledge of prostitution and . As a result of my research - and collaborations with other researchers, I have published 17 peer-reviewed articles on prostitution, and an additional 12 peer reviewed articles on related - topics.

8. I am the Executive Director of Prostitution Research & Education, a nonprofit organization that is dedicated to providing educational resources and information - about prostitution and trafficking to survivors of prostitution, law enforcement personnel judges, mental health professionals, college and high school and graduate students, governmental agencies, and the public. Our website, www.prostitutionresearch.com. receives about 50,000 page views per month. The organization is funded by private foundations, research grants and individual - donors. 9. I have provided testimony on prostitution to the governments of and New Zealand. My research has been used by other governments as they grapple with prostitution policy, including the government of Israel. I recently - (2007) provided a research report to the U.S. government in a Congressional Hearing on prostitution and trafficking in . The research was produced for the Trafficking in Persons Office of the U.S. State Department.

10. In my affidavit, based principally on my own research and that of other experts in the field of prostitution, I shall address the following:

• the links between prostitution and violence, in different cultural contexts, different countries, and in different physical locations (indoor and outdoor 14224 - 4 -

prostitution), in illegal and legal contexts; • the relation of childhood and childhood physical abuse to later prostitution; • the fact that most women in prostitution want to escape it, regardless of prostitution's location or legal status; • the extremely high HIV risk and other health risks posed by prostitution, regardless of its legal status or physical location; • the psychological consequences of prostitution, specifically posttraumatic stress disorder (PTSD) and dissociation; • the ways that prostitution damages women's sexuality; • verbal abuse and the use of drugs and alcohol as a defense against the emotional abuse and the physical pain of prostitution; • prostitution more severely harms indigenous women because of their economic vulnerability, because of social and legal discrimination against them, and because of their lack of alternatives; • the pervasiveness of pimps in all prostitution, and their violence against prostituted women; • the bond/ relationship between pimp and prostitute as similar to that between batterer and that between batterer and a battered partner; • the mistaken assumption that women in prostitution are always located either outdoors or indoors; • that johns pose serious threats of physical and emotional violence to women in prostitution, and present some new data on johns in Scotland; • that legalization does not reduce the stigma of prostitution, using examples from Nevada and elsewhere, and that legal prostitution has not been shown to make prostitution safer than illegal prostitution; • that pimps use means to control the women who work for them as victims., using methods that are similar to those used by torturers; 14225 -5-

• the reasons why prostitution cannot be considered a free choice in the usual meaning of that word; • that recent research in Scotland has revealed that there is a statistical correlation between men's purchase of sex and their sexually violent behaviors toward wives and girlfriends; and • finally, some of the assertions by Dr. John Lowman in his affidavit.

11. My expert opinion is based in part on the following research. Additional sources are footnoted in the body of my affidavit:

• Farley, M., Cotton, A., Lynne, J., Zumbeck, S., Spiwak, F., Reyes, M.E., Alvarez, D., Sezgin, U. (2003) Prostitution and Trafficking in 9 Countries: Update on Violence and Posttraumatic Stress Disorder. Journal of Trauma Practice 2 (3/4): 33-74

• Farley, M. (2006) Prostitution, Trafficking, and Cultural Amnesia: What We Must Not Know in Order To Keep the Business of Sexual Exploitation Running Smoothly. Yale Journal of Law and 18:109-144.

• Farley, M. (2007) Prostitution and Trafficking in Nevada: Making the Connections. San Francisco: Prostitution Research and Education.

• Farley, M, Lynne, J, and Cotton, A (2005) Prostitution in Vancouver: Violence and the Colonization of First Nations Women. Transcultural Psychiatry 42: 242-271.

• Farley, M. (2004) "Bad for the Body, Bad for the Heart:" Prostitution Harms Women Even If Legalized or Decriminalized. Violence Against Women10: 1087-1125

• Farley, Melissa (2005) Prostitution Harms Women Even if Indoors. Violence Against Women 11 (7): 950-964 July 2005

• Farley, M. (2003) Prostitution and the Invisibility of Harm. Women & Therapy 26(3/4): 247-280.

• Farley, M. and Seo, S. (2006) Prostitution and Trafficking in . Harvard Asia Pacific Review Volume 8 Number 2 pages 9-12 - 6 - 14226

• Farley, Melissa (2004) Prostitution is Sexual Violence. Psychiatric Times. October 2004 Special Edition. p 7-10

• Farley, M (2003) (Editor) Prostitution, Trafficking, and Traumatic Stress. Binghamton, NY: Haworth.

• Farley, M and Kelly, V (2000) Prostitution: a critical review of the medical and social sciences literature Women & Criminal Justice, 11 (4): 29-64.

• Cotton, A, Farley, M and Baron, R (2002) Attitudes toward Prostitution and Acceptance of Myths. Journal of Applied Social 32 (9): 1790- 1796.

• Ross, C., Farley, M., & Schwartz, H. (2003) Dissociation among Women in Prostitution Journal of Trauma Practice 2(3/4).

• Ugarte, M.S., Zarate, L., & Farley, M. (2003) Prostitution and Trafficking of Women and Children from Mexico to the United States. Journal of Trauma Practice 2(3/4).

Attached as Exhibits "B" through to "0" are copies of each of these reports or articles, except that, for my two books ("0" and "K"), only copies of the Table of

Contents are appended.

Vocabulary

12. It is important for the purposes of this affidavit to define a number of

key terms relating to my research on the psychological harms of prostitution:

a) Diagnosis of posttraumatic stress disorder ("PTSD") PTSD encompasses symptoms resulting from traumatic events, including the trauma of prostitution. PTSD can result when people have experienced "extreme traumatic stressors involving direct personal experience of an event that involves actual or threatened death or serious injury; or other threat to one's personal integrity; or witnessing an event that involves death, 14227 - 7 -

injury, or a threat to the physical integrity of another person; or learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associate."1 PTSD is characterized by anxiety, depression, insomnia, irritability, flashbacks, emotional numbing, and hyperalertness. Symptoms are more severe and longlasting when the stressor is of human design.

Exposure to paid or unpaid sexual violence may result in symptoms of PTSD. Symptoms are grouped into three categories: 1) traumatic re-experiencing of events, or flashbacks; 2) avoidance of situations which are reminiscent of the traumatic events, and a protective emotional numbing of responsiveness; and 3) autonomic nervous system hyperarousal (such as jittery irritability, being super­ alert or insomnia). The symptoms of PTSD may accumulate over one's lifetime. PTSD is not only related to the overall number of traumatic events, but it is also directly related to the severity of that violence. b) Dissociation Dissociation is a compartmentalization of memory, a psychological process that occurs in response to overwhelming and inescapable threat to the self, most often in response to prolonged and intense coercive persuasion. It permits psychological survival by means of a shattering of the self. In prostitution, multiple selves are created so that the prostituting self is separate from the rest of the self. Symptoms of dissociation include memory loss, "blanking out," numbing, inability to recall information that is too extensive to be explained by ordinary forgetfulness. Dissociation is common in prisoners of war who are tortured, children who have been victims of incest, and women who are prostituted.

1 American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders. (4th ed.). Washington, DC: American Psychiatric Press 14228 - 8 - c) Somatoform dissociation Somatoform dissociation is the numbing of specific areas of the body that are exploited or harmed by johns. This process serves the same purpose as other kinds of dissociation, through the trauma of a woman prostituting her body. Because of the trauma of prostitution itself, the body is compartmentalized in the same way that traumatic emotions and memories exist in states of dissociated consciousness. d) Pimp A pimp is a person, most often a man, who procures women in prostitution by enticing or kidnapping them into it, and who physically controls women in prostitution via rape or other violence. A pimp exploits women financially, at times taking all their money. A commonly used definition of pimp is "a person who is supported by the earnings of a prostitute". e) John The term john was first used by men who buy sex to conceal their identities. It is now used in a slightly derogatory manner by women in prostitution to refer to all men who buy sex. f) Stockholm Syndrome Stockholm Syndrome is the emotional bonding to an abuser under conditions of captivity has been described as the Stockholm Syndrome. Attitudes and behaviors which are part of this syndrome include: 1) intense gratefulness for small favors when the captor holds life and death power over the captive; 2) denial of the extent of violence and harm which the captor has inflicted or is obviously capable of inflicting; 3) hypervigilance with respect to the captor or pimp's needs and identification with the pimp's perspective on the world (an example of this was Patty Hearst's identification with her captors' ideology); 4) perception of those trying to assist in escape as enemies and perception of captors as friends; 5) 14229 - 9- extreme difficulty leaving one's captor/pimp, even after physical release has occurred. Paradoxically, women in prostitution may feel that they owe their lives to pimps.

g) Traumatic brain injury (TBI) TBI is an injury to the brain that occurs as a result of physical trauma to the head. TBI is one consequence of intimate partner violence. In prostitution, TBI is caused by closed-fisted blows to the head or face by pimps or johns, kicks to the head, or the woman's head slammed against walls or dashboards of cars. h) Indoor or Outdoor Prostitution The terms indoor or outdoor prostitution refer to the physical location of the purchase of sex by the john. Indoor locations include lap dance clubs, (both legal and illegal), massage parlors, the john's or the prostitute's home. Outdoor locations include vehicle or street. In most of the literature on prostitution, the term indoor prostitution refers to the location of the person in prostitution at the time the researcher interviewed her or at the time of her arrest. The term does not include concurrent locations where the person prostituted (the same day), and it does not reference locations where the person prostituted on the previous day or in previous years.

13. The conclusions that I have reached based on the research I have conducted and based on a review of the medical and social science literature on prostitution are as follows.

A. Prostitution is internationally recognized as a form of violence against women that is linked to many other forms of violence against women.

B. Prostitution is linked to violence around the world, in many different cultural contexts. -10- 14230

ENTRY INTO PROSTITUTION

C. Childhood sexual abuse overwhelmingly precedes entry into prostitution.

D. Battering in childhood is common among women who later enter prostitution.

VIOLENCE IN PROSTITUTION AND ITS CONSEQUENCES

E. Prostitution causes severe emotional stress at a level equivalent to the most emotionally traumatized populations ever studied by psychologists.

F. Prostituted women use dissociation as a psychological defense against overwhelming physical pain, emotional distress, and the feeling that prostitution is inescapable.

G. Prostitution more severely harms indigenous women because of their economic vulnerability, because of social and legal discrimination against them, and because of their lack of alternatives.

PIMPS

H. A majority of women in legal and illegal prostitution have pimps who control them either mentally or physically.

I. Pimps use many of the methods used by torturers to mentally control women in prostitution.

J. Pimps commonly engage in mentally and physically violent behavior against women in prostitution. These behaviors are the same as the behaviors experts currently define as being characteristic of relationships involving domestic violence.

K. The traumatic bond established between women in prostitution and their pimp! captors is the same as the bond between battered women and their batterers or kidnapped women and their captors.

L. Drug and alcohol abuse are associated with prostitution - but not in the ways commonly assumed. 14231 - 11 -

M. Women in prostitution suffer from serious physical health problems that are unrelated to prostitution's legal status or to its indoor or outdoor location.

N. Prostitution in any legal context places women in prostitution at the highest risk for HIV of any group that has been studied.

INDOOR AND OUTDOOR PROSTITUTION COMPARED

O. There is little difference in prostitution's link with violence whether the prostitution takes place indoors or outdoors.

P. There is no evidence for the assumption that women either prostitute indoors or outdoors but not both. The same women are prostituted in both indoor and outdoor locations.

Q. Prostitution damages women's sexuality, regardless of its physical location or its legal status.

R. Most research comparing indoor to outdoor prostitution has addressed only physical violence and not emotional violence.

S. There are anecdotal and also empirical research accounts from many countries that johns in indoor prostitution present serious threats of physical and emotional violence to prostituted women.

T. The emotional harm of prostitution is the same in indoor and outdoor prostitution, according to both research evidence and anecdotal reports.

U. Verbal abuse from johns in indoor prostitution poses a threat to prostituted women's mental health.

V. The overwhelming majority of women in prostitution want to escape it, regardless of prostitution's legal status.

W. Legalization of prostitution does not reduce the stigma of prostitution.

X. In Nevada, despite legal prostitution, the women in it are strongly stigmatized. They are treated as social outcasts. 14232 - 12 -

Y. Legalization of prostitution does not make prostitution safer than illegal prostitution.

JOHNS

z. Men who strongly support the institution of prostitution also tend to express a tolerance for rape.

AA.Recent research provides new empirical findings on the attitudes and behaviors of men who buy sex in indoor and outdoor prostitution.

BB. Men who paid for sex in Scotland held deeply contradictory attitudes about prostitution.

cc. The johns we interviewed endorsed a number of rape-tolerant attitudes.

DD. The johns' frequency of use of women in prostitution impacted their behavior toward non-prostituting women.

EE. Prostitution is not a choice according to the usual definition of the word choice which implies free selection of an option among several available alternatives.

14. My affidavit is organized in the following way:

I. I shall address each one of the above conclusions;

II. I shall address the methodology that I have used in my empirical research and the specifics of the rigors of peer-review to which it has been subjected; and, finally,

III. I shall directly address a number of the specific assertions made by Dr. John Lowman in his affidavit. 14233 -13-

I. MY CONCLUSIONS

A. Prostitution is internationally recognized as a form of violence against women that is linked to many other forms of violence against women.

15. Violence is commonplace in prostitution whether it is legal or illegal. The following table2 summarizes the violence I will be discussing, based on my own research, and that of others.

Clinical Findings Regarding Violence in All Types of Prostitution .. 95% of those in prostitution experienced that would be legany actionable in another job setting . .. 85cr~·g5% of tl10se in prostitution want to escape [1. but have 110 other options for survival. .. 80'%·90% of those in prostitution have experiencclCl verbal abuse and socia! contempt, which rt.:1S adversely affected tllet11 . .. 75% Qf those in prostitution have been homeless at some poInt. .. 70 C;io-95%were physically assaulted in prostitution. "6!Wr. of 854 people in several different types of prostitution in nine countries met criteria for PTSD . .. 65'i"o-95% of those in prostitution were sexually assaulted as children. "60%-75% were raped in IJrosutution.

Source Farley r~l (2004); data from Farley et aI. (20(3).

16. Prostitution is better understood as domestic violence than as a job. One woman explained that prostitution is "like domestic violence taken to the extreme.,,3

2 Table 1 found in Exhibit "J" (Farley, Melissa (2004) Prostitution is Sexual Violence. Psychiatric Times. October 2004 Special Edition. pages 7-10) 3 Leone, D. (2001) 1 in 100 Children in Sex Trade, Study Says. Honolulu Star Bulletin Monday September 10, 2001. Quoting Jayne B. 14234 - 14 -

B Prostitution is linked to violence around the world, in many different cultural contexts.

17. A Canadian observer noted that 99% women in prostitution were victims of violence, with more frequent injuries "than workers in [those] occupations considered . .. most dangerous, like mining, forestry, and fire fighting. ,,4

18. In a Canadian study, we found that 90% of women in prostitution had been physically assaulted in prostitution, 78% had been raped in prostitution.

19. In the United States, 70% of women in prostitution in San Francisco,

California were raped.5 A study in Portland, found that prostituted women were raped on average once a week. 6 Eighty-five percent of women in

Minneapolis, Minnesota had been raped in prostitution?

20. In the Netherlands (where prostitution is legal), 60% of prostituted women suffered physical ; 70% experienced verbal threats of , 40%

experienced sexual violence and 40% were forced into prostitution and! or sexual

abuse by acquaintances. Vanwesenbeeck found that two factors were associated with greater violence in prostitution. The greater the poverty, the greater the

4 Gibbs, Erin, Van Brunschot et al. (1999) Images of Prostitution: The Prostitute and Print Media, Women and Criminal Justice 10: 47 5 Silbert, M.H. & Pines, A. M. (1982) Victimization of street prostitutes. Victim%gy] (1-4): 122-133 6 Hunter, S. K. (1994) Prostitution is cruelty and abuse to women and children. Michigan Journal of Gender and Law 1: 1-14. 7 Parriott R. (1994) Health Experiences of Twin Cities Women Used In Prostitution. Unpublished survey initiated by WHISPER, Minneapolis, MN. 14235 - 15 - violence; and the longer one is in prostitution, the more likely one is to experience

s violence.

21. I conducted research on prostitution in 9 countries with colleagues in Canada, Colombia, Germany, Mexico, South Africa, , , United States, and Zambia. We found that prostitution was multitraumatic: 71 % of 854 people in prostitution had been physically assaulted in prostitution; 63% were raped; 75% had been homeless.9

ENTRY INTO PROSTITUTION

C. Childhood sexual abuse overwhelmingly precedes entry into prostitution.

22. Prostituted children are often termed "child prostitutes" in psychological, sociological, and legal literature, referring to those prostituted while under the age of majority (18 in most places). The age of consent for sexual activity varies from country to country. Nonetheless, the term "child prostitute" obscures the fact that when prostituted, a child is by definition being sexually abused and is a victim of sexual exploitation.

23. Most prostituted people enter the as adolescents. Adult and child prostitutes are thus not two different classes of people, but the same people at two different points in time. It is questionable that an abusive situation one enters as a child suddenly disappears when one turns 18.

8 Vanwesenbeeck I. (1994) Prostitutes' Well-Being and Risk. Amsterdam: VU University Press; Vanwesenbeeck I., de Graaf, R., van Zessen, G., Straver, C.J. & Visser, J.H. (1995). Professional HIV risk taking, levels of victimization, and well-being in female prostitutes in the Netherlands. Archives of Sexual Behavior 24(5): 503-515 9 See Exhibit ""8" (Farley, M., Cotton, A., Lynne, J., Zumbeck, S., Spiwak, F., Reyes, M.E., Alvarez, D., Sezgin, U. (2003) Prostitution and Trafficking in 9 Countries: Update on Violence and Posttraumatic Stress Disorder. Journal of Trauma Practice 2 (3/4): 33-74) - 16 - 14236

24. In Canada, 82% of 100 women prostituting in Vancouver had a history of childhood sexual abuse. The women told us that on average, they had suffered sexual abuse from an average of 4 perpetrators.10

25. Seventy percent of the adult women in prostitution in another study said that their childhood sexual abuse led to entry into prostitution. 11

26. Boyer and colleagues interviewed 60 women prostituting in escort, street, , phone sex, and massage parlors (brothels) in Seattle, Washington. All of them began prostituting between the ages of 12 and 14.12

27. Nadon found that 89% had begun prostitution before the age of 16.13

28. In another research study, 78% of 200 adult women in prostitution began prostituting as juveniles and 68% began prostitution when they were younger than 16 years of age.14

10See Exhibit ""E" (Farley, M, Lynne, J, and Cotton, A (2005) Prostitution in Vancouver: Violence and the Colonization of First Nations Women. Transcultural Psychiatry 42: 242-271) 11 Mimi H. Silbert & Ayala M. Pines, Early Sexual Exploitation as an Influence in Prostitution, 28 SOCIAL WORK 285 (1983). See also MIMI H. SILBERT ET AL., SEXUAL ASSAULT OF PROSTITUTES (National Center for the Prevention and Control of Rape, National Institute of Mental Health, Washington, D.C. 1982) 12 Boyer, D., Chapman, L., & Marshall, B.K. (1993). in King County: Helping Women Out. Report Submitted to King County Women's Advisory Board. Seattle: Northwest Resource Associates 13 Nadon, S.M., Koverola, C., Schludermann, E.H. (1998). Antecedents to Prostitution: Childhood Victimization. Journal of Interpersonal Violence 13: 206-221 14 Silbert, M.H.& Pines, A.M. (1982a). Entrance into Prostitution. Youth & Society 13: 471-500 14237 - 17 -

29. 23% of a group of women that I interviewed in Nevada legal prostitution had entered prostitution as children. 15

30. One Canadian study indicated that women enter prostitution as children at an average age of 15.16 Another Canadian study found that 75% of 50 Canadian youth (mostly female) entered prostitution before the age of 16.17

D. Battering in childhood is common among women who later enter prostitution.

31. In two separate studies of hundreds of women, both found that 90% of prostituted women had been physically battered in childhood. 18

VIOLENCE IN PROSTITUTION AND ITS CONSEQUENCES

E. Prostitution causes severe emotional stress at a level equivalent to the most emotionally traumatized populations ever studied by psychologists.

32. Although the physical violence of prostitution is brutal and pervasive, the emotional trauma of prostitution is worse.

15 See Exhibit "0" (Farley, Melissa (2007) Prostitution and Trafficking in Nevada: Making the Connections. San Francisco: Prostitution Research and Education) 16 Assistant Deputy Ministers' Committee on Prostitution and the Sexual Exploitation of Youth, (2000) Sexual exploitation of youth in British Columbia. Vancouver: Ministry of the Attorney General 17 Mcintyre, S. (1995) The youngest profession: The oldest oppression Doctoral dissertation, Department of Law, University of Sheffield 18 Giobbe, E., Harrigan, M., Ryan, J. & Gamache, D. (1990). Prostitution: A Matter of Violence against Women. Minneapolis: WHISPER, Hunter, S. K. (1994) Prostitution is cruelty and abuse to women and children. Michigan Journal of Gender and Law 1: 1-14 14238 -18-

33. The diagnosis of posttraumatic stress disorder (PTSD) encompasses symptoms resulting from traumatic events, including the trauma of prostitution. PTSD can result when people have experienced "extreme traumatic stressors involving direct personal experience of an event that involves actual or threatened death or serious injury; or other threat to one's personal integrity; or witnessing an event that involves death, injury, or a threat to the physical integrity of another person; or learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associate." PTSD is characterized by anxiety, depression, insomnia, irritability, flashbacks, emotional numbing, and hyperalertness. Symptoms are more severe and longlasting when the stressor is of human design.

34. We found a PTSD prevalence rate of 68% among those in prostitution in 9 countries. Two thirds of those in prostitution met clinical criteria for a diagnosis of PTSD. This rate was among the highest for any group of people whose traumatic stress was evaluated. This rate of PTSD is comparable to the rates of PTSD among battered women seeking shelter, rape survivors, combat veterans, and survivors of state-sponsored torture. 19

35. Vanwesenbeeck noted symptoms among women in legal Dutch prostitution that are consistent with symptoms of PTSD.20 Results from two studies of

19 See Exhibit ""8" (Farley, M., Cotton, A., Lynne, J., Zumbeck, S., Spiwak, F., Reyes, M.E., Alvarez, D., Sezgin, U. (2003) Prostitution and Trafficking in 9 Countries: Update on Violence and Posttraumatic Stress Disorder. Journal of Trauma Practice 2 (3/4): 33-74) 20 Vanwesenbeeck found that ninety percent of women who were prostituted primarily in clubs, brothels, and windows reported "extreme nervousness." 14239 - 19 - prostituted Korean women reflect the women's intense psychological distress with

PTSD prevalence rates of 78% and 80% seventy-eight and eighty percent.21

F. Prostituted women use dissociation as a psychological defense against overwhelming physical pain, emotional distress, and the feeling that prostitution is inescapable.

36. Dissociation occurs during extreme stress among prisoners of war who are tortured, among children who are being sexually assaulted, and among women being battered, raped, or prostituted.22

37. Dissociative disorders are common among those in escort, street, massage, strip club and prostitution. Women report that they cannot prostitute unless they dissociate since the dissociation protects them from the massive invasion they are subjected to by johns who, as one put it, "rent an organ for 10 minutes" in prostitution. Chemical dissociation via use of drugs and alcohol facilitates psychological dissociation, and also functions as analgesic for injuries from violence.

38. Dissociation in prostitution results from both childhood sexual violence and sexual violence in adult prostitution. The dissociation that is necessary to survive rape in prostitution is the same as that used to endure familial sexual assault. Vanwesenbeeck noted that a dissociative proficiency contributed to what she described as "professional attitudes" among women in prostitution in the Netherlands.

39. A woman I interviewed explained the gradual development of a dissociated identity during the years she prostituted in strip clubs, an indoor prostitution venue.

21 See Exhibit "I" (Farley, M. and Sea, S. (2006) Prostitution and Trafficking in Asia. Harvard Asia Pacific Review Volume 8 Number 2 pages 9-12) 22 Herman, J. L. (1992) Trauma and Recovery. New York, Basic Books. 14240 - 20-

You start changing yourself to fit a fantasy role of what they think a woman should be. In the real world, these women don't exist. They stare at you with this starving hunger. It sucks you dry; you become this empty shell. They're not really looking at you, you're not you. You're not even there. 23

40. Another woman described a dissociative response to the trauma of prostitution: Prostitution is like rape. It's like when I was 15 years old and I was raped. I used to experience leaving my body. I mean that's what I did when that man raped me. I went to the ceiling and I numbed myself because I didn't want to feel what I was feeling. I was very frightened. And while I was a prostituted I used to do that all the time. I would numb my feelings. I wouldn't even feel like I was in my body. I would actually leave my body and go somewhere else with my thoughts and with my feelings until he got off and it was over with. I don't know how else to explain it except that it felt like rape. It was rape to me. 24

41. And also:

If anything a prostitute treats herself like a chair for someone to sit on. Her mind goes blank. She just lies there. You become just an object .... After a while it becomes just a normal thing. 25

42. A woman in a legal New Zealand massage parlor explained:

Memory is an amazing thing. I leave here [brothel] and I can't remember a thing. 26

23 See Exhibit "F" (Farley, M. "Bad for the Body, Bad for the Heart: Prostitution Harms Women Even if Legalized or Decriminalized" Violence Against Women 10: 1087-1125 24 Giobbe, E. (1991) Prostitution, Buying the Right to Rape, in Burgess, A.W. (ed.) Rape and Sexual Assault III: a Research Handbook. New York: Garland Press 25 McLeod, E. 91982) Women working: Prostitution Now. London: Croom Helm 26 Farley, M. (2003) Preliminary Report: New Zealand Prostitution. Unpublished Paper: Wellington, New Zealand. May 14, 2003 attached to this my Affidavit as Exhibit "P" - 21 - 14241

G. Prostitution more severely harms indigenous women because of their economic vulnerability, because of social and legal discrimination against them, and because of their lack of alternatives.

43. Race, sex, and class are multiplicative risk factors for prostitution. Nonetheless, those who promote legal prostitution rarely address class, race, and ethnicity as factors that make women significantly more vulnerable to the violence and health risks of prostitution.

44 Within the gendered institution of prostitution, race and class create a familiar hierarchy with indigenous women at its lowest point. Especially vulnerable to violence from wars or economic devastation, indigenous women are brutally exploited in prostitution - for example Mayan women in Mexico City, Hmong women in Minneapolis, Atayal girls in Taipei, Karen or Shan women in Bangkok, and First Nations women in Vancouver.

45. Aboriginal or First Nations women in Canada are at higher risk for all of the factors that increase vulnerability to prostitution: family violence including an epidemic of sexual violence, life-threatening poverty including , lack of educational and job opportunities, lack of health services throughout their lifetimes, and lack of culturally appropriate social services.

46. Indigenous people of Canada have suffered the brutal harms of colonization that affect every aspect of their lives. Compared to other groups, indigenous people in North America have suffered multiple and cumulative trauma. Prostitution is one specific legacy of colonization although it is infrequently understood or analyzed as such.

47. When we compared Maori! Pacific Islander New Zealanders in prostitution to European-origin New Zealanders in prostitution, the Pacific Islander/ Maori were 14242 - 22- more likely to have been homeless and to have entered prostitution at a young age. Mama T ere, an Auckland community activist, referred to NZ prostitution as an "apartheid system.,,27 Plumridge & Abel similarly described the New Zealand sex industry as "segmented" noting that 7% of the population in Christchurch were Maori, 28 but 19% of those in Christchurch prostitution were Maori. Similar findings from have been reported.

48. Among women in legal prostitution in New South Wales, Australia, Aboriginal women in prostitution were more likely to have entered prostitution at a very young age, more likely to have been homeless, and to have significantly more symptoms of depression than non-Aboriginal women in prostitution.29

49. In a study of Vancouver prostitution, we noted that 52% of the women in prostitution we interviewed were women from Canada's First Nations. Yet First Nations people in Vancouver generally comprise only 1.7-7% of the population. They experienced a horrific violence in prostitution: 90% had been physically assaulted in prostitution and 78% had been raped in prostitution. 72% of the Canadian women we interviewed met clinical criteria for a diagnosis of PTSD (symptomatic of intense emotional distress), which is among the highest of any groups studied.

50. A retrospective study of violence in the lives of 47 women in prostitution in three Western Canadian provinces indicates that Aboriginal Canadians are overrepresented in prostitution relative to their representation in the general

27 See Exhibit "P" Farley, M. (2003) Preliminary Report: New Zealand Prostitution. Unpublished Paper: Wellington, New Zealand. May 14, 2003 28 Plumridge, L & Abel, G. (2001) A "segmented" sex industry in New Zealand: sexual and personal safety of female sex workers. Australian and New Zealand Journal of Public Health 15(1): 78-83. 29 Roxburgh, A., Degenhardt, L. and Copeland, J. (2006) Posttraumatic stress disorder among female street-based sex workers in the greater Sydney area, Australia. BMC Psychiatry 6:24. Available at http://www. pubmedcentral. nih.gov/articlerender. fcgi?artid= 1481550 14243 - 23-

Canadian population, and also that they tended to stay in prostitution for a longer time than non-Aboriginal women. The authors interpret this to reflect the Aboriginal women's poverty and lack of access to other opportunities because of racism. The Aboriginal women reported being more frequently sexually harassed or assaulted by police than non-Aboriginal women.30

PIMPS

H. A majority of women in legal and illegal prostitution have pimps who control them either mentally or physically.

51. It is an error to assume that legal prostitution will remove the crime of pimping. Half of the women interviewed in a recent study of legal Nevada prostitution reported that they had pimps. Furthermore, they usually did not define their husbands and boyfriends as pimps even though they were supporting these men via prostitution. Thus the actual percentage of women in legal prostitution who are controlled by pimps may be even higher than 50%.

52. Legal brothels often have a "double layer" of pimps: the legal pimp who runs the brothel and an illegal pimp who controls the woman's income, outside the legal brothel.

I. Pimps use many of the methods used by torturers to mentally control women in prostitution.

53. These techniques include social isolation, sensory deprivation! torture, deliberately induced exhaustion and physical debilitation, threats to the woman in prostitution and to her family, occasional reprieves and indulgences, posturing as omnipotent, degradation and enforced dependency, enforcing capricious rules, deliberate creation of dissociated parts of the self who happily and willingly

30 Nixon, K. Tuttly, L., Down P., Gorkoff, K., Ursel, J. (2002) ''The Everyday Occurrence: Violence Against Women", Vol. 8, NO.9: 1016-1043 14244 - 24- prostitute, drugging and forced addiction, and forced pregnancy.

J. Pimps commonly engage in mentally and physically violent behavior against women in prostitution. These behaviors are the same as the behaviors experts currently define as being characteristic of relationships involving domestic violence.

54. Prostituted women are unrecognized victims of domestic violence by pimps.31 Pimps use methods of coercion and control just like those of other batterers: economic exploitation, social isolation, verbal abuse, threats, physical violence, sexual assault, captivity, minimization and denial of physical violence and abuse.32

55. Recruitment of women into prostitution often begins with brutal violence designed to break the victim's will. After physical control is gained, pimps use

psychological domination and brainwashing. Pimps est~blish emotional dependency as quickly as possible, beginning with changing a woman's name. This removes her previous identity and history, and also isolates her from her community. The purpose of pimps' violence is to convince women of their worthlessness and social invisibility, as well as to establish physical control and captivity. Over time, escape from prostitution becomes more difficult as the woman is repeatedly overwhelmed with terror. She is forced to commit acts which are sexually humiliating and that cause her to betray her own principles. The contempt and violence aimed at her are eventually internalized, resulting in a virulent self­ hatred which then makes it even more difficult to defend herself. Survivors report a

31 Stark, C. & Hodgson, C. (2003) Sister Oppressions: A Comparison of Wife Battering and Prostitution. In M. Farley (ed.) Prostitution, Trafficking, and Traumatic Stress. Binghamton: Haworth (see Exhibit UK") 32 Giobbe, E. (1991) Prostitution, Buying the Right to Rape, in Ann W. Burgess, (ed.) Rape and Sexual Assault III: aResearch Handbook. New York: Garland Press p 143-160; Giobbe, E. (1993) An Analysis of Individual, Institutional and Cultural Pimping, Michigan Journal of Gender & Law 1 :33-57.; Giobbe, E., Harrigan, M., Ryan, J., Gamache, D. (1990) Prostitution: A Matter of Violence against Women. WHISPER, Minneapolis, MN. 14245 - 25- sense of contamination, of being different from others, and self-loathing which last many years after breaking away from prostitution.

56. Sometimes pimps deliberately exploit the shame associated with prostituting.

K. The traumatic bond established between women in prostitution and their pimpl captors is the same as the bond between battered women and their batterers or kidnapped women and their captors.

57. Unless human behavior under conditions of captivity is understood, the emotional bond between those prostituted and pimps is difficult to comprehend. In escapable situations, humans form bonds with their captors. In the absence of other emotional attachments, women appear to choose their relationships with pimps and may be psychologically at home with men who exercise coercive control over them.

58. The terror created in the prostituted woman by the pimp causes a sense of helplessness, dependence, and paradoxically, bonding with the kidnapper! batterer! pimp. The Stockholm syndrome is a psychological strategy for survival in captivity. Attitudes and behaviors which are part of this syndrome include: 1) intense gratefulness for small favors when the captor holds life and death power over the captive; 2) denial of the extent of violence and harm which the captor has inflicted or is obviously capable of inflicting; 3) hypervigilance with respect to the pimp's needs and identification with the pimp's perspective on the world; 4) perception of those trying to assist in escape as enemies and perception of captors as friends; 5) extreme difficulty leaving one's captor!pimp, even after physical release has occurred. Paradoxically, women in prostitution may feel that they owe their lives to pimps. 14246 - 26-

59. In order for a woman to survive prostitution on a day-to-day basis, she must deny the extent of harm that pimps and johns are capable of inflicting. Since her survival may depend on her ability to predict others' behavior, she vigilantly attends to the pimp's needs and may ultimately identify with his worldview. This increases her chances for survival, as in the case of Patty Hearst who temporarily identified with her captors' ideology.33

L. Drug and alcohol abuse are associated with prostitution - but not in the ways commonly assumed.

60. A misconception about prostitution is that a large majority of prostitutes are drug-abusing women who begin prostituting to pay for a drug habit. Women in prostitution use drugs and alcohol to deal with the overwhelming emotions experienced while turning tricks. Drugs and alcohol function as analgesics for the traumatic physical and sexual assaults by johns and pimps that commonly occur in prostitution. A number of studies have shown that women increase recreational drug use to the point of addiction after entry into prostitution.

61. One group of addiction researchers found that 8% of women receiving treatment for addiction reported that their drug abuse preceded prostitution, whereas 39% reported that the prostitution preceded drug abuse. 34

62. In another study, 60% of a group of Venezuelan women in prostitution began abusing drugs and alcohol only after entry into prostitution.35

33 Barry, K. (1995) The Prostitution of Sexuality. NEW YORK: NYU PRESS 34 Lange, W.R., Ball, J.C., Pfeiffer, M.B., Snyder, F.R., & Cone, E.J. (1989) The Lexington addicts, 1971-1972: Demographic characteristics drug use patterns, and selected infectious disease experience. The International Journal of the Addictions 24(7): 609-626 35 Raymond,J.G., D'Cunha,J., Dzuhayatin, S.R., Hynes,H.P., Rodriguez, Z.R., and Santos, A.2002) A Comparative Study of Women Trafficked in the Migration Process. Amherst, MA. Coalition Against Trafficking in Women 14247 - 27 -

63. Pimps and traffickers control prostitutes by coercively addicting them to drugs. In a similar way, perpetrators of sexual abuse against children drug them in order to facilitate sexual attacks or to disorient and silence them.

M. Women in prostitution suffer from serious physical health problems that are unrelated to prostitution's legal status or to its indoor or outdoor location.

64. Chronic health problems result from sexual assault, battering, untreated health problems, and overwhelming stress and violence. Prostituted women suffer from all of these. Many of the chronic symptoms of women in prostitution are similar to the physical and emotional consequences of torture.

65. The longer women remained in prostitution, the higher their rates of sexually transmitted diseases. Women in the Netherlands who serviced more customers in prostitution reported more severe physical symptoms.

66. Cervical cancer is common among women who have been in prostitution. Two risk factors for cervical cancer are younger age at first sexual activity and overall number of sexual partners. Prostituted women have an increased risk of cervical cancer and also chronic hepatitis.

67. Traumatic brain injury (T81) occurs in prostitution as a result of being beaten, hit, kicked in the head, strangled, or having one's head slammed into objects such as walls or furniture or car dashboards. Strangulation is relatively more common in indoor prostitution.

68. 75% of the Canadian women we interviewed suffered injuries from violence that occurred during prostitution. These included stabbings and beatings, concussions, broken bones (broken jaws, ribs, collar bones, fingers, spines, skulls). 50% of the Canadian women in prostitution reported traumatic and violent assaults 14248 - 28- to their heads during prostitution that resulted in alteration of consciousness.36 Long term symptoms resulting form injuries to their brains reported by the Canadian women included trouble concentrating, memory problems, headaches, pain/numbness in hands/feet, vision problems, dizziness, problems with balance, and hearing problems.

69. In a study of prostituted women from three countries, 30% of Filipino women, 33% of Russian women, and 77% of US women reported head injuries.37

70. Common medical problems of women in prostitution included tuberculosis, HIV, diabetes, cancer, arthritis, tachycardia, , malaria, asthma, anemia, and hepatitis. Across many countries, about 25% of women in prostitution reported reproductive symptoms including sexually transmitted diseases (STD), uterine infections, menstrual problems, ovarian pain, abortion complications, pregnancy, hepatitis B, hepatitis C, infertility, syphilis, and HIV.

71. 15% reported stress-related gastrointestinal symptoms such as ulcers, chronic stomachache, diarrhea, and colitis. 14% of these women and children in prostitution reported respiratory problems such as asthma, lung disease, bronchitis, and pneumonia. 14% reported joint pain, including hip pain, knee pain, backache, arthritis, rheumatism, and nonspecific multiple-site joint pain.

72. We compared women in prostitution, with those who had escaped and who had been out of prostitution on average 1.5 years. Once women were out of prostitution, awareness of the severity of the violence increased, with, for example,

36 See Exhibit "E" (Farley, M, Lynne, J, and Cotton, A (2005) Prostitution in Vancouver: Violence and the Colonization of First Nations Women. Transcultural Psychiatry 42: 242-271) 37 Raymond, J., D'Cunha, J. Dzuhayatin, S.R. " Hynes, H.P., Ramirez Rodriguez, Z., and Santos, A. (2002). A Comparative Study of Women Trafficked in the Migration Process: Patterns, Profiles and Health Consequences of Sexual Exploitation in Five Countries (, the Philippines, Thailand, Venezuela and the United States). N. Amherst, MA: Coalition Against Trafficking in Women (CATW) 14249

- 29-

95% of the exited women reporting violent injuries resulting from prostitution, including a 95% incidence of traumatic head injury.38

N. Prostitution in any legal context places women in prostitution at the highest risk for HIV of any group that has been studied.

73. Current science regarding HIV is that women with multiple partners are at highest risk.39 The greater the number of sex partners, the higher that person's risk for HIV. Since women in prostitution have many sex partners, some having serviced thousands of johns, they are at the highest risk for HIV. Women in prostitution are frequently raped, and since rape also poses a grave HIV threat, this is an additional HIV risk factor for them.

74. In a study of prostitution in and Thailand, the more johns serviced, and the greater the number of sex partners, the greater the risk for HIV. Larson and Narain found that the higher the number of johns, and the higher the number of overall sex partners, the higher women's rate of HIV in Cambodia and Thailand.4o

75. While some people assume that johns generally use , this is a myth. A number of studies indicate that a majority of johns do not use condoms.

38 See Exhibit "8" (Farley, M., Cotton, A., Lynne, J., Zumbeck, S., Spiwak, F., Reyes, M.E., Alvarez, D., Sezgin, U. (2003) Prostitution and Trafficking in 9 Countries: Update on Violence and Posttraumatic Stress Disorder. Journal of Trauma Practice 2 (3/4): 33-74) 39 Terri Coles (2006) Multiple partnerships fueling AIDS epidemic. Reuters U.K. August 15, 2006. Discussing a paper by Daniel Halperin, USAID, Southern Africa, presented at the 16th Global AIDS conference in Toronto, Canada. 40 Heidi J. Larson and Jai P. Narain (2001) Beyond 2000: Responding to HI VIA IDS in the new millennium. New Delhi: World Health Organization (WHO) Regional Office for South­ East Asia. Retrieved November 15, 2005 from http://w3.whosea.org/EN/Section10/Section18/Section356/Section410.htm. page 17 14250 - 30-

Eighty-nine percent of Canadian johns refused condoms in one study.41 Given the poverty and homelessness associated with prostitution -- 75% of women in prostitution had been homeless in the 9-country study which included Canada - women in prostitution are vulnerable to being pressured or coerced by johns and pimps into not using condoms.

76. An economic analysis of use in India found that when 42 women used condoms, they were paid 66% to 79% less by johns. UK researchers concluded that because customers paid more money for not using condoms, extremely risky sex acts "can always be purchased.,,43

77. In another study, 47% of women in U.S. prostitution stated that men expected sex without a condom; 73% reported that men offered to pay more for sex without a condom; and 45% of women said that men became abusive if they 44 insisted that men use condoms.

INDOOR AND OUTDOOR PROSTITUTION COMPARED

O. There is little difference in prostitution's link with violence whether the prostitution takes place indoors or outdoors.

78 The sex industry morphs and expands in part as a result of developments in web technology, law, and community opinion. Phone sex and Internet sex via live

41 Cunningham, L.C. & Christensen, C. (2001) Violence against women in Vancouver's street level sex trade and the police response. Vancouver: PACE Society 42 Rao, V, Gupta, I, Lokshin, M, Jana, S. (2003) Sex Workers and the Cost of Safe Sex: The Compensating Differential for Condom Use in Calcutta. Journal of Development Economics. Vol 71 (2): 585-603 43 Loff, B, Overs, C, and Longo, P (2003) Can health programmes lead to mistreatment of sex workers? Lancet 36: 1982-3. June 7 2003. 44 Raymond, J., Hughes, D. & Gomez, C. (2001). Sex Trafficking of Women in the United States: Links Between International and Domestic Sex Industries. N. Amherst, MA: Coalition Against Trafficking in Women 14251 - 31 - video chat are forms of prostitution that were not developed at the time that the laws were enacted. Indoor prostitution includes massage brothels, escort prostitution, gentlemen's clubs, topless clubs, the commercial marriage market, sauna and nail parlor prostitution, strip clubs, lap dance clubs, and peep shows. Outdoor prostitution includes street locations, and automobiles or vans owned by johns or pimps.

79 Homes or apartments are rented for use as brothels for escort prostitution. The relative invisibility of indoor prostitution may increase its danger. When women prostitute indoors, the community is less likely to see then or notice their abuse. Sometimes when prostitution is indoors, neighbors do not even know that prostitution is occurring next door. No one lodges complaints until neighbors become irritated about a lack of parking space or until neighbors become suspicious about the steady stream of men going in and out of the house in 20 minute intervals.

80. Reports from many countries indicate that residential brothels and massage parlors are locations to which women are secretly trafficked from other countries and used in prostitution.

81. Women and children can be controlled in indoor prostitution in ways that they can not be controlled on the street. They can be locked in their rooms, heavily drugged, restrained, and beaten. Pimps who run indoor prostitution are no less dangerous than pimps who are visible on the street.

82. There is a myth that class privilege protects some women in prostitution.

Oemystifying this, Giobbe explained what lies beneath the trappings of class in prostitution: 14252 - 32-

My experience in prostitution gives the lie to ... common beliefs about the hierarchy of prostitution, the streets being the worst-case scenario and .. .[escorl] service being the best. ... aliI can say is, whether you turn tricks in a car by the Holland tunnel or in the Plaza Hotel, you still have to take off your clothes, get on your knees or lie on your back, and let this stranger use you in any way he PI eases .... 45

P. There is no evidence for the assumption that women either prostitute indoors or outdoors but not both. The same women are prostituted in both indoor and outdoor locations.

83. It is an error to assume that women prostitute in one location and stay there. In fact, they move between different kinds of prostitution, depending on the location of johns, the level of police harassment, and where the most money can be made - for example, near military bases or at sports events or business conventions.

84. Kramer found that 59% of 119 women in the US had been in one or more type of indoor prostitution - strip club, massage parlor, and/or escort prostitution - in addition to . 33% had been prostituted indoors for the longest period of time while 66% were involved in street prostitution for the longest time.46

85. In similar findings, I found that 46 NZ interviewees had been prostituted in many different kinds of prostitution, including escort, strip club, phone sex, , peep show, bar prostitution, street prostitution, brothel prostitution, and prostitution associated with a military base.47

86. In Nevada's system of legal prostitution, half of the women we interviewed had also prostituted in strip clubs or lap dance clubs, and another 50% also prostituted via

45 Giobbe, E. (1991) the Vox Fights, Vox, Winter 1991 46 Kramer, L (2003) Emotional Experiences of Performing Prostitution. In M. Farley (ed.) Prostitution, Traffficking, and Traumatic Stress. Binghamton: Haworth. 47 See Exhibit "P" (Farley, M. (2003) Preliminary Report: New Zealand Prostitution. Unpublished Paper: Wellington, New Zealand. May 14, 2003) 14253 - 33- escort agencies. Many had prostituted in illegal massage parlors, street prostitution, phone sex venues, peep shows, and at military bases.48

87. These findings are paralleled by a recent study of Scottish men who bought sex. 56% bought sex outdoors and 80% bought sex indoors, with many men buying

sex both in and outdoors. 49

Q. Prostitution damages women's sexuality, regardless of its physical location or its legal status.

88. For the person in it, prostitution is harmful to her sexuality. Women in prostitution have described it as "paid rape" and experts have understood it as sexual annihilation. Most people who have been in prostitution for any length of time have tremendous difficulty with sexual intimacy. Sex becomes a job, rather than an act of love or passion. Since the sex acts of prostitution mimic the sex acts of freely chosen sex, her chosen partner feels to her like a john.

89. Men who prostitute experience similar damage to their sexuality and to their sense of self, as well as symptoms of traumatic stress that are identical to women's.

90. The assault on women's sexuality in prostitution is overwhelming, yet invisible to most people. Survivors of prostitution and those analyzing and researching prostitution from the Netherlands, Norway, Australia, and the United States have described this process of sexual destruction. When women are turned into objects that men masturbate into or as an organ that is rented for 10

48 See Exhibit "0" (Farley, Melissa (2007) Prostitution and Trafficking in Nevada: Making the Connections. San Francisco: Prostitution Research and Education. 49 Macleod, J., Farley, M., Anderson, L., and Golding, J. (2008) Challenging Men's Demand for : A Research Report Based on Interviews with 110 Men Who Bought Women in Prostitution. Glasgow: Women's Support Project 14254 - 34- minutes, as one john explained - it causes immense harm to the person who is acting as receptacle. Prostitution and sexual liberation have got nothing to do with each other, they're exactly the opposite. I don't feel free with my body, I feel bad about it, I feel self-conscious. I don't really feel like my body's alive, I think of it more as bruised, as a weight. 50

91. Women in prostitution at first may make a conscious decision to mentally disconnect themselves from the specific parts of the body rented out by johns. Stating, "I save my vagina for my lover," one woman performed only or masturbation.51 Over time, however, this piecing-out of parts of the body in prostitution (johns get this part of the body, lovers get that one) results in somatoform dissociation. Sexual and other areas of her body are numbed. Her body itself becomes an internalized commodity. Her body itself is compartmentalized because of the trauma of prostitution.

R. Most research comparing indoor to outdoor prostitution has addressed only physical violence and not emotional violence.

92. On pages 1099-1103 of the research review article, "'Bad for the Body, Bad for the Heart:' Prostitution Harms Women Even if Legalized or Decriminalized" (Exhibit "F"), I reviewed 10 published reports and research studies that address violence in indoor prostitution, including discussion of similarities and differences between indoor and outdoor prostitution. Several studies found either no differences between the violence in indoor and outdoor prostitution or increased psychiatric symptoms among women in strip club prostitution.

50 Jaget, C. (1980). Prostitutes - Our Life. Bristol: Falling Wall Press. 51 Pheterson, G. (1996). The Prostitution Prism. Amsterdam: Amsterdam University Press 14255 - 35-

93. The same frequency of rape is reported by women in both escort and street

prostitution.52 Although some studies report greater physical violence in outdoor

prostitution, other studies report equal violence regardless of the physical location

of prostitution (see South African research study below).

94. When we think of what most people consider to be reasonable physical risk

- the differences between indoor and outdoor prostitution are minimal. 81 % of

women prostituting on the street in Glasgow experienced violence at the hands of

johns. Yet 48% of the women prostituting indoors were subject to frequent and

severe violence. 53

s. There are anecdotal and also empirical research accounts from many countries that johns in indoor prostitution present serious threats of physical and emotional violence to prostituted women.

95. Boyer, Chapman & Marshall suggested that women in indoor prostitution (such as strip clubs, massage brothels and ) had less control over the conditions of their lives and probably faced greater risks of exploitation, enslavement, and physical harm, than women prostituting on

the street. 54

52 Raphael, J. & Shapiro, D.L. (2002) Sisters Speak Out: The Lives and Needs of Prostituted Women in . Chicago, Illinois: Center for Impact Research 53 Church S, Henderson M, Barnard M, Hart G. Violence by clients towards female prostitutes in different work settings: questionnaire survey. BMJ. 2001 ;322:524-525. (3 March.) 54 Boyer, D., Chapman, L., & Marshall, B.K. (1993). Survival Sex in King County: Helping Women Out. Report Submitted to King County Women's Advisory Board. Seattle: Northwest Resource Associates - 36- 14256

96. Some women in prostitution have told me that they felt safer in street prostitution as compared to indoor brothels in USA and in New Zealand where they were not permitted by legal pimps to reject potential johns. They explained that on the street they could refuse violent-appearing or intoxicated customers. On the street, they reported, friends could also make a show of writing down the john's car license plate number, which they considered a deterrent to customer violence. A john could be easily traced using such methods, whereas a brothel john's identity would likely be protected by the brothel owning pimps, making it difficult to identify or prosecute him for violent behavior.

97. Women in brothels or escort agencies or strip clubs are not encouraged to complain about violence to pimp/owners. Sometimes, even after johns rape them, they are fired for their protests.

98. Sex Workers' Education and Advocacy Taskforce (SWEAT) in South Africa addressed the dangers of indoor escort prostitution by distributing a list of safety tips. These included the recommendation that while undressing, the prostitute should "accidentally" kick a shoe under the bed, and while retrieving it, should check for knives, handcuffs or rope. The SWEAT flyer also noted that fluffing up the pillow on the bed would permit searching there for weapons.

99. An indoor brothel owner in the Netherlands complained about an ordinance requiring that brothels have pillows in the rooms: "You don't want a pillow in the

[brothel's] room. It's a murder weapon." 55 Familiar with how customers treated women in prostitution, the Dutch pimp understood that johns are regularly murderous toward women.

55 Daley, S. (2001) New Rights for Dutch Prostitutes, but No Gain. New York Times. August 12, 2001. Accessed 8-25-2001 at: http://www.nytimes.com/2001/08/12/international/12DUTC.html 14257 - 37-

100. A San Francisco organization suggested to women in indoor escort prostitution: "be aware of exits and avoid letting your customer block access to those exits," "be aware of where your client (trick) is at all times, as much as possible," "shoes should come off easily or be appropriate for running in," and "avoid necklaces, scarves, across­ the-body shoulder bags or anything else that can be accidentally or intentionally be tightened around your throat." 56

101. At the 15th International AIDS conference in Bangkok (July 11-16, 2004), several groups presented information about the occupational health and safety of prostitutes. A Bangkok organization instructed women in indoor bar prostitution how to insert and pull out razor blades from their vaginas. This is understood to be a job requirement in the indoor bar prostitution setting where johns are sexually excited by the possibility of the genital mutilation of Thai women.

T. The emotional harm of prostitution is the same in indoor and outdoor prostitution, according to both research evidence and anecdotal reports.

102. Like Plumridge & Abel in New Zealand,57 my colleagues and I found more physical violence in street compared to brothel prostitution in South Africa. However, we found no difference in the incidence of extreme emotional distress or PTSD in these two types of prostitution. I conclude from this finding that the emotional experience of prostitution is intrinsically traumatizing regardless of its indoor or outdoor location.58

nd 56 st James Infirmary (2004 2 edition) Occupational Health and Safety Handbook. San Francisco: Exotic Dancers Alliance and STD Prevention and Control Services of the City and County of San Francisco 57 Plumridge, L & Abel, G. (2001) A "segmented" sex industry in New Zealand: sexual and personal safety of female sex workers. Australian and New Zealand Journal of Public Health 15(1): 78-83 58 Farley, M; Baral, I; Kiremire, M; & Sezgin, U. (1998) Prostitution in Five Countries: Violence and Posttraumatic Stress Disorder. Feminism & Psychology, 8 (4): 405-426) 14258 - 38-

103. In a separate study, we compared strip club! massage, brothel, and street prostitution in Mexico and found no differences in the prevalence of physical assault and rape in prostitution, of childhood sexual abuse, or symptoms of PTSD. We also found no differences in the percentages of Mexican women in brothel, street, or

strip club! massage prostitution who wanted to escape prostitution. 59

104. Documenting the profound emotional distress experienced by women in two kinds of prostitution, a Canadian study compared strip club (indoor prostitution) and street prostitution. The authors found that women prostituted in strip clubs had higher rates of dissociative symptoms and other serious psychiatric symptoms when compared to women in street prostitution.6o

105. Similarly, Vanwesenbeeck noted substantial emotional distress among women in legal indoor prostitution in the Netherlands. Investigating emotional distress in women who were prostituted primarily in clubs, brothels, and windows, Vanwesenbeeck found that 90% of the women reported "extreme nervousness."

U. Verbal abuse from johns in indoor prostitution poses a threat to prostituted women's mental health.

106. The harm of toxic verbal assaults from johns against those in prostitution is emotionally devastating, often outlasting the physical injuries. Yet the verbal abuse in prostitution is socially invisible just as other sexual harassment in prostitution is normalized and invisible to many people. Yet it is pervasive: 88% of 315

59 See Exhibit "B" (Farley, M., Cotton, A., Lynne, J., Zumbeck, S., Spiwak, F., Reyes, M.E., Alvarez, D., Sezgin, U. (2003) Prostitution and Trafficking in 9 Countries: Update on Violence and Posttraumatic Stress Disorder. Journal of Trauma Practice 2 (3/4): 33-74) 60 Ross, C.A., Anderson, G; Heber, S; & Norton, G.R. (1990). Dissociation and Abuse Among Multiple Personality Patients, Prostitutes and Exotic dancers. Hospital and Community Psychiatry 41: 328-330. 14259 - 39- prostituting women and adolescents in Canada, Colombia and Mexico described verbal abuse as intrinsic to prostitution.61

107. Verbal assaults in all types of prostitution are likely to cause acute and long­ term psychological symptoms. Explaining this process, one woman explained that over time, "It is internally damaging. You become in your own mind what these people do and say with you. You wonder how could you let yourself do this and why do these people want to do this to yoU?,132

PROBLEMS OF LEGALIZATION

v. The overwhelming majority of women in prostitution want to escape it, regardless of prostitution's legal status.

108. Women in prostitution tell researchers and service providers that what they want are the same things in life that most people want: stable housing, a job that affords them dignity and self-respect while paying for the basics in life, medical care, and protection and schooling for their children.

109. A Toronto, Canada report found that 90% of women in prostitution wanted to leave prostitution but could not.63 Our study in Vancouver, Canada revealed that

95% of women in Canadian prostitution wanted to escape it. 64

61 See Exhibit "8" (Farley, M., Cotton, A., Lynne, J., Zumbeck, S., Spiwak, F., Reyes, M.E., Alvarez, D., Sezgin, U. (2003) Prostitution and Trafficking in 9 Countries: Update on Violence and Posttraumatic Stress Disorder. Journal of Trauma Practice 2 (3/4): 33-74 62 See Exhibit "H" (Farley, M. (2003) Prostitution and the Invisibility of Harm. Women & Therapy 26(3/4): 247-280)

63 Elizabeth Fry Society of Toronto. (1987). Streetwork outreach with adult female prostitutes: Final Report, 5: 12-13 64 See Exhibit "E" (Farley, M, Lynne, J, and Cotton, A (2005) Prostitution in Vancouver: Violence and the Colonization of First Nations Women. Transcultural Psychiatry 42: 242-271 14260 - 40-

110. In a multicountry study of 854 people in prostitution in 9 countries including

Canada, we found that 89% of those in it wanted to escape prostitution. 65

111. In a study of legal Nevada prostitution, 81 % told us they wanted to escape it. 66 w. Legalization of prostitution does not reduce the stigma of prostitution.

112. According to advocates of legalization or decriminalization of prostitution, the primary harm of prostitution is the social stigma against prostitution. Those on all sides of the debate agree that women in prostitution are stigmatized. Socially invisible as full human beings, those in prostitution often internalize toxic contempt, , and racism directed against them.

113. Some have suggested that legalization or decriminalization would remove this social prejudice against women in prostitution. Yet the shame of those in prostitution remains after legalization or .decriminalization.

114. Women in legal Dutch prostitution were concerned about their loss of anonymity in systems of legal prostitution. Once officially registered as prostitutes, Dutch women feared that this designation would pursue them for the rest of their lives. Despite the fact that they would accrue pension funds if officially registered as prostitutes, the women still preferred anonymity. They wanted to leave prostitution as quickly as possible with no legal record of having been in prostitution.

65 See Exhibit "8" (Farley, M., Cotton, A., Lynne, J., Zumbeck, S., Spiwak, F., Reyes, M.E., Alvarez, D., Sezgin, U. (2003) Prostitution and Trafficking in 9 Countries: Update on Violence and Posttraumatic Stress Disorder. Journal of Trauma Practice 2 (3/4): 33-74) 66 See Exhibit "0" (Farley, Melissa (2007) Prostitution and Trafficking in Nevada: Making the Connections. San Francisco: Prostitution Research and Education) 14261 - 41 -

115. No one wants the business of prostitution operating in his community. Thus, zoning of the physical locations of sex businesses is a sine qua non of legalization or decriminalization. The regulation of prostitution by zoning is a physical manifestation of its social! psychological stigma. Whether in Turkish genelevs (walled-off multi-unit brothel complexes) or in Nevada brothels (ringed with barbed wire or electric fencing), women in state-zoned prostitution are physically isolated and socially rejected by the rest of society.

X. In Nevada, despite legal prostitution, the women in it are strongly stigmatized. They are treated as social outcasts.

116. The social stigma of Nevada brothel prostitution can be seen in everyday conversation, in social practices, and in legal and illegal practices that isolate the women in the brothels from the rest of the community.

Y. Legalization of prostitution does not make prostitution safer than illegal prostitution.

117. A su rvivor of prostitution stated, There are thousands of books and classes that provide women with information on self-defense and rape "avoidance" strategies. Some of the basic lessons they teach us are not to walk alone at night on dark deserted streets, not to get into cars with strange men, not to pick up guys in a bar, not to even let a delivery man into your home when you're by yourself. Yet this is what the 'Job" of prostitution requires; that women put themselves in jeopardy every time they turn a trick. And then we ask, 'How do you prevent it from leading to danger?" The answer is, you can't. Count the bodies. 67

67 Evelina Giobbe (1991) The Vox Fights, Vox, Winter 1991 14262 - 42-

118. 80th legal and illegal sex businesses are places where sexual harassment, sexual exploitation, and sexual violence occur with impunity. The definition of the "job" of prostitution is sexual harassment and sexual exploitation.

119. It is not possible to protect the health of someone whose "job" means that she faces a statistical probability of weekly rape. A Canadian woman in prostitution explained that "what is rape for others, is normal for US.,,68 A woman at a brothel in Nevada explained that legal prostitution was "like you sign a contract to be raped.,,69

120. A majority of women in German, South African, and Zambian prostitution told us that they did not think that legal prostitution would make them physically safer than illegal prostitution.

121. In a 2007 study of Nevada prostitution and trafficking, we found that 27% of the women had been pressured or coerced into an act of prostitution in the legal brothels, 24% had been physically assaulted in legal prostitution, and 15% had been threatened with a weapon in the legal brothels. 70

JOHNS z. Men who strongly support the institution of prostitution also tend to express a tolerance for rape.

122. Among 783 college undergraduates in the US, those men who were most accepting of statements rationalizing prostitution were also the most accepting of rape myths (attitudes that justify rape, for example: 'women say no but

68 See Exhibit "E" (Farley, M, Lynne, J, and Cotton, A (2005) Prostitution in Vancouver: Violence and the Colonization of First Nations Women. Transcultural Psychiatry 42: 242-271 69 See Exhibit "0" (Farley, Melissa (2007) Prostitution and Trafficking in Nevada: Making the Connections. San Francisco: Prostitution Research and Education) 70 See Exhibit "0" (Farley, Melissa (2007) Prostitution and Trafficking in Nevada: Making the Connections. San Francisco: Prostitution Research and Education) - 43- 14263

mean yes,' 'dressing provocatively causes rape,' 'women lie about having been raped,).71

123. In related findings, a study found a positive correlation between having used a prostituted woman and finding rape generally "appealing." 72 Another study noted that arrested johns who purchased prostitutes at least once a week strongly endorsed rape myths.73

AA. Recent research provides new empirical findings on the attitudes and behaviors of men who buy sex in indoor and outdoor prostitution.

124. It has been established that violent behaviors against women are associated with attitudes that promote men's beliefs that they are entitled to sexual access to women, that they are superior to women, and that they have license for sexual aggression.74

125. Prostitution Research & Education, the educational organization I am affiliated with, has begun a cross-cultural study of men who buy sex. In collaboration with agencies in India, Scotland, Cambodia, Spain, and USA, we have interviewed hundreds of johns. These interviews have shed light on some of the underlying attitudes and behaviors that drive men's demand for purchased sex.

71 See Exhibit "M" (Cotton, A., Farley, M., Baron, R. (2002) Attitudes toward prostitution and acceptance of rape myths. Journal of Applied Social Psychology 32: 1-8) 72 Sullivan, E., & Simon, W. (1998). The client: A social, psychological, and behavioral look at the unseen patron of prostitution. In J. E. Elias, V. L. Bullogh, V. Elias, & G. Brewer (Eds.), Prostitution: On whores, , and johns (pp.134-154). New York: Prometheus Books 73 Monto, M., & Hotaling, N. (1998, April). Predictors of rape myth acceptance among the male clients of female street prostitutes. Paper presented at the Annual Meeting of the Pacific Sociological Association. San Francisco, CA 74 White,J.W. & Koss, M.P. (1993). Adolescent Sexual Aggression Within Heterosexual Relationships: Prevalence, Characteristics, and Causes. In Barbaree, H.E., Marshall, W.L. & Laws, D.R.(eds.) The Juvenile Sex Offender. New York: Guilford Press; Koss, M., Goodman, A., Browne, L., Fitzgerald, G., Keita, G., Russo, N. (1994). No Safe Haven.Washington, D.C.: American Psychological Association 14264 - 44-

126. A man we interviewed explained that in prostitution, Guys get off on controlling women, they use physical power to control women, really. If you look at it, it's paid rape. You're making them subselVient during that time, so you're the dominant person. She has to do what you want. 75

127. We have recently completed data analysis on 110 johns in Scotland. A 2008 study, Challenging Men's Demand for Prostitution in Scotland: A Research Report Based on IntelViews with 110 Men Who Bought Women in Prostitution, was authored by Jan Macleod, Lynn Anderson, Jacqueline Golding and me. Attached to this my affidavit as Exhibit "Q" is a copy of our report. Some of our findings are set out below.

BB. Men who paid for sex in Scotland held deeply contradictory attitudes about prostitution.

128. Almost all (96%) of the men stated that to a significant extent (50% or more of the time) prostitution was a consenting act between two adults. At the same time, they held diametrically opposing attitudes about prostitution: 73% observed that women prostitute strictly out of economic necessity and 85% stated that women did not enjoy the sex of prostitution. cc. The johns we interviewed endorsed a number of rape-tolerant attitudes.

129. A third of the johns stated that rape happens because men get sexually carried away or their sex drive gets "out of control." 12% told us that the rape of a prostitute or was not possible. 10% asserted that the concept of rape simply does not apply to women in prostitution. 22% of the men explained that once paid for, the customer is entitled to do whatever he wants to the woman he buys.

n 75 See Exhibit "C (Melissa Farley (2006) Prostitution, Trafficking, and Cultural Amnesia: What We Must Not Know in Order To Keep the Business of Sexual Exploitation Running Smoothly. Yale Journal of Law and Feminism 18:109-144) 14265 - 45-

130. These attitudes clarify why prostitution is so dangerous for the women in it. One of the men we interviewed stated, 'They'll basically do anything for money." The belief that the money they paid cancelled out the harm or exonerated the punter was a recurring theme in our interviews.

DO. The johns' frequency of use of women in prostitution impacted their behavior toward non-prostituting women.

131. Johns who were more frequent users of women in prostitution were also significantly more likely to have committed sexually coercive acts against non prostituting women.

CONCLUSION

EE. Prostitution is not a choice according to the usual definition of the word choice which implies free selection of an option among several available alternatives.

132. Just as wife beating was historically viewed as having been provoked by the victim, prostitution is still viewed by some as a job choice to which the victim consents. This is an error. The great majority of those in prostitution - 85-95% - tell us that they do not have alternatives to prostitution for survival.

133. Prostitution is "chosen" as a job by those who have the fewest real choices available to them. Women in legal Dutch prostitution describe it as "volunteer ." Women who are marginalized because of a lack of education, because of race and ethnic discrimination, poverty, previous physical and emotional harm and abandonment are the people who are purchased by the john for prostitution.

134. It is confusing to many that women in prostitution appear to consent to prostitution. It is only when one looks carefully at both the context of the consent, 6 - 46- 1426 as well as past traumatic abuses, that this apparent consent to and promotion of prostitution by some women in the sex industry can be understood.

135. The critical question with respect to sex, race, and class-based discrimination in prostitution is not "did she consent?" but "has she been offered the real choice to exist without prostituting?" In the following three cases, each woman said that she consented to prostitution but in each situation, her living conditions made prostitution necessary for survival. An Indian woman said that prostitution was "better pay for what was expected of her in her last job, anyway;" women in most jobs in West Bengal, India, were expected to tolerate bosses' sexual exploitation in order to keep their jobs.76 A woman in Zambia, which had a ninety percent unemployment rate at the time, stated that she volunteered to prostitute in order to feed her family.77 A Turkish woman was divorced, and had no means of support in a fundamentalist state that discouraged women from working outside the home. She applied to work in a state-run brothel where police guarded the entrance.78

II. Comment Regarding the Methodology Used in my Research

136. In psychology, the larger the number of interviews conducted using standardized measures that can be replicated, the weightier the empirical evidence. This is simply common sense: a single interview carries far less weight than 850 interviews. When standardized conditions and measures are used to assess large numbers of people, greater confidence is permitted in drawing conclusions.

76 Chattopadhyay, M., Bandyopadhyay, S., & Duttagupta, C. (1994). Biosocial Factors Influencing Women to Become Prostitutes in India. Social Biology 41: 252- 259 77 Interview with Anonymous prostituting woman in Lusaka, Zambia (Feb. 17, 1996). 78 Interview with anonymous prostituted woman in Istanbul, Turkey (June 6, 1999) 14267 - 47 -

137. In my research, I use both quantitative and qualitative means of drawing conclusions. The statistical analyses are conducted on the quantitative data. The qualitative portion of the research -- individual respondents' comments and testimony - are used to exemplify and clarify the empirical findings.

138. All research is permeated with values. Researchers have our opinions, especially where gross violations of human rights are studied. It is dangerously na"lve for any researcher to assume that he or she is capable of absolute neutrality. Generally, psychologists agree that all of us approach research with a certain perspective in mind, and that we then posit hypothetical relationships, test them, and draw conclusions. I have made my perspectives and the hypotheses that I was evaluating clear in my research.

139. The research that I am presenting here - both my own and others' - has been subject to peer review. When submitted to a psychology or social science or mrdical journal, 3 reviewers who are experts in the field are asked by a journal editor to do a blind review, that is, a review of the article that has the authors' names removed. Each criticism and suggestion from every reviewer must be considered and responded to in order to be considered for publication. This process usually takes 6 months to a year.

140. Experts in psychological research who have reviewed my research have not questioned the samples selected for study. When studying people who are prostituting, it is understood by those who have done large-scale studies of prostitution that anything resembling what is called a "random sample" is impossible. Each researcher does his or her best to clarify who was interviewed, and how those people were contacted. This has been made very clear in all my research. 14268 - 48-

141. In psychological research, what is important is that the methodology is clearly specified, how the samples are obtained is specified, and also that the research questionnaires are described so that psychologists know what is being used. Psychological tests are rarely if ever offered in their entirety in journals, as this would compromise their future use by psychologists. Instead, author contact information is given, so that only qualified individuals are supplied with the measures so that they can replicate the research. Some of my research has been replicated by other individuals.

142. When I began the study of prostitution, like other researchers, I assumed that when I interviewed someone on the street, that was the only location where they prostituted. I assumed that when I interviewed someone in a strip club, that was the only location where she prostituted. And when I interviewed someone in a coffee shop who told me that she worked in a massage parlor, I assumed that was the only location where she prostituted. I was wrong. I have discovered that almost everyone prostitutes in more than one location, often several locations, both indoors and outdoors. Furthermore, the longer someone is in prostitution, the more likely they are to prostitute in a great many locations, sometimes up to 5 or 6 different kinds of venues. Thus the absolute distinction between "street" and "indoor" prostitution is outdated.

143. The assumption that if legal prostitution exists then the person will prostitute only in legal venues - is also outdated. Researchers have now found that people move back and forth between legal and illegal venues, depending on the money earned and other factors. 14269 - 49-

III. DIRECT RESPONSES TO DR. LOWMAN'S ASSERTIONS

Direct response to Assertion #3 on page 148 of Dr. John Lowman's Affidavit

144. Dr. Lowman defines as opportunistic that prostitution in which "a person makes a choice to prostitute mainly because of the financial reward in a situation where they do have other economic choices." He defines sexual slavery as a situation where "a person forces another to prostitute" and survival sex as "a person chooses to prostitute in a situation where they have very few or no other choices."

145. Distinctions between opportunistic prostitution, sexual slavery, and survival sex are impossible to detect in the real lives of women in prostitution. As I point out in my Affidavit, 89% of the 854 women and men I have interviewed in 9 countries stated that they were in prostitution because of a lack of alternatives. Dr. Lowman's Assertion #3 does not clarify the nature of force or coercion which might be poverty in some instances or a prior history of interpersonal abuse or violence in others.

146. Historical analyses have distinguished more severe from less severe harms associated with intrinsically harmful human institutions. Wife battering and slavery serve as examples.

147. People in prostitution tell us that the harms that are invisible and that leave no physical marks -relentless and toxic verbal abuse from pimps and johns alike, mental degradation, brainwashing, social isolation, the requirement that they smile while being harmed or else their children will be harmed - are the harms that last the longest, leave the most damaging emotional scars, and in some instances never heal. These are also precisely the harms that are ignored when we futilely attempt to distinguish opportunistic prostitution, survival sex, and sexual slavery. 14270 - 50-

148. This categorization of different types of prostitution ignores the structural inequities of sex inequality, poverty and class privilege, and racism that relentlessly channel women into prostitution. These are forces that truly coerce women into making the "choice" of prostitution. As one survivor eloquently stated, prostitution is the "choice that is not a choice."

Direct response to Assertion #26 on page 158 of Dr. John Lowman's Affidavit

149. While the extreme violence that Dr. Lowman refers to as "overkill" is dramatic to the observor, many homicides of prostituted women occur by the john's strangulation or suffocation of her in indoor prostitution.

Direct response to Assertion #30 on page 161 of Dr. John Lowman's Affidavit

150. Dr. Lowman stated that " .. .the vast majority of women working in massage parlours, escort services or as independent operators have not experienced any violence." There is an assumption here that physical violence is the only kind of violence in prostitution. This is an error. My Affidavit has described other kinds of interpersonal, mental, and emotional violence.

Direct response to Assertion #31 on page 162-164 of Dr. John Lowman's Affidavit

151. Some studies comparing indoor and outdoor prostitution have found higher rates of violence in outdoor prostitution. Yet violence also occurs in indoor prostitution at a level that is unacceptable. In Dr. Lowman's charts from Tamara O'Doherty's thesis, some rates of violence against women in indoor prostitution are given. 14271

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152. The difference between "independents" and "escorts" is not clear unless it is the case that "escorts" are prostituting for a pimp who owns an agency. Following are some examples of violence in these charts. Decimals are rounded up or down based on whether the value is less than 5 or 5 or greater:

153. In escort prostitution, 29% were threatened by johns and 17% threatened by a boss or pimp. 17% were threatened with a weapon. 25% were physically assaulted by johns and 13% were sexually assaulted by johns. 21 % reported kidnapping by johns. These are significant rates of violence.

154. In massage parlors, women reported that 13% were physically assaulted and 13% were sexually assaulted by significant others. This finding speaks to the surround of violence in prostitution, whether or not these significant others were pimps, as is often the case. The assumption seems to be made that significant others or bosses are not pimps, when this may not be true.

155. In independent prostitution, 15% of wor:nen reported threats from clients. 12% had been physically assaulted and 12% had been sexually assaulted. 8% reported kidnapping.

156. See my comments about indoor and outdoor prostitution stated in my conclusions "0 to "Y" above.

Direct response to Assertion #33 on page 164 of Dr. John Lowman's Affidavit

157. Dr. Lowman stated that women who prostitute in street prostitution "begin their work at quite a young age." In our study of legal indoor Nevada prostitution, 23% also told us that they began prostituting as children. 14272 - 52-

Direct response to Assertion #41 on page 169 of Dr. John Lowman's Affidavit

158. The presence of a maid indoors does not protect women from rape, attempted rape, strangulation or other physical violence. It does not protect women from toxic verbal abuse or emotional distress in response to acts of prostitution. Even panic buttons in brothels fail to elicit a speedy enough response from bouncers or security guards or maids to prevent johns' or other violence.

159. Flats are locations where extremely violent prostitution and trafficking of Eastern European women into London takes place. Flats are also the locations into which Asian women are increasingly trafficked into brothel prostitution on the western coast of North America.

Direct response to Assertion #42 on page 170 of Dr. John Lowman's Affidavit

160. Dr. Lowman states that those in prostitution "combine" prostitution on the street with indoor locations. It is obvious in this Assertion and as I have also pointed out in this Affidavit that we can not separate the street and indoor prostitution. Women are moved to wherever the demand for prostitution exists.

Direct response to Assertion #45 on page 171-2 of Dr. John Lowman's Affidavit

161. Dr. Lowman summarized the extreme violence reported in indoor prostitution by Raphael and Shapiro: 50% of women in escort prostitution reported rape, 51 % of strip club dancers had been threatened with a weapon, 33% of women using their homes as brothels had been threatened with rape or raped. Where Dr. Lowman cites research studies with larger samples, his Affidavit bears more similarity to the empirical studies that I am citing here. 14273 - 53-

162. On the other hand, anecdotal reports, often provided by individuals with a political agenda to legalize prostitution, are simply one person's opinion rather than scientific findings.

Direct response to Assertion #45 on page 172 of Dr. John Lowman's Affidavit

163. There is no evidence that survivors of prostitution are biased interviewers any more than any other interviewer is biased. Libby Plumridge, a New Zealand researcher whose data Dr. Lowman cites, employed currently prostituting women as interviewers.

164. As Ine Vanwesenbeeck drily remarked out in her landmark 1994 book on Dutch prostitution, the most common bias in our field is that researchers tend to view prostitution from the john's perspective.

165. I make this affidavit in response to this application, and for no other or improper purpose.

SWORN before me at the City of San Francisco, in the State of California, on thi~QY' 2008. ~- ~~=FCWJ Commissioner for Taking Affidavits Melissa~ l J 14274

Melissa Farley, Ph.D. I' I' Address: Box 16254, San Francisco CA 94116-0254 r1eotioned felerred to in the aUidavH of t11 J,'f.l" Phone: (415) 922-4555 Fax: (650) 756-2552 S(Int': ./1__ ana .PI'. ~ Email: [email protected] Swornb51orsms!his /~ f-dayof/"" / A.D. 20 (J f . hr/<..7

CURRICULUM VITAE ACommissioner lor taking affidavils

Degrees, Licenses, Internships ~~ Ph.D., 1973, University ofIowa, Counseling Psychology Internship approved by American Psychological Association, 1973 M.S., 1966, San Francisco State University, Clinical Psychology B.A., 1964, Mills College, Oakland, California, Psychology Licensed as a Psychologist in the State of California since 1988 (Lic# PSY10320)

Professional Memberships American Psychological Association Division 35, Psychology of Women, American Psychological Association National Register of Health Care Providers in Psychology International Society for Traumatic Stress

Clinical, Research, and Administrative Experience 2002- Editorial Board, Journal of Trauma Practice 1996- Director, Prostitution Research & Education, a nonprofit organization 1993-2000 Principal Investigator on grants from Kaiser Foundation Research Institute, Oakland, CA 1988-2000 Staff Psychologist, Dept of Psychiatry, Kaiser San Francisco 1974- Private practice in group, individual, and couples psychotherapy

Teaching 1989-1993 Supervision of psychology interns at Kaiser Hospital, San Francisco 1990-1991 "Group Psychotherapy" course taught at New College of California, San Francisco 1978-1982 "Women and Therapy" course taught at University ofIowa, School of Social Work 1976-1977 Development of Behavioral Medicine Program for Family Practice residents, University ofIowa School of Medicine

Dr. Farley has practiced as a clinical psychologist for 40 years. She brings that experience to her consultations with agencies, governments, and advocates for prostituted and trafficked women. She has articulated the harms of prostitution, pornography, and trafficking as an expert witness in forensic evaluations. She has been categorized as an expert on the effects of sexual violence against women and children, posttraumatic stress disorder, dissociation, and prostitution.

Dr. Farley has spoken and keynoted a number of conferences, speaking on prostitution and trafficking. In her work, she has consistently addressed the connections between prostitution, racism, poverty and both domestic and international trafficking. Farley has spoken about a trafficking syndrome, which reflects the overwhelming stress experienced by women as a result of being trafficked for the purpose of prostitution or other sexual exploitation.

She has a wide range of experience in teaching and consultation. Dr. Farley has provided consultation as an expert on the harm of prostitution to the Medical Examining Board of the State of California, San Diego, California 2002. She has provided evaluations of prostituted young women for Contra Costa County and for San Francisco County and has testified in the former which went to trial. She has conducted a forensic evaluation of a woman trafficked into the USA from Asia. In 2003 she met with US State Department-sponsored visitors from Estonia, Latvia and Lithuania, offering consultation regarding outreach and prevention of trafficking in women and children. Dr. Farley is an associate scholar with the Center for World Indigenous Studies, and has taught seminars on research for social activism at CWIS in Yelapa, Mexico. 14275

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Dr. Farley constructed and manages the Prostitution Research & Education website (l:!1:t12:i!w~~:y,pro~tutiimresear5~.b.com) which provides information about trafficking and prostitution, including a list of agencies offering services to women who have been in prostitution. The PRE website receives approximately 50,000 page views per month. Advocates across the globe have used materials on the website on behalf of women and children in prostitution. The site is contacted by survivors of prostitution, students, teachers, government officials, criminal justice personnel, social workers, legal advocates and nongovernmental agencies that are developing services to women who have been prostituted or trafficked.

Dr. Farley has also collaborated with a team of researchers in northern California at who are studying the long term effects of violence against women on their health and how that violence impacts preventive health care for women. Several peer-reviewed publications have resulted from this work.

Melissa Farley edited Prostitution, Trafficking & Traumatic Stress, 2003, a collection of 16 articles on these topics, published by Haworth Press. Farley is a contributing author to three chapters:

1) Prostitution and Trafficking in 9 Countries: Update on Violence and Posttraumatic Stress Disorder Melissa Farley, Ann Cotton, Jacqueline Lynne, Sybille Zumbeck, Frida Spiwak, Maria E. Reyes, Dinorah Alvarez, Ufuk Sezgin This article is currently being distributed by the Trafficking in Persons Office of the US State Dept.

2) Dissociation among Women in Prostitution Colin Ross, Melissa Farley, Harvey Schwartz

2) Prostitution and Trafficking of Women and Children from Mexico to the United States Marisa B. Ugarte, Laura Zarate, Melissa Farley

Publications Farley, Melissa (2007) Prostitution and Trafficking in Nevada: Making the Connections. San Francisco: Prostitution Research and Education.

Farley, M. (2007) 'Renting an Organ for 10 Minutes:' What Tricks Tell us about Prostitution, Pornography, and Trafficking. In D. Guinn (ed.) Pornography: Driving the Demand for International Sex Trafficking. Los Angeles: Captive Daughters Media.

Farley, M. (2006) Prostitution, Trafficking, and Cultural Amnesia: What We Must Not Know in Order To Keep the Business of Sexual Exploitation Running Smoothly. Yale Journal of Law and Feminism 18:109-144.

Farley, M. and Seo, S. (2006) Prostitution and Trafficking in Asia. Harvard Asia Pacific Review Volume 8 Number 2 pages 9-12

Farley, M, Lynne, J, and Cotton, A (2005) Prostitution in Vancouver: Violence and the Colonization of First Nations Women. Transcultural Psychiatry 42: 242-271.

Farley, Melissa (2005) Prostitution Harms Women Even ifIndoors: Reply to Weitzer. Violence Against Women 11 (7) 950-964 July 2005.

Farley, M. and Lynne, J. (2005) Prostitution ofIndigenous Women: Sex Inequality and the Colonization of Canada's First Nations Women. Fourth World Journal VoL 6 No.1, pp 1-29. Available at http://www.cwis.orgffwj!61/prostitution_oCindigenous_women.htm.

Farley, M., Golding, LM., Young, G., Muliigan, M., and Minkoff, J.R. (2004) Trauma History and Relapse Probability among Patients Seeking Substance Abuse Treatment. Journal of Substance Abuse Treatment 27:161-167. :--::.:. 14276 3

Farley, Melissa (2004) Prostitution is Sexual Violence. Psychiatric Times. October 2004 Special Edition. p 7- 10

Farley, M.(2004) "Bad for the Body, Bad for the Heart:" Prostitution Harms Women Even If Legalized or Decriminalized. Violence Against Women I 0: 1087-1125

Farley, M. (2004) Who are Johns? Conference Report: Demand Dynamics, the Forces of Demand in Global Sex Trafficking. October 18, 2003. Captive Daughters and International Human Rights Law Institute of DePaul University College of Law.

Farley, M., Cotton, A., Lynne, J., Zumbeck, S., Spiwak, F., Reyes, M.E., Alvarez, D., Sezgin, U. (2003) Prostitution and Trafficking in 9 Countries: Update on Violence and Posttraumatic Stress Disorder. Journal of Trauma Practice 2 (3/4): 33-74

Farley, M and Ugarte, M B. (2003) Prostitution and Trafficking are Migrant Health Concerns. Streamline: Migrant Clinicians' Network 1-3. PO Box 164285 Austin, TX 78716.

Farley, M (2003) (Editor) Prostitution, Trafficking, and Traumatic Stress. Binghamton, NY: Haworth.

Farley, M (2003) Prostitution and the Invisibility of Harm. Women & Therapy 26(3/4): 247-280.

Farley, M, Minkoff, JR., & Golding, J M. (2002) Is a History of Trauma Associated with a Reduced Likelihood of Cervical Cancer Screening? Journal of Family Practice 51 (10):827-831.

Farley, M (2001) Prostitution: The Business of Sexual Exploitation. Chapter in Encyclopedia of Women & Gender, Vol II: 879-891. J. Worell (ed.) New York, Academic Press.

Farley, and Patsalides, B (2001) Physical symptoms, Posttraumatic Stress Disorder, and Healthcare Utilization of Women with and without Childhood Physical and Sexual Abuse. Psychological Reports 89:595-606.

Farley, M, Minkoff, JR., Barkan, (2001) Breast Cancer Screening and Trauma History. Women & Health 34 (2): 15-27.

Farley, M and Kelly, V (2000) Prostitution: a critical review of the medical and social sciences literature Women & Criminal Justice, 11 (4): 29-64.

Farley, M (1999) Women in Prostitution. In Support for Survivors: Training for Sexual Assault Counselors, California Coalition Against Sexual Assault, Oakland, California.

Farley, M; Baral, I; Kiremire, M; & Sezgin, U. (1998) Prostitution in Five Countries: Violence and Posttraumatic Stress Disorder. Feminism & Psychology, 8 (4): 405-426.

Farley, M and Barkan, H. (1998) "Prostitution, violence against women, and posttraumatic stress disorder," Women & Health, Vol. 27, (3): 37-49.

Farley, M A feminist perspective on prostitution and . Proceedings, Gender & Tourism Conference, University of California, Davis, CA October 1997.

Farley, M. and Barkan, H. (1997) Posttraumatic Stress Disorder, Dissociation, and Pathological Tension­ Reducing Behaviors. Psychotherapy and Psychosomatics, Vo!' 66: 133-140.

Farley, M. and Keaney, J. (1997) Physical Symptoms, Somatization, and Dissociation in Adult Women Survivors of Childhood Sexual Assault. Women and Health, Vo!' 25 (3): 33-45.

Farley, M. and Keaney, J. (1994) Development of a scale to measure physical symptoms in adults who report childhood trauma: a pilot study. Family Violence and Sexual Assault Bulletin, 10 (1-2): 23-27. 14277

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Baral, L, Sezgin, U. and Farley, M. (1998) The Traumatic Consequences of . Archives of Neuropsychiatry (Turkey), 35: 1,23-28.

Cotton, A, Farley, M and Baron, R (2002) Attitudes toward Prostitution and Acceptance of Rape Myths. Journal of Applied Social Psychology 32 (9): 1790-1796.

Keaney, J. and Farley, M. (1996) Dissociation in an outpatient sample of women reporting childhood sexual abuse. Psychological Reports, 78: 59-65.

Ross, c., Farley, M., & Schwartz, H. (2003) Dissociation among Women in Prostitution Journal of Trauma Practice 2(3/4).

Ugarte, M.B., Zarate, L., & Farley, M. (2003) Prostitution and Trafficking of Women and Children from Mexico to the United States. Journal of Trauma Practice 2(3/4).

Zumbeck, S., Teegen, F., Dahme, B & Farley, M. (2003) Posttraumatische Belastungsstorung bei Prostituierten - Ergebnisse einer Hamburger Studie im Rahmen eines internationalen Projektes. Zeitschrift fur Klinische Psychologie Psychiatrie und Psychotherapie 51 (2): 121-136.

Selected Presentations

Farley, Melissa (2007) The effects ofa prostitution culture on men and women in Nevada. Conference on Prostitution, Trafficking, and Demand: Making the Links. Glasgow Inter Agency Working Group on Trafficking. December 5, 2007

Farley, Melissa (2007) Trafficking for Prostitution: Making the Connections. Invited Symposium. American Psychological Association 115th Annual Convention. San Francisco California August 17, 2007.

Farley, Melissa (2007) "What do we know about men who buy sex?" Conference on Child Trafficking. Fuller Theological Seminary, Pasadena California. April 28, 2007

Farley, Melissa (2007) Pornography, Prostitution, and Sex Trafficking: Same Industry, False Distinctions. Pornography and Pop Culture: Reframing Theory, Rethinking Activism. Wheelock College, Boston, March 24,2007.

Farley, Melissa (2007) Psychological Trauma Caused by Being Trafficked into Prostitution. Human Sex Trafficking Conference: Raising Awareness in Social Service Communities. San Francisco State University Department of Social Work March 12,2007.

Farley, Melissa (2006) Trafficking and Prostitution: Invading Women's Human Rights. International Conference on the Links between Prostitution and Trafficking: Focusing on Women's Human Rights and the Issue of Demand. Seoul, Korea. September 6, 2006.

Farley, Melissa (2006) Harm Reduction or Harm Elimination? Global Technical Consultation on HIV and . Rio de Janeiro, . July 13, 2006.

Farley, Melissa (2006) What we know about the effects of legalized prostitution. Legalization Dialogue. Kolkata India. June 3, 2006.

Farley, Melissa (2006) 'Renting an Organ for 10 Minutes: Spanish and US Men's Attitudes Toward Prostitution. Challenging Demand Conference. Glasgow, Scotland. May 18,2006.

Farley Melissa (2006) What Must We Not Know in Order to Keep the Business of Sexual Exploitation Running Smoothly? Sexual Trafficking: Breaking the Crisis of Silence, an International Conference. Chapel Hill, North Carolina April 7, 2006.

Farley, Melissa (2005) Presentation to New York State Judges. Prostitution, Trafficking, and Domestic 14278

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Violence: understanding and innovation. Sponsored by New York State Judicial Committee on Women in the Courts. White Plains, NY November IS, 2005.

Farley, Melissa (2005) Prostitution and Family Violence. World Conference on Prevention of Family Violence. Banff, Canada, October 24,2005

Farley, Melissa (2005) Prostitution, Trafficking, and Traumatic Stress. International Congress on Trafficking for Sexual Exploitation. Madrid, Spain. October 27,2005.

Farley, Melissa (2005) Intimate connection between prostitution and trafficking. Western Regional Task Force Training Seminar on . San Diego, CA Sept 30, 2005.

Farley, Melissa (2005) Prostitution, Trafficking, and Traumatic Stress. Grand Rounds, San Francisco General Hospital, August 26, 2005.

Farley, Melissa (2005) Prostitution, Trafficking and Traumatic Stress. 6th Annual Conference on Race and Diversity Issues. Kern County Mental Health System. Bakersfield, CA. AprilS, 2005.

Farley, Melissa (2004) Domestic Violence, Trafficking, and Prostitution: Common Themes, Common Challenges. Speech at conference sponsored by Fordham University School of Law, Lawyers Committee Against Domestic Violence, and New York State Judicial Committee on Women in the Courts. NY, NY. March 1, 2004.

Farley, Melissa (2003) The Health ofIncarcerated Women: Prostitution, HIV and Violence. Panel presentation at American Public Health Association. San Francisco. Nov 19,2003.

Farley, Melissa (2003) Emerging from Invisibility: The Complex Challenges of Recovery for Women Victimized by Prostitution. Invited Symposium at International Society for Traumatic Stress Studies 19th Annual Meeting, Chicago Illinois. October 31, 2003.

Farley, Melissa (2003) Prostitution, Trafficking and Public Health. Panel presentation at Parallel Worlds: San Diego and Tijuana. Third Annual Bilateral Safety Corridor Coalition Conference. August 27,2003.

Farley, Melissa (2003) Johns: prostitutedwomen's accounts, social science anecdotes, but little research. Panel Presentation Prostitution: a Perspective on the customer's domination of women. 111 th Annual Meeting of the American Psychological Association. August 2S, 2003. Toronto, Canada.

Farley, Melissa (2003) Prostitution, Sexual Assault, and Trafficking of Women & Children (keynote) Arte Sana Training Institute: Reaching las Familias: Empowering Our Communities. Austin Texas April 3, 2003.

Farley, Melissa (2003) Prostitution and Trafficking: Working with Victims of Trafficking Stress Syndrome. Speech at Arizona's Tri-County Battered Immigrant Women Project. Tucson, Arizona. March 28,2003.

Farley. Melissa, Ackerman, Rosalie, and Banks, Martha (2003) Traumatic Brain Injury: Assessment of a Little-Known Sequela of Prostitution. The 9th National Conference on Abuse of Children and Adults with Disabilities. Riverside, CA. March 12 2003.

Farley, Melissa (2003) Prostitution: Male Violence Against Women. Panel at Commission on the Status of Women sponsored by Coalition Against Trafficking in Women. New York, NY. March 4, 2003.

Farley, Melissa (2002) The Origins of Trafficking in Colonization and Prostitution Presentation at The Human Rights Challenge of Globalization in Asia-Pacific-USA: The Trafficking in Persons, Especially Women and Children. Honolulu, Hawaii. November 142002.

Farley, Melissa (2002) Trauma and Substance Abuse: What's the Connection? (keynote speech) Illinois Coalition Against Sexual Assault. Lisle, Illinois. November 8, 2002. 14279

6

Farley, Melissa (2002) Witnessing Prostitution. Speech at International Day of No Prostitution, Berkeley, California. October 5, 2002.

Farley, Melissa (2002) Prostitution and Sexual Violence (keynote speech) Nebraska Sexual AbuselDomestic Violence Coalition. Lincoln, Nebraska September 25, 2002.

Farley, Melissa (2002) Escort Prostitution for Teenage Girls: Job Opportunity or Sexual Abuse? (keynote speech) Iowa Gender-Specific Services Task Force. Ames, Iowa. May 17,2002.

Farley, Melissa (2001) Prostitution and Homelessness: the Traumatic Effects of Violence against Women (keynote speech) at Prostitution: A Violent Reality of Homelessness, conference sponsored by Chicago Coalition for the Homeless, Chicago, Illinois, May 23,2001.

Farley, Melissa (2001) Racism, Gender, and the Global Sex Trade in Women. 45th session of Commission on the Status of Women, United Nations, New York. March 72001.

Farley, Melissa (2001) Consent and Coercion in Prostitution New York University Law School symposium on Prostitution, Trafficking, and the Global Sex Trade in Women March 2 200 I

Farley, Melissa (2001) The Prostitution Paradigm and Campus Sexual Violence (keynote speech) Technical Assistance Institute for the Grants to Combat Violent Crimes against Women on Campuses Program, University of Arizona, Tucson.

Farley, Melissa (2000) "Trafficking in Women and Children: a Global Mental Rights Work Issue." World Mental Health Day sponsored by NGO Committee on Mental Health and International Labor Organization, United Nations, New York, October 10, 2000.

Farley, Melissa (2000) Homelessness and Sexual Exploitation (keynote speech) Fourth Annual San Francisco Bay Area Regional Homeless Perinatal Conference. Oakland California April 7 2000.

Farley, Melissa (1999) Prostitution, Torture, and Human Rights Violations" Sixth European Conference on Traumatic Stress. European Society for Traumatic Stress Studies. Istanbul, June 7, 1999.

Farley, Melissa (1999) "The Price Women Pay: Mental and Physical Health Effects of Sexual Exploitation," Presentation to Commission on Status of Women, United Nations, New York, March 8,1999

Farley, M., Becker, T., Cotton, A., Sawyer, S., Fitzgerald, L., Jensen, R. (1998) "The Attitudes toward Prostitution Scale: College Students' Responses Compared to Responses of Arrested Johns." 14th Annual Meeting ofthe International Society for Traumatic Stress Studies, Washington, D.C., November 21, 1998.

Farley, Melissa (1997) "Prostitution, Slavery and Complex PTSD," Paper presented at 13th Annual Meeting of International Society for Traumatic Stress Studies, Montreal, Canada, November 8, 1997.

Farley, Melissa (1996) "Prostitution and Posttraumatic Stress Disorder: Data from United States, Thailand, and Zambia," Paper presented at Psychosocial and Behavioral Factors in Women's Health: Research, Prevention, Treatment and Service Delivery in Clinical and Community Settings, sponsored by American Psychological Association, Washington, D.C. September 19, 1996.

Farley, Melissa and Felitti, Vincent (1996) "The significance of physical, sexual and psychological abuse to delayed recovery and somatization: practical strategies for primary care, " First Interregional Conference on Primary Care, Occupational Health, Physical Therapy, and Musculoskeletal Medicine, Oakland, California.

Farley, Melissa (1996) "Trauma History, Somatization, and Healthcare Utilization," Behavioral Medicine Update, Kaiser Regional Psychological Society, Oakland, California, March 30, 1996. (6 MCEP credits). 14280

7

Farley, Melissa (1996) "Sexual Abuse and Medical Disorder," Research Grand Rounds, Regional Videoconference Series, with Vincent Felitti, M.D. and Jerome Minkoff, M.D. April 18, 1996 (1 CME credit).

Farley, Melissa (1995) "Impact of two types of early trauma on somatization and healthcare utilization," paper presented at 11 th Annual Meeting of International Society for Traumatic Stress Studies, Boston, Massachusetts, November, 1997.

Cotton, A., Farley, M., Baron, R. (2002) Attitudes toward prostitution and acceptance of rape myths. Journal of Applied Social Psychology 32: 1-8.

Cotton, Ann, Farley, Melissa, and Schmidt, Megan (2001) "Prostitution Myth Acceptance, Sexual Violence, and Pornography Use. Presentation at Annual Meeting of the American Psychological Association, San Francisco CA. August 27,2001.

Golding, J. M., Farley, M., & Minkoff, J. R. (2001) Childhood abuse and cervical cancer screening. Presented at the 109th Annual Meeting of the American Psychological Association, San Francisco. August 2001.

Schmidt, M., Cotton, A & Farley, M. (2000) Attitudes toward prostitution and self-reported sexual violence. Presentation at the 16th Annual Meeting of the International Society for Traumatic Stress Studies, San Antonio, Texas, November 18, 2000. 14281

Prostitution and Trafficking in Nine Countries: An Update on Violence and Posttraumatic Stress Disorder

Melissa Farley II 1/ Ann Cotton ..... ,' ~.: ~_ f'1en!ioned and relerred to in the allidavIT 01 .0.r. Jacqueline Lynne , :f';- .(11 do t,.rr :I"'" ,: :;~:ore me lniS_1 _day 01 m, , A.D. ~r-.. r / L-/ Sybille Zumbeck . I ~'".1' ACOIT,missioner lor laKing affidavits Frida Spiwak Maria E. Reyes ~ Dinorah Alvarez Ufuk Sezgin (il~~J\ \~~,<:::::!4~ SUMMARY. We interviewed 854 people currently or recently in pros .fiav.~() tution in 9 countries (Canada, Colombia, Germany, Mexico, South Af-

Melissa Farley, PhD, is at Prostitution Research & Education, Box 16254, San Francisco, CA 94116-0254 USA (Email: [email protected]). Ann Cotton, PsyD, is at University of Washington School of Medicine anq VA Puget Sound Health Care System, Seattle, WA USA (Email: [email protected]). Jacqueline Lynne, MSW, is at Vancouver Coastal Health, Vancouver, Canada. Sybille Zumbeck, PhD, is at Psychological Institute III, University of Hamburg, Gennany. Frida Spiwak, PhD, is in Bogota, Colombia (Email: [email protected]). Maria E. Reyes, PhD, is at Instituto Colombia no de Bienestar Familiar (ICBF) in Bogota, Colombia. Dinorah Alvarez, BA, is at San Francisco State University, CA USA. Ufuk Sezgin, PhD, is at the Psychiatry Department oflstanbul Medical University, Istanbul, Turkey (Email: [email protected]). The authors express their appreciation to Steven N. Gold, PhD, and to Harvey L. Schwartz, PhD, for their helpful editing suggestions. Printed with permission.

[Haworth co-indexing entry note]: "Prostitution and Trafficking in Nine Countries: An Update on Vio­ lence and Posttraumatic Stress Disorder." Farley et al. Co-published simultaneously in Journal ojTrauma Practice (The Haworth Maltreatment & Trauma Press, an imprint of The Haworth Press, Inc.) Vol. 2, No. 3/4, 2003, pp. 33-74; and: Prostitution, Trafficking, and Traumlllic Stress (cd: Melissa Fadey) The Haworth Mal­ U'eatment & Trauma Press, an imprint of The Haworth Press, Inc., 2003, pp. 33-74. Single or multiple copies of this article are available for a fee from The Haworth Document Delivery Service [1-800-HAWORTH, 9:00 a.m. - 5:00 p.m. (EST). E-mail address:[email protected]). http://www.haworthpress.com/store/product.asp?sku=J 189 lO.1300/J189v02n03_03 33 14282

34 PROSTITUTION, TRAFFICKING, AND TRAUMATIC STRESS

rica, Thailand, Turkey, United States, and Zambia), inquiring about current and lifetime history of sexual and physical violence. We found that prostitution was mu1titraumatic: 71 % were physically assaulted in prostitution; 63% were raped; 89% of these respondents wanted to es­ cape prostitution, but did not have other options for survival. A total of 75% had been homeless at some point in their lives; 68% met criteria for PTSD. Severity of PTSD. symptoms was strongly associated with the number of different types of lifetime sexual and physical violence. Our findings contradict common myths about prostitution: the as­ sumption that street prostitution is the worst type of prostitution, that prostitution of men and boys is different from prostitution of women and girls, that most of those in prostitution freely consent to it, that most peo­ ple are in prostitution because of drug addiction, that prostitution is qual­ itatively different from trafficking, and that legalizing or decriminalizing prostitution would decrease its harm.

INTRODUCTION

Commercial sex businesses include street prostitution, massage brothels, escort services, outcall services, strip clubs, lap dancing, phone sex, adult and (including the sexual assault of children by organized groups of pedophiles as well as non-pedophile rapists), , video and Internet pornography, trafficking, and prostitution tourism. Most people who are in prostitution for longer than a few months drift among these various permutations of the commercial sex businesses (Dalla, 2000; Kramer, 2003). Prostitution dehumanizes, commodifies and fetishizes women, in contrast to non-commercial casual sex where both people act on the basis of sexual de­ sire and both people are free to retract without economic consequence. In pros­ titution, there is always a power imbalance, where the johnt has the social and economic power to hire her/him to act like a sexualized puppet. Prostitution excludes any mutuality of privilege or pleasure: its goal is to ensure that one person does not use her personal desire to determine which sexual acts do and do not occur-while the other person acts on the basis of his personal desire (Davidson, 1998). The account of a woman from the United States who prostituted primarily in strip clubs but also in massage, escort, and street prostitution is typical in that it encompasses the following types of violence. In strip club prostitution she was sexually harassed and assaulted. The job required her to tolerate verbal abuse (with a coerced smile), being grabbed and pinched on the legs, buttocks, 14283

Farley et al. 35 breasts, and crotch. Sometimes this resulted in bruises and scratches on her thighs and arms and breasts. Her breasts were squeezed until she was in severe pain. She, was humiliated by customers ejaculating on her face. She was physi­ cally brutalized, and her hair was pulled as a means of control and torture. She was severely bruised from beatings and frequently had black eyes. She was re­ peatedly beaten on the head with closed fists, sometimes causing concussions and unconsciousness. From these beatings, her jaw was dislocated and her ear­ drum was damaged. Many years later her jaw is still dislocated. She was cut with knives. She was burned with cigarettes by customers who smoked while raping her. She was gang raped. She was raped individual1y by at least twenty men at different times in her life. Rapes by johns and pimps sometimes re­ sulted in internal bleeding. Seventy percent of women in prostitution in San Francisco, California were raped (Silbert & Pines, 1982). A study in Portland, Oregon found that prosti­ tuted women were raped on average once a week (Hunter, 1994). Eighty-five percent of women in Minneapolis, Minnesota had been raped in prostitution (Parriott, 1994). Niriety-four percent of those in street prostitution experienced sexual assault and 75% were raped by one or more johns (Miller, 1995). In the Netherlands (where prostitution is legal) 60% of prostituted women suffered physical assaults; 70% experienced verbal threats of assault, 40% experienced sexual violence and 40% were forced into prostitution andlor sexual abuse by acquaintances (Vanwesenbeeck, de Graaf, van Zessen, Straver, & Visser, 1995; Vanwesenbeeck, 1994). Prolonged and repeated trauma usually precedes entry into prostitution. From 55% to 90% of prostitutes report a childhood sexual abuse history (James & Meyerding, 1977; Silbert & Pines, 1981; Harlan et aI., 1981; Silbert & Pines, 1983; Bagley & Young, 1987; Simons & Whitbeck, 1991; Belton, 1992; Farley & Barkan, 1998). Silbert and Pines (1981, 1983) noted that 70% of their interviewees said that childhood sexual abuse had an influence on their entry into prostitution. A conservative estimate of the average age of recruitment into prostitution in U.S.A. is 13-14years. (Silbert & Pines, 1982; Weisberg, 1985). Clearly, violence is the norm for women in prostitution. Incest, sexual ha­ rassment, verbal abuse, stalking, rape, battering, and torture-are points on a continuum of violence, all of which occur regularly in prostitution. In fact, prostitution itself is a form of sexual violence that results in economic profit for those who sell women, men, and children. Though often denied or mini­ mized, other types of gender violence (while epidemic) are not sources of mass revenue. 14284 36 PROSTITUTION, TRAFFICKING, AND TRAUMATIC STRESS

Prostituted women are unrecognized victims of intimate partner violence by pimps as well as johns (Stark & Hodgson, 2003). Although there are little research data available, agencies serving prostituted women observe that a ma­ jority of prostitution is pimp-controlled.2 Giobbe described similar methods of coercion and control used by pimps and non-pimp batterers to control women: minimization and denial of physical violence and abuse, economic exploita­ tion, social isolation, verbal abuse, threats, intimidation, physical violence, sexual assault, and captivity (Giobbe, 1991; Giobbe, 1993; Giobbe, Harrigan, Ryan, & Gamache, 1990). The systematic violence of pimps against prosti­ tuted women is aimed not only at control, but also emphasizes the victim's powerlessness, worthlessness and invisibility except in her role as prostitute. A qualitative distinction between prostitution of children and prostitution of adults is arbitrary and it obscures the lengthy and extensive history of trauma that is commonplace in prostitution. For example the 5-year-old incested by her father and used in child prostitution and pornography may become par­ tially amnesic for these traumas and at adolescence may find herself drifting into prostitution 'and other savage relationships. The 14-year-old in prostitu­ tion eventually turns 18 but she has not suddenly made a new "vocational choice." The abuse and reenactment of abuse simply continue. Women who be­ gan prostituting as adolescents may have parts of themselves that are dissociatively compartmentalized into a much youngerchild's time and place.3 Posttraumatic stress disorder (PTSD) can result when people have experi­ enced

... extreme traumatic stressors involving direct personal experience of an event that involves actual or threatened death or serious injury; threat to one's personal integrity; witnessing an event that involves death, in­ jury or a threat to the physical integrity of another person; learning about unexpected or violent death, serious harm, or threat of death or injury ex­ perienced by a family member or other close associate. (American Psy-' chiatric Association, 1994)

In fact'most prostitution, most of the time includes these traumatic stressors. In response to these events, the person with PTSD experiences fear and power­ lessness, oscil1ating between emotional numbing and emotional/physiologic hyperarousal. PTSD is likely to be especially severe or long lasting when the stressor is planned and implemented by humans (as in war, rape, incest, batter­ ing, torture, or prostitution) rather than being a natural catastrophe. Exposure to paid or unpaid sexual violence may result in symptoms of PTSD. Symptoms are grouped into three categories: (1) traumatic fe-experi­ encing of events, or flashbacks; (2) avoidance of situations which ·are rerrii- 14285

Farley el al. 37

niscent of the traumatic events, and a protective emotional numbing of responsiveness; and (3) autonomic nervous system hyperarousal (e.g., jittery irritability, being super-alert, insomnia). The symptoms of PTSD may accu­ mulate over one's lifetime. Many studies report a positive correlation between a history of childhood sexual assault and symptoms of PTSD in adult women (Friedman & Schnurr, 1995; Rodriguez, Ryan, Van de Kemp, & Foy, 1997). Since almost all prostituted women have histories of childhood sexual abuse, this undoubtedly contributes to their symptoms of posttraumatic stress. PTSD is not only related to the overall number of traumatic events, but it is also di­ rectlyrelated to the severity of that violence (Houskamp & Foy, 1991). The in­ cidence of PTSD has been investigated among battered women and ranges from 45% to as high as 84% (Houskamp and Foy, 1991; Saunders, 1994; Kemp, Rawlings, & Green 1991). The prevalence ofPTSD among prostituted women from 5 countries was 67% (Farley, Baral, Kiremire, & Sezgin, 1998), which is in the same range as that of combat veterans (Weathers, Litz, Herman, Huska, & Keane, 1993). Following publication of an article which discussed the violence preceding and intrinsic to prostitution, and the symptoms of posttraumatic stress disorder resulting from prostitution in 5 countries-(South Africa, Thailand, Turkey, United States, and Zambia)-the authors were contacted by other researchers and advocates from around the world who were interested in collaborating in further study of prostitution. Consequently,'the present study expands the orig­ inal through the inclusion of four additional countries: Canada, Colombia, Germany, and Mexico.

METHODS

Brief structured interviews of people in prostitution were conducted in Van­ couver, Canada; Bogota, Colombia; Hamburg, Germany; Mexico City and Puebla, Mexico; San Francisco, CA, U.S.A.; two cities in Thailand; Lusaka, Zambia; Istanbul, Turkey; Johannesburg and Capetown, South Africa. These countries were included in the study because investigators in those states shared a commitment to documenting the experiences of women in prostitu­ tion, and in some instances to providing alternatives to prostitution.

Participants

In Canadat we interviewed 100 women prostituting in or near Vancouver's Downtown Eastside, one of the most economically destitute regions in North . America. The effects of coloniiation of First Nations people were evident 14286 38 PROSTITUTION, TRAFFICKING, AND TRAUMATIC STRESS

from their overrepresentation in Canadian prostitution. Fifty-two percent were First Nations (in a community where 1.7-7% are the official estimates of the First Nations population), 38% were white European-Canadian, 5% were Afri­ can Canadian, and 5% left the question blank. The majority of the 52 First Na­ tions women described themselves as Native. Next most often, they described themselves as Metis, a French wordthat translates to English as "mixed blood" and is used to describe people who are of both First Nations and European an­ cestries. The two major colonizers of First Nations of Canada were the British and the French; therefore, the majority of those called Metis were First Na­ tionslFrench or First Nations/British. The First Nations women also catego­ rized themselves as Native Indian, Cree, Cree Native, First Nations, Cree Metis, Ojibwa, Blackfoot/Cree, Aboriginal, and Interior Salish. In Mexico, we interviewed 123. women prostituting in street, brothel, stripclub and massage prostitution in Mexico City and in Puebla. Fifty-four women were interviewed in Hamburg, Germany where prostitu­ tion is legal. The German women were from a drop-in shelter for drug addicted women, from a program which offered vocational rehabilitation for those prostituted, and were also referred by peers, and by advertisement in a local newspaper. With respect to country of origin, 82% were German and 11% were trafficked into Germany from Thailand' or the former Soviet Union. Seven percent were raised in Germany and described themselves as ethnically Polish, Chilean, or Turkish. Two found the experience of answering questions . about traumatic events too painful to continue, and a third woman was too in­ toxicated to participate. In San Francisco we interviewed 130 respondents on the street who verbally confirmed that they were prostituting. We interviewed respondents in four dif­ ferent areas in San Francisco where people worked as prostitutes. Thirty-nine percent of the 130 interviewees were white European/American, 33% were African American, 18% were Latina, 6% were Asian or Pacific Islander, and 5% described themselves as of mixed race or left the question blank. In Thailand we interviewed several of the 110 respondents on the street, but found that pimps did not allow the prostitutes to answer our questions. We in­ terviewed some respondents at a beauty parlor that provided a supportive at­ mosphere. The majority of the Thai respondents were interviewed at an agency in northern Thailand that offered nonjudgmental support and job training. We interviewed 68 prostituted people in Johannesburg and Capetown, South Africa in brothels, on the street and at a drop-in center for prostitutes. Respondents were racially di verse: 50% were white European; 29% were Afri­ can or Black; 12% described themselves as Coloured or Brown or of mixed race; 3% were Indian; and 6% left the question blank. 14287

Farley et at. 39

We interviewed 117 current and former prostitutes at TASINTHA in Lusaka, Zambia. T ASINTHA is a non-governmental organization that offered food, vocational training, and community to approximately 600 prostituted women a week. In Turkey some prostitutes work legally in brothels which are privately owned and controlled by local commissions composed of physicians, police, and others who are "in charge of public morality." We were not permitted to interview women in brothels, so we interviewed 50 prostituted women who were brought to a hospital in Istanbul by police for the purpose of SID control. In Bogota we interviewed 96 women and children at agencies that offered services to them. Prostitution in Colombia starts at a young age, often by ado­ lescence, and is accompanied by unwanted pregnancy (Spiwak & Reyes, 1999; UNICEF, 2000; UNICEF Colombia, 2001; Rodriguez & Cabrera, 1991, Fundaci6n Renacer, 2000, 2001; ICBF, 1999; Cardenas and Rivera, 2000; DABS, 2002). Spiwak & Reyes (1999) found that 72% of the women and chil­ dren prostituting in Colombia were from families that had been internally dis­ placed by political violence. Civil wars and internal displacement are known to be risk factors for sexual exploitation (UNICEF Colombia, 2001; Fundacion Renacer, 2000; 2001; Fundaci6n Esperania, 1998,2000; CATW, 2002; U.S. Report of Trafficking in Persons, 200 1; NCMEC, 1992; ICBF, 2000; Leech, 2001). Prostitution is legal in Colombia, with thousands of brothels in urban areas, as well as in paramilitary and guerilla-controlled rural regions. It is legal to prostitute a 14-year-old girl or boy (C6digo Penal de Colombia, 2002). al­ though that act of sexual abuse violates the Convention on the Rights of the Child endorsed by Colombia in 1999 (UNICEF, 2000; UNICEF Colombia, 2001; Seities, 1997; ICBF-UNESCO, 1997; Motta et al., 1998; Morgan & Buitrago, 1992). In six of the nine countries, we interviewed women and girls. In South Af­ rica we interviewed 10 men (14% of the South African sample) and one transgendered person. In Thailand we interviewed 28 transgendered people (25% of the Thai sample). In the United States we interviewed 18 men (13%) and 15 transgendered people (12%) in addition to women and girls. Transgendered people represent a significant minority of those in prostitution. A previous study (Farley & Barkan, 1998) found that transgendered people (male-to-female) in prostitution experienced the same frequency of physical assaults and rapes as did women. Mean age, age ranges arid mean age of entry into prostitution, percentages under age 18 at time of entry into prostitution, and mean number of years in prostitution by country are shown in Table 1. Across 9 countries, ages of re­ spondents ranged from 12 to 68 with a mean age of 28 years (N =779, SD =8) The average age of entry into prostitution was 19 years (SD = 6). Forty-seven ~

TABLE 1. Age, Age of Entry, and Length ot'Time in Prostitution

9 Country South Summary Canada Colombia Germany Mexico Africa Thailand Turkey USA Zambia (N =854) n =100) (n =96) (n =54) (n =123) (n =68) (n =166) (n =50) (n = 130) (n = 117)

Mean age (SO) 28 (8) 28 (8) 31 (10) 26 (10) 27 (7) 24 (5) 26 (7) 29 31 (9) 27 (7)

Age range 12-68 13-49 14-58 15-68 18-60 17-38 14-46 16-55 14-61 12-53

Mean age entered 19 (6) 18 (6) 17 (4) 19 (6) 20 (4) 20 (5) 21 (5) Unknown 20 (8) 17 (4) prostitution (SO)

Years in prostitution (SO) 9 (8) 10 (8) 14 (8) 7 (8) 7 (8) 4 (4) 5 (4) Unknown 11 (9) 10 (7) . Percent younger than age 18 47% (353) 54% (54) 59% (56) 41% (22) 32% (38) 40% (27) 32% (28) Unknown 42% (53) 68% (75)

~t !lntry _~_. _ ~- - ... ----- .. ------~ - ~ _.... ---- ... ------

...,),. ~ ex> ex> 14289

Farley el al. 41 percent reported that they were under 18 years of age at the time of entry into prostitution. Based on respondents' current age and age of entry into prosti­ tution we calculated the average length of time in prostitution to be 9 years (SD = 8) across countries. This calculation was based on the assumption that from the age at first prostitution to the time of the interview, there was no period of time during which they did not prostitute. Since people seize the op­ portunity to interrupt or escape from prostitution, this number probably over­ estimates the amount of time spent in prostitution.

Measures

The Prostitution Questionnaire inquired about lifetime history of physical and sexual violence and the use of or making of pornography during prostitu­ tion. We asked whether respondents wished to leave prostitution and what they needed in order to leave. We asked if they had been homeless; if they had phys­ ical health problems; and if they used drugs or alcohol or both. Three questions assessed rape: "Have you been raped?" "Who raped you?" and "How many times have you been raped since you were in prostitution?" Some respondents answered "no" when asked if they were raped, but then identified who had raped them andlor how many times they had been raped. Therefore to assess rape in prostitution, if a respondent identified "pimp" or "customer" in re­ sponse to "Who raped you?" or if the respondent reported one or more rapes since being in prostitution then that respondent was identified as having been raped in prostitution. Respondents also completed the PTSD Checklist (PCL), a self-report in­ ventory for assessing the 17 DSM-IV symptoms ofPTSD (Weathers, Litz, Herman, Huska,. & Keane, 1993; Blanchard, lones-Alexander, Buckley, & Forneris, 1996). Respondents were asked to rate symptoms of PTSD on a scale with (1 =) not at all; (2 =) a little bit; (3 =) moderately; (4 =) quite a bit; and (5 =) extremely. PCL test-retest reliability was .96. Internal consistency, as measured by an alpha coefficient was .97. Validity of the scale was reflected in its strong correlations with the Mississippi Scale (.93); the PK scale of the MMPI-2 (.77); and the.lmpact of Events Scale (.90) (Weathers et aI., 1993). The PCL has functioned comparably across ethnic subcultures in U.S.A. (Keane et aI., 1996). We measured symptoms of PTSD in two ways. First, using a procedure'es­ tablished by the scale's authors, we generated a measure of overall PTSD symptom severity by summing respondents' ratings across all 17 items. If a re­ spondent filled out less than half of the PCL (more than 8 blank items) it was not included in the analysis. For those omitting one to eight items, the peL 14290

42 PROS71TUTlON, TRAFFICKING, AND TRAUMATIC STRESS sum was estimated by using the respondent's mean PCL score in place of the blank items. Second, using Weathers' (1993) scoring suggestion, we considered a score of 3 or above on a given PCL item to be a symptom of PTSD. Using those scores, we then noted whether each respondent met criteria for a diagnosis of PTSD. We report the numbers and percentages of respondents who qualified for a diagnosis of PTSD in each country. In Canada and United States, we administered a Chronic Health Problem Questionnaire that included items developed from responses to an earlier open-ended item which inquired about health problems of women in prostitu­ tion. Unanswered items were considered to indicate the absence of the health problem. Therefore, percentages reported below are percentages of the entire sample endorsing that item.

Procedure

In Canada, Colombia, Mexico, South Africa, and United States, if inter­ viewees indicated that they were prostituting, they were asked to fill out the Prostitution Questionnaire (PQ), the Post TraumaticStress Disorder Checklist (PeL), and the Chronic Health Problem Questionnaire (CHPQ). We inter­ viewed respondents in street, brothel, strip clubs, and massage prostitution. In Germany and Turkey, respondents were administered interviews in medical clinics. In Zambia and in Thailand, most respondents were interviewed in agencies offering services to women in prostitution. The questionnaires were administered in English, German, Spanish, Thai and Turkish. In Zampia, inter­ viewers translated as needed-most participants spoke some English. The au­ thors either administered or directly supervised the administration of all questionnaires. If respondents could not read, the questions, were read to them by the researchers.

RESULTS

A range of sexual and othe~ physical violence was reported by a majority of these prostituted people in all nine countries (see Table 2). Listed in the follow­ ing tables arethe percentages of respondents endorsing each item out of the to­ tal number of respondents who answered that item. The number of participants endorsing each item is in parentheses. Across countries, 59% of these interviewees reported that as children they were beaten by a caregiver to the point of injury. Sixty-three percent were sex­ ually abused as children, with an average of four perpetrators against each TABLE 2. Violence in Prostitution -

9 Country South I Summary Canada Colombia Germany Mexico Africa Thailand Turkey USA zambia (N = 854) (n=100) (n = 96) (n = 54) (n = 123) (n =68) (n = 166) (n = SO) (n = 130) (n= 117)

<,-; , i Threatened with a weapon 64% (503) 67% (66) 59% (57) . 52% (28) .48% (46) 68% (45) 39% (33) 68%(34) 78% (100) 86% (94) in prostitution

Physically assaulted 73% (595) 91%(91) 70% (67) 61% (33) 59% (72) 66% (45) 56% (50) 80% (40) 82% (106) 82% (91) In prostitution

Raped in prostitution 57% (483) 76% (76) 47% (45) 63% (34) 46% (57) 56% (38) 38% (45) 50% (25) 73% (95) 79% (93)

(Of those raped) raped more than five times 59% (286) 67% (51) 64% (29) 50% (17) 44% (25) 58% (22) 56% (25) 36% (9) 59% (56) 52% (48) in prostitution

Current or past 75% (571) 86% (84) 76% (73) 74% (40) 55% (65) 73% (49) 57% (53) 58% (29) 84% (108) 89% (99) homeless ness

As a child. was hit or beaten by caregiver until 59% (448) 73% (72) 66% (63) 48% (26) 57% (69) 56% (38) 39% (35) 56%(28) 49% (37) 71% (80) injured or bruised -. J Sexually abused as a child 63% (508) 84% (82) 67% (64) 48% (26) 54% (64) 66% (45) 47%(41) 34% (17) 57% (73) 84% (93)

I Mean number of childhood 4 5 2 17 2 2 1 unknown 2 6 sexual abuse perpetrators I Median number 1 3 1 4 1 1 0 unknown 1 3 of childhood sexual abuse ~ perpetrators ~ -30. .t=.. (\..) <.0 -30. 14292 44 PROSTITUTION, TRAFFICKING, AND TRAUMATIC STRESS

child. As adu~ts in prostitution, 64% of these respondents had been threatened with a weapon, 71 % had experienced physical assault, and 63%· had been raped. Current or past homelessness averaged 75% across countries and ranged from 55% (Mexico) to 89% (Zambia). From this range of violent events, we categorized four types of violence in these people's Ii ves: (1) childhood sexual abuse, (2) chi Idhood physical abuse, (3) rape in prostitution as an adult and (4) physical assault in prostitution as an adult. Respondents might have experienced none, one, two, three, or all four types of violence (see Table 3). Fifty-one percent of the interviewees had expe­ rienced three or four different types of lifetime violence, 36% reported one to two types of lifetime violence, and only 13% had not experienced any of these types of violence. Since those who left items blank were assumed not to have experienced the violence, this is a conservative estimate of lifetime violence. We asked 315 respondents in Canada, Colombia, and Mexico about their ex­ perience of verbal abuse in prostitution. Eighty-eight percent reported having been verbally abused. The responses of our participants suggest that pornography is integral to prostitution. Table 4 shows rates by country of those in prostitution who re­ ported that they were upset by attempts to coerce them into imitating pornogra­ phy and who had pornography made of them in prostitution. Across countries, 47% were upset by attempts to make them do what others had seen in pornog­ raphy and 49% reported pornography was made of them. Posttraumatic Stress Disorder

To meet criteria for a diagnosis of posttraumatic stress disorder (PTSD) a person must have at least one of five symptoms of intrusive re-experiencing of trauma symptoms (criterion B), at least three of six symptoms of numbing and avoidance of trauma (criterion C), and at least two offour symptoms of physio­ logic hyperarousal (criterion D). Given the extremely high rates of interper­ sonal violence reported by these respondents (stressors which meet criterion A), we made the assumption that the 13% of respondents who had not directly experienced violence themselves-had witnessed it. Thus we assumed that all respondents met criterion A for a diagnosis of PTSD. Eight hundred twenty-six of our respqndents answered at 1east 8 of the 17 items on the Post Traumatic Disorder Check List (PCL) and were included in the following .. analysis. Across 9 countries, 68% of these respondents met criteria for a diag­ nosis of PTSD (see Table 5). Mean PCL score was 53.5 (SD = 16.2) across the 9 countries, a ret1ec~ tion of the severity of the symptoms ofPTSD in this sample (see Table 6). Mean PTSD severities in the 9 countries ranged from 49 (Mexico) to 58 ~

- TABLE 3. Number of Types of Lifetime Violence

9 Country South Number of Types Summary Canada Colombia Germany Mexico Africa Thailand Turkey USA Zambia of Lifetime Violence (N =854) . (n =100) (n =96) (n =54) (n =123) (n =68) (n =166) (n =SO) (n =130) (n = 117)

No violence reported 13% (110) 2% (2) 12%(11) 6% (3) 22% (27) 12% (8) 28% (33) 20% (10) 6% (8) 7% (8)

1 Type of violence 16% (133) 12% (12) 16% (1S) 17% (9) 15% (19) 19% (13) 28% (33) 24% (12) 12% (1S) 4% (S)

2 Types of violence 20% (171) 7% (7) 22% (21) 37% (20) . 1~/o (20) 16% (11) 21% (24) 22% (11) 34% (44) 11% (13)

3 Types of violence 26% (222) 24% (24) 16% (15) 33% (18) 25% (31) 19% (13) 17% (20) 34% (17) 34% (44) 34% (40)

4 Types of violence 25% (218) 55% (55) 3S% (34) 7% (4) 21% (26) 34% (23) 5% (6) 0% (0) 15% (19) 44% (51)

L .. _._ ---~ ... .. ------~-- -

~ ..lo. ~ (0 v.> • J

~

TABLE 4. Prostitution and Pornography

9 Country South ! Summary Canada Colombia Germany Mexico Africa Thailand Turkey USA Zambia I (N =854) (n =100) (n =96) (n =54) (n =123) (n =68) (n = 166) (n =50) (n =130) (n = 117) J

Upset by an attempt to make them do what had been seen 47% (377) 64% (63) 62% (60) 44% (24) 35% (42) 56% (37) 48% (43) 20% (10) 32% (41) 47%(51) I in porno.Qrap_1]y Pomography made of her in prostitution 49%(371) 67% (64) 50% (48) 52% (28) 44% (53) 40% (26) 45% (39) N/A 49% (63) 47% (52)

-"" ~ J\) CO ~ t

TABLE 5. Posttraumatic Stress Disorder of Prostituted Respondents in 9 Countries

9 Country South I Summary Canada Colombia Germany Mexico Africa Thailand Turkey USA Zambia I (N =854) (n = 100) (n =96) (n =54) (n =123) (n =68) (n =116) (n =50) (n =130) (n =117) I

PTSD DIAGNOSIS (DSM-IV) 68% (562) 74% (72) 86% (83) 60% (32) 54% (67) 75% (51) 58% (59) 66% (33) 69% (87) 71% (78) i

_...... - L ____ ... ______~ _. ~- --- _-_ __ - ---

-I:::.. "'-l ...J.. ~ <0 OJ

L 14296 48 PROSTITUTION, TRAFFICKING, AND TRAUMATIC STRESS

TABLE 6. PTSD Checklist (PCl) Means from Three Studies

Mean PClC Sum (SO) 1 Current study 99 women in prostitution (Canada) 56 (16) 96 women in prostitution (Colombia) 58 (14) 53 women in prostitution (Gen:nany) 51 (16) 123 women in prostitution (Mexico) 49 (18) 68 people in prostitution (South Africa) 55 (16) 111 people in prostitution (Thailand) 51 (18) 50 women in prostitution (Turkey) 53 (16) 128 people in prostitution (USA) 55 (17) 112 women in orostitution (Zambia) 53 (12) 2 Weathers et a!. (1993) 123 Vietnam veterans requesting treatment 51 (20) 1006 Persia:n Gulf War veterans 35 (16) 3 Farley & Patsalides, (2001) (adult women) 26 controls 24 (7) 25 wi childhood physical abuse history 31 (10) 27 wi childhood phvsical and sexual abuse history 37 (15)

*PTSD sum is an indicator of PTSO severity.

-" (Columbia). PTSD severity was significantly positivdy correlated with the number of types of lifetime violence experienced (r = .33, p = .001). For com­ parison, Table 6 includes mean PCL scores from two other studies ofPTSP se­ verity-Vietnam and Persian Gulf veterans (Weathers et aI., 1993) and samples of women from a health maintenance plan who had and had not experienced physical and sexual abuse (Far]ey & Patsalides, 2001). We asked interviewees in the 9 countries about their use of drugs and alco­ hol. Table 7 lists substance use by country. Across countries, 48% of those re­ sponding to this item reported drug use, and 52% reported alcohol use. Colombia and Zambia reported the lowest use of drugs. Drugs were probably not available due to the poverty of respondents. We did not inquire specifically about glue sniffing which is common in Colombia. Colombia and Zambia, along with Mexico, had the highest rates of alcohol use (71 %-100%). Canada, USA, and Germany reported the highest rates of drug use (70% to 95%). We asked respondents what they needed by offering them a checklist of op­ tions that included an open-ended question for write-in responses (see Table 8). Eighty-nine percent told us that they desired to leave prostitution. A total of 75% needed a home or safe place, 76% needed job training, 61 % needed health care, 56% needed individual counseling, 51 % needed peer support, 51 % needed legal assistance, 47% needed drug/alcohol treatment, 45% wanted 14297 Fariey et ai. 49 self-defense training, 44% needed childcare, 34% wanted prostitution to be le­ galized, and 23% wanted physical protection from a pimp. We asked those we interviewed in six countries (Canada, Colombia, Ger­ many, Mexico, South Africa, and Zambia) whether they thought that legaliz­ ing prostitution would make them physically safer. Across countries 46% stated that prostitution would be no safer if it were legalized (see Table 9). It is noteworthy that in Germany where brothel prostitution is legal, 59% of re­ spondents told us that they did not think that legal prostitution made them any safer from rape and physical assault. In Mexico we were able to c0mpare several different types of prostitution: 54 women in strip clubs, 44 women in brothels and massage parlors, and 25 women who were prostituting on the street. We inquired about age of entry into prostitu­ tion, length of time in prostitution, PTSD severity, number of types of lifetime violence and whether or not women in these different types of prostitution wanted to escape from it. Age of entry into prostitution differentiated strip club from other types of prostitution. Compared to brothel, massage and street prosti­ tution, significantly more women in strip clubs entered prostitution when they were younger than 18 (F = 3.5; df = 2,113; P = .03). There were no statistically significant differences between brotheVmassage, street, and strip club prostitu­ tion with respect to PTSD severity, length of time in prostitution, childhood sex­ ual abuse, childhood physical abuse, rape in prostitution, number of types of lifetime violence experienced, and percentages of respondents who told us that they wanted escape from prostitution. We investigated differences in PTSD associated with gender and gender identity. In U.S. differences in PTSD incidence among women, men and transgendered prostitutes were not statist~cally significant. In Thailand, differ­ ences between women and transgendered prostitutes were not statistically sig­ nificant. In South Africa, differences between women ~nd men prostitutes were not significant. Previously, we found that 61 % of those in prostitution in 5 countries re­ ported a current physical health problem, 52% reported alcohol use, and 45% reported drug use (Farley et aI., 1998). We are now able to report in more detail the acute and chronic health problems experienced by those in prostitution in 7 of the 9 countries (Colombia, Mexico, South Africa, Thailand, Turkey, USA, and Zambia). Half of these people reported symptoms that were associated with violence, overwhelming stress, poverty, and homelessness. Common medical problems of these 700 people in prostitution included tu­ berculosis, HIV, diabetes, cancer, arthritis, tachycardia, syphilis, malaria, asthma, anemia, and hepatitis. Twenty-four percent reported reproductive symptoms including sexually transmitted diseases (SID), uterine infections, , , i t • t 1 "' i '"

~

TABLE 7. Use of Drugs and Alcohol Among People in Prostitution in 9 Countries

9 Country Summary Canada Colombia Germany Mexico South Africa Thailand Turkey USA Zambia (N =854) (n =100) (n =96) (n :: 54) (n =123) (n =68) (n =166) (n =50) (n = 130) (n=117)

Used drugs 48% (383) 95% (94) 4% (3) 70% (38) 34% (40) 49% (33) 39% (40) 46% (23) 75% (94) 16% (18)

Used alcohol 52% (416) 47% (44) 100% (29) 54% (29) 71% (84) 430/<;> (29) 56% (57) 64% (32) 26% (33) 72% (79)

______L-. ~-- ~-----~ ------

-lo. ,.f:I. I\.) J

TABLE 8. Responses to "What Do You Need?".Asked of 854 People in Prostitution

9 Country South Africa Thailand USA Zambia Needs ~~r;:;~~~ (~~n~~~, ~~I~~~\a ~~~~,Y (~:~i~~\ (n - 68) in-116) i~u~:6) in = 1~n\ (n - 117\

Leave prostitution 89% (699) 95% (89) 97% (93) 85% (33) 68% (81) 89% (58) 92% (82) 90% (45) 87%(111) 99% (107)

Home or safe place 75% (618) 66% (63) 74% (71) 61% (33) 87% (107) 72% (46) 59% (64) 60% (30) 78% (99) 94% (105)

Job training . 76% (600) 67% (64) 57% (55) 63% (34) 92% (113) 75% (48) 56% (61) 46% (23) 73% (93) 97% (109)

Drug/alcohol treatment 47% (356) 82% (78) 15% (14) 48% (26) 38% (47) 46% (29) 44% (33) 6% (3) 67% (85) 37% (41)

Health care 61% (480) 41% (39) 56% (54) 46% (25) 67% (82) 69% (44) 41% (45) 38% (19) 58% (74) 88% (98)

Peer support 51% (393) 41% (38) 41% (39) 65% (35) 36% (44) 58% (37) 49% (53) 24% (12) 50% (64) 63% (71)

Individual counseling 56% (431) 58% (54) 34% (33) 69% (37) 43% (53) 61% (39) 66% (72) 46% (23) 48% (61) 53% (59)

Self-defense training 45% (340) 49% (47) 29% (28) 46% (25) 35% (43) 60% (39) 59% (64) 12% (6) 49% (62) 41% (46)

Legal assistance 51% (366) 33% (31) 43% (41) 37% (20) 50% (61) 58% (37) 57% (62) Unknown 42% (54) 54% (60)

Legalize prostitution 34% (251) 32% (30) 20% (19) 35% (19) 51% (62) 37% (24) 27% (30) 4% (2) 44% (56) 8% (9)

Child care 44% (335) 12% (11) 49% (47) 7% (4) 36% (44) 48% (31) 44% (48) 20% (10) 34% (43) 87% (97)

Physical protection from pimp 23% (157) 4% (4) 6% (6) 6% (3) 15% (19) 33% (21) 20% (22) Unknown 28% (36) 41% (46) ...... VJ ....l. ,J!:a. I\) (0 (0 1

~

TABLE 9. Respondents Who Stated That Prostitution Would Not Be Safer if Legalized

6 Country South i Summary Canada Colombia Germany Mexico Africa zambia (N =558') . (n = 100) (n =96) (n = 54) (n = 123) (n = 68) (n=117) i

Prostitution would be 46% (226) 26% (25) 44% (22) 59%(27) 15% (13) 59% (40) 73% (79) no safer if legalized .

-a. ..tlI. otv o 14301 Farley et al. 53

menstrual problems, ovarian pain, abortion complications, pregnancy, hepati­ tis B, hepatitis C, infertility, syphilis, and HIV. Without specific query about mental health, 17% described severe emo­ tional problems: depression, suicidality, flashbacks of , anxiety and extreme tension, terror regarding relationships with pimps, extremely low self-esteem, and mood swings. Fifteen percent reported gastrointestinal symp­ toms such as ulcers, chronic stomachache, diarrhea, and colitis. Fifteen percent reported neurological symptoms such as migraine headaches and non-mi­ graine headaches,memory loss, numbness, seizures, and dizziness. Fourteen percent of these women and children in prostitution reported respiratory prob­ lems such as asthma, lung disease, bronchitis, and pneumonia. Fourteen per­ cent reported joint pain, including hip pain, bad knees, backache, arthritis, rheumatism, and nonspecific multiple-site joint pain. Twelve percent of those who described health problems in prostitution re­ ported injuries that were a direct result of violence. For example, a number of women had their ribs"broken by the police in Istanbul, a woman in San Fran­ cisco broke her hips jumping out of a car when a john was attempting to kidnap her. Many women had their teeth knocked out by pimps and johns. Miller (1995) cited bruises, broken bones, cuts, and abrasions that resulted from beat­ ings and sexual assaults. Of the 50 Turkish women, 18% reported mental distress, 16% reported joint or other pain, 10% reported gastrointestinal symptoms, 10% reported gynecological symptoms, 6% had respiratory symptoms, and 6% cardiac symptoms. Almost half of the Turkish women had never been "examined by a physician. IIi Mexico, 52 of 123 women responded affirmatively to an open-ended "question regarding health problems. Twenty-one percent of those who re­ sponded to this question reported gastrointestinal symptoms, and 16% re­ ported neurological problems. Other physical health problems included joint pain (12%) and cardiovascular symptoms (12%). In Thailand, 60 of "116 women responded to an open-ended question about health problems. Thirty percent of these women reported poor health in gen­ eral, and 30% described reproductive system problems. Twenty-five percent described physical injuries from violence in prostitution, 23% reported neuro­ logical symptoms, 17% joint pain, and 15% gastrointestinal symptoms. Twenty-eight percent of the Thai women described serious emotionalprob­ lems; many told us that they had been lied to, kidnapped, or trafficked into prostitution, which contributed to their distre"ss. Equating prostitution with death, one woman stated: "Why commit suicide? I'll work in prostitution in­ stead." Another woman explained that she felt "spiritually assaulted" in prosti­ tution. 14302

54 PROSTITUTION, TRAFFICKING, AND TRAUMATIC STRESS

TABLE 10. Chronic Health Problems of Women in Prostitution and Women No Longer in Prostitution*

Chronic Health Problems Canadian U.S. women out of endorsed more frequently women prostitution for when not yet out of prostitution (n = 100) at least 1.5 years (n=21)

Muscle aches/pains 78% (74) 71% (15) Trouble concentrating 66% (63) 62% (13) Colds or flu symptoms 61% (58) 43%(9) Joint pain 60% (57) 38% (8) Shortness of breath 60% (57) 57% (12) Stomach problems 59% (56) 57% (12) Headaches/migraines 56% (54) 48% (10) Constipation/diarrhea 52%(50) 43% (9) Dizziness 44% (42) 38% (8) Skin problems 43% (41) 38% (8) Chest Pain 43% (41) 33% (7) Nausea 41% (39) 14% (3) Sweaty Hands 40% (38) 14% (3) Hearing problems 40% (38) 19% (4) Jawor throat pain 38% (36) 24% (5) Muscle weakness/paralysis 38% (36) 24% (5) Vomiting 37% (35) 0%(0) Trembling 35% (33) 10% (2) Asthma 3~1o (30) 29% (6) Poor health in general 30% (28) 10% (2) Difficulty swallowing 27% (26) 10% (2) Pelvic pain 21% (20) 19% (4)

" Chronic health problems Canadian U.S. women out of· endorsed more frequently women prostitution for after getting out of prostitution (n=100) at least 1.5 years (n = 21) Injury caused by violence 76% (72) 95% (20) Memory problems 66% (63) 72% (16) Head injury 53% (50) 95% (20) Pain/numbness in hands/feet 50% (47) 52% (11) Vision problems 45% (43) 57% (12) Trouble with balance or walking 41% (39) 43% (9) Allergies 35% (33) 38% (8) Swelling of arms/hands/legs/feet 33% (31) 43% (9) Rapid or irregular heart beat 33% (31) 38% (8) Loss of feeling on skin 25% (24) 33% (7) Painful menstruation 24% (23) 48% (10) Vaginal pain 24% (23) 38% (8) Breast pain 23% (22) 24% (5)

*Items from Chronic Health Problems Questionnaire (CHPQ). 14303

Farley et al. 55

In Colombia, the most frequent health complaints were reproductive, car­ diovascular and respiratory symptoms, and joint pain. From these responses, we developed the Chronic Health Problems Ques­ tionnaire (CPHQ) which was subsequently given to 100 currently prostituting Canadian women and to a separate sample of21 women in the U.S. who were no longer in prostitution (see Table 10). Among the Canadian women cur­ rently in prostitution, 76% reported injuries from violence in prostitution, with . 53% having suffered traumatic head injuries. Once women were out of prosti­ tution, awareness of the severity of the previous violence seemed to increase. For example, 95% of the women already out of prostitution reported violent in­ juries resulting from prostitution, including a 95% incidence of head injury. Women who were still in prostitution reported these same injuries at 76% (any violence-caused injury) and 53% (head injury). Approximately half of both samples reported headaches or migraines. Some of the cardiovascular, neuro­ logical and joint complaints may have been symptoms of substance abuse or withdrawal. Fourteen of the chronic symptoms we inquired about were more prevalent among the 21 women no longer involved in prostitution than among the cur­ rently prostituting Canadian women. These symptoms were: any injury caused by violence, report of any medical diagnosis, memory problems, head injury, pain/numbness in hands or feet, vision problems, trouble with balance or walk­ ing, allergies, swelling of arms, hands, legs or feet, rapid or irregular heartbeat, loss of feeling on skin, painful menstruation, vaginal pain, and breast pain (see Table 10.) The Canadian respondents still in prostitution endorsed an average of 14 of 32 (SD = 8) symptoms. The U.S. women no longer in prostitution en­ dorsed'an average of 12 of 32 (SD =7) symptoms. There was no significant difference between the two grOl~ps in the total number of symptoms endorsed (ANOVA, F =3.3, df. = 1,118, p = .07). In three countries (Canada, Colombia, Mexico) we inquired about verbal abuse in prostitution. Eighty-eight percent of 315 respondents reported having been verbally abused ranging from 84% in Mexico to 91%· in Colombia.

DISCUSSION

Our findings from 9 countries on 5 continents indicate that the physical and emotional violence in prostitution is overwhelming. To summarize the find­ ings of this study and other research and clinical literature on different types of prosti~ution (see Farley & Kelly, 2000; Farley, 2003): 14304 56 PROSI1TUI10N, TRAFFICKING, AND TRAUMAI1C STRESS

l. 95% of those in prostitution experienced sexual harassment which in the United States would be legally actionable in a different job setting. 2. 65% to 95% of those in prostitution were sexually assaulted as children. 3. 70% to 95% were physically assaulted in prostitution. 4 4. 60% to 75% were raped in prostitution. 5. 75% of those in prostitution have been homeless at some point in their lives. 6. 89% of 785 people in prostitution from nine countries wanted to escape prostitution. 7. 68% of 827 people in several different types of prostitution in 9 coun­ tries met criteria for PTSD. The severity of PTSD symptoms of partici- pants in this study were in the same range as treatment-seeking combat veterans, battered women seeking shelter, rape survivors, and refugees from state-organized torture (Bownes, O'Gormen,. & Sayers 1991; Houskamp & Foy, 1991, Kemp et aI., 1991; Ramsay, Gorst-Unsworth, & Turner, 1993; Weathers et al., 1993), Severity of symptoms ofPTSD was strongly associated with the number of different types of lifetime sexual and physical violence. A Covenant House study of homeless ado­ lescents, many of whom were prostituting, found a ·similar association " between PTSD severity and history of violence (DiPaolo, 1999). 8. 88% of those in prostitution experience verbal abuse and social con­ tempt. Verbal abuse in prostitution has rarely been discussed as one of its harms.

Similar findings suggest that the severity of trauma-related symptoms were related to the intensity of involvement in prostitution. Women who serviced more customers in prostitution reported more severe physical symptoms (Vanwesenbeeck, 1994). The longer women were in prostitu­ tion, the more STDs were reported (Parriott, ~ 994). A nu mber of studies ~, document the greatly increased risk among prostituted women as com­ pared to nonprostituted women, for cervical cancer and chronic hepatitis (Chattopadhyay, Bandyopadhyay, & Duttagupta, 1994; de Sanjose, Palacio, Tafur, Vasquez, Espitia, Vasquez, Roman, Munoz, & Bosch, 1993; Nakashima, Kashiwagi, Hayashi, Urabe, Minami, & Maeda, 1996; Parriott, 1994; Pelzer, Duncan, Tibaux, & Mebari, 1992). Vanwesenbeeck (1994) noted that poverty and length of time spent in prostitution were each associated with greater violence in prostitution. Like Vanwesenbeeck, we concluded that those women who experienced the most extreme violence in prostitution were not represented in our research. Because of this limitation, it is likely that all of the estimates of violence reported here 14305

Farley et al. 57 are conservative, and that the actual incidence of violence is greater than we found. Traumatized individuals tend to minimize or deny their experiences, espe­ cially when they are in the midst of ongoing trauma, such as war combat or prostitution. This leads to·a decreased rate of reporting violent events. Based on a review of previous research and clinical reports, we think that our statistic on the prevalence of child sexual abuse among those prostituting in 9 countries (63%) is much lower than the actual incidence of chil~hood sexual abuse in this population, which we estimate to be closer to 85% (Silbert & Pines, 1981, 1983; Giobbe, 1991; Hunter, 1994). Describing the complex connections between childhood sexual abuse, revictimization, prostitution, and health problems, one woman made a deci­ sion to prostitute after realizing that she had been sexually abused as a child:

... there was no sense of having a life; the only life I knew of was prosti­ tuting ... I thought I couldn't be hurt no more and I felt that I could do what I want and I could have sex with whoever I wanted because some­ body already gone and messed my system. up. (Morse, Suchman, & Frankel, 1997. [Authors' italics]

In prostitution, the sexual exploitation of children and women is often indis­ tinguishable from incest, intimate partner violence, and rape (Gysels, Pool, & Nnulasiba, 2002). Like adult prostitutes, tncested children are bribed into sex acts by adults and offered food, money, or protection for their silence. Use of a child for sex by adults may thus be understood as prostitution of the child, whether the act occurs in or out of the family, and whether it is with or with­ out payment. When a child is incestuously assaulted, the perpetrator's objectifjcation of the child victim arid his rationalization and denial are similar to the john's in prostitution. The psychological symptoms resulting from in­ cest and prostitution are similar. One woman described a "prostituting mental­ ity" beginning after sexual abuse by neighbors and family members starting at age nine and continuing to adolescence, when she began prostituting (Carroll & Trull, 1999). Although this study assessed only PTSD as a psychological consequence of prostitution, additional symptoms of emotional distress are common among prostituted women, including other anxiety disorders, dissociative disorders (Ross, Farley, & Schwartz, 2003), substance abuse, personality disorders, and depression. Depression is almost universal among prostituted women. For ex­ ample, Raymond, Hughes and Gomez (2001) found that 86% of domestically trafficked and 85% of internationally trafficked Women experienced -depres­ sion. 14306 58 PROSTITUI10N, TRAFFICKING, AND TRAUMATIC STRESS

Another psychological consequence of longterm prostitution is complex PTSD (CPTSD) which results from chronic traumatic stress, captivity, and to­ talitarian control. Symptoms of CPTSD include difficulty regulating emo­ tions, altered self-perception (in prostitution: a subordinated sexual seJt), changes in relations with others (a boyfriend may be gradually seen as another john), and shifts in beliefs about the nature of the world (Herman, 1992; Van def Kolk, Pelcovitz, Roth, Mandel, McFarlane, & Herman 1996). In CPTSD, and in some Axis II personality disorders, the objectification and contempt aimed at those in prostitution can become internalized and solidified, resulting in self-loathing that is long-lasting and resistant to change (Schwartz, 2000). Existing in a state of social death, the prostitute is an outsider who is seen as having no honor or public worth; (Patterson, 1982; Farley, 1997). Those in prostitution, like slaves and concentration camp prisoners, may lose their iden­ tities as individuals, becoming primarily what masters, Nazis or customers want them to be. As one woman said about prostitution: "It is internally dam­ aging. You become in your own mind what these people do and say with you" (M. Farley, unpublished interview, 1999). Sex inequality sets the stage for sexual coercion, intimate partner vio­ lence and prostitution, thus contributing to women's likelihood of becom­ ing HIV-infected. Sexual violence has now been recognized as a primary risk factor forHIV in women (Romero-Daza, Weeks, & Singer, 1998), Kalichman and colleagues noted the coincidence of domestic violence and theHIV epi­ demic in Russia, Rwanda, and in the USA (Kalichman, Kelly, Shaboltas, & Granskaya, 2000; Kalichman, Williams, Cheery, Belcher, & Nachimson, 1998), Half of new AIDS cases are under age 25, and girls are likely to become in­ fected at a much younger age than boys, in part because of the tolerance of vio­ lence against girls and women in most cultures (Piot, 1999), In Africa and Asia, there is still a widespread belief that sex· with a girl child cures HIV. In their attempts to escape lives of hunger and poverty, young girls in Africa cannot refuse the sexual assaults of older male teachers who control their educational future (Reilly, 2001). In a review of a number of studies" Sanders-Phillips (2002) observed that prostitution and intravenous drug use are the most com­ monroutes of HIV exposure among women of color in the United States~She suggests as does Worth (1989), that women's lack of sexual safety is caused by their subordination by men and by specific other factors that increase their vul­ nerability such as race/ethnic discrimination and poverty. Aral and Mann (1998) emphasized the importance of addressing human rights issues in con­ junction with STDs. They noted that since most women ente:r prostitution as a result of poverty, rape.) infertility, or divorce-public health programs must ad­ dress the social factors which contribute to STDIHIV. We agree that it is essen- 14307

Farley et al. 59 tial to address the root causes of prostitution: sex inequality, racism and colonialism, poverty, tourism, and economic development that destroys tradi­ tional ways of living. In addition to STD and HIV, prostitution causes a multitude of other physi­ cal symptoms. Physical health problems result from physical abuse and ne­ glect in childhood (Radomsky, 1995), from sexual assault (Golding, 1994), battering (Crowell & Burgess, 1996), untreated health problems, overwhelm­ ing stress, and violence (Friedman & Yehuda, 1995; Koss & Heslet, 1992; Southwick et al., 1995). Prostituted women frequently suffer from all of the foregoing. Intimate partner violence, especially sexual violence, has been shown to inc,rease gynecological, central nervous system, and stress-related problems by 50% to 70% (Campbell, Jones, Dienemann, Kub, Schollenberger, O'Campo, Gielen & Wynne, 2002; McNutt, Carlson, Persaud, & Posmus, 2002). Among our interviewees in 9 countries, we found many health prob­ lems which were the direct result of violence in prostitution, and probably also the result of chronic and overwhelming stress. For example, 75% of the Canadian women we interviewed suffered injuries from violence that occurred during prostitution. These included stabbings.and beatings, concussions, broken bones (broken jaws, ribs, collar bones, fingers, spines, skuHs). Half of the Canadian women suffered traumatic head injuries as a result of violent assaults with baseball bats, crowbars or from having their heads slammed against walls or against car dashboards. Not surprisingly, they experienced memory problems, trouble concentrating, headaches, vision prob­ lems, dizziness, and trouble with balance or walking. These neurological symptoms are sometimes attributed solely to drug or alcohol toxicity, to PTSD or to personality disorders. However, they may also result from traumatic brain injury (TBI). In one study of prostituted women from three coun~ries, 3.0% of Filipino women, 33% of Russian women, and 77% of US women re­ ported head injuries (Raymond, D'Cunha, Dzuhaytin, Hynes, Rodriguez, & Santos, 2002). Unfortunately, physical and psychological symptoms often did not disap­ pear when women escaped prostitution. Instead 38% of the physical problems we inquired about were more frequently endorsed by women who no longer prostituted as compared to those who were still prostituting (for example, pain/numbness in hands or feet, vision problems, problems with balance, aller­ gies, irregular heartbeat, and reproductive symptoms). Psychological distress is also persistent. Comparing women who were still prostituting with those who were not, a Canadian study found that "exited respondents were only slightly less likely to experience depression, and more likely to experience anxiety attacks and emotional trauma when compared to their counterparts who were still [in prostitution]" (Benoit & MiJlar, 2001, p. 71). 14308

60 PROSTITUTION, TRAFFICKING, AND TRAUMATIC STRESS

More than three-quarters of these people in prostitution from 9 countries stated that they needed secure housing and job training. More than half ex­ pressed a need for health care in general and half specifically mentioned a need for individual counseling. These findings are consistent with a study in which prostituting respondents emphasized a need for mental health care, specifi­ cally req!lesting drop-in centers, crisis centers, and a phone hotline (Butters & Erickson, 2003).

. CONCLUSION

A Canadian woman told us: "What rape is to others, is normal to us." A Thai woman said, "I hate that I have to have sex with som€one I don't like or love." For the vast majority of the world's prostituted women, prostitution and traf­ ficking are experiences of being hunted down, dominated, sexually harassed, and assaulted. Women in prostitution are treated like commodities into which men masturbate, causing immense psychological harm to the person acting as receptacle (Hoigard & Finstad, 1986). There is widespread misinformation about prostitution, based on propa­ ganda that neutralizes the harms described above and which is disseminated by organizations that present prostitution as legitimate, if unpleasant, labor ("sex work"). We address below myths that: street prostitution is the worst type of prostitution, that prostitution of men and boys is significantly different than prpstltution of women and girls, that most of those in prostitution freely con­ sent to it, that most people are in prostitution because of a previous drug addic­ tion, that prostitution is qualitatively different from trafficking, and that legalizing prostitution would decrease its hann. Prostitution is multitraumatic whether its physical location is in clubs, brothels, hotels/motels/john's homes (also called escort prostitution or high ,,,"" class call girl prostitution), motor vehicles or the streets. Women have told us that they felt safer in street prostitution compared to (legal) Nevada broth€ls, where they were not permitted to reject any customer. Others commented that on the street they could refuse dangerous-appearing or intoxicated customers and that often a friend would make a show of writing down the john' s car li­ cense plate number, which they considered a deterrent to violence. Raphael and Shapiro (2002) found that women in Chicago reported the same frequency of rape in escort and in street prostitution. In a previous study, although we found more physical violence in street compared to brothel prostitution in South Africa-we found no difference in the incidence of PTSD in these two types of prostitution, suggesting the intrinsiCally traumatizing nature of prosti­ tution (Farley et al., 1998). 14309

Farley et al. 61

Ross, Anderson, Heber, and Norton (1990) found that women prostituting in stripclubs had significantly higher rates of dissociative and other psychiatric symptoms than those in street prostitution. In the present study we compared stripclub/massage, brothel, and street prostitution in Mexico and found no dif­ ferences in the incidence of physical assault and rape in prostitution, childhood sexual abuse, or symptoms of PTSD. We also found no differences in the per­ centages of women in brothel, street, or stripclub/massage prostitution who wanted to escape prostitution. Comparable findings have been reported in the Netherlands, where, al­ though prostitution is legal, it continues to inflict harmon those in it. For ex­ ample: 90% of women prostituting mainly in clubs, brothels and windows reported extreme nervousness, a symptom which may reflect the physiologic hyperarousal diagnostic of PTSD. In addition, 75% to 80% of the Dutch women reported distrust, symptoms of depression, irritability, and chronic physical discomfort (Vanwesenbeeck, 1994). Since the 1980s, the line between prostitution and stripping has been increas­ ingly blurred, and the amount of physical contact between exotic dancers and customers has increased, along with verbal sexual harassment and physical as­ sault of women in strip club prostitution.2 In most strip dubs, customers can now buy a lap dance where the dancer sits on the customer's lap while she wears few or no clothes and grinds her genitals against his. Although he is clothed, he usually expects ejaculation (Lewis, 1998). Touching, grabbing, pinching, and fingering of dancers removes any boundary which previously . . existed between dancing, stripping, and prostitution; As in other kinds of pros­ titution, the verbal, physical, and.sexual ~buse experienced by women in strip club prostitution includes being grabbed on the breasts, buttocks, and genitals, as well as being kicked, bitten, slapped, spit on, and penetrated vaginally and anally during lap dancing (Holsopple, 1998). Proponents of prostitution argue that most ofthe violence and trauma-related symptoms among prostitutes result from street violence or from a drug-re-· lated lifestyle rather than from prostitution itself. The following comparisons will hopefully set aside that myth. A study of the health of women street vendors in Johannesburg permits a comparison of the violence against them to violence against our South African respondents. The street vendorswere similarly situ­ ated women who spent much of their lives on the street in the same dangerous neighborhoods as the women we studied but who were not prostituting (Pick, Ross, & Dada, 2002). The· average age of the prostituted women we inter­ viewed was several years younger (24 years) than the street vendors (30 years). Seven percent of the South African street vendors experienced a verbal or physical threat, compared to 68% of the South African prostituted women who had been threatened with a weapon. Six percent of the women street vendors had been physically assaulted, compared to 66% of the prostituted women. 14310

62 PROSTITUTION, TRAFFICKING, AND TRAUMATIC STRESS

Seven percent of the street vendors reported physical sexual harassment, in contrast to the 56% of our South African interviewees who had been raped in . prostitution. Prostitutes thus suffered much greater interpersonal violence than street vendors in the same neighborhood in Johannesburg, South Africa. Since the poverty, proximity to drug dealers, experience of street life and civil war were the same for both the street vendors and prostitutes, the large differences in their experiences of sexual and physical violence can be a.ttributed to the na­ ture of prostitution itself. A Toronto survey of homeless people can be compared to our Canadian sample of women in prostitution. Crowe and Hardill (1993) found that 40% of homeless people had been assaulted in contrast to the 91 % of our Canadian re­ spondents in prostitution who had been assaulted. Although homelessness is associated with violence, prostitution is associated with a gn!ater prevalence of violence. Several researchers have studied the development of men's attitudes toward prostitution. Investigating men's behavior with prostitutes,. Scandinavian re­ searchers suggested that prostitution is an expression of men's sexuality but not women's (Mansson, 200 I). Like rape myths, prostitution myths (mis­ perceptions about the nature of prostitution as harmless) are a component of a cluster of attitudes that consider sexual violence to be normal. We found that college students' acceptance of prostitution myths was highly correlated with acceptance of rape myths (Cotton, Farley, '& Baron, 2002). Furthermore, the college men who were most accepting of prostitution tended to be those who reported having subjected their partners to coercive sexual behaviors (Schmidt, Cotton, & Farley, 2000). . Although it has sometimes been assumed that prostitution of males is quali- . tatively different from prostitution of females, we did not nnd this to be the case (Kendall & Funk, 2003). In USA, South Africa, and in Thailand, we com­ pared women, men, and transgeridered prostitutes and found no differences in PTSD. A similar study found that 76% of 100 women, men and transgendered prostitutes in Washington, DC stated that they wanted to leave the sex indus­ try. Ninety-one percent of the male prostitutes wanted to escape prostitution (Valera, Sawyer, & Schiraldi, 2001). These findings are consistent with those of the present study. For men, boys, and the transgendered, the experience of being prostituted is similar to that of women and girls. Another misconception about prostitution is that a large majority of prosti­ tutes are drug-abusing women who entered prostitution to pay for a drug habit. A number of studies have shown that women increase recreational drug use to the point of addiction after entry into prostitution (Dalla, 2002). Lange, Ball, Pfeiffer, Snyder, and Cone (1989) found that 8% of women receiving treat­ ment for addiction reported that their drug abuse preceded prostitution, 14311

Farley et al. 63 whereas 39% reported that prostitution preceded drug abuse. In another study, 60% of a group of Venezuelan women in prostitution began abusing drugs and alcohol only after entry into prostitution (Raymond et aI., 2002). Kramer (2003), and Gossop, Powis, Griffiths, and Stang (1994) discuss women's use of drugs and alcohol to deal with the overwhelming emotions experienced while turning tricks. Medrano, Hatch, Zule and Desmond (2003) found that substance abusing African-American women who had a greater severity of childhood emotional abuse, emotional neglect, or physical neglect were at higher risk of prostituting than women who were less severely abused or ne­ glected in childhood. Medrano et al. noted that this association between child­ hood abuse and prostitution was unrelated to crack cocaine use. A common tactic used by pimps and traffickers to control prostitutes is to coercively addict them to drugs. In a similar way, perpetrators of sexual abuse against children are known to drug children in order to facilitate sexual attacks or to disorient and silence them (Carroll & Trull, 1999; Schwartz, 2000). Although it is sometimes assumed that legalization would decrease the vio­ lence of prostitution, many of our respondents did not feel that they would be safer from ph ysical and sexual assault if prostitution were legal. We found that 46% of people in prostitution in 6 countries felt that they were no safer from physical and sexual assault if prostitution were legal. Fifty percent of 100 pros­ tituting respondents in a separate study in Washington, DC expressed the same views (Valera, Sawyer, & Schiraldi, 2000). In an indictment of legal prostitu­ tion, more than half of our German respondents told us that they would be no safer in legal as compared to illegal prostitution. The triple force of race, sex and class inequality disparately impact indi~e­ nous. women. Prostitution of Aboriginal women occurs globally, in epidemic

numbers, with indigenous. women at the bottom of racialized. sexual hierar- chies in prostitution itself (Scully, 2Q01). The toxic legacy of colonialism and generations ofcommunity trauma are critical factors contributing to the prosti­ tution of indigenous women (Farley & Lynne, 2003). The overrepresentation of First Nations women in prostitution was reflected in the Canadian results re­ ported here. These findings are a consequence of their marginalized and deval­ ued" status in Canada, with a concomitant lack of options for economic survival. Indigenous women are almost always trafficked from rural communities (sometimes reservations) to urban areas. In the process of trafficking-women, men, and children are transported to markets for the purpose of prostitution or they are sold for sweatshop labor, domestic servitude, or servile marriages (also called mail-order brides).5 Trafficking may occur within or across inter­ national borders, thus a person may be either domestically or internationally 14312

64 PROSTITUTION, TRAFFICKING, AND TRAUMAtIC STRESS trafficked. The harm of prostitution itself is similar whether she crosses an international legal boundary or whether she is moved from, for example, Chiapas to Mexico City, or from Saskatoon to Vancouv~r. The experience of being uprooted from one's home or community causes distress. Migration it­ self is frequently a consequence of circumstances of degradation, violence, and dehumanization (deJong, 2000). Migration may also reduce the social sup­ port women count on to protect them from sexual violence (Lyons, 1999). Trafficking cannot occur without an acceptance of prostitution in the re­ ceiving country. Governments protect prostitution/trafficking because of the monstrous profits from the business of sexual exploitation. In 1999, Thailand, Vietnam, , Mexico, Russia, , and the Czech Republic were pri­ mary source countries for trafficking of women into the United States (Rich­ ard, 2000). Source countries vary according to the economic desperation of women, culturally-based gender inequality, the promotion of prostitution and trafficking by' corrupt government officials who issue and visas, and criminal connections in both the sending and the receiving country such as gang-controlled massage parlors, and the lack of laws to protect immigrating women. Salgado (2002) described what could be appropriately termed a trafficking syndrome. resulting from repeated harm and humiliation against a person who is kept isolated and living in prisoner-of-war-like conditions. As in prostitution and domestic trafficking, international trafficking is extremely likely to result in PTSD. Like women domestically trafficked into prostitution, internation­ ally trafficked women experience extreme fear, guilt regarding behaviors which run counter to their religious or cultural beliefs, self-blame, and a sense of betrayal, not only by family and pimps-but by traffickers and governments. In addition, women may fear loss of immigration status if they attempt to leave violent husbands or pimps and they may not know how to access legal or social services. Additional barriers confronted by trafficked immigrant women are absence of services in the language of newcomer groups, discrimination and racism, and models of healthcare that are culturally irrelevant. In the five years since data from the first five countries of this study were collected (Farley et aI., 1998), prostitution has been increasingly normalized in many cultures where, whether legal or not, it is promoted or tolerated as a rea­ sonablejob for women. Internet technology. has expanded the global reach of sex businesses, which have sometimes been adopted as governments' devel­ opmentstrategies. For example, the International Labor Organization (ILO) promoted prostitution as the "sex sector" of Asian economies despite also cit­ ing their own surveys which indicated that in Indonesia, for example, 96% of those interviewed wanted to leave prostitution (Lim, 1998). Although they are 14313

Farley el al. 65

clear regarding their desire to get out of prostitution, the voices of these women in the "sex sector" are ignored. The economic motivation for this failure to lis­ ten to those in prostitution is evident: 2.4% of the gross domestic product of In­ donesia (US $3.3 billion per year) and 14% of the gross domestic product of Thailand (US $27 billion per year) was supplied by legal sex businesses (Lim, 1998). A woman in Thailand told us, "I want the world to understand that prosti­ tution is not a good job-so that there are other jobs for women. I want the government to look into what's going on." Instead of the question, "Did she voluntarily consent to prostitution?" the more relevant question would be: "Did she have real alternatives to prostitution for survival?" The incidence of homelessness (75%) among our respondents in 9 countries, and their desire to get out of prostitution (89%) reflect their lack of options for escape. It is a clini­ cal, as well as a statistical error, to assume that most women in prostitution consent to it. In prostitution, the conditions which make genuine consent pos­ sible are absent: physical safety, equal power with customers, and real alterna­ tives (MacKinnon, 1993; Hernandez, 2001). Until it is understood that prostitution and trafficking can appear voluntary but are not in reality a free choice made from a range of options, it will be difficult to garner adequate sup­ port to assist the women and children in prostitution who wish to escape but have no other economic choices.

I feel like I imagine people who were in concentration camps feel when they get out ... It's a real deep pain, an assault to my mind, my body, my dignity as a human being. I feel like what was taken away from me in prostitution is irretrievable. (Giobbe, 1991, cited by Jeffreys, 1997)

We can no longer assume that the harm perpetrated against prostitutes is in any way accidental. The institution of prostitution is carefully constructed and promoted. Those of us concerned with global human rights must- address the social invisibility of prostitution, the massive denial regarding its harms, its normalization as an inevitable social evil that can be moved far from the neigh­ borhoods of nice people, and the failure to educate students of law, psychol­ ogy, public health, and criminal justice. Prostitution and trafficking can only exist in an atmosphere of public, professional, and academic indifference.

NOTES

I. We use the term "john" throughout to refer to customers of those in prostitution, because that US EngJ.ish terminology is most commonly used by those in prostitution themselves. Women in the US also refer to customers as "tricks" or "dates." The word 14314 66 PROSTITUTION, TRAFFICKING, AND TRA UMA TIC STRESS

"trick" comes from customers' practices of tricking women into doing more than they pay for; the word "date" suggests that prostitution as a normal part of male-female rela­ tionships. There are many different words those in prostitution use to describe custom­ ers. Women in Johannesburg, for example, called customers "steamers," referring to the steamed-up windows of cars of Dutch settlers who drove into the city from their farms to buy African girls in prostitution. 2. A pimp is the man or woman who procures the prostitute, promotes, and sells her, and profits from prostitution. By this definition, pimps are not only the men on the street, pimps are also strip club owners, bar owners, disc jockeys, taxi drivers, con­ cierges, motel managers, etc. 3. One group of women (over the age of eighteen) who worked in a brothel in Ne­ vada had stuffed "kitties and puppies" in their cubicles, and their favorite foods were Captain Crunch cereal, and Nestle's Quik (Rubenstein, 1998). Similarly, Winick and Kinsie (1971, p. 146) wrote that adult prostitutes' leisure activities included roller skat­ ing and playing with dolls. We suggest that these are dissociated child parts of young women who alternate between reenacting abuse in prostitution and seeking soothing and safety in children's food and activities. 4. Many women are confused about the definition of rape. If rape is any unwanted sex act or coerced, then the statistic would be a much higher percentage. Some women in prostitution assume there is no difference between prostitution and rape, and they only call it rape if they were not paid, regardless of the violence of the act. Additionally, many studies, including our own, interviewed women who were currently prostituting. Asking them about rape is like asking someone in a combat zone if they are under fire. The responses to inquiries about rape in prostitution must make the clinical as well as the statistical assumption that a significant percentage of women currently prostituting deny rape and other violence because it would be too stressful to acknowledge the ex­ treme danger posed by johns and pimps. 5. Sweatshop labor, domestic servitude, and servile marriage frequently involve sexual exploitation or prostitution in addition to labor exploitation.

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Ekberg, G.S. (2001). Prostitution and Trafficking: The Legal Situation in Sweden. Pa­ per presented at Journees de formation sur la mondialisation de la prostitution et du trafic sexuel, Association quebecoise des organismes de cooperation intemationale, Montreal, Quebec, Canada. March 15,2001. Farley, M. (2003). Prostitution and the Invisibility of Harm. Women & Therapy, 26 (3/4). Farley, M. (1997). Prostitution, Slavery, and Complex PTSD. Paper presented at 13th Annual Meeting of the International Society for Traumatic Stress Studies. Mon- treal, November 8, 1997. . Farley, M., Baral, I., Kiremire, M.~ & Sezgin, U. (1998). Prostitution in Five Coun­ tries: Violence and Posttraumatic Stress Disorder. Feminism & Psychology 8 (4): 415-426. Farley, M., & Barkan, H. (1998). Prostitution, violence and posttraumatic stress disor­ der. Women & Health, 27 (3): 37-49. Farley, M., & Kelly, V. (2000): Prostitution: A critical review of the medical and social sciences literature. Women & Criminal Justice, 11 (4): 29-64. Farley, M., & Lynne, J. (2003). Prostitution in Vancouver: Violence and the Coloni­ zation of First Nations Women. Fourth World Journal. Available online at http://www.cwis.org/fwj/index.htm. Farley, M., & Patsalides, B. (2001). Physical symptoms, Posttraumatic Stress Disor­ der, and Heal~hcare Utilization of Women with and without Childhood Physical and Sexual Abuse. Psychological Repons 89: 595-606. Friedman, M. J., & Yehuda, R. (1995). Post-Traumatic Stress Disorder and Comorbidity: Psychobiological Approaches to Differential Diagnosis. In M. J. Friedman, D. Charney, A. Deutch (Eds.) Neurobiological and Clinical Conse­ quences ofStress: From Normal Adaptation to Posttraumatic Stress Disorder. Phil- adelphia: Lippincott-Raven. pp. 429-445. . Friedman, M.J., & Schnurr, P.P. (1995). The relationship between trauma, post-trau­ matic stress disorder, and physical health. In M. J. Friedman, D.S. Charney, & AY. Deutsch (eds.) Neurobiological and clinical consequences of stress: From normal adaptation to PTSD. Philadelphia: Lippincott-Raven. Fundacion Esperanza. (2{XX}). Trafico de nifias. A~ April 2002 at http/lwwwiundacion esperanza.org.com Fundacion Esperanza (1998). Trafico de Mujeres en Colombia. Bogota, Colombia. Fundacion Renacer (2000). Entrevista personal con el Doctor Wilson Montano. Direc­ tor Renacer, Cartagena.. Fundaci6n Renacer (2001). Explotacion Sexual Infantil en Colombia. Accessed March 2002 at http://wwwfundacionrenacer;orglfundacion-apdyo. Giobbe, E. (1991). Prostitution, Buying the Right to Rape, in Ann W. Burgess, (ed.) Rape and Sexual Assault III: A Research Handbook. New York: Garland Press p. 143-160. Giobbe, E. (1993). An Analysis of Individual, Institutional and Cultural Pimping, Michigan Journal of Gender & Law 1: 33-57. Giobbe, E., Harrigan, M., Ryan, J., & Gamache, D. (1990). Prostitution: A Matter of Violence against Women. WmSPER, Minneapolis, MN. Golding, J. (1994). Sexual Assault History and Physical Health in Randomly Selected Los Angeles Women. Health Promotion 13:130-138. 14317

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Gossop, M., Powis, B., Griffiths, P., & Stang, J. (1994). Sexual behavior and its rela­ tionship to drug-taking among prostitutes in south London. Addiction 8: 961-970. Gysels, M., Pool., R., & Nnulasiba, B. (2002). Women who sell sex in a Ugandan trad­ ing town: Life histories, survival strategies and risk. Social Science & Medicine 54: 179-192. Herman, J.L. (1992). Trauma and Recovery. New York: Basic Books. Hernandez, T. K. (2001). Sexual harassment and racial disparity: The mutual construc­ tion of gender and race. U. Iowa Journal o/Gender, Race & Justice, 4: 183-224. Hoigard, C., & Finstad, L. (1986). Backstreets: Prostitution, Money and Love. Penn­ sylvania State University Press, Universi~y Park, PA. Holsopple, K. (1998). Strip Clubs According to Strippers: Exposing Workplace Sexual Violence. Unpublished paper, available online at http://www.catwinternational. orglstripcl.htm. Houskamp, B. M., & Foy, D.W. (1991). The assessment of posttraumatic stress disor­ der in battered women. Journal 0/ Interpersonal Violence, 6, 367-375. Hunter, S. K. (1994). Prostitution is cruelty and abuse to women and children. Mithi­ gan Journal ofGender and Law 1: 1-14. ICBF. Instituto Colombiano de Bienestar Familiar (2000). Sistema de Infonnaci6n ICBF. Accessed April 2002 at http://www.icbf.gov.co!espanoVestadisticas.asp. ICBF-UNESCO & Universidad Externado (1997). Plan de acci6n en Favor de los Derechos de la Infancia Explotada Sexual mente y Contra la Explotacion Sexual. Bogota. James, J., & Meyerding, J. (1977) Early sexual experience and prostitution. American Journal 0/ Psychiatry 134: 1381-1385. Jeffreys, S. (1997). The Idea 0/ Prostitution. North Melbourne, Victoria: Spinifex Press. Kalichman" S.C., Kelly, J.A., Shaboltas, A., & Granskaya, J.(2000). Violence Against:Women and the Impending AIDS Crisis in Russia. American Psycholo­ gist 55:279-280. Kalichman, S.C., Williams, E.A., Cheery, C., Beicher, L., & Nachimson, D. (1998). Sexual.Coercion, Domestic Violence, and Negotiating Condom Use Among Low-Income African American Women. Journal o/Women's Health 7: 371-378. Keane, T. M., Kaloupek, D. G., & Weathers, f. W. (1996). Ethnocultural Consider­ ations in the Assessment ofPTSD. In A. J. Marsella, M. 1. Friedman, E. T. Gerrity, & R. M. Scurfield (eds.) Ethnocultural Aspects 0/ Posttraumatic Stress Disorder: Issues, Research, and Clinical Applications. Washington, DC: American Psycho­ logical Association. 183-205. Kemp, A., Rawlings, E., & Green, B. (1991). Post-traumatic stress disorder (PTSD) in battered women: A shelter sample. Journal o/Traumatic Stress, 4, 137-147. Kendall, C.N., & Funk, R. E. (2003). Gay Male Pornography's "Actors": When "Fan­ tasy" Isn't. In M. Farley (ed.) Prostitution, Trafficking, and Traumatic Stress. Binghamton, NY: Haworth. Koss, M., & Heslet, L. (1992). Somatic Consequences of Violence Against Women. Archives 0/ Family Medicine 1: 53-59. Kramer, L. (2003). Emotional Experiences of Perfonning Prostitution. In M. Farley (ed.) Prostitution, Trafficking, and Traumatic Stress. Binghamton, NY: Haworth. 14318 70 PROSTITUTION, TRAFFICKING, AND TRAUMATIC STRESS

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Zessen, G., Straver, C.J., & Visser, J.H. (1995). Professional HIV risk taking, levels of victimization, and well-being in female prostitutes in the Netherlands. Archives oj Sexual Behavior 24(5): 503-515. Zumbeck, S., Teegen, F., Dahme, B., & Farley, M. (2003).Posttraumatische Belastungsstorung ben Prostituierten-Ergebnisse einer Hamburger Studie im Rahmen eines intemationalen Projektes. Zeitschrijt jUr Klinische Psychologie Psychiatrie und Psychotherapie 5 J (2): 12] -136. 14323

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Prostitution, Trafficking, and Cultural Amnesia: What We Must Not Know in Order To Keep the Business of Sexual Exploitation Running Smoothly

Melissa Farleyt 1/ c.. 11_--, tp,- This is Exhibit __ me~oned and rei erred to. In the al!id~L: _ .. :0 Sworn before me this.L~... jay of rn",! ,A.D. 20~rF-/::e • ACommissionerfortakingafiidaviis ~ ~ INTRODUCTION

"Wise governments," an editor in the Economist opined, "will accept that paid sex is ineradicable, and concentrate on keeping the business clean, safe and inconspicuous."l That third adjective, "inconspicuous," and its relation to keeping prostitution "ineradicable," is the focus of this Article. Why should the sex business be invisible? What is it about the sex industry that makes most people want to look away, to pretend that it is not really as bad as we know it is? What motivates politicians to do what they can to hide it while at the same time ensuring that it runs smoothly? What is the connection between not seeing prostitution and keeping it in existence? There is an economic motive to hiding the violence in prostitution and trafficking. Although other types of gender-based violence such as incest, rape, and wife beating are similarly hidden and their prevalence denied, they are not sources of mass revenue. Prostitution is sexual violence that results in massive

tMelissa Farley is a research and clinical psychologist at Prostitution Research & Education, a San Francisco non-profit organization. She edited PROSTITUTION, TRAFFICKlNG, AND TRAUMATIC STRESS in 2003, which contains contributions from important voices in the field, and she has authored or contributed to twenty-five peer-reviewed articles. Farley is currently engaged in a series of cross-cultural studies on men who buy women in prostitution, and she is also helping to produce an art exhibition that will help shift the ways that people see prostitution, pornography, and sex trafficking. On the one-year anniversary of her death, I note that 's life and her words changed my life. Catharine MacKinnon's wisdom about exactly how women get hUlt by men, her generous heart, and her fabulous critical reviews, have made it possible for me to keep writing. Margaret Baldwin, a brilliant and compassionate attorney who is in the process of setting up a state-of-the-art treatment center for women escaping prostitution, has been a joy to work with. 's vigilance, her devotion to cyberspace, and her saucy attitude are an inspiration to me. And thank you to Dorchen Leidholdt for saying to me in the back of that bus near Beijing, "why don't you compare other countries to the US-that hasn't been done before? And write about the emotional harm, why don't you?" I thank Emily Teplin and Zachariah Bo Summers at Yale Law School for their assistance and their dedication in editing this paper. L The Sex Business, THE ECONOMIST, Feb. 14, 1998, at 17.

Copyright © 2006 by the Yale Journal of Law and Feminism 14324

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102 Yale Journal of Law and Feminism [Vol. 18:N economic profit for some of its perpetrators.2 The sex industry, like other global enterprises, has domestic and international sectors, marketing sectors, a range of physical locations out of which it operates in each community, is controlled by many different owners and managers, and is constantly expanding as technology, law, and public opinion permit. Many governments protect commercial sex businesses because of the monstrous profits. Like slavery, prostitution is a lucrative form of oppression.3 And both slavery and prostitution are rife with every imaginable type of physical and sexual violence. The institutions of prostitution and slavery have existed for thousands of years, and are so deeply embedded in cultures that they are invisible to some. In Mauritania, for example, there are 90,000 Africans enslaved by Arabs. Human rights activists have traveled to Mauritania to report on slavery, but because they think they know what slavery looks like and because they do not see precisely that stereotype in action-for example, if they do not see bidding for shackled people on auction blocks-they conclude that the Africans working in the fields in front of them are voluntary laborers who are receiving food and shelter as salary.4 Similarly, if people do not see exactly the stereotype of what they think "harmful" prostitution/trafficking is, for example, if they do not see a girl being dragged at gunpoint from one location to another, or if they see an eighteen year old who says, "I like this job and I'm getting rich," then they do not see the harm. Prostitution tourists and local johns see smiling girls waving at them from windows in Amsterdam, brothels in Mumbai, or strip clubs in . Johns and their friends decide that prostitution is a free choice. On the other hand, survivors of prostitution have described it as "volunteer slavery,,5 and as "the choice made by those who have no choice.,,6 If you're a woman or girl, global forces that choose you for prostitution are sex discrimination, race discrimination, poverty, abandonment, debilitating sexual

2. In Las Vegas, Nevada, three law enforcement sources and one investigative reporter have separately estimated that the sex industry and its ancillary operations (including both legal and illegal activities such as legal lapdancing, ext0l1ion monies paid to taxi drivers for delivery of customers to specific strip clubs, and tips to valets and bartenders for women), generate between $1 and $5 billion per year. This research is forthcoming in a report on Nevada prostitution/trafficking to be released by the author in 2006. Melissa Farley, Prostitution and Trafficking in Nevada, 2006, (unpublished manuscript, on file with author). 3. See, e.g., , FEMALE SEXUAL SLAVERY (1979); KATHLEEN BARRY, THE PROSTITUTION OF SEXUALITY (1995) [hereinafter PROSTITUTION OF SEXUALITY]; CATHARINE A. MACKlNNON, SEX EQUALITY 1447-72 (200 I) (discussing prostitution and slavery). 4. See Elinor Burkett, God Created Me to Be a Slave, N.Y. TIMES MAG., Oct. 12, 1997, at 56. Since Burkett wrote the article, there has been increasing awareness of different manifestations of slavery, sometimes including prostitution. See, e.g., U.S. DEP'T OF STATE, OFFICE TO MONITOR AND COMBAT TRAFFICKING IN PERSONS, RESCUING VICTIMS OF MODERN-DAY SLA VERY (2005), http://www.state.gov/g/tip/rls/fs/2005/55233.htm. 5. INE V ANWESENBEECK, PROSTITUTES' WELL-BEING AND RISK 149 (1994). 6. CHRISTA WISTERJCH, THE GLOBALIZED WOMAN: REPORTS FROM A FUTURE OF INEQUALITY 63 (2000). 14325

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2006J Prostitution, Trafficking and Cultural Amnesia 103

and verbal abuse, poor education or no education, and a job that does not pay a living wage. All drive girls and women into the commercial sex industry. 7 Defined as whores when they were young, women who appear to choose prostitution have been sexually abused as children at much higher rates than other women. One way that women end up 'choosing' prostitution is that they are paid for the abuse that they have already grown up with. They assume that's all they are good for. 8 In this analysis, prostitution is a gendered survival strategy based on the assumption of unreasonable risks by the person in it. Regardless of prostitution's legal status (legal, illegal, zoned, or decriminalized) or its physical location (strip club, massage parlor, street, escortlhome/hotel), prostitution is extremely dangerous for women. Prostituted women are unrecognized victims of intimate partner violence by customers as well as pimps.9 Pimps and customers use methods of coercion and control like those of other batterers: economic exploitation, social isolation, verbal abuse, threats, physical violence, sexual assault, captivity, minimization and denial oftheir use of physical violence and abuse.!O Prostitution/trafficking/pornography thus systematically discriminate against women, against the young, against the poor and against ethnically subordinated groups. When prostitution is conceptually morphed into sex - work, brutal exploitation by pimps becomes an employer-employee relationship. When prostitution is defined as labor, the predatory, pedophiliac purchase of a human being by a john becomes a banal business transaction. I I Prostitution is sometimes embraced in the media, in public health, and in the

7. The sex industry changes and expands constantly. It includes phone sex, intemet prostitution via live video chat, massage brothels, escort prostitution, gentlemen's clubs, topless clubs, the commercial marriage market, ritual abuse of children, sauna and nail parlor prostitution, street prostitution, strip clubs, lap dancing, peep shows, and pomography. 8. As a teen, one woman felt safer and more in control tuming tricks in the street than she did inside her home where her stepfather regularly raped her and stole her epilepsy medication. Interview with anonymous prostituted woman, in San Francisco, Cal. (Sept. 20, 2000). 9. See Christine Stark & Carol Hodgson, Sister Oppressions: A Comparison of Wife Battering and Prostitution, in PROSTITUTION, TRAFFICKING, AND TRAUMATIC STRESS 17 (Melissa Farley ed., 2003). 10. See EVELINA GIOBBE ET AL., A FACILITATOR'S GUIDE TO PROSTITUTION: A MATTER OF VIOLENCE AGAINST WOMEN (Denise Gamache ed., 1990)[herinafter GIOBBE, FACILITATOR'S GUIDE]; Evelina Giobbe, An Analysis ofIndividual, Institutional and Cultural Pimping, 1 MICH. J. GENDER & L. 33 (1993); Evelina Giobbe, Prostitution: Buying the Right to Rape, in RAPE AND SEXUAL ASSAULT III: A RESEARCH HANDBOOK 143 (Ann Wolbert Burgess ed., 1991). II. See Appendix A. Women Hurt in Systems of Prostitution Engaged in Revolt (WHISPER) demystified the "job" of prostitution with a tongue-in-cheek job application for prostitution. This satirical job description has been widely used in agencies that provide emotional support and altematives to women escaping prostitution. For example, the author leamed that women at SOS (Sisters Offering Support) in Honolulu tacked the job description onto the door of their group meeting room and that it led to much laughter. The job application is © WHISPER & Evelina Giobbe. All rights reserved. Permission granted to reprint. Previously printed in Melissa Farley, Preface: Prostitution, Trafficking, and Traumatic Stress, in PROSTITUTION, TRAFFICKING, AND TRAUMATIC STRESS, at xi, xx; MACKINNON, SEX EQUALITY, supra note 3, at 1437. 14326 FARLEY W ITALICS 5/3/2006 1:46:05 AM

104 Yale Journal of Law and Feminism [Vol. 18:N academy as "sex work," and in that one word-work-the , racism, and violent degradation of prostitution fade from sight. U.S. prostitution can be understood in the context of the cultural normalization of prostitution as a glamorous and wealth-producing ''job'' for girls who lack emotional support, education, and employment opportunities. The sexual exploitation of children and women in prostitution is often indistinguishable from incest, intimate partner violence, and rape. 12 Indian feminist Jean D'Cunha asked, "What will be the ... outcome of struggles against sexual harassment and violence in the home, the workplace, or the street, if men can buy the right to perpetrate these very acts against women in prostitution?,,13 This Article discusses and analyzes some of the empirical data on the harms of prostitution, pornography and trafficking. This information has to be culturally, psychologically, and legally denied because to know it would interfere with the business of sexual exploitation.

1. In order to view prostitution as a job, and in order to keep the business of sexual exploitation running smoothly, we can not know that prostitution is extremely violent.

Each act of violence that has been made visible as a result of the women's movement-incest, sexual harassment, misogynist verbal abuse, stalking, rape, battering, and sexual torture-is one point on the continuum of violence occurring in prostitution. As one survivor explained: There are thousands of books and classes that provide women with information on self-defense and rape "avoidance" strategies. Some of the basic lessons they teach us are not to walk alone at night on dark deserted streets, not to get into cars with strange men, not to pick up guys in a bar, not to even let a delivery man into your home when you're by yourself. Yet this is what the "job" of prostitution requires; that women put themselves in jeopardy every time they tum a trick. And then we ask, "How do you prevent it from leading to danger?" The answer is, you can't. Count the bodies. 14 In the past two decades, a number of authors have documented or analyzed the sexual and physical violence that is the normative experience for women in

12. See Marjolein Gysels et a!., Women Who Sell Sex in a Ugandan Trading Town: Life Histories, Survival Strategies and Risk, 54 SOCIAL SCIENCE & MEDICINE 179, 179-192 (2002). 13. Jean D'Cunha, Legalizing Prostitution: In Search of Alternatives From a Gender and Rights Perspective 39 (Seminar on the Effects of Legalisation of Prostitution Activities, Stockholm, Swed., Nov. 5-6, 2002). 14. Evelina Giobbe, The Vox Fights, vox, Winter 1991, at 34 [hereinafter Giobbe, The Vox Fights]. See also Evelina Giobbe, Confronting the Liberal Lies about Prostitution, in THE SEXUAL LIBERALS AND THE ATTACK ON FEMINISM 67, 76 (Dorchen Leidholdt & eds., 1990). 14327 FARLEY W IT ALleS 5/312006 I :46:05 AM

2006] Prostitution, Trafficking and Cultural Anmesia 105

prostitution. IS Today, there is a significant peer-reviewed literature documenting the violence in prostitution. Familial sexual abuse functions as a training ground for prostitution. Survivors link childhood physical, sexual, and emotional abuse as children to later prostitution. 16 Many studies lend support to this analysis. Seventy percent of the adult women in prostitution in one study said that their childhood sexual abuse led to entry into prostitution.17 Early adolescence is the most frequently reported age of entry into any type of prostitution. As one girl said, We've all been molested. Over and over, and raped. We were all molested and sexually abused as children, don't you know that? We ran to get away .... We were thrown out, thrown away. We've been on the street since we were 12, 13, 14.,,18 According to the empirical data (but not according to single-person, 'happy-hooker' narratives) familial abuse or neglect is almost universal among prostituted women. Of fifty-five survivors of prostitution at the Council for Prostitution Alternatives in Portland, eighty-five percent reported a history of incest, ninety percent a history of physical abuse, and ninety-eight percent a history of emotional abuse. I9 Multiple perpetrators of sexual and physical abuse were the rule rather than the exception. Sexual violence and physical assault are the norm for women in all types of prostitution. One Canadian observer noted that ninety-nine percent of women in prostitution were victims of violence, with more frequent injuries "than workers in [those] occupations considered ... most dangerous, like mining, forestry, and firefighting."zo Prostituted women in Glasgow said that violence

IS. For summaries of this literature, see BARRY, THE PROSTITUTION OF SEXUALITY, supra note 3; RYAN BISHOP & LILLIAN s. ROBINSON, NIGHT MARKET: SEXUAL CULTURES AND THE THAI ECONOMIC MIRACLE (1998); ANDREA DWORKIN, PORNOGRAPHY: MEN POSSESSING WOMEN (1981); MACKINNON, SEX EQUALITY, supra note 3; , THE IDEA OF PROSTITUTION (1997); Andrea Dworkin, Pornography, Prostitution, and a Beautiful and Tragic Recent History, in NOT FOR SALE: FEMINISTS RESISTING PROSTITUTION AND PORNOGRAPHY 137 (Rebecca Whisnant & Christine Stark eds., 2004); Melissa Farley et aI., Prostitution in Nine Countries, in PROSTITUTION, TRAFFICKlNG, AND TRAUMATIC STRESS 33 (Melissa Farley ed., 2003) [hereinafter Prostitution in Nine Countries]. There is also a wealth of relevant information available at http://www.catwintemational.org. 16. Dworkin described incest as "boot camp" for prostitution. ANDREA DWORKIN, LIFE AND DEATH 143 (1997). 17. Mimi H. Silbert & Ayala M. Pines, Early Sexual Exploitation as an Influence in Prostitution, 28 SOCIAL WORK 285 (1983). See also MIMI H. SILBERT ET AL., SEXUAL ASSAULT OF PROSTITUTES (National Center for the Prevention and Control of Rape, National Institute of Mental Health, San Francisco, CA, 1982). 18. See NORTHWEST RESOURCE Assoc., SURVIVAL SEX IN KING COUNTY, REPORT SUBMITTED TO KING COUNTY WOMEN'S ADVISORY BOARD 16 (1993). 19. E-mail from Susan Hunter to Melissa Farley (Apr. 4, 2006) (on file with author). See also Susan K. Hunter, Prostitution is Cruelty and Abuse to Women and Children, 1 MICH. J. GENDER & L 91, 103 (1993) (discussing another phase of this series of studies that demonstrate similar high rates of childhood trauma among women escaping prostitution) 20. Erin Gibbs Van Brunschot et aI., Images oj Prostitution: The Prostitute and Print Media, 10 WOMEN & CRIM. JUST. 47, 47 {I 999). 14328

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106 Yale Journal of Law and Feminism [Vol. 18:N from customers was their primary fear.21 Physical abuse was considered part of the job of prostitution, with the payment sometimes determined by each individual blow of a beating or whipping.22 Violence is commonplace in prostitution whether it is legal or illegal.23 Eighty-five percent of prostituted women interviewed in Minneapolis-St. Paul had been raped in prostitution.24 Another study found that eighty percent of women who had been domestically or transnationally trafficked suffered violence-related injuries.25 Of 854 people in prostitution in nine countries, eighty-nine percent wanted to leave prostitution but did not have other options for survival. 26 Researchers have found that two factors are consistently associated with greater violence in prostitution: poverty and length of time in prostitution. The more customers serviced, the more women reported severe physical symptoms.27 The longer women remained in prostitution, the higher their rates of sexually transmitted diseases?8 When prostitution is assumed to be a reasonable "job option," women's intense longing to escape it is made invisible.29 Violence is common in prostitution whether it is located indoors or outdoors. The boundary between stripping, dancing, and prostitution no longer exists as it did twenty-five years ago.30 In today's strip clubs, johns who buy

21. See S. T. Green & D. J. Goldberg, Female Streetworker-Prostitutes in Glasgow: A Descriptive Study of Their Lifestyle,S AIDS CARE 321,328 (1993). 22. See id. at 328. 23. See generally VANWESENBEECK, supra note 5. 24. Ruth Parriott, Health Experiences of Twin Cities Women Used in Prostitution 20 (1994) (unpublished manuscript, on file with WHISPER, Minneapolis, MN). 25. JANICE G. RAYMOND ET AL., A COMPARATIVE STUDY OF WOMEN TRAFFICKED IN THE MIGRA TlON PROCESS: PATTERNS, PROFILES AND HEALTH CONSEQUENCES OF SEXUAL EXPLOITATION IN FIVE COUNTRIES (INDONESIA, THE PHILIPPINES, THAILAND, VENEZUELA AND THE UNITED STATES) (2002), available at http://action.web.calhome/catw/readingroomlshtml?x=17062. 26. See Farley, Prostitution in Nine Countries, supra note IS. Women in prostitution note that shelters and services may be available to battered women but not to prostituted women. Speaking of the need to include prostituted women in the battered women's movement, Evelina Giobbe testified, "[WJomen who are in prostitution, myself and my sisters .. have been subjected to the same abuse that every battered woman has spoken about in this room, except men paid for the right to do it. It's not ajob. We're abused, and we need help." Joshua M. Price, Violence Against Prostitutes and a Re-evaluation of the Counterpublic Sphere, 34 GENDERS 32 (2001), http://www.genders.orglg34/g34_price.html(quoting from a speech printed in an educational manual from the Massachusetts Coalition of Battered Women Service Groups Inc.). 27. See V ANWESENBEECK, supra note 5. 28. See Parriott, supra note 24, at 14. 29. See, e.g., GLOBAL ALLIANCE AGAINST TRAFFIC IN WOMEN, HANDBOOK FOR HUMAN RIGHTS ACTION IN THE CONTEXT OF TRAFFIC IN WOMEN 3 (1997), available at http://apnsw.orglapnsw.htm ("Women have the light to make a bad decision."); see also Melissa Farley & Sunjean Seo, Prostitution and Trafficking in Asia, 8 HARV. ASIA PAC. REv. 8 (2006) (discussing the role of the World Health Organization and other groups in normalizing prostitution as labor); Stark & Hodgson, supra note 9. 30. For documentation of the increasing sexual and physical violence by men against women who strip, see Melissa Farley, Bad for the Body, Bad for the Heart, 10 VIOLENCE AGAINST WOMEN 1087, 1102 (October 2004), available at http://www.prostitutionresearch.com/laws/000073.html; see also BRENT K. JORDAN, STRIPPED: TWENTY YEARS OF SECRETS FROM INSIDE THE STRIP CLUB (2004) (discussing the roles of bouncers in strip clubs: to respond to customers' sexual assaults on dancers, and 14329 FARLEY W ITALleS 5/3/2006 I :46:05 AM

2006] Prostitution, Trafficking and Cultural Amnesia 107 lapdances assume they'll be permitted to ejaculate with their pants on. When the sexual performance is more private, as in VIP rooms or champagne rooms, the probability of violent sexual harassment including rape dramatically mcreases.. 31 Prostitution can be lethal.32 A Canadian commission found that the death rate of women in prostitution was forty times higher than that of the general population.33 A study of Vancouver prostitution reported a thirty-six percent incidence of attempted murder.34 The verbal abuse that is commonplace in prostitution is often minimized as a source of serious and longlasting harm. Despite its social invisibility, eighty­ eight percent of women in one study described verbal abuse as an intrinsic part of prostitution.35 When women are turned into objects that men masturbate into, profound psychological harm results for the person who is acting as receptade.36 In prostitution, a woman does not stay whole; she loses her name, her identity, and her feelings.37 Over time, the commodification and objectification of her body by pimps and johns are internalized. Portions of her body are numbed and compartmentalized. Eventually she also views her body as a commodity, rather than as integral to the rest of herself. Trauma and torture survivors commonly experience this profound disconnectedness.38 Continuous assaults on the woman's body in prostitution cause revulsion

to ensure that customers are beaten up if they attempt to "trick" women out of their pay); see also Jacqueline Lewis, Lap Dancing: Personal and Legal Implications Jor Exotic Dancers, in PROSTlTIJTlON: ON WHORES, HUSTLERS, AND JOHNS 376 (James A. Elias et a!. eds., 1998) (noting that the amount and type of physical contact in stripping removes the boundary between it and prostitution); Eleanor Maticka-Tyndale et a!., Exotic Dancing and Health, 31 WOMEN & HEALTH 87,104 (2000). 31. Holsopple documented the verbal, physical, and sexual abuse experienced by women in strip club prostitution including physical and sexual assaults on breasts, buttocks, and genitals. Women are kicked, bitten, slapped, spit on, and penetrated vaginally and anally during lap dancing. See Kelly Holsopple, Stripclubs According to Strippers: Exposing Workplace Violence (1998) (unpublished manuscript) (on file with author). 32. See John J. Potterat et a!., Mortality in a Long-Term Open Cohort oj Prostitute Women, 159 AM. 1. EPIDEMIOLOGY 778 (2004). 33. Special Committee on Pornography and Prostitution, Pornography and Prostitution in Canada, 2 PORN. & PROSTITIJTION CAN. 350,350 (1985). 34. Leonard Cler-Cunningham & Christine Christenson, Studying Violence to Stop It: Canadian Research on Violence Against Women in Vancouver's Street Level Sex Trade, 4 RESEARCH FOR SEX WORK 25, 26 (200 I). 35. Melissa Farley et aI., Prostitution in Vancouver: Violence and the Colonization ojFirst Nations Women, 42 TRANSCULTIJRAL PSYCHIATRY 242, 250 (2005). As one women explained, "It is internally damaging. You become in your own mind what these people do and say with you. You wonder how could you let yourself do this and why do these people want to do this to you?" Interview with anonymous prostituted woman, in San Francisco, Cal. (May 8, 2004). 36. See generally CECILlE H0IGARD & LIv FINSTED, BACKSTREETS: PROSTITUTION, MONEY AND LOVE 51 (1986) 37. See DWORKIN, LIFE AND DEATH, supra note 16, at 139-51. 38. See HARVEY L. SCHWARTZ, DIALOGUES WITH FORGOTTEN VOICES: RELATIONAL PERSPECTIVES ON CHILD ABUSE TRAUMA AND THE TREATMENT OF SEVERE DISSOCIATIVE DISORDERS (2000). 14330

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- 108 Yale Journal of Law and Feminism [Vol. 18:N

and repeated traumatization. Williams described her response to the rape/sex of prostitution: "[1] started getting physically ill whenever 1 turned a trick. My vagina closed on me again like it did when 1 was 15 years old [during a ...... rape]. . . One night a man tried to force himself inside of me and damaged his penis in the process. ,,39 Reviewing four studies of dissociation among women in prostitution, researchers concluded that dissociation is a common psychological defense in response to the trauma of prostitution. 40 The dissociation necessary to survive rape, battering, and prostitution in adulthood is the same as that used to survive ..... familial sexual assault. Dissociation has been observed as a consequence of torture and a means of surviving it. 41 Most women report that they cannot prostitute unless they dissociate.42 When they do not dissociate, they are at risk for being overwhelmed with pain, shame, and rage. One woman explains: It's almost like I trained my mind to act like I like [prostitution] but not have any thoughts. I have the thoughts like 'What is this doing to my body and my mind and my self-esteem?' a few days later but not as it's happening. . .. Even though the guys are paying me for it, I feel like they're robbing me of something personal. And I wonder, 'Why are they doing this?,43 Posttraumatic stress disorder (PTSD) commonly occurs among prostituted women, and is indicative of their extreme emotional distress. PTSD is

,..- characterized by anxiety, depression, insonmia, irritability, flashbacks, emotional numbing, and hyperalertness. In nine countries, we found that sixty­ eight percent of those in prostitution met criteria for a diagnosis of PTSD,44 a prevalence that was comparable to battered women seeking shelter,45 rape SUrvIVorS. see k'mg treatment, 46 an d SUrvIVorS . 0 f state-sponsore d torture. 47

39. Anonymous, Stories, in SOLD OUT: A RECOVERY GUIDE FOR PROSTITUTES 77 (1. L. Williams ed.,1991). 40. Colin A. Ross et aI., Dissociation Among Women in Prostitution, in PROSTITUTION, TRAFFICKING, AND TRAUMATIC STRESS 199 (Melissa Farley ed., 2003). 41. See JUDITH L. HERMAN, TRAUMA AND RECOVERY (1992); Colin A. Ross et aI., Dissociation and Abuse Among Multiple Personality Patients, Prostitutes and Exotic Dancers, 41 Hosp. & ,... COMMUNITY PSYCHIATRY 328 (1990). 42. Drugs and alcohol function as chemical dissociation, facilitating psychological dissociation. Substance abuse also functions as an analgesic for physical injuries from violence in prostitution. 43. Virginia Vitzthum, Selling Intimacy, http://archive.salon.comlsexlfeature/2000/07/25/ girl_parUii/indexl.html (July 25, 2000)(quoting a prostituted woman). See generally MARIANNE WOOD, JUST A PROSTITUTE (1995) (discussing the rage that is a consequence of tolerating johns' behaviors). 44. Prostitution in Nine Countries, supra note 15, at 44. 45. Beth M. Houskamp & David W. Foy, The Assessment of Posttraumatic Stress Disorder in ..- Battered Women: A Shelter Sample, 6 1. iNTERPERSONAL VIOLENCE 367 (1991) (citing a forty-five percent incidence rate); Anita Kemp et aI., Post-Traumatic Stress Disorder (PTSD) in Battered Women: A Shelter Sample, 4 J . TRAUMATIC STRESS 137, 143 (1991)( citing an eighty-four percent incidence rate). 46. LT. Bownes et aI., Assault Characteristics and Post-Traumatic Stress Disorder in Rape ...- 14331 FARLEY W IT ALleS 5/312006 1:46:05 AM

2006] Prostitution, Trafficking and Cultural Amnesia 109

Across widely varying cultures on five continents, the traumatic consequences of prostitution were similar. 48 Vanwesenbeeck noted comparable symptoms among women in legal Dutch prostitution.49 Results from two studies of prostituted Korean women reflect the women's intense psychological distress with PTSD prevalence rates of seventy-eight and eighty percent.50 Most people who have been in prostitution for any length of time have difficulty with sexual intimacy.51 Sex becomes ajob, rather than an act oflove or passion. It's difficult to see one's chosen partner as anything but a john. A woman who danced naked behind glass for johns who watched and masturbated noted that over a period of time "the glass had dissolved and [my partner] had become one of them.,,52 Men who prostitute experience similar damage to their sexuality and to their sense of self, as well as symptoms of traumatic stress that are identical to women's. As one man said, I got into it because I thought sex was about love, and underneath it all I was looking for a dad. It's done me no good mentally. A few years ago I thought it was a good way to make money, but it's not worth the price .... I wouldn't recommend it to anyone .... I got beaten up lots of times. I was forced to have sex and I was ripped off . . . I was abused loads of times. 53

2. In order to consider prostitution a job, and in order to keep the business of sexual exploitation running smoothly, we can not know that racism and class prejudice, like sexism, are intrinsic to prostitution.

Women who are marginalized because of a lack of education, because of

Victims, 83 ACTA PSYCHIATRICA SCANDINAVICA 27, 27-30 (1991)(citing a seventy percent incidence rate). 47. R. Ramsay et a!., Psychiatric Morbidity in Survivors of Organised State Violence Including Torture, 162 BRIT. J. PSYCHIATRY 55, 55 (\ 993) (citing a fifty-one percent incidence rate). 48. Farley, Prostitution in Nine Countries, supra note 15, at 44. 49. Vanwesenbeeck found that ninety percent of women who were prostituted primarily in clubs, brothels, and windows reported "extreme nervousness." VANWESENBEECK, supra note 5, at 82. 50. Farley & Seo, supra note 29, at 9-12. See also Hyun Sun Kim, The Violent Characteristics of Prostitution and PTSD of Prostituted Women (June 2002) (unpublished thesis, Sungkonghoe University, Seoul, Korea) (on file with Sungjean Seo, Seoul, Korea); Letter from Jeong-Ho Chae (Nov. 22, 2005) (regarding preliminary data from a study of Trauma and Psychological Health of Women in Prostitution) (on file with Sungjean Seo, Seoul, Korea). 51. See Pan'iott, supra note 24. 52. Vicky Funari, Naked, Naughty, Nasty: Peepshow Reflections, in WHORES AND OTHER FEMINISTS 19, 32 (Jill Nagle ed., 1997). Funari goes on to write, "Last night, lying in bed after work, I touched my belly, my breasts. They felt like Capri's [her peep show name] and they refused to switch back. When [my partner] kissed me I inadvertently shmnk from his touch." Id. 53. BARBARA GIBSON, MALE ORDER: LIFE STORIES FROM BOYS WHO SELL SEX 86 (\995) (quoting a prostituted boy). See also GARY INDIANA, RENT BOY (1994); ROBERTA PERKINS & GARRY BENNETT, BEING A PROSTITUTE (\985); Christopher N. Kendall & Rus Ervin Funk, Gay Male Pornography's 'Actors:' When 'Fantasy' Isn't, in PROSTITUTION, TRAFFICKING, AND TRAUMATIC STRESS 93 (Melissa Farley ed., 2003).

- 14332

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110 Yale Journal of Law and Feminism [Vol. lS:N race and ethnic discrimination, poverty, previous physical and emotional harm and abandonment are the people purchased in prostitution. Prostitution is "chosen" as a job by those who have the fewest real choices available to them.54 Women in legal Dutch prostitution describe it as "volunteer slavery.,,55 Until conditions of sex and race equality exist, laws must protect people from exploitation that might appear to be voluntary or consenting.56 The critical question with respect to sex, race, and class-based discrimination in prostitution is not "did she consent?" but "has she been offered the real choice to exist without prostituting?" In the following three cases, each woman said that she consented to prostitution but in each situation, her living conditions made prostitution necessary for survival. An Indian woman said that prostitution was "better pay for what was expected of her in her last job, anyway;" women in most jobs in West Bengal, India, were expected to tolerate bosses' sexual exploitation in order to keep their jobs.57 A woman in Zambia, which had a ninety percent unemployment rate at the time, stated that she volunteered to prostitute in order to feed her family. 58 A Turkish woman was divorced, and had no means of support because she was discouraged from working outside the home. She applied to work in a state-run brothel where police guarded the entrance. 59 Sexist and racist economic policies in the United States such as a lack of educational opportunity for poor families and a lack of sustainable income from many jobs contribute to women's and girls' entry into prostitution. The economic and legal vulnerability of undocumented immigrant women in the United States is exploited in prostitution/pornography. For example, the Sth Street Latinas website advertises, "See hot, young & brown Latinas that will do absolutely anything to get their citizenship!,,60 The intersection of racism, sexism and class is apparent in sex tourism. The prostitution tourist denies the racist exploitation of women in someone else's culture. Promoting this denial, travel agencies assure male tourists that Thai culture is 'overtly sexual' and that Thai people are child-like sensual people who never grow Up.61 The prostitution tourist denies sexual exploitation by rationalizing that he is helping women escape poverty: "These girls gotta eat, don't they? I'm putting bread on their plate. I'm making a contribution.

54. See Catharine A. MacKinnon, Prostitution and Civil Rights, I MICH. J. GENDER & L. 13 (1993). 55. VANWESENBEECK, supra note 5, at149. 56. Telephone Interview with Jessica Neuwirth, Equality Now, in New York, N.Y. (Apr. 24, 2006). 57. Molly Chattopadhyay et a!., Biosocial Factors Influencing Women to Become Prostitutes in India, 41 SOCIAL BIOLOGY 252 (1994). 58. Interview with anonymous prostituted woman in Lusaka, Zambia (Feb. 17, 1996). 59. Interview with anonymous prostituted woman in Istanbul, Turkey (June 6, 1999). 60. 8th Street Latinas, http://www.8thstreetlatinas.com/main.htm?id=faxxaff (last visited Apr. 25, 2006). 61. See generally BISHOP & ROBINSON, supra note IS, at 149. 14333 FARLEY W ITALICS 5/3/2006 I :46:05 AM

2006] Prostitution, Trafficking and Cultural Amnesia 111

They'd starve to death unless they whored.,,62 However, the Thai perspective of this situation is diametrically opposed: "Thailand is like a stage, where men from around the world come to perform their role of male supremacy over Thai women, and their white supremacy over Thai people.,,63 Pornography, prostitution, and trafficking are rooted in sexism, racism and class prejudice, all of which are sexualized. Women in prostitution are purchased for their appearance, including skin color and characteristics based on ethnic stereotyping. Racist stereotypes in prostitution are driven by johns' demand for "something different." Forced by pimps to accommodate stereotypes of the submissive exotic with nowhere to run, one Korean­ American survivor faked poor English even though she had grown up in the United States.64 The World Sex Guide recently linked to a website titled "Bangkok street whores," with a john's contemptuous description of Thai women in poverty as "dumb and desperate.,,65 Although pornography of Grace Quek being serially raped by 251 men was billed as liberation from a stereotype of Asian women as sexually passive; in fact, the pornography of Quek-who referred to herself as a "fortune cookie,,66 -was a familiar racist and sexist portrayal of slave-like, sexually 67 subordinate Asian women. Quek seemed unclear about the film's racism when she was asked by an interviewer if she felt insulted or objectified. With a postmodern perspective that locates racism in the mind but not in the world, Quek responded, "No, I don't think so .... Without any stereotypes, everything would col/apse into nothingness. That's why I have no problems with people who in friendly banter, out of humor, go 'Chink, nigger, faggot,' whatever.,,68

62. Id. at 168-69 (quoting a sex tourist in Thailand). 63. JEREMY SEABROOK, TRAVELS IN THE SKIN TRADE: TOURISM AND THE SEX INDUSTRY 89 (1996) (quoting Siripom Skrobanek). 64. See Melissa Farley, Unequal, available at http://www.prostitutionresearch.coml how_prostitution_ workslOOO Ill.html (last visited, Apr. 20, 2006) 65. World Sex Guide, Prostitution in United States, http://www.worldsexguide.orglunited­ states.html (last visited, Apr. 20, 2006). The site has changing advertising banners. On October 28, 2005, the World Sex Guide advertised "Bangkok street whores: Click to see these Asian whores get nailed by a big white dick!" with a link to Bangkok Street Whores, http://www.bangkokstreetwhores.comll/bangkokwhorel.html(last visited Apr. 25, 2006). The web location provided one john's voyeuristic and homoerotic description of a Thai woman who "tried to talk her way out of getting fucked but as soon as he shut her up by stuffing his cock in her mouth, the peace talks were over. Then he split her wide open! We all know that [another john] brings the pain, but damn she's bleeding!" See also Michelle J. Anderson, A License to Abuse: The Impact of Conditional Status on Female Immigrants, 102 YALE L.J. 140 I, 1408-1409 nn.48--49 (1993). 66. Kimberly Chun, Sex: The Annabel Chong Story, ASIAN WEEK, May 4, 2000, http://www.asianweek.coml2000_05_04/ae_annabelchong.html(quoting Grace Quek). 67. See Pamela Kaskinen, Pornstar or a Feminist?, YLIOPPlLASLEHTl, Apr. 2000, at I ("At its core, the film is yet another attempt to capitalize on the racist, sexist and worn-out fantasy that Asian women are subordinate sex slaves.") (quoting Jill Nelson). 68. D.A. Clark, The Tao of the Gangbang, SPECTATOR, July 12, 1996, at 13 (emphasis added). Another perspective on the racism in the filming of Quek's sexual abuse by 251 men was noted by Darrell Y. Hamamoto, The Joy Fuck Club, 20 NEW. POL. SCI. 3 (1998), who observed that no Asian men were in the 300-men lineup to "gangbang" Quek. The only Asian American in attendance was a 14334 FARLEY W ITALleS 5/3/2006 I :46:05 AM

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Compared to their numbers in the United States as a whole, women of color are overrepresented in prostitution. For example, in Minneapolis, a city which is ninety-six percent white European-American, more than half of the women in strip-club prostitution are women of color.69 Racially constructed pornography made of prostituted women in other parts of the world influences how women of color are treated at home. For example, Asian-American women reported rapes after men viewed pornography of Asian women.70 Families who have been subjected to race and class discrimination in housing may be economically driven to live near gangs or pimps. Strip clubs and pornography outlets are zoned into poor neighborhoods, which also tend to be neighborhoods of immigrants andlor people of color. The sex businesses create a hostile environment in which girls and women are continually harassed bYpImps · an d'hnJO s. 71 Within the gendered institution of prostitution, race and class create a familiar hierarchy willi indigenous women at its lowest point. Especially vulnerable to violence from wars or economic devastation, indigenous women are brutally exploited in prostitution-for example Mayan women in Mexico City, Hmong women in Minneapolis, Atayal girls in Taipei, Karen or Shan women in Bangkok, First Nations women in Vancouver.72 Structural development programs run by the International Monetary Fund control developing economies, profoundly impacting women's lives. Poverty is one consequence of these IMF policies, which may also result in women's migration to cities for the purpose of economic survival, including prostitution. There is a myth that class privilege protects some women in prostitution. Demystifying this, Giobbe explained what lies beneath the trappings of class in prostitution: My experience in prostitution gives the lie to . .. common beliefs about the hierarchy of prostitution, the streets being the worst-case scenario and ... [escort] service being the best. . . . all I can say IS,

man whose job was to wipe ejaculate off Quek between johns.ld. 69. Telephone Interview with Andrea Dworkin (June 17, 1997). 70. See CATHARINE A. MACKINNON & ANDREA DWORKIN, IN HARM'S WAY: THE PORNOGRAPHY CIVIL RIGHTS HEARINGS (1997). 71. Vednita Nelson, Prostitution: Where Racism and Sexism Intersect, I MICH. J. GENDER & L. 81 (1993). 72. Because of their economic vulnerability and their lack of alternatives, prostitution more severely harms indigenous women. Melissa Farley, Preliminary Report on Prostitution in New Zealand (May 14,2003) (unpublished manuscript, on file with author) (comparing Maori/Pacific Islander New Zealanders to European-origin New Zealanders in prostitution, with the former more likely to have been homeless and to have entered prostitution at a younger age, and quoting Mama Tere, an Auckland community activist who described New Zealand prostitution as an "apartheid system."); see also Libby W. Plumridge & Gillian Abel, A "Segmented" Sex Industry in New Zealand, 15 AUSTL. & N.Z. J. PUB. HEALTH 78, 78 (200 1)( describing the differential impact prostitution has on Maori women in New Zealand). FARLEY W IT ALleS 5/312006 I :46:05 AM 14335

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whether you tum tricks in a car by the Holland tunnel or in the Plaza Hotel, you still have to take off your clothes, get on your knees or lie on your back, and let this stranger use you in any way he pleases.73 It is an error to assume that the privilege of so-called high-class call-girls protects them from the expoitation and violence that exists in all prostitution. In Chicago, for example, the same frequency of rape is reported by women in both escort and street prostitution.74 Although some studies report greater violence in outdoor prostitution, the difference is trivial when contrasted with most peoples' assumptions of what constitutes reasonable physical and emotional risk. 75 For instance, while women prostituting on the street in Glasgow were almost twice as likely to experience violence than women prostituting indoors, forty-eight percent of the women prostituting indoors were subject to frequent and severe violence.76 Among women prostituting in South Africa, while there was significantly more physical violence in street as compared to brothel prostitution, there was no difference in the women's emotional distress resulting from either street or brothel prostitution.77 It is also an error to assume that those in prostitution remain in one location. The location of prostitution is determined by wherever the greatest demand for it exists, by police surveillance and by arrests that deter prostitution. Women are moved to wherever pimps and traffickers can make the most money, for example near military bases,78 near political or business

73. The Vox Fights, supra note 14, at 32. 74. lODY RAPHAEL & DEBORAH L. SHAPIRO, SISTERS SPEAK OUT: THE LIVES AND NEEDS OF PROSTITUTED WOMEN IN CHICAGO 5 (2002), available at www.impactresearch.orgl documents/sistersspeakout.pdf. 75. Women in indoor prostitution (such as strip clubs, massage brothels and pornography) may have less control over the conditions of their lives and probably face greater risks of exploitation, enslavement, and physical harm than women prostituting on the street. See NORTHWEST RESOURCE ASSOCIATES, supra note 18, (1993). 76. Stephanie Church et aI., Violence by Clients Toward Female Prostitutes in Different Work Settings, 322 BRIT. MED. l. 524, 524-25 (2001) (noting that women prostituting in the street more frequently report being slapped, punched, or kicked-while those indoors more frequently report attempted rape). 77. Melissa Farley et aI., Prostitution in Five Countries, 8 FEMINISM & PSYCHOL. 405, 415 (1998). See also Colin A. Ross et aI., Dissociation and Abuse Among Multiple Personality Patients, Prostitutes and Exotic Dancers, 41 Hosp. & COMMUNITY PSYCHIATRY 328, 328-30 (1990) (noting that women who prostituted in strip clubs suffered significantly higher rates of dissociative and other psychiatric symptoms than women in street prostitution). 78. See Aida F. Santos, Gathering the Dust: The Bases Issue in the Philipines, 32,40, in LET THE GOOD TIMES ROLL: PROSTITUTION AND THE US MILITARY IN ASIA (Sandra Sturdevant & Brenda Stolzfus eds., 1992). During World War II, for example, the Japanese Army seized as many as 200,000 Asian women and girls using deception and violence, pimping them into military brothels. Most of these 'comfort women' were Korean. See C. Sarah Soh, Japan's Responsibility Toward Comfort Women Survivors (Japan Policy Research Institute, Working Paper No. 77, 2001), available at http://www.icasinc.orgllectures/soh3.html; Deborah Zabarenko, Ex-Slaves Sue Japan for Army Rapes, Torture-Former Comfort Women Testify in US, TORONTO STAR, Sept. 21, 2000, at I (reporting on a class-action lawsuit filed by fifteen former comfort women in U.S. federal court); NORA OKJA KELLER, COMFORT WOMAN (1997) (a fictionalized account of one woman's life). 14336

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114 Yale Journal of Law and Feminism [Vol. 18:N conventIOns,. 79 or to IocatIOllS . were h sportmg . events ta ke pace. I 80

3. In order to consider prostitution a job, and in order to keep the business of sexual exploitation running smoothly, we can not know that prostitution, pornography and trafficking meet or exceed legal definitions of torture.

Torture is: any act by which severe pain or suffering, whether physical or mental, is intentionally inflicted on a person for such purposes as punishing him. . . or intimidating or coercing him or a third person, or for any reason based on discrimination of any kind, when such pain or suffering is inflicted by or at the instigation of or with the consent or acquiescence of a public official or other person acting in an official capaCIty.. 81 Specific acts commonly perpetrated against women in prostitution and pornography are the same as the acts defining what torture is: verbal sexual harassment, forced nudity, rape, sexual mocking, physical sexual harassment such as groping, and not permitting basic hygiene.82 The psychological consequences of these acts are the same whether it is named state-sponsored torture or prostItutIOn.. . 83 Torture does not have to be perpetrated by state officials, and today there is an understanding that in some regions torture can and does occur at the hands

79. See Lisa Kramer, Emotional Experiences of Peiforming Prostitution, in PROSTITUTION, TRAFFICKING, AND TRAUMATIC STRESS 187, 191 (Melissa Farley ed., 2003) (describing locations where 119 U.S. women prostituted). For a detailed refutation of the myth that indoor prostitution is safe for women and a summary of studies comparing different locations where prostitution occurs, see Farley, supra note 30, at 1099. See also Melissa Farley, Prostitution Harms Women Even if Indoors: Reply to Weitzer, II VIOLENCE AGAINST WOMEN 950, 955-960 (July 2005). 80. Germany's World Cup Games in 2006 led to predictions that 40,000 women would be trafficked from other countries in Europe to service sports fans in a country with legal prostitution. See Coalition Against Trafficking in Women, Buying Sex is Not a Sport: No to Germany's Prostitution of Women in World Cup Games, 2006, available at http://catwepetition.ouyaton.orglphp/index.php. 81. United Nations Convention Against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment, 1465 U.N.T.S. 85, Dec. 10, 1984. 82. Istanbul Protocol: Manual on the Effective Investigation and Documentation of Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment [hereinafter Istanbul Protocol], Aug. 9, 1999, available at http://www.unhchr.ch/pdf/8istprot.pdf ("Sexual torture begins with forced nudity, which in many countries is a constant factor in torture situations. One is never so vulnerable as when one is naked and helpless. Nudity enhances the psychological telTor of every aspect of torture, as there is always the background of potential abuse and rape or sodomy. Furthermore, verbal sexual threats, abuse and mocking are also part of sexual torture, as they enhance the humiliation and degrading aspects of it, all part and parcel of the procedure. Groping women is traumatic in all cases, and considered torture. There are some differences between sexual torture of men and sexual torture of women, but several issues apply to both."). See also R.F. Mollica & Y. Caspi-Yavin, Overview: The Assessment and Diagnosis of Torture Events and Symptoms, in TORTURE AND ITS CONSEQUENCES 253 (Metin Basoglu ed., 1992). 83. See Finn Somnier et aI., Psycho-social Consequences of Torture, in TORTURE AND ITS CONSEQUENCES 56 (Met in Basoglu ed., 1992). FARLEY W ITALICS 5/312006 I :46:05 AM 14337

2006] Prostitution, Trafficking and Cultural Amnesia 115 of private individuals. "holds states accountable for all acts of torture of women, whatever the context in which they are committed and whoever is the perpetrator. ,,84 The existence of state-sponsored torture is decried by social critics on the Left, yet the identical treatment of women in prostitution is ignored by those same analysts. Many view torture by the United States of prisoners at Abu Ghraib with shock and horror, yet at the same time consider the identical acts perpetrated (and photographed) against prostituted women to be sexual entertainment. 85 Condemning the Bush administration's tolerance for torture in the war on terror, one journalist noted the "gleeful sadism" of guards at Abu Ghraib.86 Yet he and other political pundits maintain silence regarding the same gleeful sadism of men toward prostituted women at bachelor parties or strip clubs. Journalists and scholars fail to note the parallel between their descriptions of torture's consequences for Abu Ghraib prisoners, on the one hand, and identical consequences for women in prostitution and pornography, on the other. Despite its obvious similarity to state-sponsored torture, there is a great silence regarding the torture of women in prostitution during the making of pornography. Yet torture is commonplace in pornography.87 A woman in Vancouver prostitution described a john' s purchase of her degradation, physical 88 and sexual assault, and his videotape of that torture. Online pornography today welds men's ejaculation to women's degradation. A popular geme is bukkake, in which a group of men ejaculate on young women's faces. The woman is usually extremely upset or crying, an emotional state that seems to sexually arouse both the men who are sexually abusing the woman, and the men who are purchasing those images of torture. 89 This spectacle of women's torture and humiliation serves as a bonding ritual for the perpetrators just as the "carnivalesque rites" of pornographic torture at Abu

84. AMNESTY INTERNATIONAL, BROKEN BODIES, SHATTERED MINDS: TORTURE AND iLL- TREATMENT OF WOMEN 4-5 (2001). 85. See ANDREA DWORKIN, LETTERS FROM A WAR ZONE 199 (1988). 86. See Richard Kim, Pop Torture, NATION, Dec. 26, 2005, at 37. 87. See, e.g., , The White Man's Burden: Gonzo Pornography and the Construction oj Black Masculinity, 18 YALE J.L. & FEMINISM [EMMA: FIRST PG] (2006). Dines describes ass-to­ mouth (A TM) pornography as a frequently-googled genre on the website of one of the most popular pornography actors, Max Hardcore. Dines points out that in A TM pornography, "the male performer anally penetrates a woman and then sticks his penis into her mouth, often joking about her having to eat shit. In this pornography the code of debasement is most stark. There is no apparent increase in male sexual pleasure by moving directly from the anus to the mouth outside of the humiliation that the woman must endure." Id. at ## 88. Jane Armstrong, Torture Tapes Stun B.G. Investigators, GLOBE AND MAIL, Jan. 19, 2004, at AI. 89. PAMELA PAUL, PORNIFlED 61 (2005); see also , You Are What You Eat: Robert Jensen Discusses the Pervasive Porn Industry and What It Says About You and Your Desires, CLAMOR, Sept.-Oct. 2002, at 54 (describing bukkake and analyzing its effects on a male observer). 14338

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Ghraib prison created bonds among the US soldiers who committed those cruelties.90 Bourke described photographs of United States and German-sponsored torture as pornography: [T]orture aims to undermine the way the victim relates to his or her own self, and thus threatens to dissolve the mainsprings of an individual's personality .... The sexual nature of these acts shows that the torturers realise the centrality of sexuality for their victims' identity. The perpetrators in these photographs aim to destroy their victim's sense of self by inflicting and recording extreme sexual humiliation.91 That description of torture applies equally to the prostitution and pornography that are everywhere on newsstands and on the world wide web. While she accurately describes what happens to people who are tortured by military regimes, Bourke fails to apply her truly insightful description of sexual torture to the women in video, internet, and magazine pornography who are similarly sexually humiliated. Only a handful of feminist analysts, beginning with Andrea Dworkin and Catharine MacKinnon,92 analyze the horrific violence that women are subjected to in pornography that documents prostituted women's abuse: "Welcome to the Rape Camp,,,93 "Beaver Hunters,,,94 "Gag Factor,,,95 "A Cum Sucking Whore Named Kimberly,,,96 "65- Guy Cream Pie,',97 "Black Poles in White Holes,',98 and "Teen Fuck Holes.,,99 The sexual humiliation of having one's face smeared with semen is commonplace during rapes of children and adults, and in pornography, prostitution, and torture. But there are a multitude of techniques of humiliation, domination, and control that are less specifically sexual, and that are almost always used in conjunction with sexual humiliation. Pimps and traffickers employ the three-pronged strategy of political torturers-debilitation, dread, and dependency. Like the state's torture experts, pimps and traffickers threaten to kill children and family members as a means

90. Joanna Bourke, Torture as Pornography, LONDON GUARDIAN, May 7, 2004, available at http://www.guardian.co.uklwomen/storyfO.3604.1211261.OO.html 91. Id. 92 See DWORKIN, UFE AND DEATH, supra note 16; DWORKIN, MEN POSSESSING WOMEN, supra note 15; ANDREA DWORKIN, SCAPEGOAT: THE JEWS, ISRAEL, AND WOMEN'S LIBERATION (2000); MACKINNON & DWORKIN, supra note 70; MACKINNON, supra note 3, at 1506-651; MacKinnon, Prostitution and Civil Rights, supra note 54. 93. D.M. Hughes, Welcome to the Rape Camp: Sexual Exploitation and the Internet in Cambodia, 6 J. SEXUAL AGGRESSION 29 (2000). 94. DWORKIN, MEN POSSESSING WOMEN, supra note 15, at 25. 95. Robert Jensen, Cruel to Be Hard: Men and Pornography, SEXUAL ASSAULT REPORT, Jan.-Feb. 2004, at 33, available at http://uts.cc.utexas.eduf-rjensen/freelance/pomography&cruelty.htm. 96. Id. 97. E-mail from Robert Jensen (Mar. 12,2006). 98. Dines, supra note 87, at [PAGE # CITED?]. 99. Jensen, supra note 95. 14339 FARLEY W IT ALleS 5/3/2006 I:46:05 AM

2006] Prostitution, Trafficking and Cultural Amnesia 117 of establishing control. Pimps' use of torture ensures that the prostituted woman will comply with any demands of johns or pimps. 100 Under conditions of prostitution, autonomous self-regulation of any sort is considered insubordination and is actively suppressed by pimps.IOI Systematic methods of brainwashing, indoctrination and physical assaults (called "seasoning" by pimps), are used against women in prostitution. These techniques are aimed at eliminating any comer of mental space for her to exist in. 102 One girl stated that when her pimp commanded "Down!", she was required to lay down on the floor without moving until he gave her permission to get Up.to3 Each act of physical and psychological torture that he committed, each its own unique expression of dominance, was part of an interlocking system of contro,1 d egrad atlOn,· and d ommatlOn. . . 104 The Stockholm syndrome is a psychological strategy for survival in captivity. In escapable situations, humans form bonds with their captors. The traumatic bonds established between women in prostitution and their pimp/captors is identical to those between battered women and their batterers.!05 In the absence of other emotional attachments, women appear to choose their relationships with pimps and may be psychologically at home with men who exercise coercive control over them. In order for a woman to survive prostitution on a day-to-day basis, she must deny the extent of harm that pimps and johns are capable of inflicting. Since her survival may depend on her ability to predict others' behavior, she vigilantly attends to the pimp's needs and may ultimately identify with his worldview. This increases her chances for survival, as in the case of Patty Hearst who temporarily identified with her captors' ideology.106 The unpredictable and extreme violence in prostitution, like that of torture, is used for economic gain and sadistic pleasure. It also sends the message that

100. See. e.g., SCHWARTZ, supra note 38, at 320 (discussing torture and prostitution of children with similar techniques and similar emotional consequences). 101. See Judith L. Herman, Hidden in Plain Sight: Clinical Observations on Prostitution, in PROSTITUTION, TRAFFICKING, AND TRAUMATIC STRESS 4 (Melissa Farley ed., 2003). 102. Describing her relationship with a pimp, one woman said that "[prostitution is] like a cult. He brainwashed me." Interview with anonymous prostituted woman, Aug. 6, 1997. Another woman explained that "[y]ou become what they say and do with you. It's internally damaging." Interview with anonymous prostituted woman, June 19, 1998. See also SCHWARTZ, supra note 38, at 314-19, 333-37 (confirming similarities between prostitution, trafficking, and political and religious cults such as the commonality in their methods of brainwashing and mind control, in the physiology of traumatic bonding, and in the manipulation of attachment by perpetrators in establishing power over the Yictim). 103. Interview with anonymous prostituted woman, in San Francisco, Cal. (May 8, 2004). 104. See also , THE POLITICS OF CRUELTY 42 (1994) (discussing political torture with language that also applies to women in prostitution and noting that judicial torments are also methods of dominating victims). 105. DEE L.R. GRAHAM ET AL., LOVING TO SURVIVE: SEXUAL TERROR, MEN'S VIOLENCE, AND WOMEN'S LIVES 44 (1994) (describing behaviors which are typical of the Stockholm syndrome, such as extreme difficulty leaving one's captor and a long-term fear of retaliation). 106. THE PROSTITUTION OF SEXUALITY, supra note 3, at 250-75. 14340 FARLEY W ITALICS 51312006 I :46:05 AM

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the victim is utterly worthless. Experts on state-sponsored torture have explained that the specific goal of sexual torture is to make a captive believe IO that she is a whore or an animal, rather than a human. ? One person stated that the outcome of state-sponsored torture is that "they make a non-person out of yoU.,,108 Similarly, Giobbe explained: [T]he word 'prostitute' does not imply a 'deeper identity;' it is the absence of an identity: the theft and subsequent abandonment of self. What remains is essential to the 'job': the mouth, the genitals, anus, l09 breasts ... and the label. The psychological consequences of state-sponsored torture and those of prostitution include the same symptoms: depression, anxiety, posttraumatic stress disorder (PTSD), dissociative symptoms, somatic symptoms, suicide attempts, cognitive symptoms resulting from violence-related traumatic brain injury, and the existential despair that persists for years after prostitution or after torture. I 10

4. In order to consider prostitution a job, and in order to keep the business of sexual exploitation running smoothly we can not know that pornography is action taken against real women, that it is advertising for prostitution, and that pornography is one way to traffic women.

Pornography has been defined as the presentation of prostitution sex. I I I Pornography is a specific type of prostitution, in which prostitution occurs and, among other things, is documented. The women whose prostitution appears in pornography are prostituted women. The sex industry is driven by pornography. Men learn how to use women by looking at and masturbating to pornography, developing a taste for

107. Inger Agger, Sexual Torture ofPolitical Prisoners, 2 1. TRAUMATIC STRESS 30S (1989). 108. Mohammed AI-Sader, Torture Survivors: A New Group of Patients, Speech at World Congress on Violence and Human Coexistence (Aug. 20, 1997) (notes on file with author). See also ORLANDO PATTERSON, SLAVERY AND SOCIAL DEATH 3 (1982) ('''Whipping was not only a method of punishment. It was a conscious device to impress upon the slaves that they were slaves."')(quoting George P. Rawick). 109. Giobbe, The Vox Fights, supra note 14, at 35 (emphasis added). 110. See Stuart Turner, Emotional Reactions to Torture and Organized State Violence, IS PTSD RESEARCH QUARTERLY I (2004); see generally, AMNESTY INTERNATIONAL, BROKEN BODIES, SHATTERED MINDS: TORTURE AND ILL-TREATMENT OF WOMEN (2001) (addressing debt-bondage prostitution but not other types of prostitution that are assumed to be consensual but in which women are psychologically or socially coerced by factors such as poverty, childhood abuse, rape, war, or abandonment); Istanbul Protocol, supra note 82, at 66-70; Hans Petter Hougen, Physical and Psychological Sequelae to Torture, 39 FORENSIC SCI. INT'L S (1988); Derrick SHove, The Psychosocial Effects of Torture, Mass Human Rights Violations, and Refugee Trauma, 187 J. NERVOUS & MENTAL DISEASE 200 (1999). III. THE PROSTITUTION OF SEXUALITY, supra note 3, at 5S. 14341 FARLEY W ITALICS 5/312006 I :46:05 AM

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prostitution. Pornographers are indistinguishable from other pimps. I 12 Both exploit women and girls' economic and psychological vulnerabilities and coerce them to get into and stay in the industry. 1I3 Both take pictures to advertise their "products," suggest specific abuses for johns to perpetrate II4 against women, and minimize the resulting harms. Pornography is a documentary of specific women's abuses in prostitution, and its consumers obtain pornography as a "document of humiliation." I 15 Yet in order to conceal the harms that are documented in the picture, the pornographer disconnects the picture from the person. The pornographer and his allies then name what is happening to her in the picture "speech" or "adult entertainment" rather than "torture" or "sexual abuse." Women have explained that they study pornography in order to learn how to perform prostitution: "I watch pornos and act like that in the room [with a john]."II6 Men show pornography to women to illustrate what they want them to do. Strip clubs show video pornography to promote lap dance and VIP-room prostitution. One pornographer advertised that he was in the business of "degrading whores for your viewing pleasure," clearly eliminating any boundary that might be imagined to exist between pornography and prostitution. I 17 The filming of 251 men's prostitution of Grace Quek (called Annabel Chong) was sold as "The World's Biggest Gang Bang."I18 After being edited down to 4 hours, the film became hardcore pornography.119 The filming of johns assaulting Quek was stopped after 10 hours because she was bleeding internally. For Quek, the film was not an idea, it was not a narrative, it was not a representation. Real johns perpetrated real sexual assaults on her resulting in

112. See, e.g., AKlYUKI NOZAKA, THE PORNOGRAPHERS (Michael Gallagher trans., 1968). 1l3. Pornography has been used as recruitment into childhood sexual assault as well as prostitution. See MACKINNON & DWORKIN, IN HARM'S WAY, supra note 70, at. Pornography that normalizes prostitution is used by pimps to teach girls what acts to perform in prostitution. Mimi H. Silbert & Ayala M. Pines, Pornography and Sexual Abuse of Women, 10 SEX ROLES 857 (1984). Women in prostitution have described pornography's role in submitting to the enactment of specific scenes for pimps or customers. Id. See also Melissa Farley & Howard Barkan, Prostitution, Violence and Posttraumatic Stress Disorder, WOMEN & HEALTH, Vol. 27 1998, at 37. 114. See Donna Hughes, Prostitution Online, in PROSTITUTION, TRAFFICKING, AND TRAUMATIC STRESS 115 (Melissa Farley ed., 2003). liS. D.A. Clarke, Prostitution for Everyone: Feminism, Globalization. and the 'Sex' Industry, in NOT FOR SALE: FEMINISTS RESISTING PROSTITUTION AND PORNOGRAPHY 199 (Rebecca Whisnant & Christine Stark eds., 2004). 116. Teela Sanders, "It's Just Acting": Sex Workers' Strategies for Capitalizing Oil Sexuality, 12 GENDER, WORK&ORG. 319,330 (2005). 117. Robert Jensen, The Paradox of Pornography, OP ED NEWS, Feb. I, 2006, at http://www.opednews.com/articles/opedneJobertj_060201_the_paradox_oeporno.htm (quoting Jeff Steward, owner of 1M Productions, http://www.jerkoffzone.com). 118. Clark, supra note 68. 119. Robin Askew, Life Thru a Lens, SPIKE MAG., http://www.spikemagazine.coml 1000annabelchong.php (last visited March 16, 2006) (interviewing the star of SEX: THE ANNABEL CHONG STORY). 14342 FARLEY W ITALleS 5/312006 I :46:05 AM

120 Yale Journal of Law and Feminism [Vol. 18:N real physical and psychological injuries. Both survivors of prostitution and johns explain that pornography is prostitution with a camera. One john explained, "Yes, the woman III pornography is a prostitute. They're prostituting before the cameras.,,120 A number of courts have understood that making pornography is an act of prostitution. 121 Pimps make more money from johns when they advertise women in prostitution as "adult film stars" who are available as "escorts.,,122 Benefiting from globalization, pornographers use women from Eastern Europe, 123 where "they cost less and do more," explained one German producer. Prostitution is advertised online, where it is indistinguishable from pornography. The Internet has expanded the reach of traffickers and it has intensified the humiliation and violence of prostitution. Pornography is one specific means of trafficking women for the purpose of selling women into prostitution.124 On pornography/prostitution websites, women are for rent and sale. They are moved across town, across the country, and from one country to another. Craigslist is an Internet site where people can post at no cost what they want to buy and what they want to sell. A cell phone and an ad on Craigslist sets a teenager up in the business of being sexually exploited in exchange for housing, drugs, or cash. In March 2005, Craigslist averaged 25,000 new ads every 10 days for "erotic services" that are probably prostitution. Internet prostitution and pornography offer the trick anonymity. There are increasing numbers of online trick communities supporting each others' predatory behaviors and exchanging information regarding where and how women can be bought. 125 As one young woman explained, "They can do more extreme things and keep a double life [on the Internet]. They can have a life with the wife and kids and have a fetish, porn thing where they are beating chicks on the side.,,126 She did not say that the john was beating images of chicks. She said he was beating chicks. How is that possible in virtual reality, when he was at a computer and in an entirely different physical location than the women he was beating?

120. Melissa Farley, Renting an Organ for Ten Minutes: What Tricks Tell us about Prostitution, Pornography and Trafficking, in PORNOGRAPHY: DRIVING THE DEMAND FOR INTERNATIONAL SEX TRAFFICKING (David Guinn ed., forthcoming 2006). 121. MACKINNON, supra note 3, at 1524. 122. Thomas Zambito, Two Plead Guilty in $13 Million Prosty Ring, N.Y. DAILY NEWS, Jan. 6, 2006, at http://www.nydailynews.comlfront/story/380758p-323279c.html. 123. The Sex Industry: Giving the Customer What He Wants, THE ECONOMIST, Feb. 14, 1998, at 21 (reporting that excruciating or humiliating acts purchased from women in economically devastated parts of Europe cost far less than pomographers paid to film the same acts a decade earlier). 124. See Catharine A. MacKinnon, Pornography as Trafficking, 26 MICH. 1. INTL. L. 993 (2005). 125. See Sven Axel Mansson, Men's Practices in Prostitution and Their Implications for Social Work, in SOCIAL WORK IN CUBA AND SWEDEN 267 (Sven Axel Mansson & Clotilde Proveyer eds., 2004). 126. Interview with anonymous, in San Francisco, Cal. (March 24, 2005). 14343 FARLEY W ITALICS 5/3/2006 I :46:05 AM

2006] Prostitution, Trafficking and Cultural Amnesia 121

The web technology of live video chat permits johns to obtain prostitution online by interacting via telephone or keyboard, or by requesting specific sex acts that are then performed to his specifications. One company hired women to prostitute in warehouse cubicles where they were equipped with microphones to communicate with johns. The johns requested assurances from the women that the prostitution was performed in real time. 127 Women in prostitution whose pimps or tricks made pornography of them displayed significantly more severe symptoms of post traumatic stress disorder than did women in prostitution who did not. 128 Even after women escaped prostitution, they continued to be traumatized by knowing that customers look at pornography made of them during their time in prostitution. 129

5. In order to consider prostitution a job, and in order to keep the business of sexual exploitation running smoothly, we can never talk about johns or tricks

A trick's perspective ofprostitution: I was like a kid in the candy store. I mean, it was nothing for me to knock off four broads in an afternoon .... I thought, This is what men do. 130 A prostituted woman's perspective: Every day I was witness to the worst of men. Their carelessness and grand entitlement. The way they can so profoundly disconnect from what it is they're having sex with .. " There was a system in place that was older and stronger than I could begin to imagine. Who was I? I was just a girl. What was I going to do about it. If I had any power I would make it so that nobody was ever bought or sold or rented. 13 1 Even where prostitution is legal, a majority of tricks' behaviors are carefully concealed from public view. Tricks are most often average citizens rather than abnormally sadistic psychopaths. They are all ages and from all social classes. Most are married or partnered. 132 When a john calls a phone number that he obtains online or via a free magazine for obtaining a prostitute, it is called escort prostitution. Indoor prostitution such as escort is advocated wherever there is a political movement promoting the decriminalization or legalization of prostitution; it is a way to protect the trick's anonymity. In indoor prostitution, the trick is much less

127. Hughes, supra note 114, at 119. 128. Farley, supra note 120. 129. MACKINNON & DWORKIN, IN HARM'S WAY, supra note 70, at 351. 130. James Kaplan, The Laughing Game, THE NEW YORKER, Feb. 7, 2000, 52, 61-62 (emphasis added). 131. MICHELLE TEA & LAURENN MCCUBBIN, RENT GIRL 29 (2004). 132. Melissa Farley, What Do We Know About Johns?, DEMAND DYNAMICS: THE FORCES OF DEMAND IN GLOBAL SEX TRAFFICKING 27 (Morrison Torrey ed., 2004). 14344 FARLEY W IT ALles 5/3/2006 1:46:05 AM

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likely to be arrested even where prostitution is illegal. 133 Yet the social invisibility of indoor prostitution may actually increase its danger for women. Internationally trafficked women and children are almost always indoors. Sometimes neighbors may not even know that prostitution is occurring next door. Although the need for services remains the same regardless of the location where prostitution takes place, the invisibility of indoor prostitution makes it less likely that services to help women escape will be funded or that women will be able to access these services. Paying for a woman in prostitution provides men with the power to turn women into what Davidson termed "the living embodiment of a masturbation fantasy. ,,134 As one man said about prostituted women, "I use them like I might use any other amenity, a restaurant, or a public convenience.,,135 Interviews with men who buy women in prostitution have confirmed what survivors of prostitution have told us about prostitution and pornography. While feminists have spoken about prostitution as the buying and selling of women's bodies, one trick more specifically explained what he did in prostitution as "renting an organ for ten minutes.,,136 In this definition, he removed her humanity. Women in prostitution became "something for him to empty himself into ... a kind of human toilet.,,137 Her self and those qualities that define her as an individual are removed in prostitution and she acts the part of the thing he wants her to be.138 This understanding of the realities of prostitution on the part of both the john and the woman he buys are at odds with the notion of prostitution as skilled labor as some prostitution advocacy groups have characterized it. 139 Many tricks have a nuanced awareness of exactly what being prostituted is like for the women. One trick explained that "[Prostitution] takes away a part of themselves that they can't get back. They can't look at themselves in the mirror." Others were aware of the extreme violence of pimps toward prostituted women and feared for their own safety.140 Mansson observed that the Swedish tricks he interviewed had greater

133. Jim Adams & Jason Riley, After Spas' Boom, Enforcement Affects Illicit Sex Business, LOUISVILLE COURIER-JOURNAL, July 11,2004, at I. 134. JULIA O'CONNELL DAVIDSON, PROSTITUTION, POWER, AND FREEDOM 209 (\ 998). 135. SEABROOK, supra note 63, at 193. 136. Interviews on file with the author and forthcoming in Farley, supra note 123. 137. HOIGARD& FINSTED, supra note 36, at 51. 138. DWORKIN, LiFE AND DEATH, supra note 16, at 139. 139. Valerie Jeness, From Sex as Sin to Sex as Work: COYOTE and the Reorganization of Prostitution as a Social Problem, 37 SOCIAL PROBLEMS 403 (1990) (referencing Margo St. James and Priscilla Alexander). 140. Farley, supra note 120 (describing the pimping relationship with quotations such as "He controls her by hitting her. And by playing mind games with her," "The pimp is the owner and the prostitute is the slave to make money for the pimp," and "Death is the end result of her relationship with a pimp"). 14345 FARLEY W ITALICS 5/3/2006 I :46:05 AM

2006] Prostitution, Trafficking and Cultural Amnesia 123 problems than other men in maintaining relationships with women. 141 One man explained, "If you can't communicate with your partner, you can go to a prostitute.,,142 Many of the men expressed unveiled hostility toward women. "I think about getting even [during prostitution]-it's like a kid's game, you're scoring points," one man told us. Another said, "She gives up the right to say no.,,143 Another man told us that he clarifies the nature of his relationship to the women he buys: "I paid for this. You have no rights. You're with me now.,,144 Tricks confinued that the relationship in prostitution is one of dominance and subordination: "Prostitution says that women have less value than men." Another explained, Guys get off on controlling women, they use physical power to control women, really. If you look at it, it's paid rape. You're making them subservient during that time, so you're the dominant person. She has to do what you want. 145 Men's ambivalence and shame about buying women in prostitution, and their desire not to be publicly known as tricks, may provide an opportunity for intervention and behavior change.

6. In order to nonualize prostitution in everybody's culture, postmodern theory helps to keep the real harms ofprostitution, pornography, and trafficking invisible.

Some words hide the truth. Just as torture can be named enhanced interrogation, and logging of old-growth forests is named the Healthy Forest Initiative, words that lie about prostitution leave people confused about the nature of prostitution and trafficking. The following words contribute to the myth of the prostitution's inevitability and to the belief that johns' sexual predation is a logical consequence of "boys being boys." Men who buy women in prostitution are called interested parties or third parties, rather than johns or tricks, which is what women call buyers. Pimps are described as boyfriends or managers. There are other words that make the hanu of prostitution invisible. Many tenus in current usage camouflage the psychological, economic, and social coercion against women in prostitution: voluntary prostitution which implies that she consented when most frequently she had no other survival options;

141. Sven-Axe1 Mansson, Men's Practices in Prostitution: The Case of Sweden, in A MAN'S WORLD? CHANGING MEN'S PRACTICES IN A GLOBALIZED WORLD 135, 138 (Bob Pease & Keith Pringle eds., 2001). 142. Farley, supra note 120. 143. [d. 144. [d. 145. [d. FARLEY W IT ALleS 5/312006 1:46:05 AM 14346

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forced trafficking which implies that some women volunteer to be trafficked into prostitution; sex work which defmes prostitution as a job rather than an act of violence against women. The term migrant sex worker blends prostitution and trafficking and implies that both are simply global labor practices. Other words that make trafficked women invisible are transnational migrant work or flexible labor. The expressions socially disadvantaged women (ostensibly used to avoid stigmatizing prostitutes) and irregular migration remove any hint of the sexual violence that is intrinsic to prostitution. The Chinese words beautiful merchandise sugar-coat the objectification of women in prostitution. A woman in Brazilian prostitution was described as an erotic entrepreneur. 146 Sexual exploitation in strip club prostitution has been reframed as sexual expression and freedom to express one's sensuality by dancing. Brothels are referred to as short-time hotels, massage parlors, saunas, health clubs, adult clubs, or sexual-encounter establishments. Older men who buy teenagers for sex in Seoul call prostitution compensated dating. In Tokyo prostitution is described as assisted . In the United States, the expression 'ho promulgates the bigoted notion that all women, especially African American women, are natural-born whores. Women in prostitution are described as escorts, hostesses, strippers, dancers, and sex workers. Sometimes these words are used by women in prostitution in order to retain some dignity. The term sex worker suggests that prostitution is a reasonable job for poor women, rather than a violation of their human rights. The words sex worker imply "order, hierarchy, and accountability... It says board of directors ... and marketplace niche.,,147 In that one word - work - we lose ground in the political struggle to understand prostitution as violence against women. 148 Postrnodern philosophy has contributed to the invisibility of the harms of prostitution/trafficking by mystifying prostitution/trafficking via a "politics of abdication and disengagement.,,149 To postrnodern Third Wavers, facts are umeliable. Incest and rape become "epistemelogical quandaries" to postmodernists.1 5o The oppressive social forces that grind women down in prostitution - race and sex-are considered "unknowable.,,151 Racism, sexism,

146. Larry Roter, She Who Controls Her Body Can Upset Her Countrymen, N.Y. TIMES, Apr. 27, 2006, at A4. 147. JeITy Carroll, The Game of the Name, SAN FRANCISCO EXAMINER, Sept I I, 1994, at I. 148. For a blunt critique of the concept of prostitution as a form of labor, see Melissa Farley, Unequal, http://www.prostitutionresearch.comlhowyrostitution_works/000111.htm!. 149. Catharine A. MacKinnon, Points Against Postmodernism, 75 CHI.-KENT L. REV. 687, 711-12 (2000). 150. /d. at 703. 151. Celine Parrenas Shimizu, Remarks at the Yale Journal of Law & Feminism Symposium, Sex for Sale: A Symposium on the Commodification of Sex (Feb. 4,2006). Noting the "paradox of pleasure and violence in racial subjection," Shimizu explores the rapes of slaves by their masters and 14347 FARLEY W ITALICS 5/3/2006 I :46:05 AM

2006] Prostitution, Trafficking and Cultural Amnesia 125 and lethal poverty become representations of reality, rather than reality itself. The assumption that material reality is mentally constructed and that nothing is real means that the actual harms of prostitution cease to exist except in a woman's mind. Her life becomes simply a "narrative.,,152 Postmodernists assume that women who have been prostituted, trafficked, or have had those experiences documented via pornography are narrating just one more version of reality. In postmodern reality, pimps' and pornographers' lies (prostitution is sexy and fun for everyone; prostitutes get rich and meet nice men) are just as valid as survivors' lived experiences of sexual exploitation and abuse. This presumed equivalence of validity reflects a postmodern " of meaninglessness,,153 that has profoundly impacted women's lives because it makes men's violence against women invisible. The disconnected verbosity of postmodern theorists on prostitution seems incomprehensible to those of us who know real women in prostitution. Under postmodern theory, the woman in prostitution is re-objectified as a "signifying system" or a "plane of consistency of desire." She is not understood as a human being whose dignity and personhood are removed by the john and whose body he sexually assaults for money. With what cruel disinterest does one write a book about prostitution that declares on page one that "the flesh­ and-blood female body engaged in... sexual interaction in exchange for some kind of payment, has no inherent meaning,,?154 Another postmodern description of the "terrain" of escort prostitution fragments women's physical and psychological experience of prostitution into a "cyborg assemblage" that is sold as a commodity in prostitution. 155 Postmodern ideology might be dismissed as elitist word-salad except that it has real effects on real women when its premises are accepted by public health advocates who work with prostituted women or by judges who interpret laws. In its celebration of fragmentation and multiplicity,156 postmodernism denies the psychological fragmentation that is a direct result of prostitution, 157 pornography, and trafficking. The overwhelming experiences of rape and torture that occur in incest and prostitution are split off from the rest of the self.

recommends that we not prematurely dismiss "a telling of slavery from the point of view of slave sexual contentment." Ce1ine Parrefias Shimizu, Master·Slave Sex Acts: Mandingo and the Race/Sex Paradox, WIDE ANGLE, Oct. 1999, at 42. 152. MacKinnon, supra note 152, at 702. 153. JEFFREYS, supra note 15, at 201. 154. SHANNON BELL, READING, WRITING AND REWRITING THE PROSTITUTE BODY I (1994). 155. Audrey Extavasia & Tessa Dora Addison, Fucking (with Theory) for Money: Toward an Interrogation of Escort Prostitution, POSTMODERN CULTURE, May 1992, htlp:llwww3.iath.virginia.edul pmcltext-only/issue.592/add-ext.592. 156. Bell, supra, note 154, at 4. 157. MacKinnon, supra note 149, at 707, makes the point that the fragmentation that is idealized by postmodemists is, in reality, psychological multiplicity caused by extreme-usually sexual-tOlture at a young age. 14348 FARLEY W IT ALleS 51312006 I :46:05 AM

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This traumatic dissociation is transformed into a "manufactured identity"Is8 that is presumed to have been deliberately created by women in prostitution who are seen by postrnodernists as "strategist[s]" full of"agency.,,159 Minimizing dissociation's origin in traumatic stress, Dutch prostitution researcher Vanwesenbeeck described a "dissociative proficiency" that made it possible for women to professionally perform the acts of prostitution. 160 Public health workers' lack of specialized training in recognizing or treating dissociation is partly a result of the postrnodern failure to grasp the connection between deliberately-inflicted violence and dissociation. Infused with postrnodern ideology, advocates may blame people who are in fact victims of men's violence. To describe prostituting women as "risk takers" is to suggest that the women themselves provoke violence aimed at them in prostitution. One group of researchers assumed that "risk-taking" prostituted women willingly exposed themselves to harm, even though the "risk takers" had been battered and raped significantly more often than the non-risk takers. 161 The risk-taking behavior of prostituted women in this particular study was not understood as trauma-based repetition of childhood sexual abuse nor as having resulted from parental neglect. Contrary to what is asserted by postrnodemists, there is a real power imbalance in prostitution, where one person has the social, legal, and economic power to hire another person to act like a sexualized puppet. Prostitution always includes the dehumanization, objectification, and fetishization of women. 162 There is no mutuality of sexual pleasure or of any other kind of power in prostitution. In fact, women are non-persons in prostitution. As one of O'Connell Davidson's interviewees explained: the only "plausible line in the ... film Pretty Woman ... [is]when Richard Gere, playing a client, asks Julia Roberts, playing a prostitute, what her name is. She replies, 'Anything you want it to be.",163 Domination of one person by another is central to prostitution, including racist and sexist verbal abuse, deliberate humiliation and ridicule, sadistic physical and psychological tormenting of a vulnerable person, the conscious or unconscious degradation of another person, and frequently acts that are equivalent to torture. Postrnodem denial of the racism and violent sexism in prostitution is

158. Sanders, supra note 116, 336. 159. Jd. 160. V ANWESENBEECK, supra note 5, at 107. 16\. Ine Vanwesenbeeck et aI., Professional HJV Risk Taking, Levels of Victimization, and Well­ Being in Female Prostitutes in The Netherlands, 24 ARCHIVES SEXUAL BEH. 503 (1995). 162. CLAUDE JAGET, PROSTITUTES-OUR LIFE 88 (Anna Furse et al. trans., 1980)(discussing the pain of "being seen, looked at, and bought as an object"); see also GIOBBE, FACILITATOR'S GUIDE, supra note 10, at 35 ("To be a prostitute is to be an object in the marketplace."); CECILIE H0IGARD & LIv FINSTED, supra note 36, at 51 (offering many examples of the fetishization and objectification of WOmen in prostitution). 163. DAVIDSON, supra note 134, at 109. 14349

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2006] Prostitution, Trafficking and Cultural Amnesia 127 highlighted in reviews and commentaries about pornography made of Grace Quek. 164 A Chinese woman from Singapore, Quek was gang-raped prior to her entry into prostitution. She then moved to Los Angeles, where she entered the sex industry, specializing in hard-core pornography where multiple men penetrated her. Quek has been dismissed by sex industry buffs as a "babbling idiot,,,165 a "multiple entity," and a "freak-show,,,166 while the industry's predators quickly moved to exploit her dissociative vulnerability. In "The World's Greatest Gang Bang," 251 men were filmed sexually assaulting Quek for 10 nonstop hours. Her real consent for this was unclear from some of her comments in some interviews and from her face which was sometimes contorted in pain during the assaults. She was originally told that the men had been tested for HIV, and upon learning that not all johns had been tested, Quek commented, "sex is worth dying for.,,167 Observing the long-term effects of self-mutilation, one interviewer asked Quek about the scars on her arms. She responded, "I find pain a relief, you knoW?,,]68 One reviewer nonetheless viewed Quek as "the new feminist icon who provokes and is not ashamed... to be viewed as nothing more than an object.,,169 This postrnodern perspective parallels the pornographers' propaganda that their film was a subversive demonstration of Asian female sexual appetite. Yet Quek did not break a record for having orgasms; rather, she set a record for how many men could penetrate her. 170 This is the same sexual exploitation and abuse that is perpetrated against other women in ., 17l pornograp hy /prostitution. At one adult video event, Quek was surrounded by men with cameras who ordered her into different poses. She seemed "empty" to one observer who noted that she "c[ arne] across like a puppet terrified of disappointing her commanders. There was no sign of the much-vaunted empowerment or control

164. See, e.g., THE WORLD'S BIGGEST GANG BANG (Zane, 1995); SEX: THE ANNABEL CHONG STORY (Coffeehouse Films, 2002). 165. Anthony Petkoyitch, Grace from Outer Space, SPECTATOR, Apr. 26, 2000, http://www.spectator.netlEDPAGES/annabelAP.html. 166. Linda Ruth Williams, Review of Sex: The Annabel Chong Story, SIGHT AND SOUND, May 2000, http://www.bfi.org.uk!sightandsoundireview/493. 167. Kimberly Chun, Sex: The Annabel Chong Story from a Singapore Schoolgirl to the Nastiest Porn Star in the World, ASIAN WEEK, May 4, 2000, http://www.asianweek.com/2000_05_04/ ae_annabelchong.html. 168. Clark, supra note 68, at 13. 169. Gaby Bila-Gunther, Review of Sex: The Annabel Chong Story, SENSES OF CINEMA, July-Aug. 2000, http://www.sensesofcinema.com/contents/00/8/sex.html. 170. Linda Ruth Williams, Review of Sex: The Annabel Chong Story, SIGHT AND SOUND, May 2000, http://www.bfi.org.uk!sightandsound/issue/200005. 171. One particularly vicious pornographer sarcastically noted, "\ simply must admire any woman who can take 250 loads on her back, ass, and tits; pounded from behind, from the side, and on top; a woman soaked, fatigued, and nearly broken." Matt Cale, Review of Sex: The Annabel Chong Story, http://ruthlessreviews.com/movies/s/sex.html{last visited Mar. 16,2006). 14350

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128 Yale Journal of Law and Feminism [Vol. 18:N in her frantic displays, just someone that had sadly become less than human.,,172 Postmodern thinking protects johns and maintains their social invisibility. The notion that all constructions of reality are equally valid colludes with, for example, rapists who deny perpetrating rape. How can we hold johns accountable for acts of sexual abuse and paid rape, when postmodernists object to the idea of a "doer behind the deed,,?173 Why weren't any of the men who gang raped Grace Quek charged with sexual assault? Postmodem ideologues are complicit with men who commit sexual violence against women, including johns, pimps and pornographers.

7. In order to view prostitution as a job, and in order to keep the business of sexual exploitation running smoothly, we can not know that when prostitution is legalized or decriminalized, it gets worse. And we can not know that there are some excellent laws that are aimed squarely at abolishing the institution of prostitution while at the same time supporting the women in it to escape.

The effects of legalized prostitution can be observed in Australia, where researchers have found that it produces a "prostitution culture,,174 with increased illegal as well as legal prostitution, increased presence of organized crime, increased demand for prostitution, increased child prostitution, and increased trafficking of women for the purpose of prostitution. 175 State­ sponsored prostitution provides a legal welcome to pimps, traffickers, and johnS. 176 But does it protect women? Well-intentioned people are confused about how to address what they intuitively understand to be the intrinsic harms of prostitution and trafficking. 177 It is misleading when right-to-prostitution advocates and pimps reframe prostitution as a human rights issue. One organization even proposed that

172. Dmetri Kakmi, Review of Sex: The Annabel Chong Story, SENSES OF CINEMA, Dec. 2000- Jan. 2001, http://www.sensesofcinema.com/contents/OOllllannabel.html. 173. MacKinnon, supra note 149, 706 n.47 (quoting JUDITH BUTLER, GENDER TROUBLE 25 (1990)). 174. MARY SULLIVAN, WHAT HAPPENS WHEN PROSTITUTION BECOMES WORK? AN UPDATE ON LEGALISATION OF PROSTITUTION IN AUSTRALIA 23 (2005), available at http://action.web.ca/home/catw/ readingroom.shtml?x=84641. 175. Id. 176. Janice G. Raymond, Ten Reasons for Not Legalizing Prostitution and a Legal Response to the Demand for Prostitution, in PROSTITUTION, TRAFFICKING, AND TRAUMATIC STRESS 315 (Melissa Farley ed., 2003). See also SULLIVAN, supra note 174; ILVI JOE-CANNON, PRIMER ON THE MALE DEMAND FOR PROSTITUTION (2006), http://action.web.calhome/catw/readingroom.shtml?x=8 5687. 177. Politicians speak about prostitution with inconsistent, sometimes wildly divergent statements. In New Zealand, for instance, Prime Minister Helen Clark argued that prostitution was "abhorrent," but that its decriminalization would benefit women. Clark failed to note that in addition to decriminalizing solicitation offenses for women, across-the-board decriminalization of prostitution also decriminalizes the predatory behaviors of pimps, johns, and traffickers. John Banks, City Shoulders Load of Making Law Work, NEW ZEALAND HERALD, Sept. 15, 2003, at I. 14351

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women's civil rights would be violated if they were denied the "right to work" as a prostitute.l 78 Laws against pimping or buying women are seen by sex workers' rights groups as obstacles to conducting business. Another source of confusion about legal prostitution is that sex industry advocates appropriate the names of legitimate human rights or public health organizations. Although their names are similar, the Global Alliance Against Trafficking in Women (GAATW) promotes prostitution as sex work, while the Coalition Against Trafficking in Women (CATW) promotes the abolition of prostltutlOn.. . 179 Legal prostitution and decriminalized prostitution are both state-sanctioned prostitution, but there are differences between them. In legalized prostitution, the state assumes the role of pimp, collecting taxes and regulating the practice of prostitution. Decriminalized prostitution is a radical removal of any and all laws regarding prostitution (including laws against pimping, pandering, purchasing, and procuring) so that the buying and selling of people in prostitution is considered the legal equivalent of buying candy. Although advocates allege that legalizing prostitution would remove its social stigma, in fact, women in legalized prostitution are still physically and socially rejected, whether they are in rural brothels ringed with razor wire or in urban brothels walled-off from the city.180 Zoning of the location of legal or state-tolerated prostitution is a constant source of legal battles, since no one wants prostitution transactions taking place in his neighborhood. Legalization is not only ineffective in removing the stigma of prostitution: it also fails to protect women from violence. Legal control of prostitution targets its "outward appearance rather than the conditions in which women find themselves. On the whole, governments are far more anxious about public order and public health than about abuse and violence.,,181 Many women in

178. VALERIE JENNESS, MAKING IT WORK: THE PROSTITUTES' RIGHTS MOVEMENT IN PERSPECTIVE 5 (1993). 179. Other organizations that accept or promote prostitution as a reasonable job for poor women include: World Health Organization (WHO); UN/AIDS; International Labor Organization (ILO); Amnesty International; Anti-Slavery International; Coalition Against Slavery and Trafficking (CAST), CARE International; and Medecins sans Frontieres. For a more extended list of such organizations, see Farley, supra note 30, at 1091-92. 180. Advocates for legalized or decriminalized prostitution argue that the primary harm of prostitution is social stigma rather than the physical and psychological violence described here. Yet there is no evidence that legalization mitigates the social stigma of prostitution. For example, Dutch women in legal prostitution have the opportunity to accrue pension funds. But they fail to take advantage of this option, fearing that the designation would pursue them for the rest of their lives. See Arjan Schippers, Turning Prostitution into a Legal Business Has Met With OppOSition from People in the Sex Industry Itself, RADIO NETHERLANDS, http://www.rnw.nlfsocietylhtmlfcritics020102.html(last visited Apr. II, 2006); Suzanne Daley, New Rights for Dutch Prostitutes, but No Gain, N.Y. TIMES, Aug. 12,2001, at 15. 18!. MARJAN WIJERS & UN LAP·CHEW, Trafficking in Women, Forced Labour and Slavery-like Practices in Marriage, in DOMESTIC LABOUR AND PROSTITUTION 152 (Foundation Against Trafficking in Women, Utrecht, Neth.,1997). In order of frequency reported, manifestations of abusive conditions in 14352 FARLEY W ITALICS 5/312006 1:46:05 AM

130 Yale Journal of Law and Feminism [Vol. 18:N prostitution tell us that legalized prostitution will not make them any safer than they were in illegal prostitution.1 82 Thus legal brothels in the Netherlands may have as many as three panic buttons in each room. 183 Dutch, South African, and Australian pimps have commented on the extreme physical violence that johns inflict on women in prostitution, 184 and Australian women in prostitution are advised to take classes in hostage negotiation. ls5 When rapes occur, however, women in legal strip clubs are told to keep silence or be fired. ls6 Women in 187 prostitution speak constantly of its violence. Although "health checks" of prostituted women occur in legal prostitution, the purpose of the screening is to provide the buyer with an HIV-free commodity. The health check is not aimed at protecting the woman in prostitution from HIV transmitted to her by johns. Under the guise of HIV prevention, and using the massive HIV prevention funding available worldwide, some advocacy groups have used HIV prevention funds to promote legalized or decriminalized prostitution. A 2005 crackdown on this misuse of 188 funds has led to legal disputes. Because sexual harassment and sexual

prostitution include: psychological abuse, physical abuse, confinement, police harassment and arrest, sexual assault, no right to refuse a customer or a mandatory minimum number of customers per day, isolation, denial of days off, no right to refuse specific sexual acts, confiscation of identity papers and/or , imposition of twelve or more hours of work daily, no access to medical care, forced or dangerous abortions, threats of reprisals against family members for non-compliance, confiscation of personal belongings, denial of right to use condoms, withholding of pay, no proper sleeping accommodations, compulsory AIDS testing and no access to the results, inadequate food, and also forcible recruitment of sisters and friends into prostitution. Id. at 199. 182. Farley supra note 15, at 33; see also Roberto J. Valera, et. ai, Perceived Health Needs of Inner-City Street Prostitutes, 25 AM. J. HEALTH BEHAV. 50, 54 (2001). 183. Interview with Jacob K. Jou, Yale University, Yale University Computer Center, in New Haven, Conn. (Feb. 4, 2006). 184. Sheila Jeffreys, The Legalisation of Prostitution: A Failed Social Experiment, WOMEN'S HEALTH WATCH, 1, 8 (Women's Health Action, Auckland, New Zealand, March/Apr., 2003) available at http://www.womenshealth.org.nz (discussing bouncers' failures to protect women from beatings in legal Australian brothels); SEX WORKER EDUCATION & ADVOCACY TASKFORCE, SAFETY TIPS FOR SEX WORKERS (1997) (pamphlet, on file with author) (recommending that those in prostitution check johns' rooms for knives, handcuffs or rope). Daley, supra note 180, at 15.( discussing a pimp who described a pillow in a brothel as a 'murder weapon.') 185. Mary Sullivan, Can Prostitution Be Safe? Applying Occupational Health and Safety Codes to Australia's Legalized Brothel Prostitution, in NOT FOR SALE 252 (Rebecca Whisnant & Christine Stark eds., 2004); see also SULLIVAN, supra note 174, at 21-22 (discussing risk management procedures and deescalation protocols). 186. Susan Sward, Dancer Says Strip Club Patron Raped Her, SAN FRANCISCO CHRONICLE, Feb. 10,2000, at A 19. 187. One woman explained that prostitution is "like domestic violence taken to the extreme," Diana Leone, One in 100 children in Sex Trade. Study Says, HONOLULU STAR-BULLETIN, Sept. 10,2001, at A I, available at http://starbulletin.com!2001l09110/news/storyl.html; A First Nations woman in Canada said, "what is rape for others, is normal for us." Farley et a!., supra note 35, at 242; see also Susan Kay Hunter, Prostitution is Cruelty and Abuse to Women and Children, 1 MICH. J. GENDER & L. 1 (1994)(stating that it is impossible to protect women in prostitution who are raped approximately weekly). 188. For a detailed discussion of these issues, see Memorandum of Law for APNE AAP and Eighteen Other Organizations as Amicus Curiae, Alliance for Open Society In!'l., Inc., and Open Soc'y Inst. v. United States Agency for In!'l. Dev., Civil Action No.05-CV -8209 (Dec. 9, 2005) 14353 FARLEY W IT ALleS ,5/312006 1:46:05 AM

2006] Prostitution, Trafficking and Cultural Amnesia 131 violence are intrinsic to legal as well as illegal prostitution, and because rape is a primary means of transmission of HIV, 189 the threat of contracting HIV is not at all diminished under legal prostitution. Ultimately, the abolition of HIV and the abolition of prostitution both require the elimination of sex inequality.190 Systematically discriminating against women of all ages, all classes, and against ethnically subordinated groups, prostitution is not safer when it is legalized. Prostitution reinforces and promotes sex inequality. A Nevada legislator stated, Condoning prostitution is the most demeaning and degrading thing the state can do to women. What. .. (Nevada] do[es] as a state is essentially put a U.S.-grade stamp on the butt of every prostitute. Instead, we should be turning them around by helping them get back mto. SOCIety. . 191 What is a better solution? In 1988, Andrea Dworkin suggested that prostitution should be decriminalized for the prostitute while at the same time criminalizing johns, pimps and traffickers. l92 Today such a law exists in Sweden. Recognizing that prostitution deserved abolition, the Swedish government criminalized the john's and pimp's and trafficker's buying of sex but not the prostituted person's selling of sex. The law made clear that "in the majority of cases ... [the woman in prostitution] is a weaker partner who is exploited," and it allocated funding for social services to "motivate prostitutes to seek help to leave their way oflife.,,193 Two years after the law's passage, a government taskforce reported that there was a fifty-percent decrease in the number of women prostituting and a seventy-five percent decrease in the number men who bought sex. Trafficking of women into Sweden has also decreased. 194

189, Press Release, Commission on the Status of Women, Remarks by Peter Piot, U.N, Doc. WOMI1104 (Mar. 3, 1999); Claudia Garcia-Moreno & Charlotte Watts, Press Release, , Violence Against Women Present Continuing Challenges, told to Third Committee, U.N. Doc. GAlSHC/3744 (Oct. 15, 2003), available at http://www,un.orglNewsiPressidocs/2003/ gashc3744.doc.htm. 190. See Editorial, The Feminization of AIDS, N.Y. TIMES, Dec. 13,2004, at A26; Maxine Frith, India's Hidden AIDS EpidemiC: Virus to Infect 25 Million by 2010, THE INDEPENDENT (London), Nov. 19, 2003, at 13. Nonprostituted women are also at high risk for HIV because of the widespread tolerance of violence against women. In India, for example, there is no law against marital rape. Id. See also Kate Hendricks, Thailand's 100% Condom Use Policy: Success is in the Eye of the Beholder (Oct. 28, 2005) (unpublished manuscript, on file with first author); Sevgi O. Aral & Jonathan M. Mann, Commercial Sex Work and STD: The Need for Policy Interventions to Change Societal Patterns, 25 SEXUALLY TRANSMIITED DISEASES 455, 455-56 (1998)(discussing Centers for Disease Control recommendations that public health programs address the human rights violations of prostitution). 191. ALEXA ALBERT, BROTHEL: AND ITS WOMEN 178 (2001) (quoting William O'Donnell). ! 92. DWORKIN, supra note 84, at 133. 193. For information about the Swedish law regarding prostitution and trafficking, see Prostitutionresearch.com, Fact Sheet in Violence Against Women, http://www.prostitutionresearch.com/ swedish.htm! (!ast visited Apr. I!, 2006). 194. Gunilla S. Ekberg, The Swedish Law that Prohibits the Purchase of Sexual Services, 10 FARLEY W ITALICS 5/312006 I :46:05 AM 14354

132 Yale Journal of Law and Feminism (Vol. 18:N

There are also progressive legal developments in Korea where buying and selling sex acts is criminalized. In 2004, following an educational campaign by women's and human rights groups, the Korean government enacted laws authorizing seizure of assets obtained by trafficking in women, increased penalties for trafficking and prostitution, established supports and resources for prostituted/trafficked women, and provided funds for public education campaigns about prostitution.I95 The passage and enforcement of these laws has been credited with a thirty-seven percent reduction in the number of brothels in Korea, a thirty-to-forty percent decrease in the number of bars and clubs (which comprise eighty-percent of the sex industry in Korea), and a fifty­ two percent decrease in the number of women prostituted in brothels. 196 A Florida state law provides civil remedies for damages that johns and pimps inflict on prostituted wornen.197 Women who are coerced into prostitution via exploitation of social and legal vulnerability can sue johns and pimps for damages. Coercion is defined as restraint of speech or communication with others; exploitation of a condition of developmental disability, cognitive limitation, affective disorder, or substance dependence; exploitation of prior victimization by sexual abuse; exploitation during the making of pornography; and exploitation of the human needs for food, shelter, safety, or affection. 198 A new consciousness about the harms of prostitution in the United Kingdom is evident in political commentary suggesting that men should be charged with rape if they have sex with women who are intimidated into having sex with them, even if money is paid for that sex act. 199 Two international agreements strongly oppose prostitution and trafficking. The United Nations 1949 Convention declares that trafficking and prostitution are incompatible with individual dignity and worth?OO The Convention

VIOLENCE AGAINST WOMEN 1187 (2004), available at http://www.prostitutionresearch.comlc-Iaws­ about-prostitution.html; see also Gunilla S. Ekberg, Prostitution and Trafficking: the Legal Situation in Sweden (Mar. 15,2001) (unpublished manuscript, on file with author.) 195. Farley & Seo, supra note 29, at 9-12. 196. !d. at 9 (discussing Gi Hwan Kim's legal proposals to prevent prostitution and sex tourism in Korea). 197. FLA. STAT. § 796.09 (2006); cf MINN. STAT. § 611A.80 (1994); see also Margaret A. Baldwin, Strategies of Connection: Prostitution and Feminist Politics, I MICH. J. GENDER & L. 65 (1993) (discussing FLA. STAT. § 796.09 (2006)). 198. FLA. STAT. § 796.09(kHo) (2006); see Meg Baldwin, What Can Be Done to Inteifere with and Ultimately Eliminate Demand?, in DEMAND DYNAMICS 105 (Mollison Torrey ed., 2004) (discussing claims brought and won under FLA. STAT. § 796.09). In 2006, the Florida Council Against Sexual Violence, in collaboration with Florida Legal Services, the Jacksonville Women's Center, and Refuge House, is seeking federal funding to support civil legal claims that may be brought by prostituted women under section 796.09 of the Florida Code. Email from Margaret Baldwin (Mar. 17, 2006)(on file with author). 199. Denis MacShane, Prosecute 'Massage Parlour' Rapists, DAILY TELEGRAPH, Jan 3,2006, at 14. 200. Convention for the Suppression of the Traffic in Persons and of the Exploitation of the FARLEYW ITALICS 5/312006 1:46:05 AM 14355

2006] Prostitution, Trafficking and Cultural Amnesia 133 addresses the harms of prostitution to consenting adult women whether transported across national boundaries or not. Viewing trafficked women as victims, not criminals, the 2000 Palermo Protocol makes consent irrelevant to whether or not trafficking has occurred and encourages states to develop 20l legislative responses to men's demand for prostitution. The Palermo Protocol establishes a method of international judicial cooperation that would permit prosecution of traffickers and organized criminals. It addresses a range of other forms of sexual exploitation including pornography. A 2006 report by the United Nations Special Rapporteur on the Human Rights Aspects of the Victims of Trafficking in Persons, Especially Women and Children, noted that prostitution as it is practiced in the world "usually satisfies the legal elements for the definition of trafficking,,202 and therefore, legalization of prostitution is "to be discouraged.,,203 The Special Rapporteur observed that "the issue of demand is of crucial importance in addressing trafficking,,,204 noting, "[b]y engaging in the act of commercial sex, the prostitute-user is ... directly inflicting an additional and substantial harm upon the trafficking victim, tantamount to rape, above and beyond the harmful means used by others to achieve her entry or maintenance in prostitution.,,205

CONCLUSION

Postrnodern descriptions of prostituted women as sex workers promote an acceptance of conditions that in any other employment context would be correctly described as sexual harassment, sexual exploitation, or rape. Women's experiences of violence and their psychological response to it cannot be theorized away. Postrnodern analyses of prostitution that consider it to be "just acting,,206 or that view women's traumatic dissociative responses as proof of "an exceptional control of the inner world" trivialize the existence of real

Prostitution of Others, 96 U.N.T.S. 271. See also Convention on the Elimination of All Forms of Discrimination Against Women, Dec. 18, 1979, art. 5, 1249 U.N.T.S. 13, 17, declaring in Article 6 that state parties shall take all appropriate measures, including legislation, to suppress all forms of traffic in women and exploitation or prostitution of women. 201. See Janice G. Raymond, The New u.N. Trafficking Protocol, 25 WOMEN'S STUD. INT'L F. 491 (2002). The Protocol also closes some loopholes previously used to define prostitution and trafficking as labor. For example, the Protocol describes payment of money for prostitution as a means of coercing a person into being sexually used. ld. At 492 202. United Nations, Commission on Human Rights, Report of the Special Rapporteur on the Human Rights Aspects of the Victims of Trafficking in Persons. Especially Women and Children, 9 U.N. Doc. E/CN.4/2006/62 (Feb. 20, 2006). 203. Id at 17. 204. Id. at 7. 205. Id. at 12. The Special Rapporteur noted that "the terms 'sex work', 'sex worker' and 'client' wrongly suggest that prostitution, as currently practised, does not typically fall within the category of trafficking." ld. at 10. 206. Sanders, supra note 116, at. 319. 14356 FARLEY W IT ALleS 51312006 1:46:05 AM

134 Yale Journal of Law and Feminism [Vol. 18:N violence against real women in prostitution.207 A false distinction between prostitution and trafficking has hindered efforts to abolish prostitution. The word trafficking has been used by sex industry promoters to separate 'innocent' victims of trafficking from women who 2os choose prostitution. In reality, no such line exists. Understanding the real­ world link between prostitution and trafficking is crucial to developing effective laws against trafficking. Since prostitution creates the demand for trafficking, the sex industry in its totality must be confronted. Unless existing prostitution laws are integrated into newer state antitrafficking laws, we won't be challenging sex trafficking as it operates in the world?09 A useful approach would be to compare the institution of prostitution to that of slavery.210 Prostitution requires a sexualized identity just as slavery requires a racialized identity, and both institutions are fueled by racism and sexism. Slavery, like prostitution, is a relation of domination and subordination that involves "direct and insidious violence ... namelessness and invisibility... endless personal violation, and... chronic dishonor. ,,211 Describing the parallel situation of Jamaicans under historical slavery and the situation of Jamaicans today who "earn their living by renting their genitals," a 2006 Kingston editorial criticized the legitimization of slavery-like conditions of those in prostitution by calling them 'sex workers,.212 Johns who buy women, groups promoting legalized prostitution, and governments that sanction or tolerate prostitution213 fonn a powerful alliance that threaten all women. Legal and illegal (but tolerated) sex businesses are places where men can commit sexual harassment and sexual exploitation without fear, and where they are socialized to inflict those same acts on other women in their lives. When prostitution is tolerated or legalized by the state,

207. MAGGIE O'NEILL, PROSTITUTION AND FEMINISM 89 (2001). 208. Dorchen A. Leidholdt, Coalition Against Trafficking in Women, Speech at University of North Carolina, Sexual Trafficking Conference: Breaking the Crisis of Silence (April 8, 2006)(also discussing the importance of developing strong state antitrafficking laws with comprehensive definitions of trafficking that include domestic as well as transnational trafficking, that address men's demand for prostitution as crucial to addressing sex trafficking, and that seek to prevent the recruitment of men to travel for the purpose of sexually exploiting women and children; also advocating state laws that clearly decriminalize the victims of prostitution, including prostituted children, and that provide funding for services for victims). 209. Neuwirth, supra note 56. 210. Melissa Farley, Prostitution, Slavery, and Complex PTSD (1997) (unpublished paper presented at International Society for Traumatic Stress Studies, Montreal, on file with author). 211. ORLANDO PATTERSON, SLAVERY AND SOCIAL DEATH 12 (1982). 212. Anthony G. Gumbs, Prostitution: A Return to Slavery, JAMAICA GLEANER ONLINE, Apr. 24, 2006, available at http://www.jamaicagleaner.com/gleaner/20060424/letters/letters I.html 213. See, e.g., Marisa. B. Ugarte et a!., Prostitution and Trafficking of Women and Children from Mexico to the United States, in PROSTITUTION, TRAFFICKING, AND TRAUMATIC STRESS 147 (Melissa Farley ed., 2003) (describing zones of tolerance for prosititution near Mexico City). Hotel in Las Vegas are another example of tolerance zones, where women are pimped to high rollers. Although prostitution is illegal in Las Vegas, police tend to ignore prostitution of adult women in casinos, and there are relatively few indoor arrests ofjohns. Id. 14357 FARLEY W ITALICS 5/3/2006 1:46:05 AM

2006] Prostitution, Trafficking and Cultural Amnesia 135 sexual predation is normalized - acts ranging from "seemingly banal verbal humiliation (such as sexist and racist verbal abuse), to dominating and degrading behavior (pornography/prostitution in which a group of men ejaculate on a woman's face while she sobs), to lethal assault (snuff prostitution with actual murders filmed).,,214 Harm reduction models of intervention in prostitution/trafficking, while sometimes helpful, fail to address the roots of the problem.215 If we are to prevent the harms of prostitution, and if its harms are intrinsic to prostitution, just as slavery's harms are intrinsic to that institution, then we must ultimately prevent the existence of prostitution. We must learn how it is that men make the choice to buy women in prostitution and how that behavior is reinforced in various cultures. This is a profoundly optimistic viewpoint, since it assumes that the even the most entrenched forms of male violence against women can be changed or eliminated. Our goal is to abolish the institution of prostitution while at the same time standing in solidarity with sisters who are currently prostituted.

214. Farley, supra note 30, at 1116. 215. Harm reduction in prostitution/sex trafficking should include the same three components as harm reduction for the addictions. For example, I) measures to reduce the harm of the addictions such as clean needles, and measures to reduce the harm of prostitution such as distribution of female condoms to reduce the incidence of cervical cancer; 2) measures to reduce the demand for drugs such as freely available methadone clinics, and measures to reduce men's demand for prostitution such as felony-level arrests of johns; 3) measures to reduce the supply of drugs, such as arrests of major drug dealers, and measures to reduce the numbers of women entering prostitution by providing stable housing or by arresting corrupt immigration officials in the case of trafficking. Harm reduction advocates often assume that women will inevitably remain in prostitution and focus only on number one above. We need to focus on harm elimination (as in numbers two and three) as well as harm reduction in prostitution/trafficking. FARLEY W IT ALleS 5/3/2006 I :46:05 AM 14358

136 Yale Journal of Law and Feminism (VoL 18:N

ApPENDIX A

HELP WANTED: WOMEN AND GIRLS Do YOU WANT THIS JOB?

Prostitution has been euphemized as an occupational alternative for women, as an answer to low­ paying, low skilled, boring dead-end jl!bs, as a solution to the high unemployment rate of poor women, as a form of sexualliberatiou, and a career women freely choose. -Are you tired of mindless, low skilled, low-paying jobs? Would you like a career with flexible hours? Working with people? Offering a professional service? -No experience required. No high school diploma needed. -No minimum age requirement. On-the-job training provided. -Special opportunities for poor women-single mothers-women of color. Women and girls applying for this position will provide the following services: -Being penetrated orally, anally, and vaginally with penises, fingers, fist,and objects, including but not limited to, bottles, brushes, dildoes, guns andlor animals; -Being bound and gagged, tied with ropes andlor chaains, burned with cigarettes, or hung from beams or trees; -Being photographed or filmed performing these acts. Workplace: lob-related activities will be performed in the following locations: in an apartment, a hotel, a "massage parlor," car, doorway, hallway, street, executive suite, fraternity house, convention, bar, public toilet, public park, alleyway, military base, on a stage, in a glass booth. Wages: -Wages will be negotiated at each and every transaction. Payment will be delivered when client detennines when and if services have been rendered to his satisfaction. -Corporate management fees range from 40-60% of wages; private manager reserves the right to impound all monies earned. Benefits: Benefits will be provided at the discretion of management. No RESPONSIBILITY OR LEGAL REDRESS FOR THE FOLLOWING ON-THE JOB HAZARDS: -Nonpayment for services rendered; ·Sexually transmitted diseases or pregnancy; -Injuries sustained through performance of services including but not limited to cuts, bruises, lacerations, internal hemorrhaging, broken bones, suffocation, mutilation, disfigurement, dismemberment, and death. Note: Accusations of rape will be treated as a breach of contract by employee. Name of applicant: ______Signature of manager on behalf of applicant: ______14359

''1) II , ' ... ~i./) ,,,~r-n / "$...>-- This is Exhibit _ ment~ned and relerred to In the all!day~ oL~ / Sworn before me this...! ..:_Jay of /11 .. ,:z A.D. 20 ~ R .:(,- ~ / ACommlssionefforta~lngaffldavlla ~~

Prostitution and Trafficking in Nevada: Making the Connections

Copyright © 2007 by lvielissa Farley. All rights reserved. book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval srstem, without permission in writing from the publisher

Prostitution Research & Education P.O. Box 16254 San Francisco, CA 94116-0254 www.prostitutioruesearch.com

ISBN-13: 978-0-6151-6205-8 14360

CONTENTS

Dedication and About the Cover Photographs

Acknowledgments VI

Foreword X11l Carofyn lvlaloney

1 Introduction 1 Summary of Nlajor Findings 12

2 Legal Brothel 15 Restrictive conditions that violate human rights and dignity in the brothels 16 Interviews with 45 women in Nevada's legal brothels 22 Table 1. Demographics of 45 Women in Nevada Legal Prostitution 27 Table 2. Types of Non-brothel Prostitution Engaged in by 45 Women in Nevada Legal Brothels 29 Table 3. Violence in the Lives of 45 Women in Legal Nevada Prostitution 31 Symptoms of Psychological Distress of Women in Legal Brothels 32 Nevada Legal Prostitution and HIV 39 Nevada Legal Prostitution and non-HIV-related adverse physical health effects 45 Stigma of prostitution despite legalization 46 14361

~- 3 Pimp Subjugation of Women by Mind Control 49 HarvE)! SchWaJ1z:; joc!:/ ~T7illiaJJls} and Melissa Far/E)! Bait-Switch-Hook (Nick) S9 Long-term Grooming (!:II eldon) 70 Degradation and Trafficking (Larry) 75

4 Johns in Legal and Illegal Nevada Prostitution 85

5 Trafficking for Legal and Illegal Prostitution in Nevada 93 Table 4. Facts on Transport of 45 Women in Nevada Legal Brothels 104

6 Illegal Escort and Strip Club Prostitution in Las Vegas 109 Adverse effects of stripping on women who strip 114

',,c~ 7 Domestic and International Trafficking

,-.. for Prostitu tion and Organized Crime in Nevada 117

8 The Role of Cab Drivers in Las Vegas Prostitution 131

9 Political and Judicial Corruption and the Nevada Sex Industry 135

Table 5. Cash Contributions to Public Officials by a Club Owner 141

10 It's the Advertising, Stupid! 145 Table 6. 2007 Estimated Advertising Costs for Prostitution in Las Vegas 151

11 Pornography, Prostitution, and Trafficking in Nevada 153 14362

12 Barriers to Services for Women Escaping Nevada Prostitution and Trafficking 159 Jocjy Williams

r-~'t 13 Attitudes toward Prostitution and Sexually Coercive Behaviors of Young Men at the University of Nevada at Reno 173 iVieiissa Farlf!Y} i\llary Stewa7~ and 10/e Smith

14 Adverse Effects of a Prostitution Culture on Nonprostituting Women 181 Table 7. U.S. Rape Rate per 100,000 Population by State 185 Table 8. U.S. Rape Rate per 100,000 Population by City 185 Cartoons by bulbul 187

15 Conclusion: Legalization of Prostitution, ",,-"'501; a Failed Social Experiment 195

Appendix A. Legal Status of Prostitution by Each of Nevada's 17 Counties in 2007 213

Appendix B. Advertising Estimate Details 215

~"' .. Endnotes 219

Index 277 14363

Transcultural Psychiatry http://tps.sagepub.com

Prostitution in Vancouver: Violence and the Colonization of First Nations Women Melissa Farley, Jacqueline Lynne and Ann J. Cotton TRANSCUL T PSYCHIA TRY 2005; 42; 242 001: 10.1177/1363461505052667

The online version of this article can be found at: http://tps.sagepub.com/cgi/contenUabstract/42/2/242

Published by: IJSAGE Publications http://www.sagepublications.com

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Citations (this article cites 39 articles hosted on the SAGE Journals Online and HighWire Press platforms): http://tps.sagepub.com/cgi/contentlrefs/42!2/242

II _ /1 This is Exhibi! ~ menlioned and relerred to in the aflidavft of./> r. m c.. /, $;;' ., Sworn before me this I ~ -r dayof;r7-r) A.D. gopi -" ...,.b r. r / e / ACommissioner for taking affidavils ~~-

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transcultural ,.,-."", psychiatry

June 2005

Prostitution in Vancouver: Violence and the Colonization of First Nations Women

MELISSA FARLEY Prostitution Research and Education, San Francisco

JACQUELINE LYNNE Vancouver, British Colombia

ANN J. COTTON University of Washington, Seattle

Abstract We interviewed 100 women prostituting in Vancouver, Canada. We found an extremely high prevalence of lifetime violence and post­ traumatic stress disorder (PTSD). Fifty-two percent of our interviewees were women from Canada's First Nations, a significant overrepresentation in prostitution compared with their representation in Vancouver generally (1.7-7%). Eighty-two percent reported a history of childhood sexual abuse, by an average of four perpetrators. Seventy-two percent reported childhood physical abuse, 90% had been physically assaulted in prostitution, 78% had been raped in prostitution. Seventy-two percent met DSM-IV criteria for PTSD. Ninety-five percent said that they wanted to leave prostitution. Eighty-six percent reported current or past homelessness with housing as one of their most urgent needs. Eighty-two percent expressed a need for treatment for drug or alcohol addictions. Findings are discussed in terms of the legacy of colonialism, the intrinsically traumatizing nature of prosti­ tution and prostitution's violations of basic human rights.

Vol 42(2): 242-271 DOl: 10.117711363461505052667 www.sagepublications.com Copyright © 2005 McGill University

242

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FARLEY ET AL.: PROSTITUTION IN VANCOUVER

Key words colonization' First Nations' post-traumatic stress disorder' prostitution' sexual assault

Prostitution is a gendered survival strategy that involves the assumption of unreasonable risks by the person in it. A number of authors have docu­ mented and analyzed the sexual and physical violence that is the norma­ tive experience for women in prostitution (Baldwin, 1993, 1999; Barry, 1979, 1995; Boyer, Chapman, & Marshall, 1993; Dworkin, 1981, 1997; Farley, Baral, Kiremire, & Sezgin, 1998; Giobbe, 1991, 1993; Hoigard & Finstad, 1986; Leidholdt, 1993; MacKinnon, 1993, 2001; McKeganey & Barnard, 1996; Miller, 1995; Silbert & Pines, 1982; Silbert, Pines & Lynch, 1982; Vanwesenbeeck, 1994; Weisberg, 1985). For example, Silbert and Pines (1981, 1982) reported that 70% of women suffered rape in prosti­ tution, with 65% having been physically assaulted by customers, and 66% assaulted by pimps. The foregoing authors include data from Burma, Germany, Mexico, Philippines, the Netherlands, Norway, Scotland, South Africa, Thailand, Turkey, USA and Zambia. Most of those in prostitution began prostituting as adolescents. Nadon, Koverola, and Schludermann (1998) found that 89% had begun prosti­ tution before the age of 16. Of 60 women prostituting in escort, street, strip club, phone sex, I and massage parlors in Seattle, all began prostituting between the ages of 12 and 14 (Boyer et al., 1993). In Canada, as elsewhere, most women and men enter prostitution as adolescents (Lowman, 1993).2 Fifty-two percent of 183 Vancouver women were first prostituted when they were younger than 16 years, and 70% first prostituted before age 18 (Cunningham & Christensen, 2001). Children typically enter prostitution subsequent to abusive treatment by caregivers (Lowman, 1993) and subsequent to running away from dangerous home environments (FederaVProvincial Territorial Working Group on Prostitution, 1998). Most people in prostitution were sexually abused as children, usually by several perpetrators. Farley and colleagues (2003) found an average of four perpetrators of childhood sexual abuse against those in prostitution in nine countries. Those in prostitution are often still children (Youth Dele­ gates of Out of the Shadows, 1998). Across nine countries on five conti­ nents, 47% of the people in prostitution entered it when they were less than 18 years of age (Farley et al., 2003). One girl prostituting in Seattle said:

We've all been molested. Over and over, and raped. We were all molested and sexually abused as children, don't you know that? We ran to get away. They didn't want us in the house anymore. We were thrown out, thrown away. We've been on the street since we were 12, 13, 14. (Boyer et al., 1993, p.16)

243

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TRANSCULTURAL PSYCHIATRY 42(2)

The most relevant paradigm currently available for understanding the harm of prostitution is that of domestic violence. Physical coercion, rape and violence by husband/partner/pimp and john are perpetrated against women in prostitution (Currie, 1994; Lowman, 1993; Lowman & Fraser, 1995; Miller, 1995). Of 854 people in prostitution, 73% reported that they had been physically assaulted in prostitution (Farley et al., 2003). In most instances, women in prostitution are battered women. Giobbe (1993) compared pimps and batterers and found similarities in their use of enforced social isolation, minimization and denial, threats, intimidation, verbal and sexual abuse, attitude of ownership, and extreme physical violence to control women. One survivor described prostitution as a 'harrowing metamorphosis' that included frequent physical assaults and which ultimately resulted in a 'neutralization of the body' (Jaget, 1980, p. 188) or somatic dissociation. The physical and emotional violence of prostitution leads to somatic dissociation which itself has been regularly associated with chronic health problems (Kirkingen, 2001). In 1858, Sanger asked 2000 prostitutes in New York about their health and concluded that 'premature old age' was the invariable result of prostitution (cited in Benjamin & Masters, 1964). Today we view the chronic ill health of those in prostitution as resulting from physical abuse and neglect in childhood (Radomsky, 1995), sexual assault (Golding, 1994), battering (Crowell & Burgess, 1996), untreated health problems, and overwhelming stress and violence (Friedman & Yehuda, 1995; Koss & Heslet, 1992; Southwick, Yehuda, & Morgan, 1995). Sanger described conditions of despair, degradation, decline, and early death among women in prostitution who survived, ori average only 4 years from entry into prostitution (Benjamin & Masters, 1964). Making the same observation in the parlance of to day's global marketplace, an anony­ mous pimp commented on the 'brief shelf life' of a girl in prostitution. Pheterson (1996) summarized the health problems of women in prosti­ tution: exhaustion, frequent viral illness, sexually transmitted diseases, vaginal infections, backaches, sleeplessness, depression, headaches, stomach­ aches, and eating disorders. The longer women were in prostitution, the more sexually transmitted diseases they reported (Parriott, 1994). Women who were used by more customers in prostitution reported a range of more severe physical symptoms (Vanwesenbeeck, 1994). Prostitution can be lethal (Potterat et aI., 2004). A Canadian commission found that the death rate of women in prostitution was 40 times higher than that of the general population (Special Committee on Pornography and Prostitution, 1985). A study of Vancouver prostitution reported a 36% incidence of attempted murder (Cler-Cunningham & Christenson, 2001). Vancouver agencies serving women in prostitution have observed many

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FARLEY ET AL.: PROSTITUTION IN VANCOUVER

First Nations women in prostitution. We use the words First Nations as a term of respect for people whose ancestors were the first nations of people in North America. We use the term Aboriginal interchangeably with First Nations.3 In a number of communities across Canada, Aboriginal youth comprise '90% of the visible sex trade' (Save the Children Canada, 2000, p. 7), suggesting the importance of placing prostitution in historical context. Acknowledging the adverse effects of colonialism, Cler-Cunning­ ham and Christenson (2001) observed the 'immense overrepresentation' of Aboriginal women in Vancouver's street-level sex trade. The Royal Commission on Aboriginal Peoples (RCAP) documented the perilous state of Aboriginal housing: 84% of Aboriginal households on reserves did not have sufficient income to cover housing (RCAP, 1996). Housing instability results in reserve-to-urban migration, leaving young women vulnerable to prostitution, in that homelessness has been established as a primary risk factor for prostitution (Boyer et al., 1993; Louie, Luu, & Tong, 1991; Silbert & Pines, 1983). When women in prosti­ tution are asked what they need, first on their list is housing (Farley et aI, 1998). Colonization and racism result in extensive and insidious trauma that wears away its victims' mental and physical health (KeIrn, 1998; Root, 1996). Colonization of First Nations in Canada by the British and the French resulted in well-documented health problems (Waldram, Herring & Young, 2000). The combined effects of poverty, race discrimination and cultural losses profoundly affect First Nations and are likely contributing factors to high rates of interpersonal violence, depression, suicide and substance abuse (Kirmayer, 1994).4 Canada's Royal Commission on Abor­ iginal Peoples referred to premature death as one of the consequences of colonization: Aboriginal people are more likely [than non-Aboriginal people] to face inadequate nutrition, substandard housing and sanitation, unemployment and poverty, discrimination and racism, violence, inappropriate or absent services, and subsequent high rates of physical, social and emotional illness, injury, disability and premature death. (ReAP, 1996, p. 107)

The suicide rate among First Nations people across Canada was three times that of other Canadians and six times higher for those aged 15-24 years (Bobet, 1990). The prevalence of violence against Aboriginal women is extremely high. The death rate of First Nations women from homicide is more than four times greater than that of all Canadian women (Health Canada, Medical Services Branch, unpublished tables, 1995, cited in RCAP, 1996, P 153). Nahanee (1993) wrote of 'the almost total victimization of [Aboriginal] women and children' and concluded 'violence against Aboriginal women

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TRANSCULTURAL PSYCHIATRY 42(2) has reached epidemic proportions according to most studies conducted over the past few years. This violence includes the victimization of women and their children, both of whom are seen as property of their men (husbands, lovers, fathers), or of the community in which they live' (Nahanee, 1993, pp. 360-361). Similarly in the United States, 80% of indigenous women seeking health care at one clinic reported having been raped (Old Dog Cross, 1982). First Nations gay men like First Nations women, are in double jeopardy. Comparing Canadian Aboriginal and non-Aboriginal gay men, researchers found that Aboriginal gay men were significantly more likely to be poor, unstably housed, more depressed, to have been sexually abused as children, to have been raped, and to have been prostituted (Heath et aI., 1999). The diagnosis of post-traumatic stress disorder (PTSD) describes psychological symptoms resulting from overwhelmingly traumatic events such as rape, war, and prostitution. PTSD can result when people have experienced 'extreme traumatic stressors involving direct personal experi­ ence of an event that involves actual or threatened death or serious injury; or other threat to one's personal integrity; or witnessing an event that involves death, injury, or a threat to the physical integrity of another person; or learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associate' (American Psychiatric Association, 1994). PTSD is characterized by anxiety, depression, insomnia, irritability, flashbacks, emotional numbing, and hyperalertness. Symptoms are more severe and long lasting when the stressor is of human design. PTSD is common among prostituted women. Farley and colleagues (1998) found a PTSD prevalence rate of 67% among those in prostitution in five countries. Cultural and social factors are known to have a causal role in PTSD symptoms (U.S. Department of Health and Human Services, 2001). Trauma history and PTSD vary by race/ethnicity and national origin with, for example, refugees from South Asian countries experiencing high rates of war-related traumatic events (Mollica et aI., 1990) and indigenous peoples in the United States suffering multiple and cumulative trauma when compared with other groups (Robin, Chester, & Goldman, 1996). In a study that included a majority of Alaska Native women, 70% of a sample of pregnant women in substance abuse treatment had experienced child­ hood physical and sexual abuse (Brems & Namyniuk, 2002). There are many anecdotal accounts and case studies of prostitution (Farley & Kelly, 2000). We noted the need for quantitative data. This work was an attempt to expand a quantitative database on prostitution, history of violence and PTSD that now includes nine countries (Farley et al., 2003). An analysis of the intersections of race, class and gender is crucial

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FARLEY ET AL.: PROSTITUTION IN VANCOUVER to an understanding of prostitution. In reviewing the literature regarding colonialism, cultural alienation, and violence against First Nations, we predicted that First Nations women, compared with non-First Nations women in prostitution, would report increased rates of violence both during prostitution and in their lives prior to prostitution. Given the previous findings of extremely high rates of PTSD among those prosti­ tuted, we did not anticipate finding differences in PTSD between First Nations women and white European-Canadian women in prostitution.

METHOD Brief structured interviews of 100 prostituting women and children were conducted in Vancouver, Canada. We contacted agencies working with prostitutes and set up collaborative efforts where possible. The second author was a board member of a Vancouver agency that provided services to prostitutes and was familiar with locations where prostitution commonly occurred in Vancouver. She was known to some of our inter­ viewees in her capacity as a social worker. Interviewers were screened for the ability to establish an easygoing rapport on the street and in occasion­ ally dangerous locations. The women we interviewed were from the Downtown Eastside, Franklin, and /Fraser prostitution strolls in Vancouver, Be. We attempted to contact any woman known to be prostituting, whether indoor or outdoors. Using a snowball recruitment technique, we asked women to let their friends who were prostituting elsewhere (e.g. in other areas or indoors) know that we would return to a specific location at a specific time the next day. Usually we had access only to people prostitut­ ing on the street. Only four women refused to participate; several appeared to be in the process of approaching customers. Informed consent included a summary of research goals and partici­ pants' rights. Respondents' copies of the consent form included names and phone numbers of local agencies that could be contacted for support and assistance and included the authors' phone numbers and email addresses. In all cases we offered to read the items to respondents. Most were able to complete the questionnaire without assistance; however, a few were illiter­ ate. If respondents indicated that they were prostituting we asked them to fill out three questionnaires. We paid a small stipend ($10 Canadian) to those who responded to the three questionnaires. The Prostitution Ques­ tionnaire (PQ), used in similar research in South Africa, Thailand, Turkey, the USA and Zambia, consists of 32 items asking about physical and sexual assault in prostitution, lifetime history of physical and sexual violence, and the use of or making of pornography during prostitution (Farley et al.,

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TRANSCULTURAL PSYCHIATRY 42(2)

1998). The questionnaire asked whether respondents wished to leave prostitution and what they needed in order to leave. We asked if they had been homeless, if they had physical health problems, and if they used drugs or alcohol or both. Because of item heterogeneity, psychometrics on the PQ are not available. Sample items include: 2. Since you've been in prostitution, have you been physically assaulted? 14a. When you were a child, were you ever hit or beaten by a parent or caregiver until you had bruises on your body or were injured in some other way by them? 16. Did you ever have pictures taken of you while you were working in prostitution? 19. Have you ever been homeless? Respondents also completed the PTSD Checklist (PCL), a 17-item scale that assesses DSM-IV symptoms of PTSD (Weathers, Litz, Herman, Huska, & Keane, 1993). Respondents were asked to rate the 17 symptoms of PTSD (see Table 1) on a 5-point scale with 1 = not at all; 2 = a little bit; 3 = moderately; 4 = quite a bit; and 5 = extremely. Weathers and colleagues (1993) report PCL test-retest reliability of .96. Internal consistency as measured by Cronbach's alpha was .97 for all 17 items. Validity of the scale is reflected in its strong correlations with the Mississippi PTSD Scale (.93), the PK scale of the MMPI-2 (.77) and the Impact of Event Scale (.90). The PCL has functioned comparably across ethnic subcultures in the USA (Keane, Kaloupek, & Weathers, 1996). Based on previous responses to open-ended questions about health problems among prostituted women, we constructed a Chronic Health Problems Questionnaire (CHPQ; Farley et al., 1998). The CHPQ is a symptom checklist with dichotomous items. Interviewees were asked whether or not they had symptoms or experienced events commonly reported by women in prostitution. Sample items included joint pain, jaw pain, loss of feeling on skin, pain in breasts and head injury. Scale mean was 17.6, with SD = 8.6. Internal consistency as measured by Cronbach's alpha was .92 for 36 items. Once it was apparent that we were interested in hearing about women's experiences during prostitution, many volunteered information regarding what prostitution was like for them. Some of their observations are included here. Whenever an interviewee wanted to talk with us, we welcomed that and took notes. During this process, referrals were made to substance abuse treatment centers, First Nations community centers and medical clinics.

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FARLEY ET AL.: PROSTITUTION IN VANCOUVER

PARTICIPANTS We describe all of the 100 interviewees in this study as women, although one respondent identified as transgendered. This person was included as a woman with the rest of our respondents. Ages ranged from 13 to 49 years, with a mean age of 28 years (SD = 7.8 years). The youngest age at recruitment into prostitution was 10 years. Respon­ dents spent an average of 10 years in escort, massage, and street prostitution (SD = 7 years). A few respondents had been in prostitution less than a year, with 4 months being the least amount of time any of our interviewees spent in prostitution. One woman had been prostituted for 31 years. With respect to race/ethnicity, 52% were First Nations, 38% were white European-Canadian, 5% were African-Canadian, and 5% left the question unanswered. Ethnicity was self-reported. The majority of the 52 First Nations women described themselves as Native (n = 24), First Nations (n = 2) or Native Indian (n = 2). Next most often, they described them­ selves as Metis (n = 10), a French word that translates to English as 'mixed blood' and is used to describe people who are of both First Nations and European ancestries. Historically, the two major colonizers of First Nations of Canada were the British and the French; therefore most of those called Metis were First Nations/French or First Nations/British. In current use in the Downtown Eastside of Vancouver, the word Metis refers to anyone who is biracial or multiracial. We use the term Metis in its broadest sense and not as a term that refers to legal status. The First Nations women also categorized themselves as Cree or Cree Native (n = 3), Cree/French (n = 2), Ojibwa (n = 2), Aboriginal (n = 2), Native/EI Salvador (n = 2), Blackfoot/Cree (n = I), Cree/Metis/Mexican (n = 1), and Interior Salish (n = 1). In order to make statistical comparisons, we collapsed all the fore­ going groups into the category 'First Nations.' Fewer than 10 women identified themselves by nation, so we were unable to compare nations in our analyses.

RESULTS

CHILDHOOD VIOLENCE Eighty-two percent of our respondents reported a history of childhood sexual abuse, by an average of four perpetrators. This statistic (those assaulted by an average of four perpetrators) did not include those who responded to the question 'If there was unwanted sexual touching or sexual contact between you and an adult, how many people in am' with 'tons' or 'J can't count that high' or 'I was too young to remember.' Seventy-two percent reported that as children, they had been hit or beaten by a care­ giver until they had bruises or were injured.

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TRANSCULTURAL PSYCHIATRY 42(2)

Eighty-six percent of these women in Vancouver prostitution reported current or past homelessness.

PHYSICAL AND SEXUAL VIOLENCE IN PROSTITUTION Ninety percent of these women had been physically assaulted in prosti­ tution. Of those who reported physical assault, 82% of the perpetrators were their customers. Eighty-nine percent had been physically threatened while in prostitution and 67% had been physically threatened with a weapon. Seventy-eight percent had been raped in prostitution, with 67% of those raped having been raped more than five times. Seventy-six percent of those who had been raped had been raped by customers. Sixty-seven percent of our interviewees reported that pornography was made of them in prostitution; and 64% had been upset by an attempt to force them to perform an act that customers had seen in pornography.

VERBAL AND EMOTIONAL ABUSE IN PROSTITUTION Eighty-eight percent of the women responding to our questionnaires reported that they had been verbally abused. One woman commented, 'lots of [customers] are super-nice at first. Then when the sex act starts, they get real verbally abusive.' Another told us that while legal prostitution might make her feel safer from physical assaults, it would not change the verbal abuse and harassment that she knew was intrinsic to prostitution.

PHYSICAL HEALTH PROBLEMS Sixty-three percent of these women in prostitution reported health problems. Common symptoms were memory problems (66%), trouble concentrating (66%), headaches (56%), dizziness (44%), vision problems (45%), hearing problems (40%), balance problems (41%), aching muscles (78%), joint pain (60%), jaw pain (38%), and swelling of limbs (33%). Cardiovascular symptoms included chest pain (43%), pain/numbness in hands/feet (49%), irregular heartbeat (33%) and shortness of breath (60%). Sixty-one percent of these respondents had cold/flu symptoms. In addition, 35% reported allergies and 32% reported asthma. Twenty four percent reported both painful menstruation and vaginal pain. Twenty three percent had breast pain. In response to a general query about health, 30% of the women we interviewed reported hepatitis C. Some of the cardiovascular, neurological and joint complaints may have been symptoms of drug withdrawal. Seventy-five percent of the women reported physical injuries from violence in prostitution. Many reported stabbings and beatings,

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FARLEY ET AL.: PROSTITUTION IN VANCOUVER concussions and broken bones (broken jaws, ribs, collar bones, fingers, spinal injuries, and a fractured skull), as well as cuts, black eyes, and 'fat lips:5 Fifty percent of these women had head injuries resulting from violent assaults with, for example, baseball bats and crowbars. Many had their heads slammed against walls and against car dashboards. Customers and pimps regularly subjected then to extreme violence when they refused to perform a specific sex act.

POST-TRAUMATIC STRESS DISORDER PTSD consists of three types of symptoms: (1) persistent, intrusive re­ experiencing of trauma; (2) numbing of responsiveness and persistent avoidance of stimuli associated with trauma; and (3) persistent autonomic hyperarousal. A diagnosis of PTSD requires at least one intrusive symptom, three numbing/avoidance symptoms, and two hyperarousal symptoms, as well as having experienced a traumatic stressor (criterion A). Criterion A requires having experienced or witnessed an event or events involving actual or threatened death or serious injury, or a threat to the physical integrity of self or others, and reacting with intense fear, helpless­ ness, or horror to these events (American Psychiatric Association, 1994). Attempted rape is commonly accepted as meeting criterion A for diagnosis of PTSD (Avina & O'Donohue, 2002). Ninety percent of our respondents had themselves been physically assaulted in prostitution. Based on previous findings we concluded that all of our respondents met criterion A by having experienced or witnessed serious injury. We summed respondents' ratings across the 17 items of the PCL, gener­ ating an overall measure of PTSD symptom severity that was previously used by the scale's authors. Mean PCL score for our respondents was 55.7 (SD = 15.6). Using Weathers et al:s (1993) formulation we considered a score of 3 (moderately), 4 (quite a bit) or 5 (extremely) on a PCL item to be a symptom of PTSD. Eighty-nine percent of our respondents endorsed at least one intrusive symptom of PTSD, 81% endorsed at least three numbing and avoidance symptoms of PTSD, and 85% endorsed at least two of the physiologic hyperarousal symptoms of PTSD. The mean scores for these 100 women in prostitution were within the clinically symptom­ atic range (3 or greater) on two of the five intrusive symptoms, for all seven of the numbing/avoidance symptoms, and all five of the hyperarousal symptoms of PTSD. See Table 1 for mean scores of each of the 17 PCL items. Seventy-two percent of our respondents met criteria for a PTSD diagnosis.

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TRANSCULTURAL PSYCHIATRY 42(2)

TABLE 1 PTSD symptoms of 100 Vancouver women in prostitution

Percent responding at PTSD symptom PTSD symptom Mean SD level (%)

Intrusive re-experiencing (B symptoms) Memories of trauma from the past 3.1 1.3 64 Dreams of trauma from the past 2.8 1.4 54 Act/feel as if traumatic event were happening again 2.8 1.3 53 Very upset when reminded of trauma from past 3.5 1.2 76 Physical reactions to memories of past trauma 2.6 1.4 52

Numbing and avoidance (C symptoms) Avoid thinking or feeling about past trauma 3.5 1.4 76 Avoid activities which remind you of past trauma 3.4 1.4 68 Trouble remembering parts of trauma from past 3.1 1.5 65 Loss of interest in activities you used to enjoy 3.8 1.3 78 Feeling distant or cut off from people 3.7 1.4 72 Emotionally numb; unable to have loving feelings 3.4 1.5 70 Feel as if future will be cut short 3.4 1.5 68

Hyperarousal (D symptoms) Trouble falling or staying asleep 3.1 1.4 67 Feeling irritable or having angry outbursts 3.3 1.5 64 Difficulty concentrating 3.3 1.3 72 'Super alert' or watchful or on guard 3.6 1.3 81 Feeling jumpy or easily startled 3.3 1.5 66

HISTORY OF VIOLENCE AND PTSD We investigated four types of lifetime violence experienced by these inter­ viewees: childhood sexual assault, childhood physical assault, rape in adult prostitution, and physical assault in adult prostitution. Eighty-nine percent reported childhood sexual assault, 72% reported childhood physical assault, 92% reported rape in adult prostitution, and 90% reported physical assault in adult prostitution. Four percent of the sample had experienced only one type of lifetime violence, 11 % reported two types, 23% reported three types, and 62% reported experiencing all four types of lifetime violence. PTSD diagnosis and severity were not related to number of types of lifetime violence as would normally be expected. These respondents' extremely high incidence of lifetime violence created a ceiling effect. Because 85% of the sample experienced three or four types of lifetime violence, there were not enough people in the group who experienced only

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FARLEY ET AL.: PROSTITUTION IN VANCOUVER one or two forms of lifetime violence (15%) to determine whether there was a relationship between PTSD severity and number of different types of lifetime violence.

CURRENT NEEDS OF INTERVIEWEES Ninety-five percent of these respondents stated that they wanted to leave prostitution. Eighty-two percent expressed a need for drug or alcohol addiction treatment. They voiced a need for job training (67%), a home or safe place (66%), individual counseling (58%), self-defense training (49%), health care (41%) and peer support (41%). Thirty-three percent needed legal assistance, 32% wanted legalized prostitution, 12% needed childcare, and 4% wanted physical protection from pimps.

DIFFERENCES WITH RESPECT TO RACEIETHNICITY We compared First Nations women with European-Canadian women in a number of analyses. Table 2 summarizes these comparisons. Childhood sexual abuse was reported significantly more often by interviewees identi­ fying as First Nations than by those describing themselves as European Canadian (X 2 (1) = 5.2, P = .02). Of those First Nations women reporting sexual abuse, relatives were specified as perpetrators 41 % of the time, adult friends or community members were specified as perpetrators 34% of the time, and an older child was specified as perpetrator 25% of the time. Significantly more First Nations women than European-Canadian women reported childhood physical abuse (X 2 (1) = 5.6, P = .02).

TABLE 2 Comparison of First Nations and European-Canadian women: Childhood physical and sexual abuse, homeless ness, and violence in prostitution

First Nations European-Canadian

% (n = 52) % (n = 38) X2 P Childhood physical abuse* 81 (42) 58 (22) 5.6 .02 Childhood sexual abuse* 96 (50) 82 (31 ) 5.2 .02 Verbal abuse in prostitution 88 (45) 92 (35) 1.0 .30 Physical abuse in prostitution 88 (46) 89 (34) .02 .88 Raped in prostitution 92 (48) 92 (35) .00 .97 Threatened with a weapon 63 (33) 66 (25) .16 .69 Homelessness 83 (43) 87 (33) .43 .51 Upset by being forced to 69 (36) 58 (22) 1.2 .28 imitate pornography Had pornography made of them 65 (34) 60 (23) .49 .48

*p < .05.

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TRANSCULTURAL PSYCHIATRY 42(2)

TABLE 3 Responses to 'What do you need?' asked of women in prostitution

First Nations European-Canadian

Need % (n = 49) % (n =36) X2 P

Drug or alcohol treatment 88 (43) 75 (27) 2.3 .13 Job training* 78 (38) 56 (20) 4.6 .03 Individual counseling* 67 (33) 44 (16) 3.9 .05 Self-defense training** 63 (31) 33 (12) 7.4 .006 Home or safe place 61 (30) 75 (27) 1.3 .25 Peer support* 53 (26) 25 (9) 6.3 .01 Medical or health care 41 (20) 36 (13) .2 .66 Legal assistance 33 (16) 28 (10) .2 .63 Legalized prostitution 24 (12) 36 (13) 1.3 .24 Childcare 16 (8) 8 (3) 1.2 .28 Physical protection from pimp 4 (2) 3 (1) .1 .75

Note. Five participants did not respond to these questions. *p < .05; **p < .01.

There were ethnic differences in response to a needs assessment. See Table 3. First Nations women indicated a significantly greater need for self­ defense training (X 2 (1) = 7.4, P = .006), a greater need for peer support (X 2 (1) = 6.3, P = .01), a greater need for job training (X 2 (1) = 4.6, P = .03), and for individual counseling (X 2 (1) = 3.9, P = .05). We found no race/ethnic differences in the frequency of health problems endorsed on the Chronic Health Problems Questionnaire (F(1,82) = .06, P = .81). First Nations women in the sample were not more likely than European Canadians to qualify for a diagnosis of PTSD (X 2 (1) = .01, p = .92) nor was there a significant statistical relationship between PTSD severity, as measured by the mean PCL sum score and First Nations heritage (Pearson r = -.02, P = .86).

DISCUSSION The clinical expression 'hypervigilance' does not adequately describe the physical terror and despair we witnessed in many of these women. Violence seemed to be in the very air they breathed. Our findings document this extreme level of sexual violence. One woman told us that she was continu­ ally raped in prostitution, explaining 'what rape is to others, is normal to us: Another woman, aged 36, described a rape as the 'defining experience' of her life. At age 16 she was raped at knifepoint after which the rapist gave her a gold chain in effect paying her for the rape and defining her as a prostitute.

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Most of our respondents had been physically assaulted (90%) or raped (78%) in prostitution. A fear of men was pervasive. One woman told us that being hit and bruised were 'just your common aggressiveness from men.' In a separate study of Vancouver prostitution, 68% of women had been recently raped, 72% had been kidnapped, and 89% had had customers refuse condoms in the previous year (Cunningham & Christen­ son, 2001). For many of our interviewees, accommodation to violence began in childhood. Most women in this study (82%) reported sexual abuse as children, usually with multiple perpetrators. Currie (1994) found a comparable prevalence of childhood sexual abuse (73%) among 600 women prostituting in Vancouver. Benoit and Millar (2001) noted a 55% incidence of childhood sexual abuse among 201 women prostituting in Victoria, Be. A Toronto study noted that many women who were prosti­ tuting cited 'persistent abuse' as precipitating their drug use (Butters & Erickson, 2003). Cler-Cunningham and Christenson (2001) reported that 85% of 183 women in Vancouver prostitution had been verbally or physically harassed more than once in the past year. The verbal abuse in prostitution is socially invisible just as other sexual harassment in prostitution is normalized and invisible. Yet it is pervasive: 88% of our respondents described verbal abuse as intrinsic to prostitution. Customers' verbal assaults in all types of prosti­ tution are likely to cause acute and long-term psychological symptoms. A woman in another study explained this: 'It is internally damaging. You become in your own mind what these people do and say with you. You wonder how could you let yourself do this and why do these people want to do this to you?' (Farley, 2003b). The verbal abuse against prostituted women is reflected in the names that all women are called by violent men during sexual assaults. The epithets seem intended 'to humiliate, to eroti­ cize, and to satisfy an urge for self-justification.' (Baldwin, 1992, p. 60). The 72% incidence of current PTSD in these women in prostitution is among the highest reported in populations where PTSD has been studied, including battered women, combat veterans, childhood trauma survivors, rape survivors, and torture survivors (Bownes, O'Gorman, & Sayers, 1991; Farley et aI., 1998; Feeney, Zoellner, & Foa, 2000; Houskamp & Foy, 1991; Kemp, Rawlings, & Green, 1991; Ramsay, Gorst-Unsworth, & Turner, 1993; Weathers et aI., 1993). Rates of PTSD among these prostituted women from Canada did not differ significantly from prostituted women in other countries including South Africa, Thailand, Turkey, the USA and Zambia (F(5,575) = .95, P = .45). The mean PCL score (56) of these prostituted women was in the same range (51-56) as that of people in prostitution in South Africa, Thailand, Turkey, the USA and Zambia (Farley et aI., 1998) and similar to the mean PTSD score (51) of treatment-seeking Vietnam

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TRANSCULTURAL PSYCHIATRY 42(2) veterans (Weathers et al., 1993) and much higher than means in studies of Persian Gulf War veterans (35, Weathers et al., 1993), and women HMO members with and without childhood physical and sexual abuse (24-37, Farley & Patsalides, 2001). When we compared European-Canadian women with First Nations women we did not find differences in PTSD. The pervasiveness and severity of trauma exposure experienced by these women in prostitution may have obscured differences in PTSD that would otherwise be expected on the basis of race/ethnicity. Our findings are consistent with two studies that failed to find race differences in PTSD symptoms among combat veterans (Beals et al., 2002; Monnier, Elhai, Frueh, Sauvageot, & Magruder, 2002). In these studies, combat (like prostitution) was the overwhelmingly traumatic event that mitigated differences in PTSD based on race. Our respondents appeared to be in a state of almost constant revictim­ ization. The assaults against these women in prostitution were part of a lifetime surround of exploitation and abuse. Because of this pervasive violence we cannot separate the effects of childhood and adult violence on current PTSD symptoms. It is likely that experiences of violence over the course of one's lifetime have a cumulative effect on PTSD symptoms (Follette, Polusny, Bechtle, & Naugle, 1996). Other research found that a history of sexual assaults is a common precursor to prostitution. West, Williams, and Siegel (2000) found that women were most likely to prosti­ tute if they had experienced both sexual abuse as children and were later revictimized by rape as adults. One young woman told Silbert and Pines (1982, p. 488), 'I started turning tricks to show my father what he made me.' Dworkin (1997, p. 143) described incest as 'boot camp' for prosti­ tution. Fifty-two percent of our respondents were First Nations women, a lower percentage than the 70% of First Nations women in street prostitution in another Vancouver study (Currie, 1994, reported in Federal/Provincial Territorial Working Group, 1998). In population census estimates, 7% of Vancouver's people are First Nations (Vancouver/Richmond Health Board, 1999). The overrepresentation of First Nations women in prostitution, and prostitution's prevalence in an area of Vancouver with a high proportion of First Nations residents reflects not only their poverty, but also their marginalized and devalued status as Canadians. Others report similar findings. For example 15% of women in escort prostitution in Victoria, BC were First Nations although the First Nations population of Victoria has been estimated at 2% (Benoit & Millar, 2001 p. 18). In New Zealand, Plumridge and Abel (2001) observed that 7% of the Christchurch population were Maori women but 19% of those in Christchurch prostitution were Maori women. Maori in prostitution were significantly more likely than European-ancestry New Zealanders to have

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FARLEY ET AL.: PROSTITUTION IN VANCOUVER experienced homelessness and to have entered prostitution as children (Farley, 2003a). As we did in Vancouver, New Zealand researchers sampled from the poorest community in Auckland and reported that twice as many Maori there were in prostitution (40%) compared with their represen­ tation in northern New Zealand generally (21%) (Saphira & Herbert, 2003). In the early 1990s, Atayal and other Aboriginal girls comprised 70% of those in Taiwanese debt-bondage prostitution although, they were only 1.8% of the total population (Hwang & Bedford, 2003). The researchers noted that pathways into prostitution for Aboriginal Taiwanese adoles­ cents were similar to those pathways elsewhere: globalization of the economy, social and cultural disruption, race/ethnic discrimination, and extremely high levels of family violence. For women, prostitution is intimately associated with poverty. Its First Nations residents refer to Vancouver's Downtown Eastside, one of the poorest areas in North America, as the 'urban reserve.' Colonization left many First Nations people in extreme poverty that has endured for gener­ ations (LaFramboise, Choney, James, & Running Wolf, 1995). Eighty-six percent of our respondents were currently or previously homeless. First Nations youth who leave their home communities for urban areas are particularly vulnerable to sexual exploitation in that they are both homeless and in an unfamiliar cultural environment (Federal/Provincial Working Group, 1998). Although we do not yet have data to confirm this, we suspect that First Nations women are more likely to be overrepresented in the poorest types of prostitution - street and massage - than in strip club, phone sex, and Internet prostitution. The first author observed that in Mexico City, Mayan women were often sold in prostitution for the lowest price and were made available for more violent sex acts, such as anal rapes, that other women refused to perform. Analyzing the effects of racism is central to an understanding of prosti­ tution. Racism has a profound effect on health (Williams, Lavizzo-Mourey, & Warren, 1994; Turner & Kramer, 1995). For example a U.S. report located more than 175 studies documenting race/ethnic disparities in diagnosis and treatment of medical conditions (Institute of Medicine, 2002). Reflecting poverty, malnutrition, chronic stress and inadequate health care, premature aging is commonplace in the Downtown Eastside where one neighborhood center categorizes anyone over age 40 as a senior. The vulnerabilities of race, class and gender have been recognized as multi­ plicative risk factors for HIV (Osmond et al., 1993), and we think that they are also multiplicative risk factors for prostitution. In Canada, the triple force of race, class and sex discrimination disparately impacts First Nations women. Prostitution of Aboriginal women occurs globally in epidemic numbers with indigenous women at the bottom of a racialized sexual hier­ archy in prostitution itself. This phenomenon has been observed by others

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TRANSCULTURAL PSYCHIATRY 42(2)

(Grant, Grabosky, & David, 1999; Ministry of Foreign Affairs and Trade, 2001; UNICEF, 2004). For many, the experience of prostitution stems from the historical trauma of colonization. Imposing a sexist and racist regime on First Nations women, colonization simultaneously elevated male power within the colonized community (Fiske, 1995). Today, many First Nations women are dominated by a 'newly evolved state of traditional governance' that replaced more egalitarian systems (Brunen, 2000). The cultural destruc­ tion of positive roles for First Nations men and their subsequent identifi­ cation with supremacist attitudes have had disastrous consequences for First Nations women, with astronomical rates of incest, rape and husband violence. Freire (1994) described the colonial destruction of positive roles for men as resulting in 'adhesion to the oppressor' (p. 27). Dworkin also discussed the harm inflicted on women by colonized men:

The stigma of the prostitute allows the violent, the angry, the socially and politically impoverished male to nurse a grudge against all women, includ­ ing prostituted women; this is aggressive bias, made rawer and more danger­ ous by the need to counter one's own presumed inferiority. (Dworkin, 2000, p.325) Sexual violence and other family violence are major social problems in First Nations communities. A Dene woman described communities in which the entire female population had been sexually assaulted by men. She had been threatened with further violence if she spoke out against this (Lynne, 1998, p. 43). Consistent with others' reports, First Nations women in our study were significantly more likely than non-First Nations to report childhood physical and sexual abuse. There is an urgent need for further exploration of these connections between gender, race/ethnicity, and class in prostitution not only in Canada but elsewhere (Bourgeault, 1989). Prostitution is one specific legacy of colonization although it is infrequently analyzed as such (Lynne, 1998; Scully, 2001). A perspective that understands prostitution to be colonization of First Nations women by both First Nations and non-First Nations men may be helpful in addressing the problem. The RCAP report suggested that a general health strategy for First Nations should involve equitable access to health services, holistic approaches to treatment, Aboriginal control of services, and diverse approaches that respond to cultural priorities and community needs (RCAP, 1996). These four strategies are applicable to the healing of women escaping prostitution. Models for healing of First Nations women in prostitution would include a decolonizing perspective that analyzes historical trauma, violent crimes, family violence, child abuse and neglect,

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FARLEY ET AL.: PROSTITUTION IN VANCOUVER discrimination, unresolved grief and mourning. Cultural moderators of these traumatic experiences that would promote healing include family/community support, traditional spiritual practices and medicine, and a positive indigenous identity (Walters, Simoni, & Evans-Campbell, 2002). A study of the needs of Vancouver prostituted women underscores these recommendations (Benoit, Carroll, & Chaudhry, 2002). A Toronto study of 30 prostituting women emphasized their need for mental health services, including drop-in crisis centers open at night as well as hotlines staffed by peers (Butters & Erickson, 2003). Access to alternative employ­ ment that would generate sustainable income is necessary in order to remove the economic motivation for prostitution. In our opinion, western medical treatment of PTSD is best combined with traditional healing for First Nations women who want to escape prostitution. The Peguis First Nation community in Manitoba found that a combination of traditional and western healing approaches was especially effective for those who suffer from emotional problems, includ­ ing those related to alcohol and drug abuse, violence and suicide (Cohen, cited in RCAP, 1996). Women in prostitution self-medicate for depression and PTSD with drugs and alcohoL6 An urgent need for treatment of drug and alcohol addiction was voiced by 82% of those we interviewed. An approach that simultaneously treats substance abuse and PTSD has proven more effec­ tive than treatment that only treats substance abuse and fails to address PTSD (Epstein, Saunders, Kilpatrick, & Resnick, 1998; Najavits, Weiss, Shaw, & Muenz, 1998; Ouimette, Kimerling, Shaw, & Moos, 2000). Women in prostitution who are dealing with addictions are not likely to benefit from treatment in mixed-gender groups. It is unsafe for them to discuss prostitution in the traditional 12-step setting, because men regularly proposition them as soon as the women are known to have prostituted. Furthermore, confidentiality is a concern in communities where everyone is either related or knows one another (Rees, 2001). Any intervention for those in prostitution must first acknowledge prosti­ tution as a form of violence. As with battered women, physical safety is a critical concern. In order to address the harm of prostitution it is necessary to use education, prevention and intervention strategies similar to those dedicated to other forms of gender-based abuse such as rape and intimate partner violence. This understanding of prostitution as violence against women must then become a part of public policy and it must be struc­ turally implemented in public health care, mental health services, homeless shelters, rape crisis centers and battered women's shelters (Stark & Hodgson, 2003). The healthcare provider must become not only culturally competent regarding differences between nations in culture and language but also acquainted with community services and anti-violence resources

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TRANSCULTURAL PSYCHIATRY 42(2)

(Polacca, 2003). In the United States there is the additional complexity of jurisdictional confusion. Tribal courts may lack the means and the will for strong prosecution of perpetrators of violence. Tribal jurisdiction some­ times conflicts with federal law enforcement, and perpetrators may be aware that there are minimal consequences for violence against women (National Sexual Violence Resource Center, 2000; Polacca, 2003). Caution is warranted in interpreting these results because we ran multiple post-hoc analyses on this data, which has not been statistically corrected for the increased probability of finding significant results when multiple analyses are performed. Nonetheless, we are confident that the trends we have described are accurate and that they warrant further investigation. Because of the ongoing trauma of prostitution and homelessness it is likely that some of these women minimized childhood violence. To review a history of trauma while in the midst of ongoing abuse was likely to have been too painful for some. Some of these women did not categorize juvenile prostitution as childhood sexual abuse.7 Others minimized violence they had experienced by comparing it with that suffered by friends. One woman told us that since she had no broken bones and had not been assaulted with a weapon, therefore her rape and strangulation by a john did not count as much. Thus we assume that the reporting of trauma history among our respondents is conservative and that the actual prevalence of traumatic events, health symptoms, and PTSD symptoms is likely to be higher than reported here. Some women we interviewed were obviously intoxicated. This does not decrease our confidence in the accuracy of these results. Along with others we have noted that addicts report life events with as much accuracy as non-addicts do (Bonito, Nurco, & Shaffer, 1976). No study of prostitution can claim a representative or random sample, given the illegality of prostitution in most locations. 'There is quite simply no such thing as a representative sample of women selling sex' (McKeganey & Barnard, 1996). We interviewed those people to whom we had access. In most cases we and other researchers have access only to people prostitut­ ing on the street. That said, we made every attempt to contact any woman known to be prostituting, indoors or outdoors. We did this by asking women to tell friends who were prostituting elsewhere (e.g. in other areas or from their homes or clubs) that we would return to a certain location at a specific time the next day. Interviewees often reported involvement in prostitution across multiple locations, for example, strip club, escort and massage parlors as well as street prostitution.s As shown in these findings, prostitution is a sexually exploitive often­ violent economic option most often entered into by those with a lengthy history of sexual, racial and economic victimization. Prostitution is only

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now beginning to be understood as violence against women and children. It has rarely been included in discussions of sexual violence against First Nations.9 It is crucial to understand the sexual exploitation of First Nations women in prostitution today in a historical context of colonial violence against nations (Frideres, 1993; Ryser, 1995; Waldram, 1997). Today, the continued displacement of women who are poor, rural and indigenous may be understood as trafficking in which women are moved from the reserve to the city for the purpose of prostitution (Lynne, 1998). Just as wife beating was historically viewed as having been provoked by the victim, prostitution is still viewed by some as a job choice to which the victim 'consents.' Ninety-five percent of our interviewees said that they wanted to escape prostitution, while also telling us that they did not feel that they had other options for survival. Another report found that 90% of women in prostitution wanted to leave prostitution but could not (Elizabeth Fry Society of Toronto, 1987). Social scientists have begun to address the harms of incest, rape and family violence. We hope to see more research that examines prostitution as part of the surround of violence against women, specifically including First Nations women. We also hope to see investigations of interventions that promote healing from prosti­ tution.

ACKNOWLEDGEMENTS Thanks to Rudolph Ryser, PhD, Center for World Indigenous Studies, Olympia, Washington, for invaluable information about colonization and geopolitics.

NOTES

1. In phone sex, a person verbally 0 provides explicit sex talk for pay for a customer who typically masturbates during the call. It can include what in other settings would be verbal sexual harassment, as well as sexist and racist epithets and other verbal abuse. Commonly, women who engage in phone sex, like women in strip clubs, also prostitute in other ways. 2. British Colombia surveys found the average age of entry into prostitution to be 14-15.5 years, and a Vancouver survey found average age of entry into prostitution to be 16.3 for girls and 15.6 for boys (Lowman & Fraser, 1989). 3. Aboriginal and First Nations, are words used to refer to indigenous peoples of Canada. No doubt some will disagree with our choice of terms. We are not using terminology that refers to a person's legal status. Instead, we are attempting to use respectful words as spoken by both insiders and outsiders in the Downtown Eastside community of Vancouver. When an author in a cited work uses the term Aboriginal, we use the word Aboriginal in connec­ tion with their work. However, we prefer not to use the term Aboriginal because the Oxford Dictionary currently lists a second descriptor for the word

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- 14384

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Aboriginal as 'primitive.' We use the term First Nations interchangeably with Aboriginal throughout the article, as Brunen does in her 2000 article on the marginalization of Aboriginal women with addictions in the Canadian healthcare system. 4. Similar health consequences of colonialism on indigenous people are seen in health data from the United States. American Indians and Alaska Natives have the second highest infant mortality rate in USA, and the suicide rate of American Indians is 50% higher than the national rate (U.S. Dept of Health and Human Services, 2001, p. 82; U.S. Dept of Health and Human Services, 2001a, p. 17). 5. Other descriptions of violence included: [I have a] long history of physical abuse. I was beaten by my mother's boyfriend, ran away from home to a pimp who beat me, I left him for a man who beat me up, and so on.... A 13-year-old told us she had: 'disalignment in my neck, cuts, and scratches, bruises caused by bad dates. Also deafness.' A stalker hit me with his car on purpose. Date tried to assault me with steel-toed boots because I wouldn't do something he wanted. A bad date hit my head on a wall. I was beaten with stones by a couple of women. [A pimp ] locked me in a room and beat me 30 times with baseball bat. My boyfriend pushed me downstairs and broke my arm, [I've had] multiple beatings by various boyfriends, broken kneecaps, broken limbs. I'm scared of men. Two years ago, I was beat and raped for 45 minutes. 6. Wayne Christian, Director of the First Nations Round Lake Treatment Centre in Armstrong noted that most of his clients have used drugs and alcohol to 'deaden' the pain of emotional and physical trauma. 'Up to 95% of clients at Round Lake reported a history of some kind of trauma, personal trauma, whether it was residential school, sexual abuse, physical violence, abandon­ ment - those types of issues .. .' (Rees, 2001). 7. One woman at first answered 'no' to the question, 'before you were 18 years old, did you experience any unwanted sexual touching or any sexual contact between you and a grown up?' Then she thought about it briefly and asked (without interviewer prompt): 'does this question mean for when I was prostituting underage?' After the interviewer said yes, the young woman said 'every time a john touches me, it's unwanted.' She started prostituting at age 12. --' 8. Although there is a common misconception that street prostitution is the most harmful type of prostitution, there is no research evidence for this. In

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fact, women have told us that they felt safer in street prostitution compared with legal brothels or massage parlors where they were not permitted to reject customers for any reason. Others commented that on the street they could refuse dangerous-appearing or intoxicated customers. Some told us that they considered it a deterrent to violence when a friend made a show of writing down the john's car license plate number. Raphael and Shapiro (2002) noted that women in Chicago reported the same frequency of rape in escort and in street prostitution. Although more physical violence was reported in street compared with brothel prostitution in South Africa - there was no difference in the incidence of PTSD in these two types of prostitution, suggesting that the experience of prostitution is intrinsically traumatizing (Farley et aI., 1998). A Canadian study comparing strip club and street prostitution found that women prostituting in strip clubs had significantly higher rates of disso­ ciative and other psychiatric symptoms than those in street prostitution (Ross, Anderson, Heber, & Norton, 1990). Strip club/massage, brothel and street prostitution were compared in Mexico. There were no differences in the incidence of physical assault and rape in prostitution, childhood sexual abuse or symptoms of PTSD, and no differences in the percentages of women in brothel, street, or strip club/massage prostitution who wanted to escape prostitution (Farley et al., 2003). We have begun inquiry about different locations where prostitution occurs. A checklist rather than open-ended questions about location of prostitution is recommended. In a 2003 study, Farley used the following list of categories of prostitution, asking each participant regardless of the location of the current interview, to check off each kind of prostitution she had previ­ ously been in. Types of prostitution included: escort, massage, phone sex, street, Internet, brothel, prostitution as a child under age 18, strip club, bar, table dance club, peep show, prostitution associated with a military base, trafficked (moved) from another country to New Zealand for prostitution, trafficked (moved) from one part of New Zealand to another for prostitution, and other. Kramer (2003) found a range of street, escort and strip club prosti­ tution experiences among interviewees in southwestern USA. Across these three types of prostitution, 90% of Kramer's respondents described the experience of prostitution as negative or traumatic. We suggest that any study of prostitution report the length of time in prostitution and the number of customers seen by respondents. These factors, more than the physical location of the prostitution, are correlated with harm (Parriott, 1994; Vanwesenbeeck, 1994). 9. Not only has there been a lack of attention to prostitution as a form of violence against First Nations women, but the RCAP report has been generally criticized for its failure to take into account the viewpoint of Abor­ iginal women (Frideres, 1996). Frideres in the same article also comments that two-thirds of the presenters at the RCAP hearings were male (Note 18, p.264).

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disorder: Issues, research, and clinical applications (pp. 183-205). Washington, DC: American Psychological Association. KeIrn, M. (1998). Colonizing bodies: Aboriginal health and healing in British Columbia, 1900-1950. Vancouver: University of British Columbia Press. Kemp, A., Rawlings, E., & Green, B. (1991). Post-traumatic stress disorder (PTSD) in battered women: A shelter sample. Journal of Traumatic Stress, 4,137-147. Kirkingen, A. L. (2001) Inscribed bodies: Health impact of childhood sexual abuse. Boston: Kluwer Academic. Kirmayer, L. J. (1994). Suicide among Canadian Aboriginal peoples. Transcultural Psychiatric Research Review, 31 (1),3-58. Kirmayer, L. J, Boothroyd, L. J., Tanner, A., Adelson, N., & Robinson, E. (2000). Psychological distress among the Cree of James Bay. Transcultural Psychiatry, 37(1),35-56. Koss, M., & Heslet, L. (1992). Somatic consequences of violence against women. Archives of Family Medicine, 1, 53-59. Kramer, L. (2003). Emotional experiences of performing prostitution. In M. Farley (Ed.), Prostitution, trafficking and traumatic stress (pp. 187-197). Bingham­ ton, NY: Haworth. LaFramboise, T. D., Chaney, S. B., James, A., & Running Wolf, P. R. (1995). American Indian women and psychology. In H. Landrine (Ed.), Bringing cultural diversity to : Theory, research, and practice (pp. 197-239). Washington, DC: American Psychological Association. LaFramboise, T. D., Heyle, A. M., & Ozer, E. J. (1990). Changing and diverse roles women in American Indian cultures. Sex Roles, 22, 455-476. Leidholdt, D. (1993). Prostitution: a violation of women's human rights. Cardozo Women's Law Journal, 1, 133-147. Louie, L., Luu, M., & Tong, B. (1991, August). Chinese American adolescent runaways. Paper presented at the annual convention of the Asian American Psychological Association, San Francisco. Lowman, J. (1993). Canada. In N. J. Davis (Ed.), Prostitution: An international handbook on trends, problems, and policies (pp. 56-86). London: Greenwood Press. Lowman, J., & Fraser, L. (1989). Street prostitution: Assessing the impact of the law. Vancouver: Dept of Supply and Services Canada. Lowman, J., & Fraser, L. (1995). Violence against persons who prostitute: The experi­ ence in British Columbia. Unedited technical report. Department of Justice Canada. Cited in Federal/Provincial Territorial Working Group on Prosti­ tution (1998) Report and recommendations in respect of legislation, policy and practices concerning prostitution-related activities. Canadian Federal/Provin­ cial Working Group on Prostitution. Lynne, J. A. M. (1998). Street prostitution as sexual exploitation in First Nations women's lives. Unpublished master's thesis, University of British Colombia, Vancouver. MacKinnon, C. A. (1993). Prostitution and civil rights. Michigan Journal ofGender and Law, 1, 13-31. MacKinnon, C. A. (2001) Sex equality. New York: Foundation Press.

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McKeganey, N., & Barnard, M. (1996). Sex work on the streets: Prostitutes and their clients. Buckingham, Scotland: Milton Keynes Open University Press. Miller, 1. (1995). Rape myths and violence against street prostitutes. Deviant Behavior, 16, 1-23. Ministry of Foreign Affairs and Trade. (2001). An address to United Nations. Wellington, New Zealand: MFAT. Mollica, R. F., Wyshak, G., Lavelle, J., Truong, T., Tor, S., & Yang, T. (1990). Assessing symptom change in Southeast Asia refugee survivors of mass violence and torture. American Journal of Psychiatry, 147, 83-88. Monnier, J., Elhai, D., Frueh, B. c., Sauvageot, J. A., & Magruder, K. M. (2002). Replication and expansion of findings related to racial differences in veterans with combat-related PTSD. Depression and Anxiety, 16(2),64-70. Nadon, S. M., Koverola, c., & Schludermann, E. H. (1998). Antecedents to prosti­ tution: Childhood victimization. Journal ofInterpersonal Violence, 13,206-221. Nahanee, T. (1993). Dancing with a gorilla: Aboriginal women, justice and the charter. In Aboriginal peoples and the justice system: Report of the National Round Table on Aboriginal Justice Issues, Royal Commission on Aboriginal Peoples (pp. 360-361). Ottawa, ON: Minister of Supply and Services. Najavits, L. M., Weiss, R. D., Shaw, S. R., & Muenz, L. R. (1998). 'Seeking safety': Outcome of a new cognitive-behavioral psychotherapy for women with post­ traumatic stress disorder and substance dependence. Journal of Traumatic Stress, 11,437-456. National Sexual Violence Resource Center. (2000). Sexual assault in Indian country: Confronting sexual violence. Available [accessed 7 June 2001]: www.nsvrc.org. Ouimette, P. c., Kimerling, R., Shaw, J., & Moos, R. H. (2000). Physical and sexual abuse among women and men with substance use disorders. Alcoholism Treatment Quarterly, 18(3),7-17. Old Dog Cross, P. (1982). Sexual abuse: A new threat to the Native American woman: An overview. Listening Post, 6(2), 18. Osmond, M. W., Wambach, K. G., Harrison, D. E., Byers, J., Levin, P., Imershein, A., et al. (1993). The multiple jeopardy of race, class and gender for AIDS risk among women. Gender and Society, 7(1), 99-120. Parriott R. (1994). Health experiences of Twin Cities women used in prostitution. Unpublished survey initiated by WHISPER, Minneapolis. Pheterson, G. (1996). The prostitution prism. Amsterdam: Amsterdam University Press. Plum ridge, L., & Abel, G. (2001). A 'segmented' sex industry in New Zealand: Sexual and personal safety of female sex workers. Australian and New Zealand Journal of Public Health, 25, 78-83. Polacca, M. (2003). Domestic violence in an American Indian tribe. In J. M. Leibschutz, S. M. Frayne, & G. N. Saxe (Eds,), Violence against women: A physician's guide to identification and management (pp. 274-282). Philadel­ phia: American College of Physicians. Population Reference Bureau. (2000). 2000 United States population data. Washington, DC: Population Reference Bureau.

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Potterat, J. J., Brewer, D. D., Muth, S. Q., Rothenberg, R. B., Woodhouse, D. E., Muth, J. B. et al. (2004). Mortality in a long-term open cohort of prostitute women. American Journal of Epidemiology, 159,778-785. Radomsky, N. A. (1995). Lost voices: Women, chronic pain, and abuse. New York: Harrington Park Press. Ramsay, R., Gorst-Unsworth, c., & Turner, S. (1993). Psychiatric morbidity in survivors of organised state violence including torture: A retrospective series. British Journal of Psychiatry, 162,55-59. Raphael, J., & Shapiro, D. L. (2002). Sisters speak out: The lives and needs ofprosti­ tuted women in Chicago. Chicago: Center for Impact Research. Rees, A. (2001). Sedating poverty. The Province. Available [accessed 31 December 2001]: http://www.canada.com/vancouver/news/story.asp. Robin, R. w., Chester, B., & Goldman, D. (1996). Cumulative trauma and PTSD in American Indian communities. In A. J. Marsella, M. J. Friedman, E. T. Gerrity, & R. M. Scurfield (Eds.), Ethnocultural aspects ofposttraumatic stress disorder: Issues, research, and clinical applications (pp. 239-253). Washington, DC: American Psychological Association. Root, M. P. P. (1996). Women of color and traumatic stress in 'domestic captivity:' Gender and race as disempowering statuses. In A. J. Marsella, M. J. Friedman, E. T. Gerrity, & R. M. Scurfield (Eds.), Ethnocultural aspects of posttraumatic stress disorder: Issues, research, and clinical applications (pp. 363-387). Washington, DC: American Psychological Association. Ross, C. A., Anderson, G., Heber, S., & Norton, G. R. (1990). Dissociation and abuse among multiple personality patients, prostitutes, and exotic dancers. Hospital and Community Psychiatry, 41, 328-330. Ross, c., Farley, M., & Schwartz, H. (2003). Dissociation among women in prosti­ tution. In M. Farley (Ed.), Prostitution, trafficking, and traumatic stress (pp. 199-212). Binghamton, NY: Haworth. Royal Commission on Aboriginal Peoples. (1996). Report of the Royal Commission on Aboriginal Peoples. Ottawa, ON: Minister of Supply and Services Canada. Ryser, R. (1995). Collapsing states and re-emerging nations: The rise of state terror, terrorism, and crime as politics. In R. C. Ryser & R. A. Griggs (Eds.), Fourth world geopolitical reader I: International relations and political geography between nations and states (pp. 1-8). Olympia, WA: DayKeeper Press. Saphira, M., & Herbert, A. (2003). The involvement of children in commercial sexual activity. Auckland: ECPAT. Save the Children Canada. (2000). Year one: 1999-2000 Out of the shadows and into the light: A project to address the commercial sexual exploitation ofgirls and boys in Canada first year end report. Vancouver, BC: Save the Children Canada. Scully, E. (2001). Pre-cold war traffic in sexual labor and its foes: Some contem­ porary lessons. In D. Kyle & R. Koslowski (Eds.), Global human smuggling: Comparative perspectives (pp. 74-106). Baltimore: Johns Hopkins University Press. Silbert, M. H., & Pines, A. M. (1981). Sexual child abuse as an antecedent to prostitution. Child Abuse & Neglect, 5, 407--411.

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Silbert, M. H., & Pines, A. M. (1982). Entrance into prostitution. Youth and Society, 13,471-500. Silbert, M. H., & Pines, A. M. (1983). Early sexual exploitation as an influence in prostitution. Social Work, 28,285-289. Silbert, M. H., Pines, A. M., & Lynch, T. (1982). Sexual assault of prostitutes. San Francisco: National Center for the Prevention and Control of Rape, National Institute of Mental Health, Delancey Street Foundation. Southwick, S., Yehuda, R., & Morgan, C. (1995). Clinical studies of neurotrans­ mitter alterations in post-traumatic stress disorder. In J. Friedman, D. Charney, & A. Deutch (Eds.), Neurobiological and clinical consequences of stress: From normal adaptation to posttraumatic stress disorder (pp. 335-349). Philadelphia: Lippincott-Raven. Special Committee on Pornography and Prostitution. (1985). 2 Pornography and Prostitution in Canada, p. 350. Stark, c., & Hodgson, C. (2003). Sister oppressions: A comparison of wife battering and prostitution. In M. Farley (Ed.), Prostitution, trafficking and traumatic stress (pp. 17-32). Binghamton, NY: Haworth. Turner, C. B., & Kramer, B. M. (1995). Connections between racism and mental health. In C. V. Willie, P. P. Rieker, B. M. Kramer, & B. S. Brown (Eds.) Mental health, racism, and sexism (pp. 3-25). Pittsburgh, PA: University of Pittsburgh Press. UNICEF. (2004). Indigenous children face greater threats to survival. Available [accessed 25 February 2004]: http://www.unicef.org/media/media_19429.html U.S. Department of Health and Human Services. (2001 a). Mental health: Culture, race, and ethnicity: A supplement to mental health: A report of the Surgeon General: Executive summary. Rockville, MD: U.S. Department of Health and Human Services, Public Health Service, Office of the Surgeon General. Vancouver/Richmond Health Board. (1999). Healing ways Aboriginal health and service review. Vancouver, BC: Vancouver Richmond Health Board. Vanwesenbeeck I. (1994). Prostitutes' well-being and risk. Amsterdam: VU University Press. Waldram, J. B. (1997). The Aboriginal peoples of Canada: Colonialism and mental health. In I. AI-Issa & M. Tousignant (Eds.), Ethnicity, immigration, and psychopathology (pp. 169-187). New York: Plenum Press. Waldram, J. 8., Herring, D. A., & Young, T. K. (2000). Aboriginal health in Canada: Historical, cultural, and epidemiological perspectives. Toronto, ON: University of Toronto Press. Walters, K. L., Simoni, J. M., & Evans-Campbell, T. (2002). Substance use among American Indians and Alaska Natives: Incorporating culture in an 'indigenist' stress-coping paradigm. Public Health Reports, 117(S1), SlO4-S117. Weathers, F. w., Litz, B. T., Herman, D. S., Huska, J. A., & Keane, T. M. (1993). The PTSD Checklist (PCL): Reliability, validity, and diagnostic utility. Paper presented at the 9th annual meeting of the International Society for Traumatic Stress Studies, San Antonio Texas, October. Weisberg, D. K. (l985). Children of the night: A study of adolescent prostitution. Lexington: Lexington Books.

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West, C. M., Williams, L. M., & Siegel, J. A. (2000). Adult sexual revictimization among Black women sexually abused in childhood: A prospective examin­ ation of serious consequences of abuse. Child Maltreatment, 5(1), 49-57. Williams, D. R., Lavizzo-Mourey, R., & Warren, R. C. (1994). The concept of race and health status in America. Public Health Reports, 109(1),26-41. Youth Delegates of Out of the Shadows: International Summit of Sexually Exploited Youth. (1998). Declaration and agenda for action of sexually exploited children and youth, 12-17 March, 1998. Victoria, British Columbia.

MELISSA FARLEY, PhD completed the edited volume Prostitution, Trafficking, and Traumatic Stress in 2003. She is a clinical and research psychologist whose research on prostitution has been used by states' governments, advocates and organizations providing services to prostituted and trafficked women. Address: Prostitution Research and Education, P.O. Box 16254, San Francisco CA 94116-0254, USA. [E-mail: [email protected]

JACQUELINE LYNNE, MSW is a social worker in the field of addictions.

ANN COTTON, PsyD is a clinical psychologist at the Addiction Treatment Center, VA Puget Sound Health Care System, Seattle, Washington. She is also acting instructor for the Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine.

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This is ExhibH_"-_menUoned and referred to in the allidav[ol' u .% e, I~:' ~ f~' ~----.... h I. Swom before me this~.:_jay of ,rl1#1'y A.D. 2Q 0 8' 4' r ~1 ACommissioner lor taking affidavits ~~_

UBad for the Body, Bad for the Heart":l Prostitution Harms Women Even if Legalized or Decriminalized

MELISSA FARLEY Prostitution Research & Education

With examples from a 2003 New Zealand , this article discusses the logi- cal inconsistencies in laws sponsoring prostitution and includes evidence for the physi- ~ cal, emotional, and social harms of prostitution. These harms are not decreased by legal­ ization or decriminalization. The article addresses the confusion caused by organizations that oppose trafficking but at the same time promote prostitution as a justifiable form of labor for poor women. The failure of condom distribution/harm reduction programs to protect women in prostitution from rape, sexually transmitted diseases (STDs), and HlV is discussed. The success of such programs in obtaining funding and in promoting prostitution as sex work is also discussed.

Keywords: decriminalization; New Zealand; prostitution; prostitution law

INTRODUCTION

Can the physical, social, and psychological harms of prostitu­ tion be controlled or decreased by decriminalization, regulation, or other state monitoring? Is there any way to make prostitution safer? Is it possible to protect the human rights of those in prosti­ tution? Does legalization or decriminalization decrease the dan­ gers of prostitution? In May 2003, prostitution was decriminalized in New Zealand (NZ) by a one-vote majority of its Parliament. Throughout this article, examples from NZ will be used to analyze arguments that decriminalizing prostitution would make prostitution safer for the women in it. Four of the five reasons proposed for the decrimi­ nalization of prostitution in NZ had to do with public health. In the law's language, these were to safeguard the human rights of

VIOLENCE AGAINST WOMEN, Vol. 10 No. 10, October 2004 1087-1125 001: 10.1177/1077801204268607 © 2004 Melissa Farley 1087 14395

1088 VIOLENCE AGAINST WOMEN / October 2004 sex workers, to protect sex workers from exploitation, to promote the welfare and occupational safety and health of sex workers, and to create an environment that is conducive to public health. It was also alleged that the law would protect children from the exploitation of prostitution (New Zealand Justice and Electoral Committee, 2001). 2 Underpinning laws that legalize or decriminalize prostitution is the belief that prostitution is inevitable. This notion is advanced from different quarters: from pimps and johns,3 governments, public health officials, and from sexologists and evolutionary psychologists. Pimps have, for example, promoted legalized prostitution with the following arguments:

Why make a married man who is looking for nothing more than an alternative to masturbation, get busted in a sting, have his name and picture be published in his local paper and have to explain everything to his wife? Isn't tha t destructive to society? Why have a legion of free-lance STD-spreaders when you could control and regulate sex-field workers' health? Why consume law­ enforcement time and resources to the tune of hundreds-of­ thousands of dollars per year instead of collecting at least an equal amount in real estate and income tax withholding? It only makes sense. (Patrick, 2000, p. 12)

Public statements by pimps emphasize that prostitution is here to stay, with in Las Vegas, Nevada, and in Sydney, Australia, repeating the mantra that "boys will be boys. 114 A Canadian attorney defended legal prostitution stating that prostitution "is a bottomless market" (Young, 2003). These stereo­ types about men not only normalize and trivialize prostitution but are also good business strategy, relieving johns of any doubts regarding the social acceptability of their sexual predation while at the same time inviting them to spend their money. Prostitution has been proposed as development policy for newly industrializing and developing countries. Often, those promoting prostitution are sex industry businessmen and gov­ ernment officials. Sex businesses such as escort prostitution, mas­ sage brothels, strip clubs, phone sex businesses, and Internet prostitution have been described by Lim (1998) as the sex sector of a state's economy. In some countries, profits from the sex sector are included in estimates of its economic activity. For example, in 14396

Farley / HARMS OF PROSTITUTION 1089

the Netherlands, the sex industry constitutes 5% of the GDP (Daley, 2001). Women in Dutch prostitution tell us that although legalization of prostitution was promoted as a way to improve their lives, they view it primarily as a way for the State to tax their earnings (Schippers, 2002). Often they do not think that their health has benefited or that they are offered more protection under legalized or decriminalized prostitution. Some social scientists define the predatory behaviors of men buying women in prostitution as normal, maintaining that prosti­ tution is simply part of human nature (Ahmad, 2001; Fisher, 1992; Masters & Johnson, 1973; Pheterson, 1996; Scambler & Scambler, 1995). This definition of normalcy is then reflected in public policy that defines prostitution as a form of labor (sex work), where pros­ titution is considered an unpleasant job but not different from other kinds of unpleasant jobs, such as factory work. From this perspective, prostituted women are viewed as simply another category of workers with special problems and needs (Bullough & Bullough, 1996; Kinnell,2001; Nairne, 2000). The World Health Organization (WHO) defined prostitution as a dynamic and adaptive process that involves a transaction between seller and buyer of a sexual service (World Health Organization, 1988). WHO has since recommended decriminalization of prostitution (Ahmad, 2001). Much of the health sciences literature has viewed prostitution as a job choice (Deren et a1., 1996; Farr, Castro, DiSantostefano, Claassen, & Olguin, 1996; Green et al., 1993; Romans, Potter, Martin, & Herbison, 2001; UN / AIDS, 2002). Yet the notion that prostitution is work tends to make its harm invisible. Where did the idea that prostitution is work originate? In 1973, the U.s. organization COYOTE (Call Off Your Old Tired Ethics) declared that prostitution was legitimate service work. In the 1980s, COYOTE capitalized on the AIDS epidemic as a health cri­ sis, keeping its organizational focus on increasing its customer base but shifting its strategy to educational outreach in addition to advocacy of decriminalization of prostitution (Jenness, 1993). These goals are reflected in the activi ties of the New Zealand Pros­ titutes' Collective (NZPC), one of many COYOTE offshoots that provide union-style organizing for those in prostitution. When prostitution is understood as violence, however, unionizing pros­ tituted women makes as little sense as unionizing battered women. 14397

1090 VIOLENCE AGAINST WOMEN I October 2004

Political parties have also adopted platforms defining prostitu­ tion as work. For example, the Green Party has championed pros­ titution as labor and those in prostitution as sex workers. A NZ Green Party member described the decriminalization of prostitu­ tion as a way of protecting prostitutes' rights as workers (Sue Bradford, Green Party public speech in Auckland, New Zealand, June 26, 2003). However, another sponsor of the NZ decriminal­ ization bill admitted, "it's going to be the owners or the operators [of brothels and other sex businesses] who are going to be the long-term beneficiaries [of decriminalization]" (Else, 2003, n.p.). In this statement, the politician seems to acknowledge that work­ ers' rights in prostitution are a political fantasy. While appearing to promote public health, the NZ law keeps the names of brothel owners secret, thus making public health inspections of brothels an impossibility. The outraged mayor of Auckland, New Zealand, wrote, "This so-called legitimate profession remains partly hid­ den behind a veil of secrecy [under the new law]" (Banks, 2003, n.p.). In fact, the law protects the privacy of pimps and generally represents the interests of johns. Support for legalized prostitution comes from many who believe that legalization will decrease the harm of prostitution, like a bandage on a wound. People are genuinely confused about how to address what they intuitively understand to be the harm of prostitution. They ask, "Wouldn't it be at least a little bit better if it were legalized? Wouldn't there be less stigma, and wouldn't prostitutes somehow be protected?" For example, NZ Prime Min­ ister Helen Clark was quoted as saying that prostitution is "abhorrent" while at the same time supporting her Labour Party's prostitution decriminalization bill as a way to reduce the harm of prostitution (Banks, 2003). People are confused by the illogic of vaguely written public policies that claim to reduce the harm of legalized prostitution. For example, the NZ Accident Compensation Commission (ACC) establishes risk assessments for various occupations, set­ ting amounts for what employers must pay to cover medical and rehabilitation claims. Prostitution has been categorized by the ACC as a safer job than child care attendant or ambulance staff (Dearnaley, 2003). Legal strategies to promote prostitution as work may be framed as issues of prostitutes' human rights, further confusing 14398

Farley / HARMS OF PROSTITUTION 1091 people. COYOTE proposed that to deny women the "right to prostitute" was to violate their civil rights (Jenness, 1993). For example, a 1993 Sex Workers Action Coalition (SWAC) flyer noted that the group opposed legislation against pimping because it violated the rights of prostitutes. SWAC further argued that even though johns could be seen to be "taking advantage of a prostitute's economic vulnerability," they opposed enforcement of antiprostitution laws against johns (SWAC, 1993). These strate­ gies are best understood as attempts to remove all obstacles to conducting the business of prostitution. Laws against sex preda­ tors-pimps and johns-are seen as barriers to business operations. The names of organizations advocating legalized prostitution are another source of confusion. Sex industry apologists calculatedly appropriate the titles of human rights or public health organizations. Although their names are similar, the Global Alliance Against Trafficking in Women (GAATW) pro­ motes prostitution as sex work, while the Coalition Against Traf­ ficking in Women (CATW) works for the abolition of prostitution and other forms of discrimination against women. Other organi­ zations that accept or promote prostitution as a reasonable job for poor women include Dutch Foundation for Women (STV); Coor­ dination for Action Research on AIDS and Mobility (CARAM/ Cambodia); European Network for HIV /STD Prevention in Europe (EUROPAP); Transnational AIDS/STD Prevention among Migrant Prostitutes (TAM PEP; Netherlands, Italy, Ger­ many, and Austria); CARE International; North American Task Force on Prostitution; Anti-Slavery International; Human Rights Watch; Amnesty International (USA); Amnesty for Women, Hamburg; Rights of Entertainers in Asia to Combat Human Oppression and Unjust Treatment, Hong Kong (REACH OUT); Bangladesh Women's Health Coalition; Medecins sans Frontieres; From Our Streets with Dignity (FROST'D), New York; Coalition Against Slavery and Trafficking (CAST), Los Angeles; Prostitution Alternatives Counseling and Education (PACE), Vancouver, Canada; Nueva Era en Salud, Panama.5 United Nations organizations such as the WHO, UN/AIDS, and the International Labor Organization (ILO) have also supported legalization of prostitution and have generally regarded prostitu­ tion as work (Lim, 1998; South African Press Association, 2001). In 14399

1092 VIOLENCE AGAINST WOMEN / October 2004

2001, Gilles Poumerot WHO's Southeast Asian advisor in sexu­ ally transmitted infections, promoted the decriminalization of (Deutsche Press-Agentur, 2001). Unfortunately, names cannot be trusted to tell the whole story. It is necessary to ask hard questions about who funds each group and how funds are used; about whether and what alternatives to prostitution are advocated; and whether the organization has any goal other than sexually transmitted disease (STD)/HIV preven­ tion. Organizations must be asked what they know about vio­ lence in prostitution, whether they view prostitution as sex work, and about housing options and job training because these are what women tell us that they need most to escape prostitution (Farley et aL, 2003). According to advocates of legalization or decriminalization of prostitution, the primary harm of prostitution is social stigma against prostitution. Those on all sides of the debate agree that women in prostitution are stigmatized. Socially invisible as full human beings, those in prostitution often internalize toxic public and private contempt directed against them. Some have suggested that legalization or decriminalization would remove this social prejudice against women in prostitu­ tion. Yet the shame of those in prostitution remains after legaliza­ tion or decriminalization. The ways in which johns are legally and socially protected and their lack of accountability are also unchanged, regardless of prostitution's legal status. No one wants the business of prostitution operating in his or her community. Thus, zoning of the physical locations of sex busi­ nesses is often a sine qua non of legalization or decriminalization. Political pundits were certain that the NZ law would not have passed without a last-minute amendment that enabled local juris­ dictions to zone prostitution into the neighborhoods of those who could least afford the legal battle to keep it away from their homes. Since passage of the NZ law, conflict has arisen regarding the zoning of prostitution. Pimps often rent homes in suburban areas for the purpose of prostitution and trafficking. Homeown­ ers, on the other hand, want prostitution zoned out of the suburbs and into city centers in Auckland and in the more rural Tauranga District (MacBrayne, 2003; New Zealand Herald, 2003). The regulation of prostitution by zoning is a physical manifestation of the same sOcial/psychological stigma that de- 14400

Farley I HARMS OF PROSTITUTION 1093 criminalization advocates allegedly want to avoid. Reflecting the social isolation of those in it, prostitution is often removed from the mainstream. Whether in Turkish genelevs (walled-off multiunit brothel complexes) or in Nevada brothels (ringed with barbed wire or electric fencing), women in state-zoned prostitu­ tion are physically isolated and socially rejected by the rest of soci­ ety. Often, when prostitution is not physically removed from other businesses, for example in the case of strip clubs, club own­ ers deny that prostitution occurs in their venues. Advocates of decriminalization argue that the health of those in prostitution will be improved by decriminalization because otherwise women will not have access to health care. It is assumed that women will seek health care as soon as the stigma of arrest is removed from prostitution. If the stigma is removed, advocates argue, women will then file a complaint whenever they are abused, raped, or assaulted in prostitution. They assume that the complaint will be followed with a police response that treats women in prostitution with dignity and as ordinary citizens. Unfortunately, health care workers and police too often share the same contempt toward those in prostitution that others do. A former prostitute in NZ said to the Parliament: "This bill pro­ vides people like me ... with some form afredress [italics added], for the brutalisation that may happen ... when you're with a client and you have a knife pulled on you" (Georgina Beyer, speech, Wellington, NZ, June 26, 2003). The specific form of redress offered by the NZ decriminalization law was not described by the speaker, nor is it articulated in the law. The dilemma for the per­ son in prostitution is not that there is no legal redress for coercion, physical assault, and rape in the new law or in old laws. The dilemma is that in prostitution there is no avoiding sexual harass­ ment, sexual exploitation, rape, and acts that are the equivalent of torture. Decriminalization in NZ was promoted as a means of provid­ ing those in prostitution with legal redress against violent johns. However, prostituted women could already take legal action under existing laws but rarely did so. Explaining this situation, a NZ Prostitutes Collective member stated, "They don't want to draw attention to themselves and what they're doing" (Else,2003, n.p.). Women in the Netherlands have expressed similar senti­ ments, even though prostitution has been legal there for many 14401

1094 VIOLENCE AGAINST WOMEN / October 2004 years. Their concern was the loss of anonymity that exists in legal prostitution. Once officially registered as prostitutes, Dutch women feared that this designation would pursue them for the rest of their lives. Despite the fact that if officially registered as prostitutes they would accrue pension funds, the women still pre­ ferred anonymity (Schippers, 2002). They wanted to leave prosti­ tution as quickly as possible with no legal record of having been in prostitution (Daley, 2001). Similarly, despite attempts to unionize women in Germany's $16.5 billion legal prostitution industry, the women not only avoided unions, they avoided registering with the government and they continued to engage in illegal prostitu­ tion in part because they felt that the remote areas where prostitu­ tion is zoned put them at increased, not decreased, risk of physical danger (Taubitz, 2004).

VIOLENCE IS PERVASIVE IN LEGAL AS WELL AS ILLEGAL PROSTITUTION

It is a cruel lie to suggest that decriminalization or legalization will protect anyone in prostitution. There is much evidence that whatever its legal status, prostitution causes great harm to women. The following sections summarize some of the many studies that now document the physical and emotional harm caused by prostitution. In the past two decades, a number of authors have documented or analyzed the sexual and physical violence that is the normative experience for women in prostitution, including Baldwin (1993, 1999); Barry (1979,1995); Boyer, Chapman, and Marshall (1993); Dworkin (1981, 1997, 2000); Farley, Baral, Kiremire, and Sezgin (1998); Giobbe (1991, 1993); Hoigard and Finstad (1986); Hughes (1999); Hunter (1994); Hynes and Raymond (2002); Jeffreys (1997); Karim, Karim, Soldan, and Zondi (1995); Leidholdt (1993); MacKinnon (1993, 1997,2001); McKeganey and Barnard (1996); Miller (1995); Silbert and Pines (1982a, 1982b); Silbert, Pines, and Lynch (1982); Valera, Sawyer, and Schiraldi (2001); Vanwesenbeeck (1994); and Weisberg (1985). Sexual violence and physical assault are the norm for women in all types of prostitution. Nemoto, Operario, Takenaka, Iwamoto, 14402

Farley I HARMS OF PROSTITUTION 1095 and Le (2003) reported that 62% of Asian women in San Francisco massage parlors had been physically assaulted by customers. These data were from only 50% of the massage parlors in San Francisco. The other 50%-those brothels controlled by pimps/ traffickers who refused entrance to the researchers-were proba­ bly even more violent toward the women inside. Raymond, D'Cunha, et al. (2002) found that 80% of women who had been trafficked or prostituted suffered violence-related injuries in pros­ titution. Among the women interviewed by Parriott (1994), 85% had been raped in prostitution. In another study, 94% of those in street prostitution had experienced sexual assault and 75% had been raped by one or more johns (Miller, 1995). In the Nether­ lands, where prostitution is legal, 60% of prostituted women suf­ fered physical assaults; 70% experienced verbal threats of physi­ cal assault; 40% experienced sexual violence; and 40% had been forced into prostitution or sexual abuse by acquaintances (Vanwesenbeeck, 1994). Most young women in prostitution were abused or beaten by johns as well as pimps. Silbert and Pines (1981, 1982b) reported that 70% of women suffered rape in prosti­ tution' with 65% having been physically assaulted by customers and 66% assaulted by pimps. Of 854 people in prostitution in nine countries (Canada, Colombia, Germany, Mexico, South Africa, Thailand, Turkey, United States, and Zambia), 71 % experienced physical assaults in prostitution, and 62% reported rapes in prostitution (Farley, Cot­ ton, et al., 2003). Eighty-nine percent told the researchers that they wanted to leave prostitution but did not have other options for economic survival. To normalize prostitution as a reasonable job choice for poor women makes invisible their strong desire to escape prostitution. Vanwesenbeeck (1994) found that two factors were associated with greater violence in prostitution. The greater the poverty, the greater the violence; and the longer one is in prostitution, the more likely one is to experience violence. Similarly, the more time women spent in prostitution, the more STDs they reported (Parriott, 1994). Those promoting prostitution rarely address class, race, and ethnicity as factors that make women even more vulnerable to health risks in prostitution. Farley (2003a) found that in NZ, as 14403

1096 VIOLENCE AGAINST WOMEN / October 2004

elsewhere, indigenous women are placed at the bottom of a brutal race and class hierarchy within prostitution itself. When the researchers compared Maori/Pacific Islander New Zealanders to European-origin New Zealanders in prostitution, the Pacific Islander /Maori were more likely to have been homeless and to have entered prostitution at a young age. Mama Tere, an Auckland community activist, referred to NZ prostitution as an "apartheid system" (Farley, 2003a). Plumridge and Abel (2001) similarly described the NZ sex industry as "segmented," noting that 7% of the population in Christchurch were Maori; however, 19% of those in Christchurch prostitution were Maori. Women in prostitution are treated as if their rapes do not mat­ ter. For example, in Venezuela, El Salvador, and Paraguay, the penalty for rape is reduced by one fifth if the victim is a prostitute (Wijers & Lap-Chew, 1997). Many people assume that when a prostituted woman is raped, that rape is part of her job and that she deserved or even asked for the rape. In an example of this bias, a California judge overturned a jury's decision to charge a cus­ tomer with rape, saying"a woman who goes out on the street and makes a whore out of herself opens herself up to anybody" (Arax, 1986, p. 1). We asked women currently in prostitution in Colombia, Ger­ many, Mexico, South Africa, and Zambia whether they thought that legal prostitution would offer them safety from physical and sexual assault. Forty-six percent of these women in prostitution from six countries felt that they were no safer from physical and sexual assault even if prostitution were legal. Brothel prostitution is legal in Germany, one of the countries surveyed. In an indict­ ment of legal prostitution, 59% of German respondents told us that they did not think that legal prostitution made them any safer from rape and physical assault (Farley et al., 2003). A comparable 50% of 100 prostitutes in a Washington, D.C., survey expressed the same opinion (Valera et al., 2001). It is not possible to protect the health of someone whose "job" means that they will get raped on average once a week (Hunter, 1993). One woman explained that prostitution is "like domestic violence taken to the extreme" (Leone, 2001). Another woman said, "What is rape for others, is normal for us" (Farley, Lynne, & Cotton, in press). 14404

Farley / HARMS OF PROSTITUTION 1097

HEALTH EFFECTS OF VIOLENCE IN PROSTITUTION

Throughout history, regardless of its legal status, prostitution has had a devastating impact on women's health. In 1858, Sanger asked 2,000 prostitutes in New York about their health and con­ cluded that premature old age was the invariable result of prosti­ tution (as cited in Benjamin & Masters, 1964). Sanger described conditions of despair, degradation, decline, and early death among prostitutes who survived on average only four years af­ ter entry into prostitution. A physician, he wondered how they lasted that long (Benjamin & Masters, 1964). Making the same observation in the parlance of today's global marketplace, an anonymous pimp commented on the "brief shelf life" of a girl in prostitution. Pheterson (1996) summarized the health problems of women in prostitution: exhaustion, frequent viral illness, STDs, vaginal infections, back aches, sleeplessness, depression, headaches, stomachaches, and eating disorders. Women who were used by more customers in prostitution reported more severe physical symptoms (Vanwesenbeeck, 1994). A Canadian commission found that the death rate of women in prostitution was 40 times higher than that of the general population (Special Committee on Pornography and Prostitution, 1985). A mortality survey of more than 1,600 women in U.s. prostitution noted that "no population of women studied previously has had a ... percentage of deaths due to murder even approximating those observed in our cohort" (Potterat et al., 2004, p. 783). In this survey, murder accounted for 50% of the deaths of women in prostitution. Reviewing compara­ ble studies, Potterat et al. (2004) noted that murder accounted for between 29% and 100% of all prostituted women's reported deaths in Birmingham, UK; Nairobi, Vancouver, Canada; and London. Cervical cancer is common among women who have been in prostitution. Two risk factors for cervical cancer are young age at first sexual activity and overall number of sexual partners. Prostituted women have an increased risk of cervical cancer and also chronic hepatitis (Chattopadhyay, Bandyopadhyay, & Duttagupta, 1994; de Sanjose et al., 1993; Nakashima et al., 1996; Pelzer, Duncan, Tibaux, & Mehari, 1992). In a Minnesota study, 14405

1098 VIOLENCE AGAINST WOMEN / October 2004 the incidence of abnormal Pap screens among women in prostitu­ tion was several times higher than the state average (Parriott, 1994). Comparing sexual assaults against prostituted women with sexual assaults against nonprostituted women, Canadian researchers found that the sexual assaults against those in prosti­ tution were more physically violent and more frequently involved weapons (Efendov & Stermac, 2003). It is sometimes assumed that young women in prostitution are knowledgeable about reproduction and sexual behaviors. This is not necessarily true. Often, women who enter prostitution as ado­ lescents know very little about pregnancy, birth control, and STD. Although they may have been cautioned about HIV, adolescents in prostitution often have had no reliable education regarding sexuality, pregnancy, and contraception and may lack informa­ tion about non-HIV-related STDs. Traumatic brain injury (TBI) occurs in prostitution as a result of being beaten, hit, or kicked in the head, strangled, or having one's head slammed into objects such as car dashboards. TBI has been documented in torture survivors (Jacobs & Iacopino, 2001) and battered women (Valera & Berenbaum, 2003). Half of a group of 100 Canadian women in prostitution reported violent assaults to their heads that resulted in alteration of consciousness (Farley, Lynne, & Cotton, in press). Likely sequelae ofTBI reported by the Canadian women included trouble concentrating, memory prob­ lems, headaches, pain/numbness in hands and feet, vision prob­ lems, dizziness, problems with balance, and hearing problems. Many of these symptoms may be confused with other diagnoses commonly experienced by prostituted women, such as post­ traumatic stress disorder (PTSD), depression, and substance abuse. TBI may be treatable but only after it is properly diagnosed. Chronic health problems generally result from physical abuse and neglect in childhood (Radomsky, 1995), from sexual assault (Golding, 1994), battering (Crowell & Burgess, 1996), untreated health problems, and overwhelming stress and violence (Fried­ man & Yehuda, 1995; Koss & Heslet, 1992; Rasmusson & Fried­ man, 2002). Prostituted women suffer from all of these. Many of the chronic symptoms of women in prostitution are similar to the 14406

Farley I HARMS OF PROSTITUTION 1099

long-term physical consequences of torture (Peel, Hinshelwood, & Forrest, 2000; Vesti, Somnier, & Kastrup, 1992).

ARE THERE DIFFERENCES IN STREET, BROTHEL, AND STRIP-CLUB PROSTITUTION THAT AFFECT WOMEN'S HEALTH AND SAFETY?

It has been assumed that decriminalization/legalization will decrease street prostitution and that prostitution will then move indoors, where it will be physically safer for those in it. Those pro­ moting legalized prostitution suggest that women will be safer in indoor prostitution than they are in street prostitution. However, women in Chicago reported the same frequency of rape in escort and in street prostitution (Raphael & Shapiro, 2002). No research has demonstrated that legal prostitution decreases illegal (street and brothel) prostitution. Following legalization of prostitution in Victoria, Australia, although the number of legal brothels doubled, the greatest expansion was in illegal prostitu­ tion. In 1 year (1999), there was a 300% growth of illegal brothels (Sullivan & Jeffreys, 2001). It is an error to assume that women in prostitution sign up for prostitution in one location and stay there. In fact, they move between different kinds of prostitution, depending on the loca­ tion of johns, the level of police harassment, and where the most money can be made (e.g., near military bases or during political or business conventions). Kramer (2003) found that 59% of 119 U.S. respondents had been in one or more types of indoor prostitution (such as strip club, massage parlor, escort prostitution) in addi­ tion to street prostitution. Thirty-three percent of Kramer's respondents had been prostituted indoors for the longest period of time, while 66% were involved in street prostitution for the lon­ gest time. In similar findings, Farley (2003a) found that 46 NZ interviewees had been in many different kinds of prostitution, including escort, strip club, phone sex, Internet prostitution, peep show, bar prostitution, street prostitution, brothel prostitution, and prostitution associated with a military base. Twenty-two per­ cent of these interviewees had been domestically trafficked from one region of NZ to another, and 6% had been trafficked from another country into NZ (Farley, 2003a). 14407

1100 VIOLENCE AGAINST WOMEN / October 2004

Some studies have found differences in the level of violence in street as opposed to brothel prostitution, with more incidents of violence in street than in brothel prostitution. These findings are relative, however. Most of us would not consider any predictable and systematic violence acceptable in our jobs. While 83% of 303 NZ respondents interviewed by Plumridge and Abel (2001) expe­ rienced some type of violence in prostitution, 27% of those in street prostitution and 8% of those in brothel prostitution reported rape. Forty-one percent in street prostitution and 21 % in brothel prostitution had been physically assaulted. It is likely that the low rape incidence reported in some studies is a result of unclear definitions of rape. We found in our research that even women in prostitution themselves assume that rape cannot occur in prostitution when, in fact, it occurs constantly. Future research on prostitution should behaviorally define rape. For example, if rape is defined as any unwanted sex act, then pros­ titution has an extremely high rate of rape because many survi­ vors view prostitution as almost entirely consisting of unwanted sex acts or even, in one person's words, paid rape. Like Plumridge and Abel in NZ, we (Farley, Baral, et aL, 1998) found more physical violence in street prostitution compared to brothel prostitution in South Africa. However, we found no dif­ ference in the incidence of PTSD in these two types of prostitu­ tion, suggesting that the emotional experience of prostitution is intrinsically traumatizing regardless of its indoor or outdoor loca­ tion. Documenting the profound emotional distress experienced by women in two kinds of prostitution, a Canadian study com­ pared strip club prostitution and street prostitution. The authors found that women prostituted in strip clubs had higher rates of dissociative and other psychiatric symptoms than those in street prostitution (Ross, Anderson, Heber, & Norton, 1990). In a sepa­ rate study, we compared strip club/massage, brothel, and street prostitution in Mexico and found no differences in the prevalence of physical assault and rape in prostitution, of childhood sexual abuse, or symptoms of PTSD (Farley, et aL, 2003). We also found no differences in the percentages of Mexican women in brothel, street, or strip club / massage prostitution who wanted to escape prostitution. Vanwesenbeeck (1994) also observed great emotional distress among women in legal indoor prostitution in the Netherlands. 14408

Farley / HARMS OF PROSmUTION 1101

Investigating emotional distress in women who were prostituted primarily in clubs, brothels, and windows, Vanwesenbeeck found that 90% of the women reported "extreme nervousness". Just as we know that violent men from all social classes batter women, so we also know that the difference between pimps who terrorize women on the street and pimps in business suits who terrorize women in gentlemen's clubs is a difference in class only, not a difference in . Generally, it is class prejudice to assume that street prostitution is far worse than what is called high-class escort prostitution. Boyer, Chapman, & Marshall (1993) suggested that women in indoor prostitution (such as strip clubs, massage brothels, and pornography) had less control of the conditions of their lives and probably faced greater risks of exploitation, enslavement, and physical harm than women pros­ tituting on the street. Some women have said that they felt safer in street prostitution as compared to brothels (in the United States and in NZ) where they were not permitted to reject customers. They explained that on the street they could refuse dangerous­ appearing or intoxicated customers. On the street, they reported, friends could make a show of writing down the john's car license plate number, which they considered a deterrent to customer vio­ lence. A john could be easily traced using such methods, whereas a brothel customer's identity would likely be protected by the brothel owners, making it difficult to prosecute him for violent behavior. Women in brothels or clubs are not encouraged to complain about violence to pimps/owners. Sometimes, they are fired for these protests, even after being raped. In 2000, a dancer in San Francisco was raped in a private booth at the Mitchell Brothers strip club. When she complained to the owners about the rape, they fired her. Promoting an atmosphere that winked conspirato­ rially at sexual exploitation, harassment, and violence, the club had distributed advertisements that told customers, "What you do on your side of the curtain is your little secret" (Sward, 2000). In 2004, a woman prostituting at a Nevada brothel filed civil law­ suits against a john who assaulted her and against pimp Dennis Hof because he failed to call police and because the panic button in her room was not working (, 2004) Brothel owners and advocates of escort prostitution are well aware of the dangers of these kinds of prostitution, although they 14409

1102 VIOLENCE AGAINST WOMEN / October 2004 rarely admit it publicly. For example! an organization in South Africa that advocates decriminalization of prostitution! Sex Work­ ers! Education and Advocacy Taskforce (SWEAT)! addressed the dangers of escort prostitution by distributing a list of safety tips for women. These included the recommendation that while undressing! the prostitute should accidentally kick a shoe under the bed! and while retrieving it! should check for knives, hand­ cuffs! or rope. The SWEAT flyer also noted that fluffing up the pil­ low on the bed would permit searching there for weapons. A brothel owner in the Netherlands complained about an ordi­ nance requiring that brothels have pillows in the rooms: "You don!t want a pillow in the [brothers] room. Ifs a murder weaponll (Daley! 2001! p. 1). Familiar with how customers treated women in prostitution! this Dutch pimp understood that johns are regu­ larly murderous toward women. People often assume that prostitution does not occur in strip clubs. Yet the lines between prostitution and other sexually exploitive activities such as stripping have become increasingly blurred. The amount of physical contact between customers and women who strip has escalated since 1980! along wi th an increase in sexual harassment and physical assault. Touching! grabbing! pinching, and fingering of dancers removes any boundaries between dancing! stripping! and prostitution (Lewis, 1998). Holsopple (1998) documented the verbal, physicat and sexual abuse experienced by women in strip club prostitution! which included being grabbed on the breasts! buttocks! and genitals! as well as being kicked! bitten! slapped! spit on, and penetrated vagi­ nally and anally during lap dancing. In most clubs, customers can buy either a table dance or a lap dance where the dancer sits on the customer's lap while she wears few or no clothes and grinds her genitals against his. Although he is clothed, he usually expects ejaculation. The lap dance may take place on the main floor of the club or in a private room. The more private the sexual perfor­ mance, the more it costs! and the more likely that violent sexual harassment or rape will occur. At one strip club! a woman reported, "We know when [prostitution] happens [during private lap dances]. Then four songs are played instead of two!! (Son! 2003! n.p.). Coney (2003) described the NZ Department of Occupational Safety and Health measures as a "farcell with respect to protecting 14410

Farley / HARMS OF PROSTITUTION 1103

women in prostitution from violence. The NZ prostitution bill's provision to allow health officers entry to brothels would not per­ mit surveillance of violent acts occurring behind closed doors. The panic buttons in massage parlors, saunas, and brothels can never be answered quickly enough to prevent violence. Panic but­ tons in brothels make as little sense as panic buttons in the homes of battered women. A bouncer in an Australian (legal) brothel said that when the women ring the buzzer, he breaks the door open, but there is really no way to prevent violence and, accord­ ing to this bouncer, johns beat women with some regularity (Jeffreys, 2003). A woman who was in escort prostitution (where customers call phone numbers listed in the phone book or adver­ tising section of newspapers, and a meeting place is agreed on) stated that her driver "functioned as a bodyguard. You're sup­ posed to call when you get in, to ascertain that everything was OK. But they are not standing outside the door while you're in there, so anything could happen"(Raymond, Hughes, & Gomez, 2001, p. 74). Specifications in the Australian Occupational and Safety Codes (OSC) for prostitution betray the danger in prostitution, which is not the same as that in any other job. The Australian OSC recom­ mend self defense for women in prostitution and promote classes in hostage negotiation skills. The Australian OSC, while suggest­ ing that a woman use her intuition to predict which johns will be violent, also distribute a list of violent johns to police, social work­ ers, and prostituted women (Jeffreys, 2003).

VERBAL ABUSE RESULTS IN INCREASED HEALTH RISKS IN PROSTITUTION

In most sexual assaults outside of prostitution, women are characterized as prostitutes. In prostitution, women are called the same names that all women are called by violent men. For the sex predator, the names justify the violence, just as racist names jus­ tify racist violence. Along with humiliation of the victim, verbal abuse also eroticizes the john's violence (Baldwin, 1993). The harm of toxic verbal assaults (primarily from johns) against those in prostitution is emotionally devastating, often outlasting the physical injuries. The verbal abuse in prostitution is socially invisible, just as other sexual harassment in prostitution is 14411

1104 VIOLENCE AGAINST WOMEN / October 2004

normalized and invisible. Yet it is pervasive: 88% of 315 prostitut­ ing women and adolescents in Canada, Colombia, and Mexico described verbal abuse as intrinsic to prostitution (Farley et a1., 2003). Verbal assaults in all types of prostitution are likely to cause acute and long-term psychological symptoms. Explaining this process, one woman said that over time "it is internally damag­ ing. You become in your own mind what these people do and say with you. You wonder how could you let yourself do this and why do these people want to do this to you?" (Farley, 2003b, p. 267).

PTSD IS A CONSEQUENCE OF PROSTITUTION

Laws that justify legalization or decriminalization of prostitu­ tion to safeguard women's health fail to address the psychologi­ cal harm of prostitution. Although the traumatic effects of rape and other violence to women who are not in prostitution are well established, the same trauma is not well understood among women in prostitution. Research on the traumatic effects of rape applies to women in prostitution. Aosved and Long (2003), for example, found that women who experience rape resulting from coercive tactics such as abuse of authority, arguments, or social pressure experience the same high levels of depression and PTSD as women who have been raped as a result of force and threat of force. The diagnosis of PTSD encompasses symptoms resulting from traumatic events, including the trauma of prostitution. PTSD can result when people have experienced

extreme traumatic stressors involving direct personal experience of an event that involves actual or threatened death or serious injury; or other threat to one's personal integrity; or witnessing an event that involves death, injury, or a threat to the physical integ­ rity of another person; or learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associate. (American Psychiatric Association, 1994, p. 424)

PTSD is characterized by anxiety, depression, insomnia, irrita­ bility, flashbacks, emotional numbing, and hyperalertness. Symptoms are more severe and long lasting when the stressor is 14412

Farley / HARMS OF PROSTITUTION 1105

of human design. PTSD is normative among prostituted women. Farley et al. (2003) found a PTSD prevalence rate of 68% among those in prostitution in nine countries. This rate was comparable to the rates of PTSD among battered women seeking shelter (45%, Housekamp & Foy, 1991; 84%, Kemp, Rawlings, & Green, 1991), rape survivors (70%, Bownes, O'Gorman, & Sayers, 1991), and survivors of state-sponsored torture (51 %, Ramsay, Gorst­ Unsworth, & Turner, 1993). Illustrating a severe symptom of PTSD, one prostitution survivor said, "For the first few months I worked [in prostitution] I had a lot of nightmares involving mass numbers of penises" (Williams, 1991, p. 75). Many years after escaping prostitution, an Okinawan woman who was purchased by US. military personnel during the Vietnam War became agi­ tated and had flashbacks of sexual assaults on the 15th and the 30th of each month-those days that were U.S. military paydays (Sturdevant & Stoltzfus, 1992). A third survivor described an altered consciousness of time that may be understood as a symp­ tom of PTSD: "When you are a prostitute, you do not think of tomorrow, you just think of now" (Karim et al., 1995, p. 1523).

PROSTITUTION CAUSES OTHER PSYCHOLOGICAL HARM, IN ADDITION TO PTSD

Description of the psychological harm of prostitution some­ times comes from its advocates. For example, the NZPC wrote in an unpublished flyer that people in prostitution know they should take a break from prostitution "when every client makes your skin crawl, when your jaw aches from clenching your teeth ,I' ., to prevent yourself spitting in the bastard's face ... [or] when you can't stand what you see when you look in the mirror" (NZPC flyer by Michelle, circa 1994). Most women who have been in prostitution for any length of time experience sexual dysfunction with their chosen partners. Feelings are disconnected from sexual acts. It becomes nearly impossible to view partners as anything but johns. Funari (1997) worked in a mirror-walled booth, naked. In this type of prostitu­ tion, there is no physical contact between prostitute and john, yet it still adversely affected her view of her self, her sexuality, and her attitude toward men. A thick glass wall separated Funari from 14413

1106 VIOLENCE AGAINST WOMEN / October 2004 the peeping men, and when the shutters went down every 30 sec­ onds, they paid again to watch her and to masturbate. In peep shows and in pornography/prostitution booths, men's booths are hosed down with Clorox after each customer. Funari described the effects on her after less than a year in peep show prostitution:

At work, what my hands find when they touch my body is "prod­ uct." Away from work, my body has continuity, integrity. Last night, lying in bed after work, I touched my belly, my breasts. They felt like Capri's [her peep show name] and they refused to switch back. When [her partner] kissed me I inadvertently shrunk from his touch. Shocked, we both jerked away and stared at each other. Somehow the glass had dissolved, and he had become one of them. (p.32)

To retain her self-respect, Funari resisted emotional connection with men who considered her to be essentially worthless. Yet she felt "poisoned" by the contempt of customers. Her sexual feelings for her boyfriend waned. Dissociation occurs during extreme stress among prisoners of war who are tortured, among children who are sexually assaulted, and among women who are battered, raped, or prosti­ tuted (Herman, 1992). Dissociation, depression, and other mood disorders are common among prostituted women in street, escort, and strip club prostitution (Belton, 1998; Ross et al., 1990; Vanwesenbeeck, 1994). Dissociation in prostitution results from both childhood sexual violence and sexual violence in adult pros­ titution. At the same time, dissociation is a job requirement for surviving prostitution.

Regardless of the variations in the type of prostitution, women feel that they have to rent out the most intimate parts of the body to anonymous strangers to use as a hole to jerk off in. The women try to keep themselves as unharmed as possible from this massive invasion by maintaining a distance from the customer. (Hoigard & Finstad, 1986, p. 132) If anything a prostitute treats herself like a chair for someone to sit on. Her mind goes blank. She just lies there. You become just an object. ... After a while it becomes just a normal thing. (McLeod, 1982, p. 39) 14414

Farley / HARMS OF PROSmUTION 1107

Prostitution is like rape. It's like when I was 15 years old and I was raped. I used to experience leaving my body. I mean that's what I did when that man raped me. I went to the ceiling, and I numbed myself because I didn't want to feel what I was feeling. I was very frightened. And while I was a prostitute I used to do that all the time. I would numb my feelings. I wouldn't even feel like I was in my body. I would actually leave my body and go somewhere else with my thoughts and with my feelings until he got off, and it was over with. I don't know how else to explain it except that it felt like rape. It was rape to me. (Giobbe, 1991, p. 144)

A New Zealand pimp of 25 years, B-, reported that after turn­ ing one trick, almost all of her girls knew whether they could sur­ vive prostitution. According to this pimp, 30% of women abso­ lutely could not endure prostitution. It is likely that this 30% who could not continue were those who could not dissociate. Making a similar observation about women in the Netherlands, Vanwesenbeeck (1994) noted that what she called a dissociative proficiency contributed to a "professional attitude" among women in Dutch prostitution (p. 107). A Thai woman said, "You make yourself empty inside" (Bishop & Robinson, 1998, p. 47).

[In prostitution] I would just go someplace else mentally as well as emotionally. Soon I just lost track of days at a time. When I was awake, I started feeling "invisible." When I would come back home from a call, I used to stand in front of a mirror and pinch myself just to see if I was real. Spending months with people just looking at your body can make you wonder if "you" exist at all. (Williams, 1991, p. 80)

"Memory is an amazing thing. I leave here [brothel] and I can't re­ member a thing" (Farley, 2003a). Another woman described the gradual development of a dissociated identity during the years she was prostituted in strip clubs:

You start changing yourself to fit a fantasy role of what they think a woman should be. In the real world, these women don't exist. They stare at you with this starving hunger. It sucks you dry; you become this empty shell. They're not really looking at you; you're not you. You're not even there. (Unnamed woman, personal inter­ view, May 10, 1998)

It is confusing to many, including governments, that women in prostitution appear to consent to prostitution. It is only when one 14415

1108 VIOLENCE AGAINST WOMEN / October 2004 looks carefully at the context of the consent, as well as past trau­ matic abuses, that this apparent consent to and promotion of prostitution by some women in the sex industry can be under­ stood. Playwright Carolyn Gage (in press) has written about the relation between incest, dissociation, and advocacy of prostitu­ tion in the life of one woman:

Angie ... had sexually serviced, she estimated, about two thou­ sand men. She owned a horne, which she referred to as "the house that fucking built." As a prostitute, Angie had become a spokes­ woman for prostitution. She described herself as a "poster child" for liberal organizations advocating for legalization of prostitu­ tion. She was, apparently, their model of the happy, healthy hooker. Angie's prostitution was socially supported and paid well. To understand herself as a former child victim would be to see that her seemingly autonomous, even rebellious choices were, in fact, pro­ grammed responses to previous torture and captivity. The ele­ ments of choice and free will so critical to her sense of personhood were not as she had seen them. With every act of so-called sexual liberation, she was reinscribing her trauma. For three decades, Angie had had no memories of her sexual abuse as a child. Growing up in the Midwest as the only child of Christian fundamentalist parents, she had not remembered any­ thing extraordinary about her childhood .... Later, she married and began to participate in group sex and partner-swapping. It was the Sixties, and Angie considered herself liberated. (n.p.)

Angie's memories of chronic sexual abuse returned only after she had stopped prostitution. Until that time, the memories of childhood abuse were completely split off from her normal con­ sciousness. Later, she met a supportive friend and took a class in which she began to write about her life. At this point, memories of the sexual abuse surfaced. For a time, she felt that she had betrayed other women by her previous advocacy of prostitution as a glamorous career choice. A primary function of dissociation is to endure and manage the overwhelming fear, pain, and systematized cruelty that is experi­ enced during prostitution in addition to earlier abuse by separat­ ing these atrocities from the rest of the self (Ross, Farley, & Schwartz, 2003).

The dissociated identity has a profound investment in denying that it is split off, because the original stakes were usually nothing 14416

Farley I HARMS OF PROSTITUTION 1109

less than survival. For this reason, the dissociated personality can be very persuasive. When Angie said she loved being a prostitute, loved servicing her clients, would have done it even without pay, she was persuasive because she believed it-and because she believed it, she was very credible. (Gage, in press, n.p.)

CAN WOMEN IN PROSTITUTION BE PROTECTED FROM HIV?

There is extensive medical documentation that HIV is trans­ mitted from john to prostitute via vaginal and anal intercourse. Rape by customers is a primary source of HIV infection among prostituted women, adolescents, and children. Yet one of the lies about prostitution is that she is the source of infection. Although there has been an intense focus on the HIV risk posed by the pros­ titute to men who buy her, at the same time there has been a lack of attention to psychological and physical violence against women in prostitution. In the HIV literature from 1980 to 2000, most authors mini­ mized or ignored HIV risk posed by the customer to the woman in prostitution. Most also failed to mention alternatives to prostitu­ tion as a means of improving women's health. For example, Karim and colleagues (1995) interviewed women who were pros­ tituted at a truck stop located between Durban and Johannesburg, South Africa. This group of researchers found that women were at a higher risk for physical violence when they insisted on condom use with customers. Ignoring their own finding of the dangers to women who attempted to persuade customers to use condoms, the researchers recommended that women in prostitution learn negotiation and communication skills to reduce HIV risk. It seems tragically likely that this particular project, and others with comparable recommendations, may result in additional injury, even death, to some women in prostitution. From the time that HIV was recognized as an epidemic in the early 1980s, HIV education programs focused on what has been called safer sex education or safer sex negotiation, assuming that if the woman in prostitution can be taught to be more assertive, then she can persuade the customer to use a condom. What many HIV prevention programs fail to address is the customer's demand for sex without a condom in situations of vastly unequal 14417

1110 VIOLENCE AGAINST WOMEN / October 2004 power where the woman in prostitution does not have the physi­ calor economic power to refuse him. Eighty-nine percent of Canadian customers of prostitutes refused condoms in one study (Cunningham & Christensen, 2001). Because customers paid more money for not using condoms, extremely risky sex acts" can always be purchased" (Loff, Overs, & Longo, 2003). In another study, 47% of women in U.s. prostitution stated that men expected sex without a condom, 73% reported that men offered to pay more for sex without a condom, and 45% of women said that men became abusive if they insisted that men use condoms (Ray­ mond, Hughes, et al.,200l). "It's 'regulation' to wear a condom at the sauna, but negotiable between parties on the side. Most guys expected blowjobs without a condom" (Raymond et al., 2001, p.72). In public health circles it is still assumed that the health conse­ quences of prostitution are primarily STD- or HIV-related and that male condom use will solve the overall health problems of prostituted women (Hsu & du Guerny, 2002; Wolffers & van Beelen,2003). Yet in 2003, the AIDS Epidemiology Group at Otago University reported no association between HIV / AIDS and pros­ titution in New Zealand (Coney, 2003). Many now understand that women in prostitution will do everything they can to avoid HIV and other STDs. When not physically prevented from using male condoms and when female condoms are made available, women in prostitution use barrier methods of protection from STD and HIY. Proponents of legalization/decriminalization rarely mention that the woman in prostitution is most often infected by the john, not because she deliberately avoids con­ doms, but because he raped her without a condom or because he persuaded or coerced her by paying her much more for sex acts without a condom. A UN / AIDS and WHO campaign in Thailand began in the late 1980s to ensure 100% condom use. (In prostitution, 100% condom use is an oxymoron.) According to women in prostitution, under this policy they suffered the same social contempt as always but with additional coercive tactics such as being taken to clinics for health checks under police or military escort. The campaign humiliated women by posting their photographs in brothels so that johns could inform pimps which of the women had agreed to 14418

Farley I HARMS OF PROSTITUTION 1111 have sex without a condom (Loff et al., 2003). Johns' culpability for their own failure to use condoms was ignored. Responding to pressure from HIV educators that women should initiate and enforce condom use with customers, a group of Nicaraguan women in prostitution urged that customers, not prostitutes, be compelled to use condoms (Gorter et al., 2000). This recommendation rarely comes from pimps, brothel owners, HIV educators, and government regulators, who instead unite to enforce women's sole responsibility for condom use, rather than holding male customers accountable. Globally, the incidence of HIV seropositivity among prosti­ tuted women is devastating. Homeless children and adolescents in and Colombia, for example, are at highest risk for sex­ ual predation as well as HIV. Piot (1999) noted that one half of new AIDS cases are people younger than age 25 years, and that girls are likely to become infected at a much younger age than boys, in part, because of the acceptance of violence perpetrated against girls and women in most cultures. Violence against women is a primary risk factor for HIV (Garcia­ Moreno & Watts, 2000; Matsamura, 2003; Piot, 1999; United Nations, 2003). Aral and Mann (1998), at the U.S. Centers for Dis­ ease Control, emphasized the importance of addressing human rights issues in conjunction with public health campaigns against STD. They noted that because most women enter prostitution as a result of poverty, rape, infertility and subsequent abandonment, or divorce, public health programs must address the social factors that contribute to STD /HIV. Gender inequality in any culture normalizes sexual coercion thereby promoting domestic violence and prostitution, ultimately contributing to women's likelihood of becoming HIV infected (Pyne, 1995; Raymond, 1998) Understanding the connection between partner violence, rape, and HIV / AIDS is crucial to understanding the continued vulner­ ability of women in prostitution, despite condom distribution programs. For example Kalichman, Kelly, Shaboltas, and Granskaya (2000) and Kalichman, Williams, Cheery, Belcher, and Nachimson (1998) noted the coincidence of the HIV epidemic and domestic violence in Russia, Rwanda, and the United States. STD and HIV have increased exponentially in states of the former Soviet Union since 1995. From 1987 to 1995, fewer than 200 new 14419

1112 VIOLENCE AGAINST WOMEN I October 2004

HIV infections per year were diagnosed in Russia. In the first 6 months of 1999, 5,000 new cases of mv were reported (Dehne, Khodakevich, Hamers, & Schwartlander, 1999). In the city of Kaliningrad, Russia, 1 in 3 people infected with HIV was a woman, and 80% of the infected women were in prostitution (Smolskaya, Momot, Tahkinova, & Kotova, 1998). It is likely that this massive increase in HIV resulted from an extremely high rate of violence against women in Russia (Hamers, Downs, Infuso, &

Brunet, 1998). In Russia, women are treated as 1/ office prostitutes" via job requirements that require them to tolerate sexual harassment (Hughes, 2000). In Senegal, prostitution is government regulated based on the assumption that regulation will reduce rates of HIY. Women are required to register as prostitutes, to have monthly medical checks, and to receive HIV counseling. They are also supplied with condoms. In a study comparing registered women who had received HIV education with those who were unregistered and uneducated about HIV, researchers found higher HIV infection rates among the registered women (Laurent et al., 2003). This study raises questions about the efficacy of HIV education programs.

HIVIAIDS EDUCATION AND THE PROMOTION OF PROSTITUTION

Some prostitutes' organizations such as the NZPC have done valuable HIV / AIDS education, needle exchange, and condom distribution (Coney, 2003). This is a contribution to public health and has undoubtedly saved lives. On the other hand, there is an ominous side to the HIV education activities of groups who claim to represent all women in prostitution while they simultaneously promote prostitution as a job. Alexander (1996) commented that the AIDS epidemic brought with it certain advantages to those promoting prostitution. The HIV epidemic has indirectly facilitated the growth of the commer­ cial sex industry by creating funding opportunities for HIV edu­ cation and outreach programs. Government funding for pro­ grams promoting both HIV education and legal recognition of prostitution has taken place in Brazil, Cambodia, Canada, Ger­ many, the Netherlands, Mexico, Australia, New Zealand, China, 14420

Farley / HARMS OF PROSTITUTION 1113

Panama, Bangladesh, Austria, India, Russia, and the United States, among others. Groups such as the New Zealand Prosti­ tutes Collective (NZPC), SWEAT in South Africa, and the Califor­ nia Prostitutes' Education Project (Cal-PEP) have benefited from funding that has supported their efforts to legalize or decriminal­ ize the sex industry. These programs have created unions and lob­ bying opportunities for decriminalizing prostitution. SWEAT, for example, distributed a pamphlet in 1995, the goal of which was to "assist you in your careerin the [sex Jindustry." Funded with HIV prevention monies, SWEAT offered training in sexual massage. Other programs operate much like SWEAT. Although de­ signed to prevent STD /HIV among those in prostitution, such organizations not only distribute condoms but promote prostitu­ tion as well. For example, a European publication titled "Hustling for Health" recommended drop-in centers, condoms, and coffee as necessary services for those in prostitution (Bloem, 1999, p. 7). However, the options of housing, drug treatment, or escape from prostitution are not mentioned in the pamphlet. The best possible outcome for those in prostitution is assumed to be a frank, casual chat with peers in prostitution. The pamphlet tacitly assumes the recipient's continuation in prostitution. The NZPC was founded in 1987 as a lobbying organization for sex businesses and to improve the working conditions of women in prostitution. Since 1987, the NZPC has been funded by the NZ Ministry of Health to provide HIV education to those in prostitu­ tion and to distribute clean needles. In the process of funding the NZPC, the NZ Health Ministry was educated about prostitution exclusively by that one organization and subsequently became aligned with the political goal of the NZPC: to decriminalize pros­ titution. Representatives of the NZ Health Ministry told me that they knew everything they needed to know about prostitution via information received from the NZPC. In this case, the links are clear: First, there is public health funding for AIDS outreach, then the organizations conducting the health outreach lobby for decriminalization or other legal recognition of prostitution, and subsequently government agencies adopt the perspective that prostitution is a form of labor rather than a human rights violation. The distribution of public health funds for HIV prevention has occurred with little oversight of recipient goals, program 14421

1114 VIOLENCE AGAINST WOMEN I October 2004

implementation, or ethics. Public health educators may negotiate with pimps to ensure that they will be able to enter brothels to dis­ tribute condoms to women and even to children in prostitution. Sometimes deals are made, for example in Kerala State, India, where social workers had to obtain permission from brothel pimps to hand out condoms. In exchange, the social workers agreed to ignore the presence of prostituted children and not to ad vocate escape from prostitution by informing the women about available services (Friedman, 1996). ,,,,-,, Bargaining with brothel owners and pimps also occurred at the Calcutta-based Project. Jana, Bandyopadhyay, Saha, and Dutta (1999) explained that in the Sonagachi Project,

Prostitution was accepted as a valid profession and no attempt was made at discouraging sex workers to practice prostitution or at res­ cuing or rehabilitating them. This reassured the other stakeholders in the sex trade that we outsiders were not going to disrupt their business. (p. 23)

An alliance between pimps and others who use HIV education monies to promote prostitution is also clear in the case of Cal-PEP. By 1993, Cal-PEP had received US$1.6 million in state and federal grants to work on AIDS prevention among prostitutes. The founder of Cal-PEP was a member of COYOTE, a U.s. organiza­ tion promoting decriminalization of prostitution. Furthermore, the agency was directed by the founder's former pimp who had a felony conviction for running an interstate prostitution business (Marinucci & Williams, 1993). This Oakland, California, project continued to receive state HIV-prevention funding in 2003. Although it provides comprehensive health and HIV­ prevention services, the Tan Bazar brothel in Bangladesh is in reality a prison encampment. The Tan Bazar brothel advertises the following services for prostitutes in a clinic attached to the brothel:. contraceptives, counseling, condoms, srD /HIV treat­ ment, abortion, antenatal and postnatal checkups, infertility care, gynecological care, and treatment of minor ailments. A children's clinic is included (Ahmed, 2001). This huge brothel, the largest in Bangladesh, locked women and their children inside and essen­ tially functioned as a prison for poor women in prostitution. They lived most of their lives in the brothel, constantly available for purchase but out of public view. 14422

Farley I HARMS OF PROSTITUTION 1115

In another egregious case of misguided public health policy, Hernandez (2003) investigated the trafficking of Mexican girls to brothels near San Diego where criminal networks control at least 50 brothels including outdoor sexual exploitation camps for migrant farm laborers. During a lO-year period, hundreds of ado­ lescent girls from rural Mexico were either kidnapped or tricked into crossing the U.S. border by coyotes, traffickers, and pimps. These girls were sold for sex acts not only to hundreds of farm workers who were transported to camps where they sexually assaulted girls in prostitution but also to u.s. tourists and U.S. military personnel. A U.S. physician who worked for a clinic that provided health care to migrant workers said, "The first time I went to the camps I didn't vomit only because I had nothing in my stomach. It was truly grotesque and unimaginable" (Hernandez, 2003). Many of the girls were 9 or 10 years old. On one occasion, the physician counted 35 men paying to rape a girl during a single hour. After she reported the girls' sexual assaults in prostitution, the physi­ cian was instructed by U.S. public health officials that prostitution was not a migrant health concern. Advised by her superiors to work with the pimps, she limited her practice to "prevent[ing] HIV / AIDS and other venereal diseases in the exploited minor girls" (Hernandez, 2003). It is frankly criminal to address only STD/HIV and to ignore child and adolescent physical abuse, rape, kidnapping, trafficking, and child prostitution. Yet in public health clinics and STD /HIV clinics, this tunnel vision is the rule rather than the exception. Bernard Trink,a U.s. expatriate living in Bangkok who is an avid customer of prostitution, writes weekly columns in the Bang­ kok Post about the Thai sex industry. Trink is an unlikely critic of groups such as SWEAT, NZPC, Cal-PEP, or EMPOWER in Bang­ kok, but he does not mince words when asked about the effective­ ness of groups working against HIV among prostitutes:

EMPOWER is a bullshit operation ... they're working on AIDS dis­ crimination, which is fine, but it doesn't help the women. For them it is only money. The only thing that would move them out [of prostitu­ tion] is a job that pays as well [italics added]. (Bernard Trink, quoted by Bishop & Robinson, 1998, p. 184) 14423

1116 VIOLENCE AGAINST WOMEN / October 2004

CONCLUSION

Legal sex businesses provide locations where sexual harass­ ment, sexual exploitation, and violence against women are perpe­ trated with impunity. State-sponsored prostitution endangers all women and children in that acts of sexual predation are normal­ ized-acts ranging from the seemingly banal (breast massage) to the lethal (snuff prostitution that includes filming of actual mur­ ders of real women and children). A report on the sexual exploita­ .-.~ tion of children noted that the presence of a thriving adult sex industry in a community had the effect of increasing child prosti­ tution in that same community (Estes & Weiner, 2001). Nevada, the one U.S. state where prostitution is legal in 13 counties, had significantly higher rates of sex crimes than the rest of the United States in the 1990s (Albert, 2001).6 Johns who buy women, groups promoting legalized prostitu­ tion, and governments that support state-sponsored sex indus­ tries comprise a tripartite partnership that endangers all women. These groups collude in denying the everyday violence and sub­ sequent health dangers to those in prostitution. One john, for

example.1 ' rationalized ...prostitution as ...... ,providing health benefits to women in prostitution: Dave (2003) opined that by providing breast massage, he would thereby improve the breast health of women in prostitution. He cited numerous medical studies justi­ fying his (paid-for) sexual assaults as medically beneficiaL Those who promote legalization or decriminalization defend the customer base of sex industries with far-fetched rationaliza­ tions. Although duly noting the problem of "murderous clients" of prostitutes, Kinnell (2001) nonetheless suggested that legally targeting dangerous johns for arrest somehow increases the dan­ ger to those in prostitution. She stated that although "many attacks are perpetrated by clients," we should still not assume therefore that" a high proportion of clients is potentially violent." Pimp states across the globe7 operate with sophisticated subter­ fuge in defending legalization or decriminalization of prostitu­ tion. Although violence has been declared a priority area of the New Zealand Health Strategy, no part of the NZ prostitution bill offers any specific protection from the violence that is intrinsic to prostitution. Giving lip service to protecting women's health, the NZ prostitution law claims to protect everyone from HIV and 14424

Farley / HARMS OF PROSTITUTION 1117

STDs, even though it has already been established that there is no association between prostitution and HIV in New Zealand (Coney, 2003). The NZ human rights law has provisions that protect women from sexual harassment. It is a far more protective law than the NZ law that decriminalizes prostitution in the name of women's health, safety, and right to work. Because one of the job require­ ments of prostitution is tolerating sexual harassment, how will the NZ human rights law protect women in prostitution from sex­ ual harassment? "What will be the ... outcome of struggles against sexual harassment and violence in the home, the work­ place, or the street, if men can buy the right to perpetrate these very acts against women in prostitution?" (D'Cunha,2002, p. 41). Prostitution is an institution that systematically discriminates against women, against the young, against the poor, and against ethnically subordinated groups. Prostitution cannot be made safer or a little bit better by legalizing or decriminalizing it (Ray­ mond, 2003). It is a particularly vicious institution of inequality of the sexes. Understanding this, Nevada legislator William O'Donnell stated,

It bothers me that we're making money off the backs of women. Condoning prostitution is the most demeaning and degrading thing the state can do to women. What we do as a state is essentially put a u.S.-grade stamp on the butt of every prostitute. Instead, we should be turning them around by helping them back into society. (quoted in Albert, 2001, p. 178)

Does a john's payment of money to a woman in prostitution erase all that we know of sexual harassment, rape, and domestic violence? The adage silence is consent is mistakenly applied to women in prostitution. We blame those who keep silent for what­ ever happens to them because, the logic goes, they should have protested abuse. Women in prostitution are silent for many rea­ sons. They are rarely given the opportunity to speak about their real lives because this would interfere with sex businesses. The silence of most of those in prostitution is a result of intimidation, terror, dissociation, and shame. Their silence, like the silence of battered women, should not be misinterpreted, ever, as their consent to prostitution. 14425

1118 VIOLENCE AGAINST WOMEN / October 2004

NOTES

1. "Bad for the body, bad for the heart" was the way a young Thai woman summarized the effects of prostitution in Hello My Big Big Honey: Love Letters to Bangkok Bar Girls and Their Revealing Interviews (Walker & Ehrlich, 2000). 2. Legal prostitution cannot possibly protect children from being exploited. The exis­ tence of a neighborhood adult sex industry constitutes one of the risk factors for adoles­ cents' entry into prostitution (Estes & Weiner, 2001). 3. What shall we call the men who buy the women and children in prostitution? They are socially tolerated sexual predators but are rarely identified as such. I use the word johns because that is the word most commonly used by women in prostitution for them. They're also called customers, buyers, clients, tricks, dates. The word trick is used because johns constantly try to trick, wheedle, or coerce women into performing more sex acts in prosti­ tution than they are paid for. 4. In 2003, Heidi Fleiss celebrated the opening of a brothel franchise in Australia, where prostitution is legalized. Fleiss is a survivor of childhood sexual abuse and later prostitu­ tion who turned to pimping other women as a way out of prostitution for herself. 5. Organizations occaSionally change their politics. If I have included anyorganization in error, I would be happy to hear about that. 6. Nevada's rate of rape per 1,000 population was .57 in 1997, while the overall U.S. rate was .36. Nevada's two largest metropolitan areas, Reno and Las Vegas, ranked far ahead in rapes than other popular U.S. tourist destinations, including Los Angeles and San Fran­ cisco. Reno and Las Vegas are adjacent to 2 of the 13 Nevada counties where prostitution is legalized (Albert, 2001, pp. 182-183, citing Nevada Crime Statistics). 7. By law, pimps are defined as those who support themselves via the earnings of prosti­ tutes. Thus, when a government benefits from taxing the earnings of prostitutes in legal­ ized or decriminalized prostitution, it is appropriate to bring the notion of pimping into the discussion, hence pimp-states.

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1120 VIOLENCE AGAINST WOMEN / October 2004 de Sanjose, 5., Palacio, V., Tafur, 1., Vazquez,S., Espitia, V., Vazquez, E, Roman, G., Munoz, N., & Bosch, E (1993). Prostitution, HIV, and cervical neoplasia: A survey in Spain and Colombia. Cancer Epidemiology, Biomarkers, and Prevention, 2, 531-535. Deutsche Press-Agentur. (2001, August 13). WHO urges decriminalization of prostitution. Germany: BC Cycle of Deutsche-Press-Agentur. Dworkin, A. (1981). Pornography: Men possessing women. New York: Putnam. Dworkin, A. (1997). Prostitution and male supremacy. In Life and death (pp. 131-151). New York: Free Press. Dworkin, A. (2000). Scapegoat: The Jews, Israel, and women 's liberation. New York: Free Press. Efendov, A. A., & Stermac, L. E. (2003, August). Sexual assault offemale sex trade workers in an urban population. Paper presented at the Annual Meeting of the American Psychological Association, Toronto, Canada. Else, A. (2003, July 6). Opinion. New Zealand Forward, Sunday Supplement, n.p. Estes, R J., & Weiner, N. A. (2001). The commercial sexual exploitation of children in the United States, Canada, and Mexico. Philadelphia: University of Pennsylvania, School of Social Work. Farley, M. (2003a, May 14). Preliminary report on prostitution in New Zealand. Unpublished paper. Available from [email protected] Farley, M. (2003b). Prostitution and the invisibility of harm. Women and Therapy, 26(3/4), 247-280. Farley, M., Baral, 1., Kiremire, M., & Sezgin, U. (1998). Prostitution in five countries: Vio­ lence and posttraumatic stress disorder. Feminism and Psychology, 8, 415-426. Farley, M., Cotton, A., Lynne, J., Zumbeck, 5., Spiwak, E, Reyes, M. E., Alvarez, D., & Sezgin, V. (2003). Prostitution in nine countries: Update on violence and posttraumatic stress disorder. In M. Farley (Ed.), Prostitution, trafficking,and traumatic stress (pp. 33-74). Binghamton, NY: Haworth. Farley, M., Lynne, J., & Cotton, A. (in press). Prostitution in Vancouver: Violence and the colonization of First Nations women. Journal of Transcultural Psychiatry. Farr, E, Castro, 1., DiSantostefano, R, Claassen, E., & Olguin, F. (1996). Use of spermicide and impact of prophylactic condom use among sex workers in Santa Fe de Bogota, Columbia. Sexually Transmitted Diseases, 23, 206-212. Fisher, H. (1992). The anatomy of love. New York: Norton. Friedman, J., & Yehuda, R (1995). Post-traumatic stress disorder and comorbidity: Psycho­ biological approaches to differential diagnosis. In]. Friedman, D. Charney, & A. Deutch (Eds.), Neurobiological and clinical consequences of stress: From normal adaptation to post­ traumatic stress disorder (pp. 429-445). Philadelphia: Lippincott-Raven. Friedman, R 1. (1996, April 8). India's shame: Sexual slavery and political corruption are leading to an AIDS catastrophe. Nation, pp. 11-20. Funari, V. (1997). Naked, naughty, nasty: Peepshow reflections. In J. Nagle (Ed.), Whores and other feminists (pp. 19-35). New York: Routledge. Gage, C. (in press). Angie. In C. Stark & R. Whisnant (Eds.), Not for sale: Feminists resisting prostitution and pornography. Melbourne, Australia: Spinifex Press. Garcia-Moreno, c., & Watts, C. (2000). Violence against women: Its importance for HIV / AIDS. AIDS, 14(3),5253-5265. Giobbe, E. (1991). Prostitution: Buying the right to rape. In A. W. Burgess (Ed.), Rape and sex­ ual assault III: A research handbook (pp. 143-160). New York: Garland. Giobbe, E. (1993). An analysis of individual, institutional, and cultural pimping. Michigan Journal of Gender and Law, 1,33-57. Golding, J. (1994). Sexual assault history and physical health in randomly selected Los Angeles women. Health Promotion, 13, 130-138. 14428

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Gorter, A, Segura, Z., Sandiford, P., Zuniga, E., Torrentes, R., & Adahl, S. (2000). You should not tell us to use condoms, but our clients!: An extended voucher programme in Nicaragua. Research for Sex Work, 3, 25-28. Green, S. T., Goldberg, D. J., Christie, P. R., Frischer, M., Thomson, A, Carr, S. V., & Taylor, A. (1993). Female streetworker-prostitutes in Glasgow: Adescriptive study of their life­ style. AIDS Care, 5, 321-335. Hamers, F. F., Downs, A. M., Infuso, A, & Brunet, J.-B. (1998). Diversity of the HIV I AIDS epidemic in Europe. AIDS, 12(Suppl. A), S63-S70. Herman, J. L. (1992). Trauma and recovery. New York: Basic Books. Hernandez, A. (2003, January 11). The sex trafficking of children in San Diego: Minors are prostituted in farm labor camps in San Diego. EI Universal, n.p. Hoigard, c., & Finstad, L. (1986). Backstreets: Prostitution, money and love. University Park: Pennsylvania State University Press. Holsopple, K. (1998). Stripc/ubs according to strippers: Exposing workplace violence. Unpub­ lished manuscript. Houskamp, B. M., & Foy; D. W. (1991). The assessment of post-traumatic stress disorder in battered women. Journal of Interpersonal Violence, 6,367-375. Hsu, L., & du Guerny, J. (2002). Mapping for the health and well-being of mobile sex work­ ers and the communities they serve. Research for Sex Work, 5. Retrieved November 22, 2003, from www.med.vu.nl/hcc/artikelen/hsu.htm Hughes, D. M. (1999). Pimps and predators on the Internet: Globalizing the sexual exploitation of women and children. Kingston, RI: Coalition Against Trafficking in Women. Hughes, D. M. (2000). The "Natasha" trade: The transnational shadow market of traffick­ ing in women. Journal of International Affairs, 53, 625-651. Hunter, S. K. (1993). Prostitution is cruelty and abuse to women and children. Michigan Journal of Gender and Law, 1,1-14. Hynes, H. P., & Raymond, J. G. (2002). Put in harm's way: The neglected health conse­ quences of sex trafficking in the United States. InJ. Silliman & A Bhattacharjee (Eds.), Policing the national body: Sex, race, and criminalization (pp. 197-229). Cambridge, MA: South End. Jacobs, U., & Iacopino, V. (2001). Torture and its consequences: A challenge to clinical neuropsychology. Professional Psychology: Research and Practice, 32, 458-464. Jana,S., Bandyopadhyay; N., Saha, A, & Dutta, M. K. (1999, August). Creating an enabling environment: Lessons learnt from the Sonagachi Project, India. Research for Sex Work Newsletter, 2, 22-24. Jeffreys, S. (1997). The idea of prostitution. North Melbourne, Australia: Spinifex Press. Jeffreys, S. (2003). The Jegalisation of prostitution: A failed social experiment. Women's Health Watch Newsletter, 64,8-11. Available at www.women.shealth.org.nz. Jenness, v. (1993). Making it work: The prostitutes' rights movement in perspective. New York: de Gruyter. Justice and Electoral Committee Report. (2001). Prostitution Reform Bill. New Zealand Par­ liament Member's Bill. Wellington, New Zealand: Justice and Electoral Committee. Kalichman, S. c., Kelly, f. A, Shaboltas, A., & Granskaya,J. (2000). Violence against women and the impending AIDS crisis in Russia. American Psychologist, 55, 279-280. Kalichman, S. c., Williams, E. A., Cheery, c., Belcher, L., & Nachimson, D. (1998). Sexual coercion, domestic violence, and negotiating condom use among low-income African American women. Journal of Women's Health, 7,371-378. Karim, Q. A., Karim, S. S., Soldan, K., & Zondi, M. (1995). Reducing the risk of HlV infec­ tion among South African sex workers: Socioeconomic and gender barriers. American Journal of Public Health, 85, 1521-1525. 14429

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Kemp, A., Rawlings, E., & Green, B. (1991). Post-traumatic stress disorder (PTSD) in bat­ tered women: A shelter sample. Journal of Traumatic Stress, 4,137-147. Kinnell, H. (2001). Murderous clients and indifferent justice: Violence against sex workers in the UK Research for Sex Work, 4, 22-24. Koss, M., & Heslet, L. (1992). Somatic consequences of violence against women. Archives of Family Medicine, 1,53-59. Kramer, L. (2003). Emotional experiences of performing prostitution. In M. Farley (Ed.), Prostitution, trafficking, and traumatic stress (pp. 187-198). Binghamton, NY: Haworth. Laurent, c., Seck, K, Coumba, N., Kane, T., Samb, N., Wade, A., Liegeois, E, Mboup, S., Ndoye, I., & Delaparte, E. (2003). Prevalence of HIV and other sexually transmitted infections, and risk behaviors in unregistered sex workers in Dakar, Senegal. AlDS, 17, 1811-1816. Leidholdt, D. (1993). Prostitution: A violation of women's human rights. Cardozo Women's Law Journal, 1, 133-147. Leone, D. (2001, September 10). One in 100 children in sex trade, study says. Honolulu Star Bulletin. Retrieved September 29, 2001, from http://starbulletin.com/2001/09/10/ news/ storyl.html Lewis, J. (1998). Lap dancing: Personal and legal implications for exotic dancers. In J. A. Elias, V. L. Bullough, V. Elias, & G. Brewer (Eds.), Prostitution: On whores, hustlers, and johns (pp. 376-389). Amherst, NY: Prometheus Books. Lim, L. L. (Ed.). (1998). The sex sector: The economic and social bases of prostitution in Southeast Asia. Geneva, Switzerland: International Labor Organization. Loff, B., Overs, c., & Longo, P. (2003). Can health programmes lead to mistreatment of sex workers? Lancet, 36, 1982-1983. MacBrayne, R. (2003, December 5). Brothel bylaws cause local-body headaches. New Zea­ land Herald. Retrieved December 6, 2003, from www.nzherald.co.nz/storydisplay. cfm?storyID=3537678&thesection=news&thesubsection=general MacKinnon, C. A. (1993). Prostitution and civil rights. Michigan Journal of Gender and Law, 1, 13-31. MacKinnon, C. A. (2001). Sex equality. New York: Foundation Press. MacKinnon, C. A., & Dworkin, A. (1997). In harm's way: The pornography civil rights hearings. Cambridge, MA: Harvard University Press. Marinucci, c., & Williams, L. (1993, August 15). Ex-felon directs safe-sex project. San Fran­ cisco Examiner, pp. 1-12. Masters, W., & Johnson, V. (1973). Ten sex myths exploded: The sensuous society. Chicago: Play­ boy Press. Matsamura, E. K (2003, September 2). Lack of women's rights helps the spread of AIDS. Global Information Network, English IPS News, Retrieved October 15, 2003, from www. aegis.com/news/ips/2003/IP030902.html McKeganey; N., & Barnard, M. (1996). Sex work on the streets: Prostitutes and their clients. Buckingham, Scotland: Milton Keynes Open University Press. McLeod, E. (1982). Women working: Prostitution now. London: Croom Helm. Miller, E. M. (1986). Street woman. Philadelphia: Temple University Press. Miller, J. (1995). Gender and power on the streets: Street prostitution in the era of crack cocaine. Journal of Contemporary Ethnography, 23, 427-452. Nairne, D. (2000). We want the power: Findings from focus group discussions in Hillbrow, Johannesburg. Research for Sex Work, 3, 3-5. Nakashima, K, Kashiwagi, S., Hayashi,J., Urabe, K, Minami, K., & Maeda, Y. (1996). Prev­ alence of hepatitis C virus infection among female prostitutes in Fukuoka, Japan. Jour­ nal of Gastoenterology, 31, 664-448. 14430

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United Nations. (2003, October 15). United Nations release. Retrieved October 15,2003, from www.un.org/ appsl newsl printnews.asp ?nid=8574 Valera, E. M., & Berenbaum, H. (2003). Brain injury in battered women. Journal ofConsulting and Clinical Psychology, 71, 797-804. Valera, R., Sawyer, R G., & Schiraldi, G. R. (2001). Perceived health needs of inner-city street prostitutes. American Journal of Health Behavior, 25, 50-59. Vanwesenbeeck, I. (1994). Prostitutes' well-being and risk. Amsterdam: VU University Press. Vesti, P., Somnier, F., & Kastrup, M. (1992). Psychotherapy with torture survivors: A report of practice from the Rehabilitation and Research Centre for Torture Victims (RCT). Copenhagen, Denmark: Rehabilitation and Research Centre for Torture Victims. Walker, D., & Ehrlich, R. S. (2000). Hello my big big honey: Love letters to Bangkok bar girls and their revealing interviews. San Francisco: Last Gasp of San Francisco. Weisberg, D. K. (1985). Children ofthe night: A study ofadolescent prostitution. Lexington, MA: Lexington Books. Wijers, M., & Lap-Chew, L. (1997). Trafficking in women,forced labor, and slavery-like practices in marriage, domestic labor, and prostitution. Utrecht, the Netherlands: Foundation Against Trafficking in Women. Williams, J. L. (1991). Sold out: A recovery guide for Prostitutes Anonymous. Available from: P.O. Box 3279, North Las Vegas, NY 89036. Wolffers, I., & van Beelen, N. (2003). Public health and the human rights of sex workers. Lancet, 361, 1981. World Health Organization. (1988). STD control in prostitution: Guidelines for policy. WHO consultation on prevention and control of sexually transmitted diseases in popUlation groups at risk. Geneva, Switzerland: Author. Young, A. (2003, October 26). Reasonable doubt. Toronto Star. Retrieved October 26, 2003, from www.thestar.com/NASApp I csl ContentServer?pagename=thestar ILayout/ Article_Typel&c=Article&cid=1066993266395&call_pageid=991479973472&col= 991929131147

Melissa Farley is a research and clinical psychologist who has been in practice for 35 years. She is the author of25 publications. In addition to consulting with orga­ nizations on the topics ofprostitution and trafficking, she conducts forensic evalu­ ations on behalf ofsurvivors of prostitution. She edited and contributed to Prosti­ tution, Trafficking, and Traumatic Stress, 2003. 14433

1/ /1 • -T-.j)r. m "I"~,, This is Exhibit ~ menlioned and ralerred to In the aIHdavR ~~ / Sworn before me Ihis I~ r day of J1f'1 A.D.20P r .., r- )Y ACommissioner lor taking affidavits ~~_

Prostitution Harms Women Even if Indoors

Reply to Weitzer

MELISSA FARLEY Prostitution Research [1' Education

I cannot avoid expressing my deepest grief in learning of the efforts of pro-prostitution organizations to decriminalize the act of pur­ chasing a person for sex. It is simply not possible for me to convey in words the intense pain and struggle I have endured as a result of my experience in prostitution. I chose to work as a prostitute because I believed I had no other options. I entered prostitution due to extreme emotional and finan­ cial stress and a lack of a supportive family system. Because I was white and not exhibiting obvious signs of a seri­ ous drug addiction, I was able to work in "upscale" massage par­ lors in [California]. While street walking was extremely danger­ ous, it is completely erroneous to assume that the brothels were immune to violence. There were incidents of attempted strangula­ tion and forceful restraint. Customers would intentionally remove condoms against the prostitute's wishes. They often requested bondage and acts of sadism. If the managers (madams or pimps) felt that the customer's request was reasonable, the prostitute was obligated to comply, or find another house to work in. I now choose to be an advocate for the right of prostitutes to be free of the forces that restrict their escape. I ... urge all compassion­ ate people to consult the data and research that has been conducted regarding the demographics and desires of the women, men, chil­ dren, and transgendered who are in prostitution. This ... research illustrates that those involved in prostitution advocacy represent a very small minority of the prostitute population. -A survivor who chooses to remain anonymous

AUTHOR'S NOTE: For their words and for each of their conceptual genius, the author thanks Michelle j. Anderson and Catherine A. MacKinnon. VIOLENCE AGAINST WOMEN. Vol. 11 No_ 7, July 2005 950-964 DOl: 10.1177/1077801205276987 © 2005 Sage Publications

950

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Farley I REPLY TO WEITZER 951

DIFFERENT PERSPECTIVES ON PROSTITUTION

All science is infused with values, whether it's stem cell research, research on the psychological effects of colonization of one people by another, or research on the effects of incest or rape or prostitution. The issue is not whether research is permeated with values-it always is-but whether those values are made explicit as opposed to being vaguely stated or deliberately con­ cealed. Baral, Kiremire, Sezgin, and I wrote,

We initiated this research in order to address some of the issues that have arisen in discussions about the nature of prostitution. In par­ ticular: is prostitution just a job or is it a violation of human rights? From the authors' perspective, prostitution is an act of violence against women: it is an act which is intrinsically traumatizing to the person being prostituted. (Farley, Baral, Kirernire, & Sezgin, 1998,p.405)

We made our perspective and hypotheses transparent. We then made our procedures and the ways in which those hypothe­ ses were tested sufficiently explicit for others to replicate the study. As Weitzer noted, our results were not always as we had predicted. After a decade of research on prostitution that includes more than 854 interviews with people in nine countries, I wrote an arti­ cle in Violence Against Women (Farley, 2004) that was, as Weitzer (2005 [this issue]) said, a "wide-ranging" (p. 940) discussion about prostitution legalization and decriminalization (Weitzer, 2005). Along with many others, I concluded that prostitution is multi­ traumatic with extremely high rates of phYSical and sexual vio­ lence perpetrated against people who are vulnerable usually as a result of gender, poverty, previous history of sexual assault, mar­ ginalization because of race or ethnicity, or a combination of these factors. My coauthors and I stated,

Our findings contradict common myths about prostitution: the assumption that street prostitution is the worst type of prostitu­ tion, that prostitution of men and boys is different from prostitu­ tion of women and girls, that most of those in prostitution freely consent to it, that most people are in prostitution because of drug addiction, that prostitution is qualitatively different from traffick-

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952 VIOLENCE AGAINST WOMEN / July 2005

ing, and that legalizing or decriminalizing prostitution would decrease its harm. (Farley et al., 2003)

Weitzer, on the other hand, failed to make his perspective trans­ parent. In fact, he is a supporter of indoor prostitution. In his writ­ ings, Weitzer has focused on the community disruption caused by outdoor (street or car) prostitution and has supported indoor prostitution. Indoor prostitution includes massage parlors and saunas, brothels, strip clubs, and escort prostitution. Escort pros­ titution simply means that an ad is placed online or in a newspa­ per, that she or her pimp has a cell phone, and that there is access to a horne or hotel room or car. "High-class-call-girl" prostitution means that more money passes through several people's hands in escort prostitution. In a 1994 collection of articles titled In Defense of Prostitution, Weitzer published an article about community resistance to street prostitution. This special issue of The Gauntlet was edited by COYOTE member who also promotes decriminalization of prostitution. Weitzer views prostitution from the community's perspective. He decries the mess created by used condoms and discarded syringes, the loss ofbusiness rev­ enue as a result of a neighborhood's "seedy ambiance/' and the verbal harassment of nonprostituting women by customers of prostitutes (Weitzer, 1994, p. 122). Dutch researcher Ine Vanwesenbeeck wrote the following: "Researchers seem to identify more easily with clients than with prostitutes" (Vanwesenbeeck, 1994, p. 33). Weitzer does not con­ sider prostitution from the perspective of the prostitute. Rather, he tends to view prostitution either from the perspective of the trick or from the perspective of the nonprostitute community (Adams & Riley, 2004).

RESEARCH METHODOLOGY USED BY THE AUTHOR AND COLLEAGUES

Weitzer charges that research exploring the harms of prostitu­ tion is riddled with methodological flaws. In fact, our research is methodologically sound and has been replicated. For example, we used a standardized and validated test of post-traumatic stress disorder. We also asked about respondents' histories and demographics with a number of true-false questions. In peer-

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Farley / REPLY TO WEITZER 953 reviewed psychology journals, questionnaires are rarely included in their entirety, although the lead author's contact information is publicized. I have been contacted by numerous researchers, some of whom have independently replicated the methodology I used and subsequently published the results (Baral et aL, 1998; Valera, Sawyer, & Schiraldi, 2001; Zumbeck, Teegen, Dahme, & Farley, 2003). Weitzer bemoans our lack of a random sample. As other researchers of prostitution have noted, it is not possible to obtain a random sample of people currently prostituting (McKeganey & Barnard, 1996). Investigators, therefore, use a variety of tech­ niques to learn about the experience of prostitution for those in it. Generally, smaller numbers of interviewees limit the generaliz­ ability of results. We have reported data from a large number of respondents in different countries and in different types of prostitution. We described in detail where and how we located respondents. We attempted to reach as diverse a range of people in prostitution as we could, including people of diverse races, cultures, ages, locations of prostitution, and genders. We observed, as others have, that those who were the most harmed or the most vulnera­ ble were not available to us to interview (Vanwesenbeeck, 1994). They are either imprisoned or kept indoors and out of public view. But there are additional difficulties in conducting research on prostitution. Although it is likely that funding will be more acces­ sible in the next decade, at this moment in time it is extremely dif­ ficult to obtain funding that would permit the expense of ade­ quate sampling of either women in prostitution or their tricks. Therefore, one must interview whomever one can access. Adam Ruiz, Odette Levy Barbara Strachan, and I have con­ ducted research interviews with tricks and have faced prob­ lems with obtaining representative samples. Although some U.S. research on customers of prostitutes interviewed men in diver­ sion programs who solicited prostitutes (Manto & Hotaling, 1998), we interviewed men who had not been arrested, in part because we wished to interview men who bought women in indoor prostitution. Customers who are not in a police-sponsored program tend to exhibit more "john-like" behaviors. All four interviewers encountered verbal sexual harassment from the nonarrested johns while conducting the interviews.

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954 VIOLENCE AGAINST WOMEN / July 2005

We encountered other difficulties. Publishers of sex industry magazines such as the Bachelor's Beat in Phoenix are reluctant or unwilling to permit advertisements regarding research on prosti­ tution. For example, I attempted to place a classified advertise­ ment in Bachelor's Beat (January 2005) seeking interviews with customers of prostitutes. The advertisement was refused by the editor. The announcement I was seeking to run in Bachelor's Beat was perhaps considered a threat to the ongoing business of adver­ tising prostitution. Weitzer states that I have "simply decree[dJ that prostitution is violence, a proclamation that is neither verifiable nor falsifiable" (Weitzer, 2005, p. 942). He appears not to have read the series of studies that permit me to conclude, "Our findings from 9 countries on 5 continents consistently indicate that the physical and emotional violence in prostitution is overwhelming" (Farley et aLI 2003, p. 55). The 2003 study described the frequency of six types of lifetime violence, the number of types of lifetime vio­ lence, and rates of post-traumatic stress disorder (PTSD) in nine countries. Weitzer states that he is unclear if my work includes male and transgender prostitution in spite of the fact that I have described inclusion of both these groups in publications (Farley et aL, 1998; Farley et aC 2003). Weitzer cites our reports that there was more physical violence in street prostitution than in brothel prostitution in South Africa as evidence against my claim of violence in all prostitution. Of course, the fact that some types of prostitution are associated with more severe harm than others does not mean that the marginally less harmful types of prostitution are not harmful at alL Weitzer noted that some of our respondents favored legalized or decriminalized prostitution. Like everyone else, our interview­ ees minimized the harms of prostitution and they sometimes believed the myth that legalization or decriminalization will some­ how make them safer. Sadly, there is no evidence for their belief.

INDOOR PROSTITUTION TENDS TO BE SOCIALLY INVISIBLE PROSTITUTION

Advocates, researchers, feminist theorists, and Weitzer all agree that most prostitution in the U.s. takes place indoors, .vith a relatively small percentage of prostitution taking place outdoors.

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Farley / REPLY TO WEITZER 955

Even when prostitution is illegal, tricks are much less likely to be arrested in indoor prostitution because in most jurisdictions, police ignore indoor prostitution unless they receive a complaint. Multipage advertisements for escort and massage prostitution run daily in metropolitan U.s. newspapers. The Manhattan yel­ low pages contain 30 pages of listings under "escorts" (Jacobs, 2004). Although prostitution is illegal in locations where it is advertised, newspapers use code words that keep prostitution teasingly veiled and totally accessible: "personal services," "mas­ sage," "conversation," "dating," "women seeking men," "intro­ ductions," "modeling," "escort services," "personal businesses," "private services," "erotic services," "DeSade," "phone entertain­ ment," "adult fun," "TV ITS," and so on. The relative harms of indoor and outdoor prostitution have been debated. There is some research evidence suggesting that outdoor prostitution may subject women in prostihltion to higher rates of physical violence, but according to several studies, the rates of psychological violence among indoor and outdoor prosti­ tution are comparable. In practice, indoor prostitution increases the trick's safety, but it does nothing to decrease psychologi­ cal trauma for the prostituted woman. The social invisibility of indoor prostitution may actually increase its danger. When women prostitute indoors, the community is less likely to see them. Homes or apartments are rented for use as brothels for escort prostitution. No one lodges complaints until neighbors become irritated about a lack of parking space or they become suspicious about the steady stream of men going in and out of the house in 20-min intervals. In 2004, a brothel with trafficked Asian women operated in a San Francisco neighborhood. No one knew that it was a brothel until federal agents and immigration officials arrested a woman pimp (Wallace, 2004).

IS INDOOR PROSTITUTION SAFER THAN OUTDOOR PROSTITUTION?

Most research comparing indoor prostitution to outdoor pros­ titution has addressed only physical violence. I described more than 10 studies that address similarities and differences between indoor and outdoor prostitution (Farley, 2004, p. 1099). Several studies found either no differences between the two

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956 VIOLENCE AGAINST WOMEN I July 2005

or increased psychiatric symptoms among women in strip club (indoor) prostitution. Documenting the profound emotional distress experienced by women in two kinds of prostitution, a Canadian study compared strip club and street prostitution. The authors found that women who prostituted in strip clubs had higher rates of dissociative and other psychiatric symptoms than those in street prostitution (Ross, Anderson, Heber, & Norton, 1990). In a separate study, we compared strip club / massage, brothel, and street prostitution in Mexico. We found no differences in the prevalence of physical assault and rape in prostitution, of childhood sexual abuse, or of symptoms of PTSD. We also found no differences in the percent­ ages of Mexican women in brothel, street, or strip club/massage prostitution who wanted to escape prostitution (Farley, 2004, p. 1100; Farley et aI., 2003). Yet Weitzer (2004) states, IJlndoor prostitution typically involves much less exploitation, much less risk of violence, more control over working conditions, more job satisfaction, and higher self-esteem." He defines exploitation as extreme physical coercion, ignoring psychological violence. He fails to define what types of control are exercised over the "working conditions" of prostitution. Job satisfaction and self-esteem are undefined by Weitzer, who also fails to notice the silence created by the lack of research on this subject. In a recent newspaper editorial, Weitzer (2004) proposed a two­ tiered system of prostitution decriminalization. He recommend­ ed keeping prostitution indoors and out of sight while at the same time prosecuting those committing the IJnuisance prostitution" that happens outdoors, on the street, and in plain view. These are critical issues because the current argument of sex industry advocates is that decriminalization will mysteriously provide prostitutes greater safety and greater job satisfaction. Just how safety will be brought about by decriminalization of prosti­ tution has never been clearly articulated, much less empirically assessed. Weitzer's support of massage parlor prostitution-one type of indoor prostitution-surfaced in the context of newspaper reports about a series of arrests connected with massage parlor prostitution in Louisville, Kentucky. Although there are numerous

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Farley I REPLY TO WEITZER 957 reports that residential brothels and massage parlors are locations to which women are secretly trafficked from other countries and used in prostitution (Coughlin, 2004; Dopp, 2003; Matier & Ross, 2004; Wallace & Zamora, 2004), Weitzer has argued that a police focus on massage parlors is unwarranted from the standpoint of public safety (Adams & Riley, 2004, p. 2). Does public safety include women trafficked into prostitution? Legal service agen­ cies for immigrants, battered women's shelters in Louisville, and federal agencies are aware of criminal trafficking networks that move Asian and Latin American women from one indoor prosti­ tution location to another on a Midwest prostitution/ trafficking circuit (see www.PolarisProject.org). Women and children can be controlled in indoor prostitution in ways they cannot be con­ trolled on the street. They can be locked in their rooms, heavily drugged, restrained, and beaten. Pimps who run indoor prostitu­ tion are no less dangerous than pimps who are visible on the street. Weitzer nonetheless supports men's rights to access women indoors: "Street prostitution is the problem; indoor prostihttion is much less of a problem/' and "I would lean toward saying that massage parlors-especially if they do not advertise in terms of signage and are fairly invisible-have a positive effect in terms of providing a service that clearly men want" (Weitzer, 2004). These comments fail to account for the empirically demonstrated psychological harm of prostitution, wherever it is perpetrated. Despite this evidence of harm, Weitzer sympathizes with and sides with the needs of the trick. If we read between the lines, techniques for harm reduction in prostitution are indicative of the physical and emotional dangers of indoor prostitution. The same sexually invasive dehumaniza­ tion occurs, regardless of the physical location of prostitution (Anderson, 2005, p. 13). For example, a San Francisco organiza­ tion suggests the following:

Be aware of exits and avoid letting your customer block access to those exits ... be aware of where your client (trick) is at all times, as much as possible ... shoes should come off easily or be appropriate for running in ... avoid necklaces, scarves, across-the-body shoul­ der bags or anything else that can be accidentally or intentionally tightened around your throat. (St. James Infirmary, 2004, p. 172)

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958 VIOLENCE AGAINST WOMEN I July 2005

Regarding negotiation with tricks, COYOTE occupational safety recommendations include these:

Have a time limit for each service--if a customer can't come within a reasonable period, he's costing you money by preventing you from seeing other customers. His failure to get off may also make him agitated or violent [italics added]. [And] use some mentholated salve (for chapped lips, colds) in­ side your nostrils-you'll smell the customer less when you give head. (St. James Infirmary, 2004, p. 173)

At the 15th International AIDS conference in Bangkok (July 2004), several sex worker groups presented information about the occupational health and safety of prostitutes. Members of Bang­ kok organization EMPOWER instructed women in bar prostitu­ tion (one type of indoor prostitution) how to insert and pull out razor blades from their vaginas. This is understood to be a job requirement in the bar-show setting where tricks are sexually excited by the possibility of the genital mutilation of Thai women (J. Oriel, personal communication, August 10, 2004). Describing seemingly banal harm reduction techniques, New Zealand issued a 100-page guide for sex workers (New Zealand, 2004) which included information on repetitive strain wrist inju­ ries from masturbation of the customer by the prostitute, warn­ ings to carry a flashlight to inspect customers for STDs, and instructions for setting up a brothel. Traditionally, an overall strategy for addressing harm reduc­ tion among drug addicts includes three components: (a) reducing the harm (e.g., clean needles so that HIV is not transmitted), (b) reducing the demand (e.g., providing immediate and accessible addiction treatment), and (c) reducing the supply (e.g., arresting drug dealers and narcotics traffickers). See Ministerial Council on Drug Strategy (2004). When prostitution and sex trafficking are addressed, it is usually only the first component-harm reduc­ tion-that is considered. Recent thinking, however, is that an overall strategy regarding prostitution/sex trafficking should include all three components, just as all three are included in addressing the addictions. We need (a) harm reduction tech­ niques such as female condom distribution programs, (b) mea­ sures to reduce the demand for prostitution such as arresting

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Farley / REPLY TO WEITZER 959 tricks, and (c) measures to reduce the supply of women in prosti­ tution such as providing what women need in order to escape prostitution or monitoring borders for pimps and traffickers (H. McDermott, personal communication, January 26, 2005). Some have alleged that decriminalization of prostitution reduces its harm. The city of San Francisco has recently begun implementing de facto decriminalization of indoor prostitution by transferring supervision of massage parlors from the police department to the health department. Inspections of massage parlors will be much like inspections of restaurants. By removing police jurisdiction over massage brothels, San Francisco increased the vulnerability of all women in indoor prostitution. Yet some of the dangers of indoor prostitution were revealed recently during hearings held by the San Francisco Commission on the Status of Women (CSW) regarding the "labor and safety conditions of exotic dancers." San Franciscans Terence Hallinan, an attorney for the Mitchell Brothers strip club, and Willie Brown, an attorney for strip club owner Sam Conte, were previously the district attorney (Hallinan) and the mayor (Brown) of San Fran­ cisco. Beginning in 1996, Hallinan and Brown defended the rights of sex industry pimps to build private booths in strip clubs. According to testimonies of many women in 2004 to 2005 before the CSW, increased privacy in the booths and increased physical contact in strip clubs also increase sexual assaults against them. Thus while the private booths increased the women's vulnerabil­ ity to rape-at the same time the booths permitted increased pro­ tection and anonymity for the tricks who used women in indoor prostitution. Defining prostitution as a job, the CSW floundered in its attempts to discover how they might improve "working condi­ tions" of women in prostitution. Should they recommend that private booths be outlawed, even though some women (who were accompanied by club owners) testified that they made lots of money in the booths? Should they recommend that booths in strip clubs must have no locking door-only a curtain-or that the booths must be videotaped or that the walls of the booths could only be 3 ft high? Should they install panic buttons in the booths? One woman testified that she was forcibly restrained from pressing a panic button while a customer raped her. Despite

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960 VIOLENCE I\GAINST WOMEN / July 2005 evidence of harm, the commissioners attempted to construct prostitution as a job like any other. Yet it was apparent from the women's testimony that the strip club owners and pimps would resist any attempt to limit prostitution or their profitmaking. The pimps disconnected video cameras, installed locking doors on the booths, and collected II stage fees" ($550 per weekend night at the Mitchell Brothers) that put economic pressure on women to pros­ titute in the private booths rather than just strip but not prostitute, as some women preferred to do. One club owner commented, "We would not be able to make money just with lap dancing. That's not what [customers] come for. They come for a one-on-one experience with a beautiful showgirl" (Romney, 2004).

THE EMOTIONAL HARM OF PROSTITUTION IS ESPECIALLY INVISIBLE

Despite the fact that my article in Violence Against Women pre­ sented analyses and research regarding the psychological harm of strip club and massage prostitution, Weitzer, like some others, continues to ignore the psychological reality of those prostituted, focusing only on the physical violence of prostitution. Although the physical violence of prostitution is brutal and pervasive, it pales in comparison to the emotional trauma of pros­ titution. Employing egregious stereotypes about women in pros­ titution, Weitzer has described prostitutes as "hardened to the ways of the street" and "difficult to intimidate" (Weitzer, 1994, p. 123). On the contrary, my observation during the past decade has been that women in indoor and outdoor prostitution often appear shell-shocked and numb with terror (which I suppose could be misinterpreted as "hard" if you're not looking atthe situ­ ation through her eyes). Attempting to explain what time was like when prostituting on the street, one woman told me that "it's like a second lasts for a year." This slowed-down passage of time occurs in situations that are life threatening or overwhelmingly stressful. The "paid rapes" (that's what one woman called the acts she performed for tricks in prostitution; she never called it sex) feel like the same psychological state she was in when her [male

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Farley / REPLY TO WElTZER 961 relative} sexually assaulted her in childhood. Women in prostitu­ tion sometimes reason to themselves, "That's what I am, so why not get paid for it? I might as well get paid for what is going to happen to me again, anyway." Pimps and tricks use that fearful logic to recruit women to prostitution, exploiting each woman's private despair and each woman's deep awareness of her lack of safety from sexual assault in our culture. From decades of research, we know the devastating and long­ term psychological effects of rape are not diminished if she is paid for the rape or if the rape is named working in a massage parlor. A hallmark of the PTSD that frequently results from prostitu­ tion is a chaotic emotional volatility that alternates with numb­ ness. Confused, one woman wrote about her experience in strip club prostitution:

Out there, you heard them; they sounded like wolves, you could breathe them ... my God; there was this wall of sweatvwhite faces, open-mouthed, glistening with booze, hate and fea;. Yes-fear. I used to feel almost detached, sometimes, going through my rou­ tine, and-I couldn't help myself-looking into the punters' eyes (the part of me that wasn't scared shitless, that is). And they bewil­ dered me, more than anything else. I felt like stopping the show and saying, "Listen: what's happening here?" (Roberts, 1986, p. 83)

We have much more to learn about prostitution, especially men's thinking about and demand for prostitution. In addition to focusing on tricks' attitudes and predatory behaviors, future research should focus on indoor prostitution. We should describe locations where all respondents have ever been prostituted. Tricks should be asked where they have purchased women or men in prostitution. Because a researcher interviews a trick in the street, one cannot assume that his prostitution activities are exclu­ sively street prostitution. He may also purchase women indoors. Similarly, because a researcher interviews a woman in street pros­ titution, one cannot assume that her prostitution activities have not also included escort or massage prostitution. We should avoid stereotypes about pimps, who often work indoors. Pimps can be women or men. Sometimes pimps deliber­ ately exploit the shame associated with prostituting. Stating that she was not the type of pimp who "enforces the rules with a

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962 VIOLENCE AGAINST WOMEN I July 2005 baseball bat," one pimp explained that when one of "her girls" failed to show up for work all day, necessitating cancellation of thousands of dollars worth of appointments, she knew how to makethe woman "want to commit suicide by the end of the week­ end." In one instance, the pimp telephoned the young woman's boyfriend, informing him that his longtime girlfriend was a pros­ titute and prepared to send a CD of the young woman's promo­ tional pictures (likely pornography) to her family (Jacobs, 2004). Indoor prostitution, above all, protects the trick. Men are physi­ cally and psychologically safer when prostitution is indoors. Weitzer and others who support indoor prostitution contrast it with street prostitution on the basis of indoor prostitution's invis­ ibility to the community, sometimes referring to it as discrete. This perspective ret1ects the interests of tricks for privacy, anonymity, and constant access to women in prostitution with minimal risk of arrest even in locations where prostitution is illegal. Yet 89% of 854 women we interviewed said that they wanted to escape prostitution. They did not specify that they wanted to escape street prostitution. Rather, they wanted escape from all prostitution, including indoor prostitution. Indoor prostitution, like other prostitution, is profoundly harmful. What is wrong with prostitution cannot be fixed by moving it indoors. The same harms are there whether she is in a trick's house, a back alley, his car, or a room at a hotel. And the same physical violence occurs whether it is in a pimp's massage parlor, the private booth of a pimp's strip club, a pimp's legal brothel, or on a pimp's street turf. The same psychological violence occurs indoors, too-none of that changes based on the location of the prostitution. She still gets called those vicious names while he is masturbating in her, those names that as one woman said, "cut you like a knife," so that she has to get high or she must dissociate to tune out the poison. Weitzer's apologetics for and evasions of this reality cannot obscure it or change it.

REFERENCES

Adams, J., & Riley,]. (2004, July 11). After spas' boom, enforcement affects illicit sex busi­ ness. Louisville Courier-Joumal, pp. 1-2. Anderson, M.]. (ZOOS). All-American rape. Sf. John's Law Reviezu, 79(3), 1-13.

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Farley / REPLY TO vVEITZER 963

Baral,I., Sezgin, U., & Farle)~ M. (1998). TI1e traumatic consequences ofprostitution in Tur­ key. Archives of NeuropsyclzU1try, 35(1), 23-28. Coughlin, M. (2004, January 15). Spa workers charged with prostitution. Philadelphia Reporter. Accessed January 17, 2005, from http://www.thereporteronline.com/site/ news.cfm?newsid=10811271&BRD=2275&PAG=461&depUd=466404&rfi=6 Dopp, T. (2003, May 1). Sex slaves smuggled into New Jersey. Express-Times. Retrieved December 20, 2004, from http://www.nj.com/news/expresstimes/nj/index.ssf?/ base/news-2/1051779849166850.xml Farley, M. (2004). "Bad for the body, bad for the heart": Prostitution harms women even if legalized or decriminalized. Violence Against Women, 10, 1087-1125. Farley, M., Baral, I., Kiremire, M., & Sezgin, U. (1998). Prostitution in five countries: Vio­ lence and post-traumatic stress disorder. Feminism mzd PsychologJj,8, 415-426. Farley, M., Cotton, A., Lynne, L Zumbeck, S., Spiwak, E, Reyes, M. E., Alvarez, D., & Sezgin, U. (2003). Prostitution and trafficking in 9 countries: Update on violence and post-traumatic stress disorder. In M. Farley (Ed.), Prostitution, trafficking, and traumatic stress (pp. 33-74). Binghamton, NY: Haworth. Jacobs, A. (2004, October 12). Call girLq, updated. New York Times. Retrieved November 30, 2004, from http://www.nytimes.com/2004/10/12!nyregion/12madam.html?ex= 1098599063&ei= 1&en=20de55812ce4a4a7 Matier, P., & Ross, A. (2004, October 25). S.P. parlor hi t in crackdown on sex-slave trade. San Francisco Chronic/e, p. Bl. McKeganey; N., & Barnard, M. (1996). Sex work on the streets: Prostitutes and their clients. Buckingham, Scotland: Milton Keynes Open University Press. Ministerial Council on Drug Strategy. (2004). The national drug strategy: Australia's inte­ grated framework 2004-2009. Retrieved January 25, 2005, from http://www. nationaldrugstrategy.gov.au/pdf/framework0409.pdf Monto,M., & Hotaling, N. (1998, April). Rape myth acceptance among the male clients offemale street prostitutes. Paper presented at the annual meeting of the Pacific Sociological Asso­ ciation, San Francisco, CA. New Zealand. (2004). Prostitutes get "how to" guide. Independent Online. Retrieved August 4, 2004, from http://www.iol.co.za/index.php?seUd=1&c1ick_id=29& arUd=qw1091360343464N245 Roberts, N. (1986). The front line: Women in the sex industry speak. London: Grafton. Romney, L. (2004, December 19). Weighing strippers' rights. Los Angeles Times. Retrieved December 28, 2004, from http://www.latimes.com/news/local/la-me-stripper19dec 19,0,7233162.story?coll=la-home-Iocal Ross, C. A., Anderson, G., Heber, S., & Norton, G. R. (1990). Dissociation and abuse among multiple personality patients, prostitutes and exotic dancers. Hospital and Community Psychiatry, 4.1,328-330. St. James Infirmary. (2004). Occupational health and safety handbook (2nd ed.). San Francisco: Exotic Dancers Alliance and STD Prevention and Control Services of the City and County of San Francisco. Valera, R. J., Sawyer, R. G., & Schiraldi, G. R. (2001). Perceived health needs of inner-city street prostitutes: A preliminary study. American [oUInDI of HeilIth Behavior, 25, 50-59. Vanwesenbeeck,1. (1994). ProstitlItes' ,ucll-beingand risk. Amsterdam: VU University Press. Wallace, B. (2004, January 23). Prostitution raids in 4 San Francisco homes. San Francisco Chronicle. Retrieved January 30,2004, from http:/ / sfgate.com/ cgi-bin/ article.cgi?fiIe= / chronicle! archive/2004 /01 /23/MNGTA4GD2K1.DTL Wallace, B., & Zamora, J. H. (2004, January 24). Sex trafficking mthless, lucrative: Brothels proliferate despite crackdowns. Sal! Francisco Chronic/e . .Retrieved January 10, 2005, from http://www.sfgate.com/cgi-bin/article.cgi?file=/ c/ a/2004/01 /24/ MNGU84GUJOl.DTL

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964 VIOLENCE AGAINST WOMEN! July 2005

Weitzer, R. (1994). Community groups vs. prostitutes. The Gauntlet, 1(7), 121-124. Weitzer, R. (2004). Why prostitution initiative misses. San Fmncisco Chronic/e. Retrieved September 29,2004, from http://www.sfgate.com/cgi-bin/article.cgi?file= ! chronicle/ archive/2004/09 /26/INGAG8T3GP1.DTL Weitzer, R. (2005). Flawed theory and method in studies of prostitution. Violence Against Women, 11, 934-949. Zumbeck, S., Tecgen, E, Dahme, 8., & Farley, M. (2003). Posth'aumatische belastungs­ storung bei prostituierten-Ergebnisse einer Hamburger studie im rahmen eines internationalen projektes. Zeitscllrift far Klinische Psychologie Psychiatrie und Psychotherapie, 51, 121-l36.

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I' II A This is Exhibit L mentioned and relerred 10 in the alildava 01 r. m i.- /1 $. >41 ;1- ,.~.' .. '~'-- Sworn before me this_'_dayof ;'??"'J A.O.ZQ,ff F; ,-/e.7 ACommissionerfortakingaffidavils ~~.

Prostitution and the Invisibility of Hann

Melissa Farley

SUMMARY. 'l1lc harm of prostitution i~ socially invisible. and i! is also invisibk in the law, in public health. and in psychology. This article ad­ dmsses (lrigin$ of thi~ invisibility, how words i.i1 eurrent usage promote the inVisibility of prostittni()n's hann, and how public he,)lth perspCt> lives and p~ycho!ogieal theory lend to ignore the harm done by men 10 women in pn,stitution. Literature whith documents the \wcrwhelming phy;;k;a! and lWycholi.)gica! hnrm to thpsJ:: in pm:;litulion i1i summarized here. The inlcn;onnc(tedlle~$ ()r racism. cqlonialism, and child sexual ns­ .~ault wIth prostirution is diseu';i>ed. i/lr!h'le ci)pics iil'oiiahh: fiJr <'t p:e ji-Ofl1 The fimmrth /)()CUlIW!lf Deh'very S(?rvic,:.~ i ·S(J{)·HA l,VORTH DmiJil (l{idress: ~-:'5!;c;infa(wfu.iH'{JI1Jipressilv,{·O!if;~ \.V'id)slw: {() 20(J3 l.ry 7Yle iifH.'}'{'f!1h Pn}S5, Int'. /\l! F(~hfS tc,~;<,rve(LJ

KEY'WORDS. Prostitution, domestic violence. rape, PTSD. torture

liVTRODUC110N ProsLltmi(Jll is sexual violence which re:-u!ts in economic profit for perpctrarors. Other type,s of gender violence. such as incc'.st, rapt. Clnd

pr::)jCt~t ;; ~r the S;m FrtHl.{it,co \Vonl~t1; 5 Ccntcr~~ hv:" and \\iith Kais:::,r Foundation R~:"i..:w(:h h,ti(m~. O'I~Jalld. CA, to: lVlcli:"aFatiey. PhD. p, 0, Bux I 615·t S;!.i\ Frannsw. CA 941} 6,"{}25;~ (E·:·nla~i:, nlt~n':.;:y(~'prGsttn~'(;tu.'C~earc!~,{~9nl}. . . 1 f'H""> arudc t.s dc.dtCMt~G k~ A,ndrca I.1\vorkul, \>vHh lovi..! Hnd grc;,\t ~pprtt~m!.lOrL

flfJw1)nil ""-""";.",,,,>"HHy l'l(jh::l~ ·T'!"~)':'>:;H.Hl{"ln ~Hld th~! tn,>':{s,J:"1ilny t)f IhtiTc" f:·~Hk.:".,. Meii:.,s;" C{~_PV~~h .,-.;; (Th4.: HiPl.'orth Prt."~,;,-, ko.;,.l \'vL lh. :':0. 3/.cl, 2~jO:t_ 2·1.7 2)\{); "wd. Wvr.,-::'fI \1·;th Vn:ihi.(.: <~nd If;,>hd;fc A!Ni1ii~/(' hf<:.rS(,o:'oH.'i. l~4utli,j1j1' ';:san. Tho', :Vhl't!n E. B-zm};<;. ~ll'hi {~~liyr. Ka'H:iHkj""["{H: HI.lW~}rt"h F'rr.::$;\. hw., 1nO.t ':~t7":Xt1 • .s;n{d~' IX N;ll~\" :~f l~W, :u'tt<:k ,E'; t.1\'a~!'!bk Ifn :! t.." ..... h(Hn Til\,." !h1\vj~tt!1 S"~-iVl('t" l,}:Ofi ~un ,.:"t"J{~ r lH (L')Tf F· m,;:tI 14449

2-18 WOA1EiV Wl7H VlS'lBLE AND INVf5"fBLE DlSABfLITlES

',',ife-beating, are hidden and frequently denied, but they are not sources of 1'11:1% revenue, Like slavery, prostitution is a lucrative form of oppres­ sion nfhurnan beings, l"ihmy governments protect commercial sex busi·· ne;:;~es because of the monstrous profits. Institutiril1s such as prostitution and slavery.\,vhich have existed for thousand!; of years, are so deeply embedded in cultures that they become invisible. In Mauritania, for cxan';ple. there are 90,000 Africans enslaved by Anlhs. Human rights activists trHvel to Mi\Uritania to report on slavery, but because they do not observe the stereotype of what they think slavery should look like·-if they don't see bidding for shackled pe.ople on auction blocks-­ they conclude that the Africans \vorking (in slavery) in frollt of them are voluntary laborers who are receiving food and shelter as salary (Burkett, 1997). In a similar way, if observers don't observe the stereotype of "hann­ fur prostitution, for example, if they do not see a teenaged girt being trafficked at gunpoint from one country to another. jfwh'lt they sec h; a :;tn'elwise teenager who says. "I likc this job, and Fm making a 10( of monev," then they don '( see the harm. Johns (customers) gO to Atlanta, !\m"t~rdam. Phn~)m Penh, Moscow, Capetown, or Ha~ana and SEC smiling girls and women waving at them. Customers decide that prosti­ tution is 11 free choice. The social and legal refusal to acknowledge the harm of prostitution i<; stunning. Normalization of prostitution by researchers, public health and the lal;\, is a sifmificanl. barrier to addressirH.! the harrn of prostitution. For example, the Int~~rnati<)nQl L,abor Organization dc­ scnlx:d pro~littltion as the "sex seclor" of Asian economies in spite of their own surveys v:hich indicated that. in Indone~ia, 969;, or those interviewed wanted tn leave prostitution if they could (Lim. It m;lke~, no sense to oppose trafficking on the one hand. and pm­ mote the "consensual sex sector" or "dmllncrcial sex work" on the ,)ther. One eannot exi scI without the other; trafficking is the marketing or nrostitution. . To assume that there is consent In the cascoI' prostitutkm, is 10 disap­ pear harm. Social and kgal assertic.H1. that there is consent involved in women's oppregsion is nOl new. Rape laW. for example, cOlnmonIy wheth~;r ()r not the woman consented to any sexual act, than asking if the rapist obtained her freely given affirmalive permission without vcrhai or physical coercioll_ In situations of domes­ tic violence. the olJeslio!1 is ni'tcH "whv did she a~rCe to stav in tbe rela­ rafhcr'than "he)'.,v did hi.: ~ut ofT hcr'"physic<}l ;nd psycho· ability to safely escape?" And in Gt~es of sexual harassment, the 14450

lt1efissa Farh'.': ]49

question is "did she invite, provoke, or welcome the behavior?" rather thal1 "did he use his position elf authority to compromise her ability to re­ sist?" Ji.lst as \ve have not moved beyond the obstacle of consent f(l[ raped, hattcrcd, or sexually harassed women. S() ..ve arc ahm still at ground l.ew where prostitution is concerned. l The line betw(:''erl coercion and consent i;; deliberately hlurred in prostitution. The politician';'. insis­ tence that prostitution is consensual parallels t.he john'sinslstcl1ce that mutuality occurs in prostitution. In prostitUlion. the conditions which make genuine consent possible arc absent: physical safety. cquulpower with cuslOmers, and real alter­ natives (Hernandez. 20(1). One woman in ,Amsterdam described pros­ iitution as "volunteer slavery," a description which reflects b01h the appearance of choice and the coercion behind that choice. Instead Qf the question "did she consent?" the more relevant question would be "did she have real alternatives to prostitution for survival?" As \VC will dis­ nlSS hclow. it is 11 S[Ulislical, as well as an ethical, e11'qf to aS~lIme that most women in prostitution consent to it. There is no mUilwliry of consideration or pleasure in prostitution. The purpose of prostitution 1~ to make sure that one person is objeCT 10 the other's subiecl. to make sure that one person does not nsc her per­ sona! de!iir,~ (0 determine which sexual acts do and do no! occur. while Ihe nthcr person acts on the basis of his personal desire.. This is in stark contrw;t to 11001-commcrcla! promiscuous, anonymous s.ex where both act on the basis of personal desire, and both p~trties arc free to re­ traGl wiJllOul economic consequences (Davidson, 1998). ~

lNV1Sl1llUTY

'-Vords which conc(;.nl harm lead to confusion about the real nMme of Sorne \vorcls in carrem u::;age mflKc the harrn of prostitution 1l1\isib!e: mlwuory proslitution which implies that she consented when. usually, she acwal1y had no otheroptioilS w survive;/i>r(:ed [tal whidl implieS tbat somewhere there are womerl who vo!unte.er to be trafiicked into prostitution: and sex \vork, which defines prostitu­ lion as it rather than an act of violence against women. The term mi· gram ,ex worker blends prostitution and trafficking and implies that both arc acc(~ptable. The Chinese words beawifi.t! merdulIldise benevo- C()lKCai the objcctilkatiOll (if v,omen in pr~)stitulion. The cxprc::;siol1 disadviJntoged ,1'01111:'11. (ostensibly used to avoid stigmatizing

-' 14451

250 WOlviEN WON FISIBLE AND iNWSlBL£ DlSAB!UTiE~ pro~titutes) removes any hint of the sexual violence which IS intrinsic 10 prostitution. Libcnari,m or postmodem idcoOlogy ob~curcs the harm of prostitu­ tion. defining it as a forrn of sex. The harshest sexual exploitation in strip club prostitution has been rei'rarne.d as sexlial expression orfj'eedom j() express (J1lt"S seNsuality by dancing. I3r01hds are. refem:d to as short­ time him:!s, massage /Jorlors, saunas, and sometimes health duhs. Older men who huy teenagers for sex acts in Seoul chll prostitution compellsaled dating. In Tokyo, prostitution is described ,:omen cal! customers. Pimps are described as ho)j'rienJs or managers. One pimp recently re­ ferred to the hrier~he~f l(t'i' of a girl 111 prostitution. What that means is tIUi! he knows the extent of the damage in prostitution, flnd realizes thaI she w1H not be saleable after a few years. In the United States, the ex­ pression 'ho reflects the widely accepted view of all women. and espe­ ciallv 'Women of Color. natural-horn whores.:; \VOlnen in prostitution ,u'e called escorts, hostesses, strippers. and Sometimes these words are attempts by women in prostitution to retain some shred of dignity. The purpose of exposing these words is not to remove women's inherem dignity and worth, btlt to expose the brutal institmion which harms them. Wh"H worels can be used, without insulting women in prostitution? The expression sex vmrker implies that prm;titution is an accc:ptablc type of work (instead of brutal vio­ le-nee). We do not rder to battered women as "bartering workers." And as we would not turn a woman into the harm done to her (we don'! !dee to a woman who ha:; been hatkyed as a "baneree") we should no! call a woman \\ibn has been proc;(ituleti, a "prostitute." We re­ taininll her humanity bv referring to her ai' a '\vornan who is il1 proslilI!· liofl, \~ho \ViiS pros/ftulcd, or wh~) is pmstifuting.We also usc [he word '~ohn" '.Iillieh is the word women themselves usc 10 refer to customers. The lines berwl:cn prostitution and l1onprosiitminn have become in­ crea~ingl y b! urrecl. Sin.ce the 1980$. there h1.1S b,,\cn htl gc growth in so­ ciallv lelriLi mized pimpin£ in Ihc United Slates. For exarnplc. the atYlOlH1i ofpliysi~al contaCt berwc~n siripclub employees and customers has esca­ lat.ed since 1980. CllS[()merS can usually buy either a tahle dance Of a lap dance \vherc the dancer sits on the cuslotner· s lap while she wears fe\v or no clothes and grinds her genitals against his. Although he is ciorhec, he usually expects ejaculation. 'rile lap Janee may wke place on the main noor of the dub or in a privat~~ room. The more private the sexual 14452

251

performance, the more it costs, and the morc likely that violent sexual harassment or rape will OCCUL

Pervasive invisibility oflhe Violence in Prostitution

Despite the faCl that prostitution is an in.~litution in which one person has tl1(; social and economjc power (0 transform a human being into the living embodiment of a masturbation fantasy (Davidson, 1998), psy­ chotherapistsand the public alike collude in vicv/ing prostitution as ba­ nal or denying its harm aitof!,cther. ProstitutiOl; formalizes w7mlcn' s subordination by gender, race, and <:lass. Povenv. racism. and sc;"ism are inextricablv connected in prosti­ tution. \Vnm~',n are purchased hecause they are vt;lnerable

"1',;c'''II'''(I''''"I';Y1P'',,,.,,",,,\\.. tt:: .. t J F~' L''::>' ~ • ~. " Tht; physically and psychologically harmful effects of strip dub prostitution have no! been addressed. Th,,; level of hnrassmelH and php­ lCil! ,t;;SilUlt of \Vomen in ~tTin cluh prostitution has drasticallv increased in the' past 20 years. Toucl;ing, grabbing, pinching, and fingering of dancers removes any boundary which previolls!y existed between dane· mg:. stripping. ,md prostitution (lj.;.wis, 190S). Hoi;;;oppie (1998) dncu- 14453

152 WOlvf£N WITH VISIBLE AND INVISIBLE DISABILITIES lYlcl1!ed the verbal, physicaL and sexual abuse experienced by women m strip club pro;,;titution, which included being grabbed on the breasts. and genitals, as weI! as being kicked, bitten, slapped. spit on, and penetrated vaginally and anally during lap dancing, Sexual v!91ence a.nd physicaJ iissauh are the normative experiences for women in prostitution, Si !bert and Pines ( ! 982b) reported that 70'/(; of women in prostitution wen:: raped. The Council for Prostitution Alter­ narives in Portland reported toat prostituted women were raped M aver­ age of once a \vt'oCk (Hunler. 1994). In the Netherlands. 600/l' of prostituted worllen suffered physical i.issaults, 70C;{ experienced wrba! threats of phy,~ical assault, 40%, experienced sexual violence, and 40l1ohad bee.n forced into prostitution and/or sexualitbuse by acquaintances (Vanwesen­ beeck, 1994), Most young \vomen in prostitution were abUSed or beaten by pimps as well tis johns. Eighty-five percent of women interviewed by Parriott (1994) had been raped in prostitution. Of 854 people in proslitu­ tion in llinecountries (Canada, Colombia, Germany, Mexico, South Af­ rica, Th,~iland, Turkey, United Stares, aHd Zambia), 71 CJt had experienced physical assaults in prostitution, and 62% had bee,t1 raped in pros[itu~ dOll, Bighty-nine percem of 854 people in prostitution from nin(>c.oun~ tries interviewed by Farley el at \in press) stated that they wishcti to kave prostitution; but did n.ot have', other options, For these peopk:, the, proslitHtion as consenc:;uul makes their deKirc to leave prostitu­ (ion iuvisible, Tn another siudy, 94% of those in street prostitution had exp~:rienced sexual ass<:!uH and 75£;1(1 had been raped by one or more jnhns O'vlilkr. 1995), . Summarizing the literature on different types of prostiTUtion, Farley (~i aL (in have found that 100% of lhoc;e in prostitution experi­ ,'need sexual harassmcnt which in the United Slates \vould be legally ac­ tionable in lmy oUlcrjob seuing. Sixty to ninety percent had been sexuaUy nssaulted il$ children, Seventy to ninety-five percenl were, physically as­ saulied in prostitution. and 0)1*. io 75(;'~, were raped in prm;titution. Sev .. percc.nt of those in prostitution had been homele;.;s ut some in their !lve;;, Vartwesenbceck (1994) found thaI lWO factors were Jssociated with greater violence ill prostitution, The greater the poveny, the grealer the, and rhe longer one works in pn}slifUtioll the more likely one is violence. I.ike Vanwesenbeeck. we found thut \vomen the most extreme violence in prostitution Were not in Ollr research. it i.s likely that ali of the aforementioned es­ linmtc:s of violence arc cUllscrvali vc. and that the actual incidence of vi- otcnce is than \,vhat is reported here, 14454

Mi!lissu Farley

The most relevant paradigm availahle in psychology for understand- the harm of prostitution is that of dornesttc violence, Prostitution is l/f)l1u:stic violence, Giobbc (199l) compared pimps and batterers and found simil£llitics in the ways they llsed extreme physical violence to con­ tro! women., the ways they fotted women into sociai isolation, USt'(l minimization and denial, threats; imimidation, verbal and sexual abuse, and had an attitude of ownership, The techniques of physicaJ violence uscd by pimps are often the same as those used by batterers and £Qrturers. A majority of prostitution is pimp-controlled. Recruitment of young women inlo prostitution beg-inti with what San'Y (1995) has called se{/~ .wming-·brutnl violence designed 10 break the victim' s wi 11. After physical contra! is gained. pimps use psychological domination and brainwashing. Pimps esil1blish emotional d(~penclency as quickly as possible, beginning with changing a girl's name, This removes her previous identity and his­ tory, and additionaHy, isolates her from her community. The purpose of ph'nps' violence is to convince women ofthe.ir worthlessness and social invisibility. as well as to estab!i:;h physical control and captivity_ Ovcr lime, escape from prostitution hecomes mon~ diJficnlt as the woman is repeatedly overwhelmed with termr. She i,; forced tocomrnit acts which tlrc .'K'xllally humiliating ,mel which cause her to betray her Qvm princj .. pies. The. contempt and violence ail'flCd at hcr arc eventually intt-rml! .. ized, resulting in virulent self-harred which then makcs it even more dink-nIt to defend herself. SnrvivOl's report a sense of contumi nation. of diff(TCm from others, and self-Jo~thing which las! many years ar· rer brerlking [1\V,ly fronl prostitution. Tremn1

254 WOMEN WiTH VISiBLE AND INVISIBLE D1S/'JJIUTlES

The Invisibili(y of Racism aml Colonialism in Prostitutiun

The racism which i& inextricably connected to sexism in prostitution tends to he invisible to most observers, Women in prostitution are pur­ chased for their appearance, including skin color and characteri:;tics based on ethnic stereotyping, Throughout historv, women have been prOstituted on rhe basis of race and eth;;icity, as wei I as gender and class. Entire communities are affected by the racism which is entrenched in prnstinnioll, The insidious trauma of racism continnally Wears aWl:iY at People of Coinr, creating vulnerability to stress disorders (Root, 1996), Families who have been subjected to race and class discrimination might interface \'lith street networks \vhich normalize prostitution for economic survivaL Legal prostitution, such as strip dubs and Stores which sell pornography (that is, pictures of women in prostitution). tends to be zoned into POC}!' neighborhoods, which in many urban areas in the United States" also tend iO be neighborhoods of People of Color, Commercial sex husiilesscs create a hostile environment in which £iris and women are continually hl.irllSsed by pimps and johns, Women and girls are a~,tively recruited by pimps and arc harassed by johns driving through their neighborhoods, There is a similarity betwt~en lhe abduc­ tion into prn:m, st:xism and d.nss is eSlx'ciaUy apparent in sex tourisrn, His· toricallv, t.:oluniuii)';tn ill Asia and the Caribbean nromo(cd a view of '>VonIC!; of Coior as natura i-born sex workers, sC~lla!Iy promiscuous. ;tnd immoral nature, Over tilllC', 'Nomen of Color have come to be V'(;'.vcd a~ "'exotic others" and ,,\'ere defined as inherentlY hypersexual OJ] the t>asis or racc and gender (Hernandez. 2001). T!;c l;rostilUtion 14456

/vfdissa Farlc, 255 tourist denie~ the racist exploitation of women in "native cultures," as in Bishop and Robinson's (1998) analysis ofthe Thai sex hURincss: "Indige­ nous Thai people are :>een as Peter-Pan-like children who arc sensual and never grow up. Sex tourists believe that they are simply partttking of the Thai culture, which just happens to be 'overtly sexmtl. ", He might fee! like H rnHlionaire in a third or flmrth world economy. and rationalize that he is helping women out of poverty. "These giris gNU! eat, don '\ they'? rrf! potting bread on their plate. I'm making ,,1 contribution. They'd swrve to death unless they whored" (Bishop & Robinson, 1998, p. 16B). The Thai perspective of this situ;1tibn is diametrically opposed to that of the pnlstitution tourist: "Thailand is like a stage. where men from around the v;()rld come to perform their rok of male supremacy over Thai women, and their white supremacy over Thai people" (Skrobanek cited in Seabrook, 1996. p. 89). Raciallv-constructed ideas about W()men in sex tourism have a greater an{! gJ"cater effcC! on the ways Women of Color are treated at home. For example., A$ian-Amerit;an women reported rJpes after me.n viewed pornography of Asian women (MacKinnon & Dworkin, 19(7). Once in prostitution, Women of Color fate barriers to escape. these is an absence of eulturally sensitive advocacy services in the Stales. Ot11<.:r barriers faced by all women escaping prostit.u­ tlUll are a lack of~ervices which accommodate emergency needs such H$ sheiters, treatment of drug/alcohol dependence, and treatment of acute post-traumatic stress disorder (PTSD). There is a similar lack of services to address long-term needs, such as treatment of depression tmd other mood disorders. \.:omp!cx posHnnlHHll!c Stf\;~SS disorder (CPTSD). vocational training. and long-term housing.

J1Ul Invisible Continuum: ChiM libuse alld Prostitution

The~ystermuic nature of vioiencc Hf!:ainst girls and women is dearly seen wh~~n ince~;[ is \lnderswod as (:hil~l prostitution. Use of a child for sex ~ldult$, with or vvHhotlt payment is prostitution of the child. \Vben a child is inc~:sw(}usly assaUlted, the peq}Clrawr\; objectification of the child victin:! and his rationalization and denial are lhe same as rhose of the john in prostitution. Incest and prostitution caU$e similar phvsicai and nsvchological synmloms in the victim. . ('hiid S(~xu:ll'ahuse is a prima'!,v risk faclor for prostitution. Familial sexual abuse functions as a trainli;g ground for pn)slitulion. One young '.'/oman told Silbert and Pines (198:2a, p. 488). "T slarted turning tricks to 14457

256 WUME{\' Hi/TN FfSlBLEANV INVISIBLE Di.YAlUUTll:.S s/1O\", my father what he made me'" Dworkin (1997,) described sC7'ual abuse of children as "boot camp" for prostitution. rvlos! women over the age of eighteen in prostitution began prostitut­ ing when they wcrendo!escents. du Plessis, who worked with homeless and prostituted childrc.J1 in Johannesburg, Somh Africa, reported that she could not refuse her agency' Ii services to 21 year olds becnuse she understood them to be grown up child prostitutes (Personal eommLlni­ cdtion, 1997). Ear.ly adolescence is the most frequently reported age of efllly into any type of prostjtution. Boyer and colleagues (1993) inter­ ViC'NCd 60 women prostituting in escort street, strip club, phone sex .. and rnassage parlors (brothels) in Seattle, Washington, All of them be­ gan prostituting between the ages of 12 and 14. !n another sUldy, Nadon, KovewJa, and Schludermann (1998) found that 89% had begun nrostimlion before the age of 16. Of 200 adult women in prostimtinl1. 78% began prostituting 'as juveniles and 68% beg

Mdi.Htl Fude! of 40 women prostilllting in Vancouver had been sexuaHy assaulted as childre.n, by an average of five perpetrators. This lauer statistic (those assaulted by an average of five perpetrators) did not include those who responded to the question "If there was unwanted sexual touching or sexual contact between you:md an adult. how many people in all?" with "Lons" or "I can't count that high" or ;'1 was toQ young to remember." Sixty-three percent of those interviewed \'lere First Nations women. One girl in prostitution said,

We've all been mQiesled. Over and over. and raped. We Were an moksted and sexually ilhused

'I'raumatic sexualization is the inappropriate conditi(ming of the child's BC~Llal responsiveness and the socialization oUno child into tim]ty beliefs and assumptions about sexuality which leave her vulnerable in addi­ llonal sexual exploitation (Browne & Finkelof, 1986), Trallmatic sexual­ ization is- an essential cmnponent of the grooming process for subsequcn! prostitution. Some of the COH$cque.nccs of childhood sexual abuse are behaviors which arc prostitution-like. A common symptom of sexually abused children is sexualized behavior. Sexual abuse may resuliin different be­ haviors at different of the child's development Sexualized be­ haviprs ~lre likely to be prorninem among sexuaUy abused prc;,;cnoo!· children, submerge during the latency years, and then reemerge adolescence as behavior described as promiscuity, prostitution, or sexual agl!tession. The sex~;lly abilse·d child might incorporate the perpetrator'S per­ spective into her identitv. cventua!!v viewing herself as i!:ood for noll! .. i;,g. but SeX, Icvhich ix I;) say, she: j;light adZ;pt hi:;; vic\; [hat sh(~ is a prostitutc (putnam, 1990). Survivors link physical, sexual, and emo­ tioiUll abuse as children £0 latel' prostitution. Seventy percent of the ,iliult women ill pro:;litution m one study stated thai childhood sexual assault \'i,lS brgely responsible for their entry into prostitution (Silbert & Pines, 1981a). Family abux(' and neglect were (h:~scribed ,b not only c;ausillg direct physical and emotional harm, but aiso creating a cycie or vil.:timization which affected their flHures. For example, one woman ~tated lllat by the tint<: $he was 17. 14459

158 WONlHN WITH ViSIBLE Mv[} INVISIBLE DlS,.1BfUFlES

.. all I knew was how 10 be raped, and how io be attacked, and how to be bemt~11 up, and thaI's all I knew. So when he put me 011 the game [pimped her] I was [00 down in the dumps t() do imy­ lhing. Alll knew was abuse. (Phoenix, 1999, p. Ill)

The constricted sense oLself of the sexually of control and power by \vomen who are pmsl.itutlng. The emotional and physical helpJessl1(~sS of the sexually abused child might be reenacted in the prostitution transaction, Wilh Vigilant attention to the tinie~t shard of controL Payment of money kfr an unwanted sex act in prostitution can make the girl or woman fecI more in control when eompared to the Sllme experience with no pay­ ment of m(}Hcy, For example, one woman said that at age 17, ::>he fell safer and more in control turning tricks on the stteet than she did at hom(~ with her $lepfath~:r raping hec Pimps exploit the vulnerability of nmawity or thrown-out children in recruiting them 10 prostitution. 1n Vancouver, 46% of homeless girls had received offers of "assistance to help them work in prostitution:' OneI3-year-old wbo had run away from home was given housing hy a pimp, hut onlv in exchange for nrostitlHiw,L Njn(~ry··six percent of the adults imervi~\-ved by Silbert ,m:l Pines U()83) had been runaway chil­ dren befor(~ {hey bc.grln prostituting. More than half of 50 prostituting Asian tions <\bol1! specific behaviors. (hey responded as follows: :)2

259 prostituting of gay young men in that gay youth may have been thrown out of their homes because of their sexual orientation. Furthcnllore, in many cities, prostitution was the only availahle entry into the gay com­ munity; it .. vas an activitv where bovs could "practice" being gay. Thus, gily adolescent boys might dcvelor; an identity \'lhich links 'lh~i~ sexual orientation to prostitution (Boyer. 198<»).

flE;!Ll'H COIVSEQUElVCES OF PROSI1TUTION

Vialence-Related Physical Health COl/seqaences ofProstitution

Although at first glance, (he public health attention to HIV/STD in­ fection includes the prostituted woman herselL on doser inspeetion it becomes appm~ent that the ovemrching concern ie; for the health of the CU$[Oll!cr: to decrease his exposure 10 disease. i\side from HIV/STD, the physical harm of prostitution to her is invisi ble. In spile of extensi ve documentation that .mv is ovenvhclrninulv transmitted via male-ro~fe­ male vaginal and anal intercourse, not viZ./verso, OI1C ofthe misogynist myth:, about pros ti nil ion is th;J! she is the source of infection. The ~xcltl­ sive focus (lI\ mak customers' HfV risk~which ignorcslhe psydwlogi­ cal and physical violence to women---is a variant of this prejudice agninsi prostitured wom.en. Rape by customers is a primary source of t-lIV infection in women. In the HIV literature ftom 1980 to :2000, most aurhors minimized or ignored HIV risk posed by the customer to the woman in prostitution. Most iliso faikd to mention the option of escape from prostitution. For Karim r:l nl. (1995) interviewed women who pro:;liwledat a truck stop in South Africa. This group of researchers found that women were at a higher risk physicni violence when they insisted on con­ dom ux with customers, whose violence cOf1iribured to their relative tbeir finding that fhe ,vomell ,Ncre at a hi£her risk; for violence. (he researchers rec(~lTImc!l(kJ thaI women in prostitu­ tion lC~I.rn negotiation and communication skills to reduce HIV risk. It seems tragically likely that this particular project (and others ,is well) mighi have resulted in additional injury. even dearh. 10 some: tVomen In prostitution. Globally, the incidence of HIV seropositivity among prostilUted women is Homeless children are at bi!!hest fisk for HIV, for example, in Romania ilnd Colombia. Piot (1999) nOled that half of new /UDS cases arc less than age 25, and tbat girt;; are likely to become 14461

260 WOMEN' \v1Tll VISiBLE Ai'iD !NVJSllJLE DISABILITIES infected at a rnuch younger age than bovs. in p,m because of the accep" tance of vioiencc pcrpet?med~agHjn$tgi~ls and women in most cultures. The invisibility' of wmnen'$ HTV risk, as compared to men's ri$k, has resulted in a lack of attenrion tt) early H1V infection in women (Allen ct aL 1993: Schoenbaum & Webber. ! 993). Allen et al. (1993) investi­ gated HIV risk-assessments in inner-city US women's health clinics and found {hilt despite the presence of HIV infection acroSs a broad age range for both SeXeS, eady HIV infection (notyel AIDS) Was "cOmpl(;~le!y unrecLlgnized among all adolescent, young adult, and older women" (p.367). STD and HIV have increased exponentially in the Ukraine and other former Soviel UniOIl states since 1995. From 1987 to 1995. fewer than 200 new HIV infections per year were diagnosed itl Russia. In the first six month~ of 1999, 5,000 new cases of HIV were repOlted (Dehne, Khodak­ evich, Hamers, & Schwartlander. 1999\. II) the city of Kalinin2.l'ud, one in !llr<..'t;': people infected with HIVwasawoman, aild 80% ofthe infected women ',vere in prostirution (Smolskaya, MomHt Tahkinova. & Kotova. 19(8). It is likely that this massive lncre,tse in mv resulted from an eKlremcly high' rate of violence against women in Russia {Hamel'S, DOWl1ii, Infus(}, & Brunet, 19(8), Women in Russia are trans­ formed into "office prostillltes" via job requirements to tolerate sexual ha· rassment (or in the direct Russian translation. "sexual terror"; Hughes, 20(0). In addition, political restructuring with control of stare agen­ cies hdd by criminals, extreme poverty~ and collapse of health~are systems ('ontributed to the HIV pandemic in Russia (Hamel'S et aI., 1998i. Arkr 1\\10 decadc:-; of research on HIV. the World Health Organiza­ tion (i noretl that women's primm)' riskfiu'rurfor lUll is Ffolenct' (Pim, 1(99). Aral and iVlann (1998) at the Centers for Disease ControL the impon~mc.e of addressing human rights iS$ues in C011- with STD~. They nOled that since most women enter prnstitu­ as a f<:"suh of poverty, rapt:, infertility, or divorce. public health programs !nUS! ~iddress the social factors which contribute to STD/HIV. (:;Gl;derinequality in "my ell/hIre normahzes s(:xual coercion, promoting violence and pn)srirtHiol1, ultimmcly contribming to women's likelihood of becoming HIV·-ini'ected. Kalichmal1. Kelly, Shaboha:>. and Granskaya (2000) and Kalichman, Williams, ChGcry, Belcher, and Nachirnson (1998) noted the coincidence of (he HIV epidemic and do­ mestic violence in Russia, Rwanda, and the USA. Chronic h:alth problems result frorn physical abuse and neglect in childhood (R"d0msky, 1(95). from sexual assault (Golding. 1994), bat- 14462

Meiissa Fwky 261 tefing (Crowell & Burgess. 1996), untreated health probit'lll:', ovenvhelm- ;;;.!ress, and violence (Friedman & Yehuda, 1995; Koss & Heslet, 1992: Southwick. Ychuda. & Morgan, 1995} Prostituted \Vomen suffer from all of these, Many of the chronic physkal symptoms of women in pros­ iiwtion were similar to the physical consequences of torture. The lethal nature of prostitution is suggested by a 1985 Canadian study which found that the death rate of those in prostitution was 40 times higher than that of the genent! population (Special Committee on Pornography nne! Prostitution. ! 9RSt Prostituted wome:n had an increased risknf,,'Crvical cancer and chronic hepatitis (ChattopadhY'l}; 13andyopadhyay, & Dutragupta, 1994; de Sanjosc c! aI., 1993; Naknshima tt aL 19%; Peizer, Duncan, Tibaux, & Mebari; 1992), Incidence of ahnol'lnal P ..ip screens was several times higher than the stale average in a Minnesota study of prostituted women's health (Pantott, 1994). ChHdho(ld rape was associated \'lith incre..1sed inci­ dence of cervical dysplasia in a study of women plisoners (Coker, Patel, Krishnaswami, Schrnidt, & Richter, 1998). Women in prisons are fre,< quently incarcerated for prostitmkm-related acts. We 'lsled 700 people in prostitution in 7 Gountries if they had health pmbleml> (Farley tot a!., 20(0)< AimoSi half of these people in Colombia, Mexico. South Africa. Thailand, Turkey, US/\, and Zarnbia mporh"d sympi0l11s ,vhieh were associated with violence, over'ivhelming stress. poverty, and homeJessness. Physicians' diagnoses of these 700 peupie in prostitudon included tu­ berculosis, HrV, diancles, cancer, al'thlitis, tachycardia, syphilis, ma­ hlria, asthma. anemia, and hc-palilis. Twenty-four percent rt:ported reprodw:!ive syrnptoms including sexually transmitted diseases (STD), ulerine infe.cLlol1!>, menstrual problerns. ovarian pain, abortion compli­ cations, pregnancy. hepatitis B, hepatitiS C, infertility; syphiiis, and HIV. Without spccjJic query about rnent"ll health, !'Jl!" of these 700 pwple in prostitutioil described severe emotional problems: depression, SUl« cldality. tlashb;lcks or child abuse, anxiety and er;treme tension, tenor re­ garding a relationship INith a pimp, lack of self-esteem, ami mood sVlings. Fifteen percem reponed gastroinfesrinal symptoms such as ukers, chronic sH.lluachache, diarrhea. and colitis, Fifteen percent reported ncu­ symptoms such as migraine headaches and non-migraine memory los'\, numbness. seizures, and dizziness. Fourteen percent of these women and children in prostitut.iol1 reported respiratory problems such as asthma. IUl!g disease, bronchi\i:;, and pneumonia. 14463

262 WOMEN WiTH Ii/SIBLE AND INVISIBLE DISABILITiES

Fourteen percent reported joint pain, including hip pain, bad knees, backache~ aI1hrills, rheumatism. and nonspecific multiple-site joinl

Twelve percenl of those who described health problcrns in prostitution reported injuries which were a direct result of violence. For example. a nllmber of WOmen had their ribs broken by the police inlstanhul, a woman in San Francisco hroke her hips jumping out of a car when ,I john was at­ lernpling t.o kidnap her. Many women had their teeth knocked (lut by pimps and johns. 1\1 ilkr (1986) cited bruises. broken bones, cuts and abrasions which fe·suIted from beat.ings and sexual assaults. OtiC \;Voman said about her health:

I've had three broken arms, nose broken twice, [and] I'm partiaily deaf in one ear. , . I have a small fragment of a hone Hoating in my hend that gives lUi..' migraines, I've had a fractured skulL i\~ry legs ain't worth shit no more: my toes have been broken. My bot· tom of my fect, have been bumcd; they've been \vhopped with a hot in)n ilnd clothes hnnger , .. {he halr on mv pussy had heen burned off at 01\e lime. , ~ I have scars. r ve bee;l cut \\;ilh L\ knife, bent with guns, two-by-fours. There hasn't been a place on Iny hody that hasn't been bruised somehow. some way. some big. some f;maIL (Giobbe. 1992, p. ]26)

[n the firsl phase of an in-depth review of chronic health problems rc, sttlLingfrom prostitution, we interviewed IOU \vomen and transgendcred in VHHCOUVCr. Canada. rCl!,arding their chronic h~:alth problems (Farley, Lynne. & Cotton, 200!).~S(:ven~;y-t1ve percell[ of tht:s~ women reported injurie" from vioi.ence in prostitulion. Fifty percent suffered he.ad h~jUlies, The author has found that a majority of women in tution report trauHiatjc head injuries inflicted by johns and pimps. Conum:m symptoms were memory problems (66%). troubk concen­ trating (669c·), headaches {S6(}r.;), dizziness (44%), vision problems (45%), hearing problems (40f;1:), balant.:t problems (41 aching muscles (78';;0, jOint pain (60%), jaw pain (38,};», and swelling of limbs (3Yk).. Sixty-one percent of these respondent::; had coldlt1u symp­ tom:;, Cardiovascular syrnptmm included chest pain (43%); pain/numb­ ness in hand:Jfeet ilTcgular heartbt'iOti (330h); shortness of breath In addilion.C;S% reported allergies and 32'1(1 reponed asthma. TVJcnty .. fouf perc-em fq.lorted both painful menstruation and vClgina! pain. T\venry-threc percenl had breast pain. 14464

163

Some of the health problem~ suffered by women in pros1itulion re­ 'iulted ii'on1 powrty. Although public health agencies in Bombay could obtain expensive drugs (0 treat HlV, they were unable to obtain antibi­ otics ilnd other more "mundane" drugs to tfeat tuberculosis, which was the primary cause of death of \'lomen in prostitution (Jean D'Cunha, personal communication, 19(7). Seventy percent of 100 prostituted giris and women in Bogota rep()ftcd physical health problcms. In addi­ tion to STD, their diseases were those of poveny and despair: aHergies, mspiratory problems {md hlindness caused by glue sniffing, migraines, symplOmsof premature aging, dental probJems, and complications of abortion (Spiwak, 1999), . AdOlescent girls and boys in prostitution surveyed by Weisberg ( 1985) reporkd STD, hepatitis, pregnancies, sore throat:;, flu, and re­ peared suicide aHempts. Women who serviced more customers in pros­ titution reported more severe physical symptoms (Vanwe.senbeeck. l(94). The longer WOlllen \,vere in prostitution, the more STD they fe' por!cd (Parriott. 1(94).

The lw)isibilit)' (if Psychological Symptoms ,4.£llOllg Women in Prostitutit,ill

The a:;sauit on wornen'i) sexuality in prostitution is overwhelming, yet invi!jible to most peuple. When women are turned into objects which men masturbate int,) (as prostitution has been described by Hoigard & Finstad, ! (86), ir callsesimrnense harm t(} the person who is acting as

Prostitution i!nd scxuallibermion have got notbing 10 do -with each other, they're exactly the opposite. I don't fee! fi-ee with my body, I feel bad about it. I fed sclf~com;cious. I don't redllv led like mv body's

in all prostitution there is commodification of the woman's body. This tornmQdiilca!ion often r,:su!ts in internalized ()bjectilfcation, '.vhcrc the pmstituted woman begins to see sexually ohjeclifkd parts of her (n\'l1 body as separate from, rather [han imegral to her entire $<:11'. ThiS pnXt':$s of interna!jzt~d objectification leads to somatic di;;socia­ lion, even ill prostilulion where there is no physical contact between rhe woman and the john. For example, Funari (997) described the effects of peep show prostitution. where she worked in a mirror-walled booth. 14465

2:64 WOM£'N hIm VISIBLE AND INVISiBLE DlSA.BlLITJES naked. i\ thick glass wall separated her from the men, and. when the shutters wenl down men had 10 pay again in order to watch and mastur­ bate. She wrote.

;.'\£ work, what my hand$ find when they touch my body is 'prod­ UCL' Away from work. my body has continuity, intcg1ity. Last night, lying in bed after work J touched my belly. my breasts, They felt like Ctpri' s [her peep sbowname] Imd they refused to switch back. When [her partner I kissed me [inadvertently shrunk from hi;; touch. Shocked, we both jerked away and stared at each other. Somehow the glass had dissolved and he had become one of them. (Funari. 1997, p. 32)

In order to retain her self-respect, Funari resisted emotional connection ,<,vith men who considered her to be essentially worthless. )'et she fclt "poisoned" by the cllIltempl of l'I.!S!Olners. Her sexual feelings for her boyfriend waned. in an attempt to defend the self, women in prostitution al first might make ,I conscious decision 10 disconnect from parts oithe body, Stating "'I save my vagina fonny lover," one woman pelformed only oral sex or masmrbation (Phcterson, I 996). Over lime, hcnvever. this piecing-om of parts ofthe body in prostitution (johns genhis, lovers gel that) results in somatofotm dissociation, \vim the body numbed, considered ni)! -me, the body a commodity, itself tniUlnalically comp(l!1ln<~ntalized in the ilame way thi:\l traumatic affects and memories exist in states of dissoci­ 'lted cOl1sciousnc;-;s. T!lis disconnection between pans d' the whole self is COlnmon among survivors of extreme traUl1'\,i (SCh\,i,Il'!Z, 2000). In prostitution. the continuous assaults on the hody result in physical revulsion and retraumatization, One woman VYTote "lbout her body's re­ sprmse to repeated rape:

I started getting physically ilIwhenever I turned a trid. My vagina closed on me again like it did 'Nhen I \vas ! 5 years old [during a rape J. The men sl,rrred getting reul pissed off abOUt that because it meant no i ntercuU[,se ... One night a man tried 1.0 force himself in- 1;ide of me and damaged his penIs in the process. (\Villiams. 199!. p,77)

!I.·lost women who have been in prostiLUtion for ;111Y length of time ex- sexual dysfunction with their cho;5<:n partm:rs, ,1f(" 14466

265 disconnected frorn sexual acts. It becomes nearly impossible to vicw partncrs as anything bur johns. One woinan said,

I feit like a prostitute every time I got into bed with him. I had lo~t myse.lf in P;'ostilUtiol1 and hl:ld become so \','ell established in my identity and role as a prostitute that once I had stopped I couldn't thcn relate io my lover as myself (Perkins & Bcnndt, 1985. p. 112')

The same sexual trauma whicb occurs whh wnmen in proslituli{lfi also (len!!"s \vith men. As Onc man said,

[prostitution] can destroy your sex life. I had a lover at one stage and there \-vcre times when I'd be haVIng sex with him and I'd nash on to an old man that I'd had the nigl1tbefore and then r d JUS! have to stop. you know. (Perkins & Bennett. 1985. p. 152)

Dissociation occurs during t:xtreme stress among prisoners of 'war who are 10l1ured, among children who are being sexually assaulted, and among women being battered, raped, or prostituted (lIerman, 1992). \Vhen one is prostituted for any length of time, a state of intense, un­ bearable fear develops. Dissociative disrrrdefs, depression, and other lrlood disorders wcre common among prostituted women in SIred, es­ cort, and strip club prostitution (Belton, 1998; Ross, Anderson, Heber. & (\'011011, !990; VmWlcsenbet'{;k, 1994), DissociatiDn in prostitution re­ sults from both dliidhood sexual violence and sexual violence in adult nrostitut!on. The dissociation whith is ncccssarv to survive rape in iJ!'Os,iwtiOll is the same as that used to endure f;;milial sexual assault (Giobbc, 1991; Milkr, 19X6). Vanwescnbeed:. noled thnl"dissocialivc proficiency" contributed to the professional attitudes among women in prostitution iii the Netherlands (1994, p. 1(7). A Th<,i v':()!l'lan "Yem make yourself empty inside" (Bisbop &-. Robinson, ! 998. r 47 j, 1\1oSi \vomc.u. rcoon that thev cannot prostitute uniess thew dissociate. Chemical dissOcl;.;tion aids psychological dissociation. an~l also fU1\(:> lions as analgesic for inji.Iries frorn violence. \Vhen v/omen in prostitu­ tion do nor dissociate. 1i1(:v are al risk for hein£ overwhe.irned with pain, shame, and mge. One wO~lan said. "Thl~ disgt;;';l is difficult to deaJ ~Vilh. I can deal ,vith Ithe johns! individually btl! in allow myself to think of them e,ll ma,;se I feel like ~rabhiI1Q a machine >!un and mowim: the lo! down" (\\'ood, i995, p, 29).~· ~. ~ One woman described the graduaJ development of a dissociated during the years she prostiTuted in sixipclubs: 14467

2(i1\ WOtvfEN WiTH VlSiBLE AND INVISiBLE DlSABIUTiES

y ou ~(art changing yourself to fit a faJltasy role of what they think a woman should be. In the real world, lhese 'Nomen don't exist They slare at you with this starving hunger. It sucks yon dry; yon becom~ this emplv shell. They're not really looking at you, vou're not vou. \{Oll're n;)1 even there. (Farley, un"rmblished interView, 19(8) -

Another worn an described a dissociative response wrhe traUl1UI of pros­ titution:

Prostitution if( like rape. It's iike when I was 15 years old ,\lid I Was raped. I used to experience lea ving my body . 1 mcnn that's what I did when that man raped me. I went to theceilirtg and 1 numbed mvsclfbccause I didn't want to feel what! \vas feelinl!. J was very frightened. And while I was a prostitute r used 10 d;; that all [lie time. I would numb my feelings. I wouldn't eVen feel like I was in my body. I wouid actually leave; fUY body and go somewhere else with my thoughts mId with my feelings until he 201 off and it was Over with, I d(;n't know how c!se IO explain itexc~pt that it felt like rape It was rape to me. (Giobbe, 1991, p. 144).

While the traumatic effects of rape are well established, the (;x tremcly high incidence of rape in prostitution, with resuiting symptom!> of PTSD, is not so well understood. Olwsurvivor said, "For the first few months! worked [in pmstitlltion] I had a lot of nightmares involving ma~s numbers of penises" (Williams, 1991, p. 75). Manv years after escapinl-l from prostitution, an Okinawan '.voman who ha;l been purchased by t)S military pefsOImd during ihe Vietnam war bccarne extremely agitaTed and had visions of sexual abuse

I wonder why I keep going 10 therapists and telling them! can'l. and I have nightmares. They pass right over the fact that I was a prostitute and I was beaten with t\vo·by·four boards, I had my and \oes broken by a pimp. and I was nlped more than :30 limes. Why do they ignore lhal? (Farley & Barkan, 1998, p. 46)

P'fSD is common amOI1£, Dro::;tiwted women. 1n nine countries. ('1 '11. (in press) foum11hat 68(;1, met criteria for a diagnosis (li' <:\ prevalence comparable In battered women :c.eeking: ::;hel!er 14468

Mdissa Fadey

(Houskamp & Foy, J991), rape survivors seekingtreulment (Bownes, 0' Gorman, & Sayers, 1991). and survivors of state-sponsored torture (R.unsay, Gorsr-Uns\vonh. & Turner, 1993). These raks suggest that the traumuti(· consequences of plostitut'ion were sim.ilar across different culnires. There is a myth thar escort and strip club prostitution are safer than street prostitution. This has not been verified by research. We compared street, bwtJiCL and st.ripc1ub prostitution in two cities in Mexico, and found no (jifferences in the incidence of physical assault, rape, childhood sexllal ahuse, or in the percentage of women who \>jantexi to gel out of prostitution. Furthermore, there \\fere no differences in symptoms of PTS1) among \Vomen in these three types of prostitution (Farley ct aL in press], Prostitution is intrinsically traumatizing, wherever it Deems. Vanwcsenbeez:k (1994} rcpo;ted similar rfndings. She investigated emotional distress in women prostituting primarily in clubs, brothels. and windows. Although she did not measi.!re PTSD, the symptoms she reported ',)vefe similar to PTSD. Ninety percent of Vanv.resenbceck's of prostituted women reponed "extreme nervousness." john!';' PQiS0110US verbal a$sHulrsin all types of prostitution cause acute and l()ng-!ermpsychniogical symptoms. The verbal abuse in pros­ tirnfl0f1 is normalized and is invisible, One woman said that OVt'f time, "it is internally damaging. You become in your own rnind Wh(~l these people do and say with you. You wonder how could you let yourself (kl this and why do theSe people want to do this to you?" (Fadey, unpub­ lished intervic'N, 1(97). The phy~ical violence of prosritution. the constant verbal humilia­ tion. tbe so..:ial indignity and contempt, resuit in personality changes which !lave been described as complex posttraumatic stress disOftkr lCPTSD) (Hcnnan. 1992). Symptoms of CP'fSD include in consciousness aJld se"ll'-concept, changes in [he ability to regulate emo­ !ions.chalH!CS in systems olmeanlrH;.;uch "IS loss o(f,tith, ~;·,d an unre­ mining sel~~e of despair. Once out '(;r prostirtnion. 76<*, of a group of \vornen iiltcrviev.lcd bv Parriott (19941 rCl)(}rt~;(l that thev had great diffi· culty with intimate relationsh.ips. . ..- ~ Unless human beh,ivior under condih

2()8 WOMEN l,nTH VISlB[,E AND INV/SIBLE DISABILITIES

L intense gratefulness for small favors when the captor holds life and death power over the CLlptive; 2. denial of the extent of violence and harm which the captor has inflicfcd or is ohviously capable of inflicting; 3. hypervigilam,;c with respecl to the pimp's needs and identifica·· tion wirh the pimp's perspective on the world (an example of this was Pauy Hea.rst's identification With her captors' ideol­ ogy); 4. perception of those trying to assist in escape as enemies and per­ ception of captors as friends; and 5. extreme diftlcu!ty leaving one's captor/pimp, even after physi­ cal release has occurred.

Paradoxically, women in prostitution rnigh! feel that Ihey owe, their iiv(':-; to pimp!) (Graham, Ra\v!ings. & Rigsby, 1994).

Corwepts il1 the Medical ami 8acial Sciences Which Contribute to the Invisibility of Prostitutioll 's liarm. alUi lYhich h~{iict At1d/.ti(JI1al b~iury

The socia! invisibility of prostitution is lhe first barrier 10 grasping its hann, I f the harrn is not perceived, there is no possibility of healing the psychological damage which occurs as a resull of being proi>tituted, Cotton and Forster (2000) surveyed psycnok)gy of wornen tCi'.rbooKs and found that eleven of fourteen texts published since J995 failed io mention prostimtiol1. \Vhen pmstitmion \Vas mentioned, i1 ViHS usually ;Hldressed as 11 "feminist debate" or as "work" rather than as violence. Some have suggested that prostituted women in the sex businesse;; are ""imply another category of workcn with special problems Hnd ne,_,ds" fBullough & ,Bul1ough, 1996, p. 177), In 1988, the \Vodd Health Organization defined prostitution as "dynamic and adaptive sex work. involVing U lransacrilm between seller and buyer of a sexual s':fvice'· (cited in Scambler & Scamble" 1995, p, 18). Recent psychological and heallh sciences literature regularly assumed that prostitution is a voultionai choice (Deren et aI., 1996; FaIT, Castro, DiSanwslefano, & Olguin, 1996; Green el aI., J 093), The notion 1hat prosti­ tLHi"ll is work tends to make its harm invisible ('except pCThaps for the need for lahor unions)' Once understood ;lS violence, however, union- pmslilutcd wowell makes <;5 little sense as unionizing battered 14470

269

Historically. there have been a number of medical, psychological, and "sexological" theories which not only make the harm of prostitu­ tion invisihle, but which further blaIne women fortheir own victimiza­ tion. Tn 1898, Lombfl)';o and Femlro suggested that prostitutes have a "demonic nature which is observable upon precise skull measuremenL" Damaging theories ahout why women prostitute are sti!! in vogue. For example. some HIV researchers have represented ,vomen in pro&titu­ tinn as "vectors of disease," a concept akin to Lombroso' '; notion that prostitutes are demon:;. These views originate in Judeo-Christian for­ mulations of women as sexually evil. It seems to be titillating to theorize a mysterious perversity as a factor in entc:ring prostitution. Urologist and criminologist Reit.man wrQte in 1931:

Why does a woman fall in love with a pimp? It may be because she is a moron Of a psychopathic personalily, an eccentric ego. She may have either a superiority or aninferiorily cmnplex. It may be becau:.;e. she i:') poor ;:md hungry or rich and bored. (p. 31)

Abraham speculated that "[The prosti(ute'~! frigidity signifies t\ humili­ ation of all mt~n ... and her whole life is given up to Ihis purpose" (Al::Jn't· harn, I p. 3(1). Prostituted women do become sexually numbed. hut Abraham reverses cause and effecL The woman in prostitution iloes not begin with ihc intention of humiliating men, fnsteild, she becomes sexuaHy frozen in response to rhe accumulated t!1lUl11at1c effects of sex­ ual and psychological violence. A.. similar numbing can occur in viGllms of state-sponsored torture. SC!toJogy, the study of sexu:,lity, was built on the uncritical a('ccplance (~rpr()sti!ution as an institution w/tidl expresses mel! 's {{nd \Vomell 's .>0;11- alir},. Kinsey, Pmneroy, and ivlartin (1949) and Masters and Johnson (1973) worked in the late !940s through the 1970$ and articulated a sexu- \vhich was graphically porrrayed in Playboy magazine. The I>layboy Press. for cXilmpk. pubJishcdM

270 ~\'OMEiV WiTH VISIBLE AND INVISIBLE DISABILITIES

The psychological literature of the 1980& posited an essential mas­ ochism among battered women, a viewpoint which was later rejected for lack of evidence (Caplan. 19M; Koss er at, 1994). Yer it is still as­ sumed thaI pro~titutcd .,vomen have underlying personality characteris­ lic!; \vhich lead l\) their victimization. Rilsiello (1993) described the inherent ma$ochism of prostitmed women as a '·nt.'Cessary ingredient" of their self-concept. Mac Vicar and Dilion (1980) suggested thai mas­ ochism led to women's acceptance of abuse by pimps. Other victim-blaming occur:; when prostitut(',.ci women are described as "rbk takers," with the implication that they themselves provoked lhe vio­ lence

CONCLUSION

\Vomcn in prostitution consistently report thut what is most painful is the l!1visibility of tht· ham1 done to them. When johns treat thern a~ non·human, or when passersby contemptuously ignore them, their men- t;11 lS overWhelming. In order to end the human rights abuses 0.1 it is necessary to makl;.~ vIsihle: ~

.. lethal gender inequaLity; • inGest and olher childhood sc;xual assault; • poverty and homelessuess; • the ways in which racism :InO colonialism are ineXTricably c<>n­ neclccl withscxism in pro"tiullion; • domestic violence, including rape; • posuraumatic stress disorder, depression, mood and dis;:;oc;iative disorder..,; as COll1\cquellces of prostitution: 14472

Melissa "(iric,\' 271

4 drug and alcohol addiction; • the fact that pmsfitution is a globaJ business ;,v!lith involves interstate and inter-country trafficking as necessary to its profitable operation;

4 the ways in \vhich economic development programs erode tradi­ tional ways ofliving and Cre

Stripping, exotic dancing. nude dancing, table dancing, phone sex. child and adult pornography, online prostitution. and Internet pimping of women and childtcn (Hughes. i 999'l.lap danciJ1g, mflssagebrothels, and peep shows an~ different types of prostitution, but prosritution noneihelesli. One's politic!.!! perspective win determine whether prosti~ lurion is viewed primarily as a pubtic health issue, as an issue of zoning and property values (ill whose neighborhoods \vill strip clubs and por­ nography stores be zoned?).

272 WOMEN wrru VISiBLE AND INVISJl3LE DlSABlllTIES and Gifford (1997) noted that, on the one hand,johns be.lieved that com­ mercial sex was <1 mutually pleasurable exchange. and on the other hand. they asserted thai payment of n1<.mcy removed an sucial and ethi~ cal ohliemions. Whi!~' and Koss (1993) observed that violent behaviors ag~tinst VdHnen have been associated with attitudes which prorrl()te men's beliefs tbat are erititkd w sexual access to women. that they are superior to women. and that they have license for sexual aggression. Prostitution are a component of attitudes which normalize sexual violence. Monro (1999) found that johns' acceptance of commodified sexuality was strongly aSSQciated with their acceptance ·of rap(~ myths, violem sex, and less frequent use of condoms with women in prostilUtion. The reliltionship between atr.itudes toward prostitution and rape myth accep~ taHce has been described hyCotton (1999). The positive con'clation be~ tween iluiwoes !(rINard prostitution and self~reportcd sexual violence has been described by Schmidt, Cotton, and l'arley (2000). An aceep .. WncC' ill' what has been described ;)$ nonrelationa! $t~xuality might be it contributing factor \0 the nQnmllizali()l1 of prostitution. Confusion re.. g;lrding ~t~X thm is cocn:ive/exploitative and sex that is positive human resulted in what B

Aleiiss(I Farlev 273

NOTES

!. Thanh 10 1\'lich<',He J. Anderson. ASso(;iUle Profll53{1r of Lnw. Vil1;lll(}V~l UniV<'!f' sil)' Schl,)(,j of [cllW, Pennsylvania. (,Jr clarifying how U.s. Jaw regarding mp'~, ,e,ti:ll ilarasmlent ,md domestic violcnl:!: is currently being inwrprctcd. 2, Morri,Oll, McGee. Md Roben {19'45) ObStTV('il that the mostohviously !t11{)xicitlt:d prostitutes appeared to be the most ,ucces$fu! at :1iiracting; clients. They speculated thUI the fca:"m [o\' this W,lS {hal WDiuen who ;;.ppcufcd the most po\vcdcg and icasl Cilpabie (if seHing limits would ;;ttr1K! HK~1l who w

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277

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rd:tti'Jn~~hip~;: Pl'cvakncc. charactcn$tl(:~. and causes. in I L [:. BarbariJ.>;::., -"01 > L. 14481

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Marshall. & D. R, Laws (Ed~.\ Th;: Juvcnile Scx qrf'ender. :'Ilcw York: Guilford Prc:;s. \V iHiam~.]. L. (199 II. Sold out: A i,'Wl'"Tr gl(i(il! jill Pmslillli('S Am!itvl1w1ls. i ! 225 Magnolia Blvd. #181 N. Hol!yw{)od Blvd, CA. W(!oJ. M. (I 995L Jilst a p1"(JsliTU;e. QUt~en~lal1d: Ilnivcrsi(y of Queensland Press. W(.irld Hcnlth Clrgltni.~il(io!l 099,,), Ht!f1UI'! Oil rhrgioiJai HH;~4!DS epidemic. 14482

This is Exhibit Ilf '~entioned and referred to in the affidavit of ./Jr. m, / I .,!j> ~ ;:::; r 1(.7 Swocn before me this /.77- day of ", /YJ"i AD.20Pf' r~'OI\aking affidavits ~~ Prostitution and Trafficking in Asia Melissa Farley; Sungjean Seo Harvard Asia Pacific Review; Winter 2005; 8, 2; ProQuest Asian Business and Reference 14483 pg.9

BE:\EATH THE SURFACE

Prostitution and Trafficking in Asia

MELISSA FARLEY AND SUNGJEAN SE~

"IF you're afraid of pain, you shouldn't be a flower girl. Sometimes the girls in this house beg to be put out of These girls gotta eat, don't they? I'm putting bread on their misery. Good people are not in this profession. " [1] their plate. I'm making a contribution. They'd starve Prostitution causes grave physical and emotional harm to to death unless they whored. (7) women and girls. It transforms women and children into a special type of commodity in which men who cent her One Thai perspective of this situation is diametrically shape her into their own entity to masturbate into. Sexual opposed to that of the prostitution tourist: and physical violence are the norm for women in all types of prostitution whether it occurs in an indoor or outdoor Thailand is like a stage, where men from around the location, and whether it takes place in Asia or not. A Thai world come to perform their role of male supremacy woman said, over Thai women, and their white supremacy over Thai people. (8) I fed repulsion for him, because he does not see me, he does not know me. He does not know who I am, Military demand for prostitution has also contributed he just sees my body and feels his own desire and for to the sexual exploitation of women and girls in Asia. As him I am an empty person. I do not exist, so he just Santos observed, "Wherever militarism goes in the world, fills me with what he is feeling. (2) so goes prostitution" (9). During World War II the Japa­ nese Army took up to 200,000 Asian women and girls by Another woman explained, "What is rape to others, violent force and deception, and pimped them into its is normal to us" (3). They could be speaking for women military brothels. Most of these "comfort women" were in prostitution virtually anywhere. Asian prostitution and Korean (10). After the war, US troops used prostituted trafficking result from lethal sexism, child abuse, neglect, women near "rest and relaxation" centers created by the racism/colonialism, poverty. and from men's demands for US military, sometimes with the assistance of government prostitution. Poverty alone does not explain the existence officials who screened the women for sexually transmitted of prostitution in Asia or anyplace else. In Khmer culture, diseases (SID) (11). for example, the very definition of what it is to be female in Cambodia is tantamount to slavery (4). Prostitution PHYsICAL AND PSYCHOLOGICAL HAllMS SUFFElUID BY thrives wherever women have a devalued status compared AsIAN AND NON-AsIAN WOMEN IN PROSTITUTION/ with men. It is a specific manifestation of sex inequality TRAFFICKING with women in prostitution/ traffickiog described as the In the past 25 years, the sexual and physical violence most raped class of women in the world (5). of prostitution has been documented by many research­ Prostitution and trafficking are institutions built on ers. In one study 80% of women who had been prosti­ race and class prejudice. Historically, coloniaIism in Asia tuted or trafficked in Asia and elsewhere suffered injuries promoted stereotypes of the women in the region as ex­ caused by violence in prostitution (12). The longer otic others who were sexually women were prostituted, the moce promiscuous by nature. Western IfYOllre afraid of pain,yoll shollldnt be a they became infected with STDs men often deny the racist exploi- flower girl .. .sometimes the girls in this hollse (13). More than SOOIo of prosti­ tation of women in "native cul- beg to be Pllt Ollt of their misery ... Good peo- tuted women in Korea who used tutes," as detailed in Bishop and pk are not in this profession. (1) emergency services suffered from Robinson's analysis of the Thai symptoms affecting their repro- sex industry (6). Women in less dominant Asian cultures ductive system (14). are seen as more erotic and therefore more available for Several factors worsen the harm of prostitution. The sexual use by those from more dominant cultures. The greater the poverty, the greater the violence, and the middle-class prostitution tourist feels like a rich man in a longer a woman is in prostitution. the more likely she is to third world economy, and rationalizes that he is helping experience violence (15). Women who service more cus­ poor women. tomers in prostitution reported more severe physical

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symptoms, and higher rates of human immunodeficiency Instead, alcohol and accessible drugs are used by women in virus (HIV) (16). Asia and elsewhere to diminish the physical and emotional One woman explained, "Prostitution is like domestic pain caused by prostitution. For example, 90% of prosti­ violence taken to the extreme." Pimps and johns use the tuted Korean women had symptoms of alcoholism (28). same techniques that batterers use to control their part­ ners: intimidation, domination, social isolation, economic SOUTH KOREA: AN EXAMPLE OF PROSTITUTION AND control, minimization and denial of abuse, verbal abuse, TRAFFICKING IN AsIA physical and sexual violence, and captivity (17). Many We describe prostitution and trafficking in Korea for chronic symptoms of prostituted or trafficked women are two reasons. First, these practices in Korea are similar in like those of torture survivors (18). Prostituted women in many respects to prostitution elsewhere in Asia.. But more general die far more frequently than other women and importantly, Korea has enacted groundbreaking laws which often their deaths are from homicide (19). have begun to decrease prostitution and trafficking and In a nine-country study of prostitution on five conti­ which may help women to escape prostitution (29) nents (Canada, Colombia, Germany, Mexico, South Africa, Men rent women in prostitution in brothels, clubs Thailand, Turkey, United States, and Zambia), 71% of 854 and bars near military bases, in massage brothels, barber people experienced physical assaults in prostitution, and 62% shops, karaoke bars, tea houses, and via the internet. reported rapes in prostitution (20). A similar study found Revenues from the sex industry were estimated at 4.4% of that 76% of 100 Korean women experienced physical assault Korea's GDP in 2002 (30). Korean prostitution increased and 80% were raped in prostitution (21). in the 1970s and 1980s, in part a result of demand by US Dissociation enables women to function despite military and Japanese tourists. Encouraging this growth overwhelming, inescapable fear and pain. In prostitution, was a legal environment in which prostitution was toler­ dissociation is a consequence of both childhood sexual ated as a necessary social evil (31). Demand by Korean violence and the violence of adult prostitution (22). Sur­ men for women in prostitution also increased during this vivors have noted that dissociation is almost a job re­ period as businessmen used prostituted women for busi­ quirement for prostitution. A woman from Thailand ex­ ness entertainment and socializing (32). plained, "You make yourself empty inside" (23). Korean prostitution and trafficking include rape, Post-traumatic stress disorder (PTSD) occurs when battering, kidnapping, and imprisonment. Korean girls people are subjected to overwhelming and inescapable and women are recruited or trafficked into prostitution stress. The psychiatric diagnosis of PTSD includes avoid­ via deceptive promises of employment (33). As in the rest ance behaviors, psychological numbing, social distancing, of Asia and in the United States, Korean girls who run flashbacks (such as hearing the voices of traffickers), and away from home are vulnerable to recruitment (34). anxious hyper-vigilance. It is one measure of the extent Sometimes women and girls' may prostitute as a way to of psychological harm perpetrated against women in earn a living, but they quickly find themselves in unantici­ prostitution. Two-thirds of the women in prostitution in pated exploitive or dangerous circumstances (35). nine countries had symptoms of PTSD. Comparable Pimps and traffickers in Korea, as elsewhere in Asia, rates of PTSD have been recorded among battered use debt bondage to coerce women into prostitution and women seeking shelter, war combat veterans, rape survi­ to prevent their escape. In debt bondage, the woman as­ vors, and survivors of state-sponsored torture (24). In a sumes a debt in exchange for what she is tricked into be­ separate study, 80% of prostituted Korean women suf­ lieving is a legitimate job. She accumulates additional debt fered from PTSD (25). In a third investigation, 78% of in the form of fines and fees levied by pimps (36). Prosti­ 89 Korean women in prostitution had PTSD, according to tuted women and their families are threatened with bodily a preliminary analysis of a 2005 study (26). harm if they escape without paying off these coerced AFESIP, an international agency working in South debts. In 2005, Korean police arrested crime syndicate East Asia, helps women escape prostitUtion and learn members who had trafficked 37 women into brothels in alternative means of survival. A staff member recently Australia, New Zealand and Canada as punishment for noticed that about 20% of young women in a Phnom failures to pay alleged debts (37). Once smuggled into the Penh brothel district regularly cut themselves (27). This destination country, organized crime members sell off the self-mutilation is a consequence of extreme emotional women's debts to massage parlor pimps who in turn keep distress coupled with a lack of means to escape. In addi­ the women imprisoned in brothel prostitution until the tion to dissociation, acute and chronic PTSD, and self­ ever-increasing "debt" is paid off (38). . injury, other psychological harms commonly resulting from prostitution include anxiety disorders, depression TRAFFICKING OF WOMEN TO AND FROM SOUTH KOREA and suicidality, mood disorders, substance abuse, dissocia­ Prostitution is a global business, and the pimps who tive disorders, and traumatic brain injury (from violent control prostitution transport women to wherever the assaults to the head). demand exists. Transnational pimps quickly exploit op­ Substance abuse among prostituting women is soi:ne­ portunities created by erratic enforcement of laws against times misunderstood as the cause of their prostitution. prostitution and trafficking (39). Women from Russia,

10 HarvanlAsia Pacifo Review

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the People's Republic of China, the Philippines, and Thai­ workers (52). land, among others, are trafficked into Korea (40). Ninety percent of prostituted women near US military Many other organizations in Asia view prostitution as bases were non-Korean, according to a 2005 report (41). a reasonable job for poor women, e.g. Global Alliance Korean authorities estimate that large numbers of Against Trafficking in Women (GAA1W); UN/AIDS; Korean women are trafficked to other countries, including Amnesty International; Anti-Slavery International; Human Australia, Japan, New Zealand, Philippines, Taiwan, Thai­ Rights Watch; Empower, Bangkok; Dutch Foundation for land, United States, and Vietnam (42). US authorities ar­ Women (STV); International Labor Organization (ILO); rested 50 people who were suspected of smuggling and CARE International; Medeclns sans Frontieres; Coordina­ pimping Korean women into California. Some of the tion for Action Research on AIDS and Mobility - women had entered the United States on tourist visas (CARAM/Cambodia); and Bangladesh Women's Health while others were trafficked via Canadian or Mexican Coalition. travel agencies (43). Similar arrests of traffickers occurred Sex businesses such as escort prostitution, massage in Colorado (44). brothels, strip clubs, phone sex businesses, and internet prostitution were described by the ILO as the "sex sec­ RECENT KOREAN LAWS AGAINST PROSTITUTION tor" of a state's economy and prostitution has been pro­ Korean law criminalizes buying and selling sex acts, posed as development policy for newly industrializing levying fines against customers of prostitutes. In 2004, countries (53). In addition to pimps and traffickers, those following an educational campaign by women's and hu­ promoting prostitution may be law enforcement, gov­ man rights groups, the Korean government enacted two ernment officials or public health officials who promote landmark laws against prostitution (45). The laws provide and normalize prostitution while they simultaneously di­ that victims' debts to their employers are invalid and pun­ rect HIV prevention programs (54). ish those who use threats, violence, or debt bondage to force people into prostitution. The laws authorize seizure HIV AND THE PROMOTION OF PROSTITUTION IN AsIA of assets obtained by trafficking in women, increase pen­ In Cambodia, India and other Asian countries, the alties for trafficking and prostitution, establish supports devalued status of women sets the stage· for prostitution and resources for prostituted/trafficked women, and pro­ and trafficking (55). Groups such as the WHO are com­ vide funds for public education campaigns about prostitu­ plicit in that when an organization accepts prostitution as tion. The passage and subsequent enforcement of these a reasonable job for poor women, sex inequality is stead­ laws has been credited with a 37% reduction in the num­ fastly maintained. Prostitution does not thrive anywhere ber of brothels in Korea, a 30-40% decrease in the num­ in the world without the complicity of police, politicians, ber of bars and clubs (which comprise 80% of the sex and public health officials, among others. Prostitution/ industry in Korea), and a 52% decrease in the numbers of trafficking morphs, "shifting forms to accommodate women prostituted in brothels (46). pressures from state authorities, social activists, donors of In conjunction with these efforts by the Korean gov­ HIV prevention projects and others, while still trying to ernment, the United States military in Korea has adopted maintain access to clients and profitability" (56). a "zero tolerance" policy towards prostitution and its Since 1990, public and private agencies have initiated links to human trafficking (47). AIDS prevention projects among women prostituting in India's brothels. To DESCRIBE PROSTITUTION AS 'sEX WORK' MAKES ITS Sonagachi is a walled-in sector of Kolkata with an HARM INVISmLE estimated 60,000 women and girls prostituting, many traf­ Despite much evidence of its harms, some have pro­ ficked into India from Bangladesh and Nepal. The Sona­ posed that prostitution is work. Truong, a Vietnamese­ gachi Project was initiated in 1992 by the All-India Insti­ born Dutch citizen, conflated prostitution with enslaved tute of Hygiene and Public Health with initial funding breeding of women and wet-nursing as "sexual labor" (48). and technical support provided by the WHO (57). The The World Health Organization (WHO) defined prostitu­ founder of the Durbar Mahila Samanwaya Committee tion as a dynamic and adaptive transaction between seller (DMSC), a prostitutes and pimps' union that controls and buyer of a sexual service (49). Disappearing the con­ Sonagachi's residents, stated that "since sex workers fulfill cept of trafficking in women, WHO turned trafficked an important social need, prostitution must be seen as a women into "migrant sex workers" (SO). WHO has also profession" (58). recommended decriminalization of prostitution, a means Behind the women of Sonagachi and out of the of legally defining prostitution as a job (51). Chillingly, one spotlight are criminals who dominate the DMSC, control WHO member-partner saw it this way: the money, and run the organization. Despite its descrip­ tion as a "cooperative," the DMSC's women pimps and Selling sex is a pragmatic response to a limited range their male handlers extort SO% of the earnings of the of options ... Some women who have been trafficked women who are prostituted or trafficked in Sonagachi. As may eventually begin to define themselves as sex

Harvard Asia Padfo Review 11

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in Korea and elsewhere, women who are tmfficked to titution both require the elimination of sex inequality Sooagachi &om tutal areu are subjected to prison-like (10). debt bondage that extinguishes their hope for escape. CONCLUSIONS Hundreds of millions of AIDS prevention dollars In nine countries, we found that 89% of 854 people have poured into India and Sonagachi from WHO ($1400 in prostitution who wanted to escape it did not have other million by 2002) and &om the Bill and Melinda Gates options for economic survival. The numbers inside Sooa­ Foundation ($100 million by 2002) (59). What happens to gachi are the same: only 9"10 were said to be prostituting this money? It has not been spent on housing outside "volunta.rily; with the rest coerced, widowed, abandoned, brothels or on vocational and psychological rehab_tion or destitute (11). centeJ:S. In its greed to control every cent of mv preven­ Prostitution and ttafficlcing result from the combined tion money. the Indian health ministry has banned the forces of sex inequality. ncism/colonialism. and life­ free distribution of condoms to women prostituting in threatening poverty. Women and girls in prostitution will Sonagacbi (60). AIDS prevention funds were instead used remain marginalized and devalued if otganizations such to advertise events promoting prostitution or the funds as the WHO fail to recognize the inevita.bility of the vio­ were distributed directly to corrupt politicians. police., and lence intrinsic to the institution of prostitution. As the medical workers (60). WHO has sta.ted: Since WHO's sta.ted goal was to "manage and control the sex work business rather than closing down the The AIDS epidemic will not diminish until discrimina­ brothels" (61). it is likely that WHO partnet:ed with pe0- tion, including persistent gender bias and inequity is ple who in any other context might be descn"bed as pimps eliminated. The protection of the rights of girls and and ttllffickers. WHO offered these sex industry busi­ women is critical in the context of AIDS, especially nessmen public relations venues where they spoke at their right to set the terms of their own sexual activity, celebrations (62). WHO partnered with DMSC, which is including its safety, and to refuse sex altogether (12). "possibly the only otganizatioo of sex workers in India which sta.tes clearly and unambiguously that its putpose is The WHO is correct in this analysis. but its Sl3.te­ not to

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October 1 , 2004 Psychiatric Times. Vol. 21 No. 12 Prostitution Is Sexual Violence

Melissa Farley, PhD. Dr. Farley is a research and clinical psychologist who has been in practice for 35 years. She edited the book Prostitution, Trafficking, and Traumatic Stress, and has authored 24 other publications.

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Sexology, the study of sexuality, was built on the uncritical acceptance of prostitution as an institution expressive of both men's and women's sexuality. Alfred C. Kinsey, Sc.D., and his colleagues worked from the 1940s through the 1970s to articulate a sexuality that was graphically portrayed in magazines. Even today, some assume that prostitution is sex. In fact, prostitution is a last-ditch means of economic survival or "paid rape," as one survivor described it. Its harms are made invisible by the idea that prostitution is sex, rather than sexual violence. PRACTICI MANAGE Prostitution has much in common with other kinds of violence against women. What incest SY! is to the family, prostitution is to the community. Prostitution is widely socially tolerated and Exp$rt schlif its consumers (commercial sex customers who are called johns or tricks by women in getUngthem of your mans: prostitution) are socially invisible. software or UI

Herman (2003) polled attendees at a trauma conference, asking how many currently or previously treated patients who had been used in prostitution. Three-quarters of the 600 attendees raised their hands. Describing prostitution as hidden in plain sight, Herman noted that 30 years ago, rape, domestic violence and incest were similarly invisible.

Prostitution Is Violent

Although clinicians are beginning to recognize the overwhelming physical violence in prostitution, the internal ravages of prostitution have not been well understood. Prostitution and trafficking are experiences of being hunted down, dominated, sexually harassed and assaulted. There is a lack of awareness among clinicians regarding the systematic methods of brainwashing, indoctrination and physical control that are used against women in prostitution. There has been far more clinical attention paid to sexually transmitted diseases (STDs) among those prostituted than to their depressions, lethal suicidality, mood disorders, anxiety disorders (including posttraumatic stress disorder) dissociative disorders and chemical dependence.

Regardless of prostitution's status (legal, illegal or decriminalized) or its physical location (strip club, massage parlor, street, escortfhome/hotel), prostitution is extremely dangerous for women. Homicide is a frequent cause of death (Potterat et aI., 2004).

Prolonged and repeated trauma precedes entry into prostitution, with most women beginning prostitution as sexually abused adolescents (Bagley and Young, 1987; Belton, 1992; Dworkin, 1997; Farley and Barkan, 1998; Silbert and Pines, 1983b, 1981; Simons

and Whitbeck, 1991) (TClQ-'~1). Homelessness is frequently a precipitating event to prostitution. Women in prostitution are frequently raped and physically assaulted (Farley et aI., 2003; Hunter, 1994; Miller, 1995; Parriott, 1994; Silbert and Pines, 1983a).

Prostituted women are unrecognized victims of intimate partner violence by pimps and

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customers (Stark and Hodgson, 2003). Pimps and customers use methods of coercion and control like those of other batterers: minimization and denial of physical violence, economic exploitation, social isolation, verbal abuse, threats and intimidation, physical violence, sexual assault, and captivity (Giobbe, 1993, 1991; Giobbe et aI., 1990). The systematic violence emphasizes the victim's worthlessness except in her role as prostitute.

Clearly, violence is the norm for women in prostitution. Incest, sexual harassment, verbal abuse, stalking, rape, battering and torture are points on a continuum of violence, all of which occur regularly in prostitution. A difference between prostitution and other types of gender violence is the payment of money for the abuse. Yet payment of money does not erase all that we know about sexual harassment, rape and domestic violence.

The experiences of a woman who prostituted primarily in strip clubs, but also in massage, escort and street prostitution, are typical (Farley et aI., 2003). In strip club prostitution, she was sexually harassed and assaulted. Stripping required her to smilingly accommodate customers' verbal abuse. Customers grabbed and pinched her legs, arms, breasts, buttocks and crotch, sometimes resulting in bruises and scratches. Customers squeezed her breasts until she was in severe pain, and they humiliated her by ejaculating on her face. Customers and pimps physically brutalized her. She was severely bruised from beatings and frequently had black eyes. Pimps pulled her hair as a means of control and torture. She was repeatedly beaten on the head with closed fists, sometimes resulting in unconsciousness. From these beatings, her eardrum was damaged, and her jaw was dislocated and remains so many years later. She was cut with knives. She was burned with cigarettes by customers who smoked while raping her. She was gang-raped and she was also raped individually by at least 20 men at different times in her life. These rapes by johns and pimps sometimes resulted in internal bleeding.

Yet this woman described the psychological damage of prostitution as far worse than the physical violence. She explained that prostitution "is intemally damaging. You become in your own mind what these people do and say with you" (Farley et aI., 2003).

Almost two decades earlier, Norwegian researchers noted that women in prostitution were treated like commodities into which men masturbate, causing immense psychological harm to the person acting as receptacle (Hoigard and Finstad, 1986).

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II II A This fa ExhibH L mentioned and relerred to in the aHldaYil 01 .. 'r. /J7 ~ /, p So , Swornbaforemelhis /7 ~ayof /J?"v A.D.20oi--~T. r}e)' I ACommissioner lor taking affldavil& ~~

Prostitution, Trafficking, and Traumatic Stress~~

,u::;: j .. ~ \~t v if .~\~';~, 'r? ~~Jhmd~ Melissa Farley, PhD Editor

Prostitution, Trt~fficking, and Traurnatic Stress has been co-published si­ multaneously as JO'l(fl1al of Traumn Practice, Volume 2, Numbers 3/4 2003.

~HMTP The Haworth Maltreatment & Trauma Prcss@ An Imprint of The Haworth Press, Inc. ~~ New York· London" Vkto-na (Al!) wwwJlawordrPreu.c.lIl ~~ 14492

Published by

The llaworth Maltrcatmcm & Trauma Press, J 0 Alice Street, BinghanHon, NY 13904-1580 lJSA

The Haworth Maltxeatment & Trauma Press is .10 imprint of The Haworth Press, Inc .. 1(} Alice Street. Binghamton, NY 13904-1580 USA,

Prostitution, Trqfficking, and Traumatic Stress has been co-published si­ fimltaneously as Journal of Trauma Practice, Volume 2, Numbers 3/4 2003.

© 2003 by The IInworth Press, Inc, All rights reserved. No pal1 of this work may lx~ reproduced Of uti· lized in any form or by any means. electronic or mechanicaL including photocopying, microfilm and re­ cording. or by any infonnation storage and retrieval system. without permission in writing frorn the publisher. Printed in the United States of Amcrit:a.

The development. preparation, and puhlication of this work has been undel1akcn with great care. How­ ever, the publisher, employees, editors, and ~Igents of The Haworth Press and all imprints of The .H(lworth Press, Inc., including The Hawol1h Medical Prcss@ and The Pharmaceutical Products Press@!. are not responsible for any errors contained herein or for consequences that :l11ay ensue from use of ma­ terials or information contained in this work. Opinions expressed hy the nurhor(s) arc nol neeessmily those of The Haworth Press. Inc.

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Cover photograph by Melissa I·arley. (f)MelissaFilricy 2000. All Rights Reserved. Forpholo pennission con· tact Mdissaf,'urley, Box 16254, San Fnmcisc{), CA 94116·0254 orcrnail: mfm'[email protected]

Library of Congress Catalogjng~in-PllblicatjoJ) Data

Prostilution, trafficking, 'Ind traumatic stress/ Melissa farley, editor. p.; em. "SimUltaneously published as Journal of trauma practice, volume 2, numbers 3/4 2003." Includes bibliographical references and index. ISBN 0-7890-2378-4 (hardcover :alk. paper)" ISBN 0-7890-2379-2 (sofkovcr: alk. paper) J. Post-traumatic stress disorder. 2. Prostitution. [DNLM: L Prostitution. 2. Stress Disorders. Posl,Traumalic. 3. Domestic Violence. WM 170 P966 20031 L Farley, Melissa. RC552.P67 P745 2003 2003018824 14493 Prostitution, Trafficking, and Traumatic Stress

CONTENTS

Preface: Prostitution, Trafficking, and Tramnatic Stress Xl lWeli.,,\\'O Farley

Introduction: Hidden in Plain Si.ght: Clinical Observations on Prostitution 1 Judith L.e}vis liennan

UNDERSTANDING PROSTITUTION AND TRAFFICKING AS ORGANIZED INTERPERSONAL VIOLENCE

Sister Oppressions: A Comparison of Wife Battering and Prostitution 17 Chri:·;tine Stark C'aro/ Hotig,\'on

Prostitution and Trafficking in Nine Countries: An Update on Violence and Posttraumatic Stress Disorder 33 Meli,s',";a Farle.v Ann Cotton Jacqueline Lynne Sybille Zumbeck Frida Spiwak k1aria E. Reyes Dinorah Alvarez l/fuk SeZgill

Prostitution and 'rraurna in U.S. Rape Law 75 IVlicizelfe 1. Anderson 14494

(Jay~ M. ale1 Ph'ornograp y s "A.. clors " : When "Fantasyn Isn't 93 Christopher N. Kendall Rus Ervin Frwk

Prostitution Online 115 .Donna 1\!. Hughe,')'

From Duty to Despair: Brothel 133 Wendy Freed

Prostitution and Trafficking of Women and Children from Mexico to the United States Mari,s'o B. Ugarte Laura Zarate Melissa F'arley

Prostitution and Trafficking in Women: An Intimate Relationship 167 Dorchen A. Leidholdt

HEALING FROfvI PROSTITUTION AND TRAFFICKING

EtTIotional Experiences of Performing Prostitution 187 Lisa A. Krmner

Dissociation Among WOlnen in Prostitntion 199 Colin A. Ross Melissa f'arlev Harvey L Schtvartz

Providing Services to Aflican Arrlerican Prostituted WOIllen 2 13 Vednita Carter

The Importance of Supportive Relationships Among Women Leaving Prostitution 223 Uila-Carin lledin Sven ILrel Mlinsson 14495

PEERS: The Prostitutes' Empowennent, Education and Resource Society 239 Jalll'lit Rabinovitch

Been There Done That: SAGE, a Peer Leadership Model Among Prostitution Survivors 255 Norma Hotaling AutUlnn Burris B. Julie Johnson Yoshi M. Bird Kirsten A. Melbye

Living in Longing: Prostitution, Trauma Recovery, and Public Assistance 267 Margaret A. Baldwin

Ten Reasons for ,Not Legalizing Prostitution and a Legal Response to the Demand for Prostitution 315 Janice G. Raymond

Author Index 333

Subject Index 34J 14496

1

Prostitution: a critical review of the medical and social sciences literature Melissa Farley and Vanessa Kelly Women & Criminal Justice 2000, Vol 11 (4): 29-64. Melissa Farley & Vanessa Kelly c 2000 All Rights Reserved.

ABSTRACT. In the recent literature on prostitution, there has been a focus on HIV which has tended to exclude discussion of the physical and sexual violence which precedes and which is intrinsic to prostitution. The literature of two time periods (1980-84 and 1992-1996) is critically reviewed in order to describe this trend. The normalization of prostitution in the medical and social sciences literature, the tendency to blame the victim of sexual exploitation, and the ways in which racism and poverty are an inextricable part of prostitution are discussed here. The social invisibility of prostitution, needs of women escaping prostitution, and an overview of recent criminal justice responses to prostitution are summarized. Introduction Some laws in USA have been profoundly influenced by social science research - for example, rape law and sexual harassment law. In an era of changing attitudes toward prostitution, familiarity with recent research is essential to those who are a part of the criminal justice system. As psychologists, we hope to see a change in the health professions' relative silence regarding prostitution's harm to women, as well as a change in the perspective on prostitution held by the criminal justice system. The social and medical sciences have been limited by a failure to adequately address the harm of prostitution to women. Concerned about the

Melissa Farley, Ph.D. is at Kaiser Foundation Research Institute, Oakland, Ca. and Prostitution Research & Education, a project of San Francisco Women's Centers, Inc. Box 16254, San Francisco CA 94116-0254 http://www.prostitutionresearch.com Vanessa Kelly, Psy.D. is Coordinator, University of California at San Francisco Traumatic Stress Treatment Program, San Francisco General Hospital, San Francisco,

ilL 1/ .. :l ,J!)r. /71 c./I".. s .., 1bis is Exhibit _ mentioned and relerred to In the alfidavl~ 0, .:. ~""";..c:. / 'Sworn before me this /.1 r day of .m;r A.D. 2(})? 3" ., r ~ .A Commissioner lor taking affidavits 14497

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invisibility of prostitution's harm in the health professions (in addition to its invisibility in the culture at large), we reviewed the literature on prostitution. The authors concur with Vanwesenbeeck (1994, page 33) who wrote: "Researchers seem to identify more easily with clients than with prostitutes ... " Much of what has been written about prostitution in the medical and social sciences fails to address the sexual violence and psychological harm which both precede and are intrinsic to prostitution. A few (see below) have noted that prostitution involves a lifelong continuum of sexual exploitation and violence which begins with sexual assault or prostitution in childhood. Most authors between 1980 and 1998 failed to address the violence in prostitution. Instead, there has been an almost exclusive focus on sexually transmitted disease (STD) , especially the human immunodeficiency virus (HIV) in the recent social science and medical literature on prostitution. Although HIV has certainly created a public health crisis, the violence and human rights violations in prostitution have also resulted in health crises for those prostituted. To describe this trend in more detail, we reviewed the MELVYL Medline and PsycINFO on-line databases on prostitution for 2 time periods: 1980 - 1984, and 1992 - 1996 (MELVYL Medline and PsycINFO, 1980-84 and 1992-1996) . Medline lists citations and abstracts of articles in medical and life sciences journals. PsycINFO lists citations and abstracts of articles in psychology journals. During the decade 1980-1990, there was a pronounced trend in the social sciences literature to view prostitution primarily as a means of HIV transmission, from prostitute to john. We compared the percentages of journal articles which focused primarily on STD and HIV to those articles which addressed prostitution itself as a source of harm to the woman involved. We organized the literature into three content categories based on themes that emerged from the databases in the two time periods. As seen in Table 1, these three categories were: (1) STD/HIV, (2) other harmful consequences of prostitution, (3) legal/demographic/psychoanalytic. The first category, STD/HIV, included those references which discussed means of transmission and infection rates of STD, and various approaches to HIV prevention. The second category (other harm) included discussions of non- 14498

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HIV-related harm of prostitution. Citations included discussions of sexual and physical violence in prostitution, and antecedent harm, such as juvenile prostitution and childhood sexual assault. The third category included demographic descriptions of those in prostitution (e.g. number of arrests, gender differences), b) psychoanalytic theorizing about the origin of prostitution behavior which did not discuss trauma, c) discussions of legalization or decriminalization which did not discuss harm to those being prostituted, and d) historical accounts of prostitution. The first part of this paper describes the quantitative results of this review. In the second part of the paper, we critically discuss why the literature failed to address the harm of prostitution, and we present some alternative perspectives which take into account the harm caused by prostitution. TABLE 1 GOES APPROXIMATELY HERE

A Quantitative Summary of Two Online Databases on Prostitution: 1980-1984 and 1992-1996

1980-1984 From 1980 through 1984, 119 references to prostitution appeared in the Medline database. See Table 1. 68% (81) were discussions of STD. The PsycINFO database during that same time period contained 41 references to prostitution, of which 2% (1) focused on STD. 15% (18) of the Medline prostitution database, and 41% (21) of the PsycINFO prostitution citations 1980-1984 addressed the harm of prostitution other than STD. These included discussions of juvenile prostitution, child pornography, child abuse, substance abuse, and physical violence in the lives of those prostituted (Brown, 1980; Pierce,1984; Paperny & Deisher, 1983; Coleman, 1982; Lamb & Grant, 1983). A third of the 1980-1984 PsycINFO citations noted the relation between early sexual exploitation and entry into prostitution (Silbert & Pines, 1983). Other discussions included gender differences in post-arrest detention (Bernat, 1984); and how a functionalist analysis of prostitution ignores its harm (Hawkesworth, 1984). 17% (20) of Medline and 57% (19) of the PsycINFO citations between 1980-1984 discussed legal/demographic/psychoanalytic aspects of prostitution. Examples from the Medline database included a psychoanalytic view of the 14499

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"fallen woman," where and how often men used prostitutes, 'sexual stress, a description of how Jack the Ripper tortured prostitutes, and an iconography of the sexualized woman (Meyer, 1984; Alzate, 1984; Mims, 1982; Gee, 1984; Gilman, 1984). References from PsycINFO discussed CB radio prostitution (Luxenburg & Klein, 1984); and assertiveness and hostility in prostitutes (Schwartz, 1981). In the early 1980's, the work of Silbert and Pines was a remarkable exception to the relative silence about the harm of prostitution. These authors published a number of groundbreaking studies which documented the role of child sexual abuse as an antecedent to prostitution (Silbert & Pines, 1981; 1983); documented sexual and other violence perpetrated against women in prostitution (Silbert & Pines, 1983; Silbert, Pines, & Lynch, 1982); and noted the role of pornography in the harm of prostitution (Silbert & Pines, 1984). Silbert and her colleagues further described a "psychological paralysis" of prostituted women, characterized by immobility, acceptance of victimization, hopelessness, and an inability to take the opportunity to change, which resulted from the inescapable violence they encountered throughout their lives (Silbert & Pines, 1982b).

1992-1996 By 1992, the content and emphasis of the two databases on prostitution had shifted dramatically. See Table 1. There was an 18% increase in Medline and 68% increase in PsycINFO citations focusing on HIV. This was accompanied by a 13% decrease in Medline and 33% decrease in PsycINFO references to the harm caused by prostitution, other than STD. The topic of HIV dominated the 1992-1996 medical literature on prostitution, with subcategories emphasizing the comorbidity of alcohol/drug use. From 1992-1996, we located 551 prostitution-related references in Medline. 86% (476) of these made primary reference to HIV or STD, an increase of 18% from the 1980-1984 database. Examples of the HIV focus included a study of the HIV risk behaviors among Dominican women prostituting in New York City, HIV education programs, and the coincidence of HIV disease with lack of access to health care (Deren et al., 1996; Lim et al., 1995; Singh & Malaviya, 1994). References to HIV and prostitution frequently normalized prostitution as in "Healthy and Unhealthy Life Styles of Female 14500

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Brothel Workers and Call Girls in Sydney" (Perkins & Lovejoy, 1996), and "Prostitutes Can Help Prevent the Transmission of HIV" (Donegan, 1996). The psychological literature on prostitution, even more clearly than the medical literature, reflects this change in emphasis. The 1992 - 1996 PsyclNFO database shifted from a discussion of the psychological and demographic aspects of prostitution to a focus on HIV: 70% (146) of the PsyclNFO literature now made primary reference to HIV or other STD, a 68% increase from 2% (1) in 1980-1984. In contrast, the percentage of journal references addressing prostitution-related harm other than STD significantly decreased in both databases. Only 2% (10) of the Medline literature addressed the harm caused by prostitution, a 13% decrease from 15% (18). References to prostitution­ related harm on PsychlNFO decreased by 33% (from 41% (21) in 1980-1984 to 8% (18) in 1992-1996). Several studies focused on childhood physical or sexual abuse or neglect, as precursors to prostitution (Cunningham et al., 1994; ";. Marwitz & Hornle, 1992; Widom & Kuhns, 1996); one investigated the health of Honduran street children (Wright et al., 1993). Other references from the PsyclNFO database noted violence against prostitutes; reported suicide attempts among Brazilian prostitutes; defined and recognized prostitution as a form of sadistic abuse; and noted that physical abuse was an antecedent to prostitution (Miller & Schwartz, 1995; De Meis & De Vasconcellos, 1992; Goodwin, 1993; Savin-Williams, 1994). The number of articles with legal/demographic/psychoanalytic content decreased in both databases. Medline references decreased 5%, from 17% (20) in 1980 - 1984, to 12% (65) in 1992 - 1996. Examples of these citations were: sexuality in ancient Egypt; a literature review on adolescent female prostitution; and discussions of decriminalization and legalization of prostitution (Androutsos & Marketos, 1994; Jesson, 1993; Donovan & Harcourt. 1996) Twenty-two percent (46)of the references in the 1992-1996 PsyclNFO database focused on legal/demographic/psychoanalytic aspects of prostitution, a decrease of 35% from 1980-1984. Content of these references ranged from a critique of feminist analyses of prostitution. to demographic variables associated with prostitution by choice. to family economic obligation as a factor which led to prostitution among Taiwanese women; and "Rational 14501

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Decision-Making Among Male Prostitutes," (Shameem, 1993; Cates & Markley, 1992; McCaghy & Hou, 1994; Calhoun & Weaver, 1996).

Discussion and Analysis of the Content of the Medical and Social Science Prosititution Databases In the discussion which follows, we discuss in more detail, research which reflects the customer's perspective that prostitution is both a convenient sexual service as well as a source of anxiety about his physical health. We also discuss the need for research and clinical interventions which address the physical and emotional harm to the person in prostitution herself. We briefly summarize diverse criminal justice responses to prostitution, and conclude with some proposals for urgent and long-term health care provision.

Controlling the transmission of HIV Although at first glance, the public health attention to risk of HIV infection includes the prostituted woman herself; on closer inspection, it becomes apparent that the overarching concern is for the health of the customer: to decrease his exposure to disease. In spite of extensive documentation that HIV is overwhelmingly transmitted via male-to-female vaginal and anal intercourse, not vice versa, one of the misogynist myths about prostitution is that she is a vector of disease, that she is ultimately the source of contamination of the 'good wife' through the husband's weak moment. The focus on HIV in the prostitution literature is a variant of this prejudice against prostituted women. These notions appear to form the basis of the HIV-focused research, with the ultimate goal of making prostitution either governmentally regulated, or decriminalized (Lancet, 1996). Many studies emphasized the education of prostituted women regarding condom and safe needle use (Fajans et al., 1995; Pyett et al., 1996; Wong et al., 1994). Others investigated prostituted women's perceptions of HIV risk (Graaf et al., 1995; Gossop et al., 1995; Morrison et al., 1994). Graaf et al. (1995) interviewed 127 prostituted women and 27 prostituted men. They found that drug use (but not alcohol use) decreased condom use in the following way: when women needed money for drugs, they were more willing to accede to johns' demands for unsafe sex. Graaf recommended methadone as a vehicle for · 14502

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increasing condom use, and suggested that prostituted women needed to change their "distinctively negative work-attitude." In much the same way that slave-owners discussed the inevitability of slavery, and the improved care of slaves, there was an underlying assumption in much of the research that prostitution is inevitable. Although education efforts appeared well-intentioned, most HIV-focused authors minimized or ignored the harm of prostitution as well as the option of escape. For example, Karim et al. (1995) interviewed women who prostituted at a truck stop in South Africa. The researchers found that women were at a higher risk for physical violence when they attempted to insist on condom use with customers, whose violence contributed to their relative powerlessness. Ignoring their earlier finding that the women were at a higher risk for violence if they insisted on condom use, the researchers recommended that women in prostitution learn negotiation and communication skills' to reduce HIV risk. They failed to clarify how one would persuade a dominant customer into using a condom when he does not want to. After two decades of research on HIV, the World Health Organization noted that women's primary risk factor for HIV is violence (Piot, 1999). Aral and Mann (1998) at the Centers for Disease Control, emphasized the importance of addressing human rights issues in relation to communicable disease. They noted that since most women enter prostitution as a result of poverty, rape, infertility, or divorce, public health programs must address the social factors which contribute to STD!HIV. Globally, the incidence of HIV seropositivity among prostituted women is devastating. 58% of prostituted women in Burkina Faso, West Africaj 52% of Kenyan women in prostitution in one study, and 74% of prostituted Nairobi, Kenyan women in another study tested positive for HIV (Lankoande et aI, 1998; Kaul et al., 1997; Kreis et al., 1992). 50% of prostituted women as compared to 20% of women attending an antenatal clinic in KwaZulu-Natal, South Africa tested positive for HIV (Ramjee et al., 1998; Kharsany et al., 1997) In Cambodia, approximately 1 in 2 women in prostitution tested positive for HIV, compared to 1 in 30 pregnant women, and 1 in 16 soldiers and police. (World Health Organization, 1998). In Italy, a recent study noted a 16% seroprevalence among prostituted women, which represented a significant increase in the 1991-1995 rate (11%) over the 1988 to 1990 rate (2%) (Spina, et aI, 1998). Rates of HIV among us prostituted women vary, for example, 57% 14503

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in New Jersey; and in Atlanta, - 12% among women, 29% among men, and 68% among transgendered people in prostitution (Elifson et al., 1999). The differential medical treatment of women compared to men resulted in a lack of attention to early HIV infection in women (Allen et al., 1993; Schoenbaum and Webber, 1993). Allen (1993) investigated HIV risk-assessments in inner-city us women's health clinics and found that despite the presence of HIV infection across a broad age range for both sexes, early HIV infection (not yet AIDS) was "completely unrecognized among all adolescent, young adult, and older women." In Thailand, a study of brothel-based prostitution reported that 26% of women nationwide and 34% in the northern provinces (where women migrated to escape war or economic devastation) were HIV-positive (Kilmarx et aI, 1998). Despite a high level of condom use in Thailand, women in brothels, especially the young, were not protected from HIV. The authors speculate that this may be because men who use prostituted women are more likely to be HIV-infected than other men. Another investigation of johns' seropositivity in USA reported an HIV+ rate of 37% among customers of men in prostitution and a seropositivity rate of 3% among customers of women in prostitution (Elifson et al., 1999) Homeless children are at highest risk for HIV, for example in Romania (Hamers et al., 1998) and Colombia (Spiwak, 1999). Piot (1999) noted that half of new AIDS cases are in the under-25 age group, and that girls are likely to become infected at a much younger age than boys, in part because of the acceptance of violence perpetrated against girls and women in most cultures. Men frequently seek out younger girls in prostitution and elsewhere because it is assumed that they are less likely to have HIV. STD and HIV have increased exponentially in the Ukraine and other former Soviet Union states since 1995. Although data on seropositivity among women in prostitution was not available, a 1998 review article speculated that the increase in STD/HIV was a result of political restructuring, poverty, collapse of healthcare systems, and a dramatic increase in prostitution (Hamers et al., 1998).

Normalizing prostitution Much of the health sciences literature assumed the normalcy of prostitution as vocational choice for women (Deren et al. 1996; Farr et al., 14504

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1996; Green et al 1993). It was often suggested that prostitution could be a safe activity. However, this perspective seemed only to consider safety from HIV. In 1988, the World Health Organization contributed to the normalizing of prostitution by describing it as ~dynamic and adaptive sex work, involving a transaction between seller and buyer of a sexual service." (cited in Scambler & Scambler, 1995, page 18) Other researchers virtually instructed women in prostitution to smile in the face of abuse and to proceed with the job of servicing johns (Perkins & Lovejoy,1996; Graaf et al., 1995). Graaf et al. (1995, page 45) recommended a ~positive professional image." Wong et al. (1994) formulated a STD/HIV prevention program in Singapore which ignored pervasive violence in prostitution. Role playing and use of comic books were aimed at increasing condom use. Pederson (1994) noted the coincidence of the HIV epidemic and the concept of prostitution as vocational choice. Some have suggested that prostituted women in the commercial sex industry are ~simply another category of workers with special problems and needs" (Bullough & Bullough, 1996, page 177). This perspective reflects the customer's view that if prostitutes' behavior can be controlled, perhaps HIV can also be controlled. An editorial in Lancet (1996) suggested that decriminalization of prostitution would decrease police harassment and assist prostituted women in finding safer state licensed brothels in which to work, although the writer questioned whether ~herding" prostitutes into brothels would actually benefit their health or safety. Other negative health consequences of prostitution were not discussed. Several authors assumed that the primary problem with prostitution was its illegal status. Donegan (1996) suggested that because prostitution is underground, young women suffer from social stigma. This perspective, however, does not address the social stigma and enormous contempt aimed at women in areas where prostitution is legal - for example, Nevada.

Victim blaming Subtle and blatant examples of blaming the victim of prostitution were noted throughout the research reviewed here. Prostituted women were sometimes described as ~risk takers," with the implication that they 14505

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deliberately provoked the violence and harassment aimed at them in prostitution (Rosiello, 1993, Vanwesenbeeck et aI, 1993). The psychological literature of the 1980's assumed an essential masochism among battered women- a theoretical perspective which was later rejected for lack of evidence (Koss et aI, 1994). It is still assumed that prostituted women have personality characteristics which lead to their victimization. Rosiello (1993), for example, described the inherent masochism of prostituted women as a "necessary ingredient" of their self-concept. MacVicar and Dillon (1980) suggested that masochism plays a central role in the acceptance of abuse by pimps. Psychoanalytic theories that prostituting originates in maternal deprivation or from the anal desires of the child -have been described by Weisberg (1985) and Bullough & Bullough (1996). Vanwesenbeeck, et al (1993) identified three groups of prostituted women as 1) those who had a positive, businesslike attitude and consistent condom use, 2) those who had a negative attitude and occasional failure to use condoms) ,and 3) "risk takers" who did not use condoms and who reported feeling powerless. The "risk takers" reported fears of violence and despair in situations where they were powerless. One woman stated that health planning was not a priority when "your whole life's a misery and pain" (Vanwesenbeeck et al., 1993, page 87). The women in the "risk taker" category reported the greatest financial pressure, and serviced the largest number of johns. It was assumed that "risk-taking" prostituted women willingly exposed themselves to harm, although the histories of the "risk-takers" revealed that they had been battered and raped significantly more often than the non-risk­ takers. Risk-taking behavior was rarely interpreted as trauma-based repetition of childhood sexual abuse. Although some described risk-taking behaviors as occurring in the context of childhood poverty, trauma, or violence (Cunningham et al., 1994; Vanwesenbeeck et al., 1995), others pejoratively implied intentional or callous risk-taking on the part of women in prostitution (Faugier & Cranfield, 1995). It would be more appropriate to view all prostituted women as at-risk. It has been established that johns pressure women into unsafe sex (Farr et al., 1996). Women were unable to prevent johns' demands for unsafe sex, and were often physically assaulted when they requested condoms (Ford & Koetsawang, 1991; Karim, et al., 1995; Miller & Schwartz, 1995). 14506

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Drug addiction was often viewed as the only reason for prostituting. The view that addicted prostitutes were the source of all health problems which occur in prostitution was rarely challenged. Addicted prostitutes were seen as the source of danger to the john, rather than the john's posing a threat to the woman in prostitution. Morrison et al. (1995) opined that women in 'high class' prostitution did not need alcohol or drugs to cope with the psychological trauma of their work, implying that only 'lower class' women do. Women in prostitution were often assumed to have an underlying personality disorder. De Schampheleire (1990) concluded that 61 prostituted women had emotional difficulties that resulted first in addictions, and later in prostitution, which was itself described as a "diversion" from other psychological problems. Noting the utter vulnerability of intoxicated women on the street, Morrison (1995) wrote:

"The most inebriated prostitutes on the street appear to be the most successful at attracting clients. Women who appear entirely powerless and incapable of setting the boundaries of the sexual activity to take place will attract men who may wish to legitimize an act of sexual abuse by the payment of cash" (page 292-293).

In the authors' experience, a significant percentage of women enter prostitution with no previous drug or alcohol abuse. Some initiated or increased drug or alcohol use to anesthetize the pain of physical injuries and verbal abuse inflicted on them in prostitution. Graaf et al. (1995) and Plant et al. (1989) found that women's alcohol use in prostitution was related to the psychological trauma of prostitution. It permitted a chemical dissociation, as well as a means of anesthetizing their physical aversion for johns. Green et al (1993) noted that some Glasgow women were only able to prostitute under the influence of drugs or alcohol.

"I have to be a little stoned before I go through with it. I have to shove my emotions to the side." Another woman said: "The whole thing is sick. I cut out everything to do with feelings - it's never, never okay." (Hoigard & Finstad, 1986, page 165) 14507

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Alegria et al. (1994) found that 70% of 127 Puerto Rican women in prostitution had symptoms of depression which were associated with increased risk behaviors for HIV. In most studies, however, psychological factors motivating HIV risk-taking were not discussed.

Socioeconomic factors The economic vulnerability and limited career options of poor women are significant factors in their recruitment into prostitution. In the authors' view, poverty is one precondition for prostitution, in addition to female gender. Barrett & Beckett (1996) described poverty and childhood sexual abuse as factors preceding entry into prostitution. An editorial in Lancet (1996) referred to the economic needs that impel women to prostitution, as opposed to the instincts which impel men to buy prostitutes. Many authors assumed that women enter prostitution to get rich (Carr, 1995; Lancet, 1996; McCaghy & Hou, 1994). Reinforcing the notion that women are in prostitution solely for the money, Taiwanese women in one study were described as entrepreneurs, although more than half entered prostitution because of family pressure (McCaghy & Hou, 1994). Many of these women were sold into brothels, coerced into prostitution, or were escaping violence in their homes. To consider these human rights violations as the inevitable risks of entrepreneurship is a cynical denial of harm. Calhoun & Weaver (1996) described the "rational decision-making" of boys who were prostituting, suggesting that quick and easy financial gain was a primary motivation to prostitute. They describe one youth's reasoning:

"To James ... [prostitution] solves a financial need, and he has apparently decided that the high monetary return for a minimal investment of time is preferable to legitimate employment and that it also exceeds the negative consequences of arrest" (page 218) .

Most of the interviewees in the Calhoun study however, were under the age of 18 and had little education. This suggests that escape from family violence and lack of sustainable job options may have led to prostitution. Other articles we reviewed similarly emphasized lack of education as a precursor to entering prostitution (Deren et al., 1996; Parr et al., 1996; Karim et al., 1995). Chattopadhyay, et al. (1994) noted that 70% of the Indian 14508

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women they interviewed wanted to leave prostitution, but cultural factors which channeled them into prostitution prevented their escape: a 6% literacy rate, beatings, starvation, rape by family members, and sexual exploitation at their jobs. The most frequent reason given by these women for leaving their last job was that prostitution would provide "better pay for what they had to do anyway" (Chattopadhyay et al., 1994, page 254). Women in most jobs in West Bengal, India, were expected to permit sexual exploitation. Scambler & Scambler (1995) noted that underemployment, unemployment and poverty were principal reasons for entering prostitution. Of 475 people in prostitution from 5 countries, 72% reported current or previous homelessness (Farley et al., 1998). A California agency serving women in prostitution reported that 67% of those requesting services were currently or formerly homeless. (PROMISE, 1997) Poverty alone does not explain the gender imbalance in prostitution. For example, Booth et al. (1995) interviewed 383 addicts and found that women were more likely to have prostituted to earn money than men. Female gender and having been prostituted were the strongest predictors in Booth's study for low self-concept, depression, and anxiety. Exchanging sex for money or drugs led to a profound sense of worthlessness and other psychological problems. El Bassel et al. (1997) found that women who traded sex for drugs were in more severe psychological distress than women who did not trade sex for their drugs.

Racism in Prostitution There was a deafening silence regarding racism in the literature reviewed here. Women in prostitution are purchased for their appearance, including skin color and characteristics based on ethnic stereotyping. Throughout history, women have been enslaved and prostituted based on race and ethnicity, as well as gender (Barry, 1995). Root (1996) characterized racism as a form of insidious trauma which continually wears away at people of color and makes them vulnerable to stress disorders. Legal prostitution, such as strip clubs and stores which sell pornography (that is, pictures of women in prostitution) tend to be zoned into poor neighborhoods, which in many urban areas in the USA, tend also to be neighborhoods of people of color. The presence of commercial sex businesses creates a hostile environment in which girls and women are 14509

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continually harassed by pimps and johns. Women and girls are actively recruited by pimps and are harassed by johns driving through their neighborhoods. There is an essential sameness between the abduction into prostitution of African women by slavers, on the one hand, and today's cruising of African American neighborhoods by white johns searching for Black women to buy (Nelson, 1993). In most cities in the US, women of color are overrepresented in prostitution, compared to their numbers in the society as a whole. For example, in Minneapolis, a city which is 96% white European-American, more than 50% of women in strip club prostitution are women of color. (Dworkin, personal communication, 1997). Especially vulnerable to violence from wars or economic devastation, indigenous women are brutally exploited in prostitution - Mayan women in Mexico city, Hmong women in Minneapolis, Karen women in Thailand, or First Nat-ions women in Vancouver. African American women are arrested in prostitution at a higher rate than others charged with this crime (Nelson, 1993, MacKinnon & Dworkin, 1997) . Once in prostitution, women of color face barriers to escape. Among these is an absence of culturally-sensitive advocacy services. Other barriers faced by all women escaping prostitution are a lack of services which address emergency needs (shelters, drug/alcohol detoxification, and treatment of acute posttraumatic stress disorder or PTSD) and long-term needs (treatment of depression and chronic PTSD, vocational training, and longterm housing) .

Violence precedes entry into prostitution Research and clinical reports have documented the prevalence of childhood sexual abuse and chronic traumatization among prostituted women (Belton, 1992; Burgess,et al., 1987; Giobbe et al., 1990; James & Meyerding, 1977; Paperny & Deisher, 1983; Silbert & Pines, 1981, 1982a; 1983; Simons & Whitbeck, 1991; Widom & Kuhns, 1996). From 60% to 90% of those in prostitution were sexually assaulted in childhood (Harlan, Rodgers & Slattery, 1981, Murphy, 1993; Silbert & Pines, 1983). One young woman told Silbert and Pines (1982a, page 488): "I started turning tricks to show my father what he made me." Many of the adolescents interviewed by Weisberg (1985) reported that they began prostituting before running away from home. 14510

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Multiple perpetrators of sexual abuse were common, as was physical abuse in childhood (Farley et al., 1998). Sixty-two percent of women in prostitution reported a history of physical abuse as children (Bagley & Young, 1987; Silbert & Pines, 1981, 1983). In another study, 90% of the women had been physically battered in childhood; 74% were sexually abused in their families- with 50% also having been sexually abused by someone outside the family (Giobbe, 1991; Giobbe et al., 1990). Of 123 survivors of prostitution at the Council for Prostitution Alternatives in Portland - 85% reported a history of incest, 90% a history of physical abuse, and 98% a history of emotional abuse (Hunter, 1994). One woman in prostitution said:

We've all been molested. Over and over, and raped. We were all molested and sexually abused as children, don't you know that? We ran to get away. They didn't want us in the house anymore. We were thrown out, thrown away. We've been on the street since we were 12, 13, 14. (Boyer et aI, 1993, page 16) Child sexual abuse was a precursor to prostitution among 50% of 150 Nigerian prostituted teenagers (Adedoyin & Adegoke, 1995). Widom and Ames (1994) noted that child sexual abuse survivors were more likely than child physical abuse survivors to be arrested for prostitution as adults. 30% of a sample of women in San Francisco entered prostitution at the age of 15 or younger, and described themselves as runaways (PROMISE, 1997). Women who experienced early sexual abuse were at risk for a later recurrence of sexual and physical trauma (Browne & Finkelhor, 1986; Wyatt & Powell, 1988), but these behaviors were based in trauma, and were not the result of an innate risk-taking personality. Trauma researchers have described the complexity of repetitive behaviors found in survivors of chronic trauma (Herman, 1992; Terr, 1991). Traumatic reenactments occur along with psychobiological dysfunction, including self-destructive thoughts and behaviors, self-contempt, feelings of shame and worthlessness, substance abuse, eating disorders, and sexual aversions or compulsions (Herman, 1992; Terr, 1991). Incest, rape, and prostitution may be seen as points on a continuum of sexual exploitation and abuse. Some described the emotional distancing necessary to survive rape and prostitution as the same technique used to endure familial sexual assault (Giobbe, 1991; Miller, 1986). Dworkin (1997a) described incest as "boot camp" for prostitution. 14511

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Pervasive violence in prostitution A number of authors have documented and analyzed the sexual and physical violence which is the normative experience for women in prostitution, including Baldwin (1993), Chesler (1993), Dworkin (1981; 1997a), Farley et al. (1998), Hunter (1994), Jeffreys, (1997), Karim, et al., (1995), MacKinnon (1993), McKeganey & Barnard (1996), Miller (1995), Silbert & Pines (1982a, 1982b) Weisberg (1985), and Vanwesenbeeck (1994). Silbert & Pines (1981, 1982b) reported that 70% of women suffered rape in prostitution, with 65% of prostitutes having been physically assaulted by customers; and 66% assaulted by pimps. Vanwesenbeeck (1994) reported that 60% of prostituted women in the Netherlands suffered physical assaults; 70% experienced verbal threats of physical assaultj 40% reported sexual violence; and 40% reported having been forced into prostitution and/or sexual abuse by acquaintances (Vanwesenbeeck, 1994). After reviewing a number of studies, Weisberg (1985) concluded that most juvenile prostitutes had been abused or beaten by both pimps and customers. 85% of women interviewed by Parriott (1994) had been raped in prostitution. Of 475 people in prostitution who were interviewed in 5 countries, Farley et al (1998) reported that 73% had experienced physical assaults in prostitution, and 62% had been raped in prostitution. The Council for Prostitution Alternatives in Portland, Oregon, reported that prostituted women were raped an average of once a week (Hunter, 1994). Women in prostitution are battered women. Prostitution, like battering, is a form of domestic violence. Giobbe (1993) compared pimps and batterers and found similarities in their use of enforced social isolation, minimization and denial, threats, intimidation, verbal and sexual abuse, attitude of ownership, and extreme physical violence to control women. The techniques of physical violence used by pimps are often the same as those used by torturers. Gray (1973, cited in Weisberg, 1985) reported that one teenager was beaten with a 6-foot bullwhip and another was tied to a car and forced to run behind it. It has been reasonably estimated that prostitution is 80% to 90% pimp-controlled (Giobbe & Gamache, 1990j Hunter, 1994). The primary concern of prostituted women in Glasgow was violence from customers (Green et al., 1993). Rape was common. The women in Glasgow were physically abused as part of the job of prostitution. They were whipped and 14512

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beaten up, with payment at times received "per individual blow" (Green et al., 1993, page 328). Prostituted women described a minority of johns as extremely dangerous. These men were likely to assault or murder women in prostitution for pleasure. They used fists, feet, baseball bats, knives, or guns in their assaults on the women. One man inserted a shotgun into at least one woman's vagina and mouth. 87% of prostituted women interviewed by Miller (1995) were physically assaulted in prostitution, with 31% having been stabbed, and 25% being hit with an object. 37% of her sample had been held captive. Prostituted women were often assaulted and robbed (Green et al, 1993; Hardesty & Greif, 1994; Miller, 1995). Miller & Schwartz (1995) found that 94% of those in street prostitution had experienced some form of sexual assault; 75% had been raped by one or more johns. In spite of this, there was a widespread belief that the concept of rape did not apply to prostitutes. If rape of a prostituting woman occurs, some have considered the rape to be "theft" or "breach of contract" rather than rape. Many people assumed that when a prostituted woman was raped, it was part of her job and that she deserved or even asked for the rape. In an example of this bias, a California judge overturned a jury's decision to charge a customer with rape, saying that "a woman who goes out on the street and makes a whore out of herself opens herself up to anybody." One juror interpreted the judge's decision as a refusal to give rights to prostitutes (Arax, 1986). Because of the difficulty in obtaining testimony from those who are addicted or homeless, and because of bias against those in prostitution, district attorneys and police tend to place a low priority on prosecution of those who rape prostitutes (Gross, 1990).

Symptoms of psychological trauma in women in prostitution Describing the trauma of prostitution, and its consequences, one fourteen year old stated: "You feel like a piece of hamburger meat - all chopped up and barely holding together" (Weisberg, 1985, page 112). Dissociation is the psychological process of banishing traumatic events from consciousness (Herman, 1992). It is an emotional shutting-down which occurs during extreme stress among prisoners of war who are being tortured, among children who are being sexually assaulted, and among women being battered or raped or prostituted. 14513

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Vanwesenbeeck (1994) considered dissociation in those prostituted to be a consequence of both childhood violence and adult violence in prostitution. She noted that a proficiency in dissociation, perhaps learned in order to survive sexual abuse as a child, was required in prostitution. Vanwesenbeeck et al. (1995) found that the more severe the victimization in childhood, the more frequently dissociation and denial were used in adulthood. Ross et al. (1990) noted dissociative symptoms in women in strip club prostitution. Belton (1998) reported that depression as well as dissociative disorders were common among prostituted women. One prostituted teenager stated:

"I left my body. Very seldom was I ever there. I had a good technique for leaving. I knew where I was at, I mean I knew what they were doing, but it was like I have no feeling ... it was my survival. That was a way of knowing that they might have my body, but they're not going to get me." (Giobbe, 1992, page 125) People in prostitution suffer from posttraumatic stress disorder (PTSD). Symptoms are anxiety, depression, insomnia, irritability, flashbacks, emotional numbing, and hyperalertness. Farley et al., (1998) interviewed 475 prostituted people in 5 countries (South Africa, Thailand, Turkey, USA, and Zambia) and found that 67% met diagnostic criteria for PTSD, suggesting that the traumatic sequelae of prostitution were similar across different cultures. The following are three examples of PTSD: Many years after escaping from prostitution, an Okinawan woman who had been purchased by US military personnel during the Vietnam war became extremely agitated and had visions of sexual abuse and persecution on the 15th and 30th of each month, those days which were GI paydays (Sturdevant & Stolzfus, 1992). Another woman described how her symptoms of PTSD were ignored by her counselor: "I wonder why I keep going to therapists and telling them I can't sleep, and I have nightmares. They pass right over the fact that I was a prostitute and I was beaten with two-by-four boards, I had my fingers and toes broken by a pimp, and I was raped more than 30 times. Why do they ignore that?" (Farley & Barkan, 1998, page 46) . 14514

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An observant john noted of the woman he was raping: " ... maybe she was undergoing a slight nightmare or something like confusion." (Hite, 1981, page 773) The violence of prostitution, the constant humiliation, the social indignity and misogyny result in personality changes which have been described by Herman (1992) as complex posttraumatic stress disorder (CPTSD). Symptoms of CPTSD include changes in consciousness and self-concept, changes in the ability to regulate emotions, changes in systems of meaning, such as loss of faith, and an unremitting sense of despair. Once out of prostitution, 76% of a group of women interviewed by Parriott (1994) reported that they had great difficulty with intimate relationships. Not only were sexual feelings destroyed in prostitution, but the emotional part of the self was eroded. (Hoigard & Finstad,1986; Giobbe, 1991, 1992) One of the longer-lasting effects of CPTSD involves changes in relations with other people, including changes in perception of the perpetrator of abuse. Unless human behavior under conditions of captivity is understood, the emotional bond between those prostituted and pimps is difficult to comprehend. The terror created in the prostituted woman by the pimp causes a" sense of helplessness and dependence. This emotional bonding to an abuser under conditions of captivity has been described as the Stockholm Syndrome (Graham et al., 1994). Attitudes and behaviors which are part of this syndrome include: 1) intense gratefulness for small favors when the captor holds life and death power over the captive; 2) denial of the extent of violence and harm which the captor has inflicted or is obviously capable of inflicting; 3) hypervigilance with respect to the pimp's needs and identification with the pimp's perspective on the world (an example of this was Patty Hearst's identification with her captors' ideology); 4) perception of those trying to assist in escape as enemies and perception of captors as friends; 5) extreme difficulty leaving one's captor/pimp, even after physical release has occurred. Paradoxically, women in prostitution may feel that they owe their lives to pimps.

Physical Health Problems A focus on the spread of HIV shifted attention away from the inaccessibility of health care for women in prostitution in USA (Lawless, Kippax & Crawford, 1996; Pederson, 1994; Sacks, 1996). This same trend has 14515

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been observed in non-dominant countries. Moses (1996) noted that the lack of access to health services resulted in unsuccessful implementation of large­ scale STD prevention programs in Asia and Africa. A lack of attention to women's experiences of violence and sexual abuse has resulted in repeated failures of the health care system for women (Dean­ Patterson, 1999). Those in prostitution lacked access to social and medical services which were available to others (Scambler & Scambler, 1995). Fear of arrest and social contempt made it difficult for prostituted women to seek shelter or medical treatment (Weiner, 1996). Some research addressed non-HIV-related health problems of women in prostitution. Prostituted women had an increased risk of cervical cancer and chronic hepatitis (Chattopadhyay et al., 1994; de Sanjose et al., 1993; Pelzer et al., 1992; Nakashima et al., 1996). Incidence of abnormal Pap screens was several times higher than the state average in a Minnesota study of prostituted women's health (Parriott, 1994). Childhood rape was associated with increased incidence of cervical dysplasia in a study of women prisoners (Coker et al., 1998). Half of the women interviewed in San Francisco by Farley & Barkan (1998) reported physical health problems, including joint pain, cardiovascular symptoms, respiratory symptoms, neurological problems, and HIV (8%). 17% stated that, if it were accessible, they would request immediate hospital admission for drug addiction or emotional problems. Some acute and chronic problems were directly related to violence. One woman said about her health:

"I've had three broken arms, nose broken twice, [and] I'm partially deaf in one ear.... I have a small fragment of a bone floating in my head that gives me migraines. I've had a fractured skull. My legs ain't worth shit no more; my toes have been broken. My feet, bottom of my feet, have been burned; they've been whopped with a hot iron and clothes hanger... the hair on my pussy had been burned off at one time ... I have scars. I've been cut with a knife, beat with guns, two by fours. There hasn't been a place on my body that hasn't been bruised somehow, some way, some big, some small." (Giobbe, 1992, page 126). 14516

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70% of 100 prostituted girls and women in Bogota reported physical health problems. In addition to STD, their diseases were those of poverty and despair: allergies, respiratory problems and blindness caused by glue sniffing, migraines, symptoms of premature aging, dental problems, and complications of abortion (Spiwak, 1999). Adolescent girls and boys in prostitution surveyed by Weisberg (1985) reported STD, hepatitis, pregnancies, sore throats, flu, and repeated suicide attempts. Women who serviced more customers in prostitution reported more severe physical symptoms (Vanwesenbeeck,1994). The longer women were in prostitution, the more STD reported (Parriott, 1994). We found no study to date of the chronic nature of the health problems suffered by women in prostitution, although it has been well documented that chronic health problems result from physical abuse and neglect in childhood

(Radomsky, 1995), sexual assault (Golding, 1994), battering (Crowell &

Burgess, 1996), untreated health problems and overwhelming stress (Friedman &

Yehuda,1995; Koss & Heslet, 1992; Southwick et al. 1995). Prostituted women suffer from all of the foregoing. Many of the chronic physical symptoms of women in prostitution were similar to the physical sequelae of torture

(Basoglu, 1992). The death rate of those in prostitution was 40 times higher than that of the general population (Special Committee on Pornography and Prostitution,

1985; cited in Baldwin, 1992).

Pornography and prostitution Barry (1995) defined pornography as the presentation of prostitution sex. Pornography is a specific type of prostitution, in which prostitution occurs and, among other things, is documented. The women whose prostitution appears in pornography are prostituted women. The harm of prostitution is made to disappear in pornography. Pornography has been used as recruitment into childhood sexual assault as well as recruitment into prostitution (MacKinnon & Dworkin, 1997). Pornography which normalizes prostitution is used by pimps to teach girls what acts to perform in prostitution (Silbert & Pines, 1984). Women in prostitution have described pornography's role in their being coerced by 14517

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pimps or customers to enact specific scenes (Silbert & Pines, 1984; MacKinnon & Dworkin, 1997; Farley & Barkan, 1998). Customers show women pornography to illustrate what they want. Strip clubs show video pornography to promote prostitution. 49% of 130 people in one study reported that pornography was made of them while they were in prostitution; and 32% had been upset by an attempt to coerce them into performing what customers had seen in pornography (Farley & Barkan, 1998). 56% of those in prostitution in South Africa, 48% in Thailand, and 47% in Zambia reported being upset at attempts to coerce them into acts seen in pornography (Farley et al., 1998). 38% of 200 prostituted women interviewed by Silbert & Pines (1984) reported that pornography had been made of them as children. 27% of the adolescent boys interviewed by Weisberg (1985) reported that pornography had been made of them. Even after women escaped prostitution, they continued to be traumatized by the knowledge that customers look at pornography which documented what was done to them in prostitution (MacKinnon & Dworkin, 1997).

Needs of women escaping prostitution In order to offer genuine choices to people in prostitution, programs which claim to offer assistance must offer more than condoms and safer sex negotiation skills. These are not only insufficient, but they have been shown to result in increased violence against prostituted women. It is necessary to look at the vast array of social conditions in women's lives which eliminate meaningful choices. In order to understand prostitution, it is necessary to also understand 1) incest and other childhood sexual assault; 2) poverty and homelessness; 3) the ways in which racism is inextricably connected with sexism in prostitution; 4) domestic violence; 5) posttraumatic stress disorder, mood and dissociative disorders as sequelae of prostitution; 6) chemical dependence; 7) the need for culturally-relevant treatment; and 8) the fact that the global nature of the commercial sex industry involves interstate and inter-country trafficking as a necessary part of its profitable operation. The most urgent need of girls and women escaping prostitution was housing (Boyer et aI, 1993; Commercial Sexual Exploitation Resource Institute, 1998; EI Bassel et al., 1997; Farley et aI, 1998; Serre et aI, 1996; Weisberg, 1985). Both transitional and longterm housing was needed. 14518

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Serre et al. (1996) found that 50% of the 355 women in prostitution were in unsafe living conditions, and that 33% had been physically assaulted during the prior 5 months. 92% of 475 people in prostitution stated that they wanted to escape. When asked about their needs, 73% told the researchers that they needed a home or place of asylum; 70% needed job training; 59% needed health care, including treatment for drug or alcohol addiction (Farley et al., 1998). As part of intake assessments, health service providers should not only inquire about history of sexual assault, violence, and addictions. Belton (1992) and Goodman & Fallot (1998) have discussed the need for routine inquiry regarding prostitution history. The questions "have you ever exchanged sex for money or clothes, food, housing, or drugs?" and "have you ever worked in the commercial sex industry: dancing, escort, massage, prostitution, pornography, phone sex?" have been used in the first author's clinical practice. Emergency services used by women in prostitution, such as crisis lines, emergency housing, medical and psychological treatment, substance abuse treatment, and outreach programs rarely if ever addressed the sexual trauma of women in prostitution (Boyer et aI, 1993). Often, medical and social service providers were disrespectful to women in prostitution. Although it is commonly assumed that street prostitution is the most dangerous type of prostitution, Boyer observed that women in non-street prostitution, such as strip clubs, massage brothels and pornography, had less control over the conditions of their lives and probably faced greater risks of exploitation, enslavement, and physical harm, than women prostituting on the street. Her report on the needs of prostituted women in the Seattle area recommended increased outreach to women in non-street prostitution. Training for service providers was recommended, as were peer support groups where women could speak openly with others about their experiences of sexual exploitation. Chemical dependence treatment specifically for commercial sex industry survivors was also proposed (Boyer et aI, 1993). The vocational needs of women escaping prostitution are complex and long-term. Women leaving prostitution in their twenties and thirties may have been in prostitution since they were very young, and may never have had a job other than prostitution. Vocational counselors should be able to articulate the impact of prostitution on a woman's vocational identity. 14519

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Vocational rehabilitation counselors must be expert in labor market issues, federal and state laws regarding disability, and they must be skilled at using psychiatric diagnoses in disability applications (Murphy, 1993). Asthana and Oostvogels (1996) predicted that programs to assist those in prostitution would continue to fail unless significant changes were made to systems which keep women in a position of subordination and exploitation. In one particular instance of this, women drug users were prostituted far more frequently than men drug users, were at greater risk for HIV than men, had lower self-concepts than did men drug users, and had fewer employment opportunities, legal or illegal, than did men drug users (Booth et al., 1995) . Weisberg (1985) noted the importance of prostitution prevention programs for children. The Commercial Sexual Exploitation Resource Institute (1998) offered multilingual curricula for prostitution prevention in junior and high schools, a legal services clinic, and a program which placed survivors of prostitution into host families in the community.

Criminal Justice Responses to Prostitution

It is beyond the scope of this paper to critique the history of legal approaches to prostitution in the USA. Feminist attorneys Margaret Baldwin, Dorchen Leidholdt, and Catharine MacKinnon have begun discussions of a range of legal responses to prostitution (Baldwin, 1993; Leidholdt, 1993; MacKinnon, 1993).

In most parts of the USA, prostitution is a criminal act. Yet there has been a hugely disparate arrest rate of women in prostitution, compared to arrests of johns. The law enforcement focus on the woman in prostitution rather than on predatory behaviors of pimps and johns, reflects the emphasis of the social sciences literature reviewed here. The demand side of prostitution has been largely ignored. For example, The Seattle Women's

Commission (1995) reported that in 1993, there were 1,210 arrests of women on prostitution-related charges. Of those arrested, 62% were charged and 42% convicted. During the same time period, 228 men were arrested for patronizing a prostitute. Of those men, 98% were charged and only 8% convicted. Arrests of women in prostitution and the simultaneous failure to arrest customers comprised unfair and discriminatory practices (Davis, 1993). 14520

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It is commonly assumed that the greater the legal tolerance of

prostitution, the easier it is to control public health (Green et aI, 1993).

"Public health" in this context refers primarily to STD in johns, rather than

to the mental and physical health of prostituted women. Legalized

prostitution involves state, county, or city ordinances which regulate

prostitution, for example, requiring STD tests and collecting taxes. In

Nevada, regulations determine geographic location and size of brothels, as

well as activities of women outside the brothel. Prostituted women are only

allowed into nearby towns from 1-4pm, are restricted to certain locations,

and are even prohibited from talking to certain persons (Miller et al.,

1993) . The HIV epidemic has brought with it the advocacy of another legal

approach to prostitution: decriminalization, or the cessation of enforcement

of all laws against prostitution. Decriminalization of prostitution has been

promoted by the commercial sex industry as a means of removing the social

stigma associated with prostitution. The likely result of decriminalization

would be to make men's access to women and children in prostitution far

easier than when prostitution is illegal. Decriminalization would normalize

commercial sex but it would not reduce the trauma and the humiliation of

being prostituted. Respondents in South Africa and Zambia were asked whether

they thought they would be safer from sexual and physical assault if

prostitution were legal. A significant majority (68%) said "no" (Farleyet

al., 1998). The implication was that regardless of the legal status of

prostitution, those in it knew that they would continue to experience violence. Dworkin proposed decriminalization of prostitution for the prostitute

and recognition of the pimp or john as criminal (1988). In Norway,

criminologists Finstad and Hoigard proposed "unilateral criminalization of

customers" (1993, page 222). Stating that "prostitution is not a desirable

social phenomenon" (Ministry of Labour, Sweden, 1998,page 3), the Swedish

government in 1999 criminalized the buying of sexual services but not the

selling of sexual services. Noting that " ... it is not reasonable to punish the person who sells a sexual service. In the majority of cases ... this person is a 14521

26 weaker partner who is exploited," (Ministry of Labour, Sweden, 1998, page 4) the Swedish government allocated social welfare monies to "motivate prostitutes to seek help to leave their way of life" (Ministry of Labour,

Sweden, 1998, page 3). These social interventionist approaches reflect the state's interest in counteracting the spread of the commercial sex industry

(Mansson and Hedin, in press). As Finstad and Hoigard wrote in 1993:

"If any sort of criminal law must exist, it should be directed against 'normal' people's harmful behavior, such as being the customer of a prostitute. This suggestion... rests on the objective consequences of customers' actions, the long-term effects suffered by women. Many customers are in the kind of social situation in which the threat of a criminal conviction would be effective... " (page 222). Another criminal justice approach to prostitution is the diversion program which focuses on educating arrested johns (Monto, 1998). The Sexual Exploitation Education Program (SEEP), in Portland, Oregon, operated in conjunction with the Council for Prostitution Alternatives. Goals of SEEP's interventions with johns were: 1) to reframe the definition of prostitution from a "victimless crime" to a system of violence against women; 2) to deconstruct male sexual identity in order to clarify how men's socialization led to a propensity for commiting violence against women; and 3) to stress the choice and responsibility which men have to create egalitarian relationships without coercion or violence. (cited in Monto, 1998). In the United Kingdom, the Kerb Crawlers Rehabilitation Programme operates as part of the Research Centre on Violence, Abuse, and Gender Relations. Like SEEP, the Kerb Crawlers (an expression which refers to johns) program attempts remedial social education by shifting the focus from the woman in prostitution to the john. The Programme was designed to challenge misconceptions about prostitution, about male sexuality, about the consequences of child abuse, and to address the reasons why people enter prostitution (Bindel, 1998). Although the johns' education programs report significantly reduced recidivism, a trial treatment program for arrested pimps in Nova Scotia resulted in 100% recidivism (McGrath, 1998). Pimps are significantly more dangerous perpetrators than most customers of prostitutes. Other legal approaches to prostitution include confiscation of the cars of arrested johns. A number of states and municipalities, including California, Minnesota, Illinois, Pennsylvania, New York, and Wisconsin have 14522

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enacted such laws. Monies from such confiscations should be used exclusively to develop services for women escaping prostitution.

The social invisibility of prostitution The social and legal refusal to acknowledge the harm of prostitution is stunning. Libertarian ideology obfuscates the harm of prostitution, defining it as a form of sex. The statement that prostitution is "just a job which can be difficult at times, like any other job" - is far from the truth. Institutions such as slavery and prostitution which have existed for thousands of years are so deeply embedded in cultures that they become invisible. In Mauritania, for example, there are 90,000 Africans enslaved by Arabs. Human rights activists travel to Maurit.ania to report on slavery, but because they don't observe their stereotyped notion of what slavery looks like - if they don't see bidding for shackled people on auction blocks - they conclude that the Africans working in the fields in front of them are voluntary laborers who are receiving food and shelter as salary (Burkett, 1997) . Similarly, if observers don't see exactly what their stereotype of "harmful" prostitution is - for example, if they don't see a gun pointed at the head of a girl being trafficked from one state to another, if all they see is a smiling streetwise teenager who says 'I like this job, I'm getting rich' - then they don't see the harm. Prostitution tourists go to Amsterdam's, New York's, or Bangkok's prostitution zones and see smiling girls waving at them from glass cages or clubs. The customers decide that prostitution is a free choice. In prostitution, a necessary part of the role is to look happy: to ask for the rape, to say she enjoyed the rape. Wonten who escape prostitution have reported that saying these words of pleasure to those who are torturing them was a nightmare. The language recently used to describe prostitution has contributed to confusion regarding whether or not prostitution is a form of violence against women. Some words which refer to prostitution cover up its cruelty. The term "sex work" implies vocational choice. Accepting prostituted women as "commercial sex workers" brings with it an acceptance of what in any other context would be described as sexual harassment, sexual exploitation, or sexual abuse. If prostitution becomes "sex work," then the brutal 14523

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exploitation of those prostituted by pimps becomes an employer-employee relationship. And the predatory, pedophiliac purchase of a human being by the john becomes just one more business transaction. Women who have survived prostitution and who have gotten out, have asked that they not be transformed into the object/noun, "prostitute." The word "prostitute" eliminates the human being in prostitution. Just as we avoid referring to a battered woman as a "batteree," someone who has actually evolved into being the thing that was done to her, we can avoid turning the woman in prostitution into that which was inflicted on her. We are invited instead to use the adjective, verb, or prepositional phrase: "prostituted," "prostituting," or "person in prostitution." One of the myths about prostitution is that "high-class" call-girl prostitution is vastly different, and much safer than street prostitution. This has not been verified by research. One study reported that there was no difference in the incidence of posttraumatic stress disorder experienced by those prostituting on the street and those prostituting in "high-class brothels." (Farley et al., 1998). Parriott (1994) found no differences in health problems reported by women in massage brothels, escort services, strip clubs, bars, and street prostitution. Boyer et al (1993) reported that women in all forms of prostitution (escort, strip club, street, phone sex, and massage brothel) were subject to sexual violence. One customer said: "With all of this sexual harassment stuff going around these days, men need somewhere to go where they can say and act like they want ... I think that going to a [strip] club is a release" (Frank, 1999, page 20). All mutations of the commercial sex industry were unpredictable and dangerous for women. Furthermore, most women in prostitution participate in several different kinds of prostitution. Sexual exploitation seems to happen with the "consent" of those involved. But doesn't consent involve the option to make other choices? If prostitution is a choice, why are those with the fewest options the ones in it? (MacKinnon, 1993). The greatest obstacle to seeing prostitution as abuse and exploitation is the notion of prostitution as -free will" (Finstad & Hoigard, 1993, page 213). One woman described prostitution as "volunteer slavery," clearly articulating both the appearance of choice and the overwhelming coercion behind that choice. (Vanwesenbeeck, 1994, page 149) . 14524 29

Most of those in prostitution have few or no other options for the necessities of life.

Conclusion The commercial sex industry is a multibillion dollar global market which includes strip clubs, massage brothels, phone sex, adult and child pornography, street, brothel, and escort prostitution. One's political perspective will determine whether prostitution is viewed primarily as a public health issue, as an issue of zoning and property values (which parts of town should house strip clubs and pornography stores?), as vocational choice, as sexual liberation, as petty crime, as domestic violence, or as human rights violation. For the vast majority of the world's prostituted women, prostitution is the experience of being hunted, dominated, harassed, assaulted, and battered. Intrinsic to prostitution are numerous violations of human rights: sexual harassment, economic servitude, educational deprivation, job discrimination, domestic violence, racism, classism, vulnerability to frequent physical and sexual assault, and being subjected to body invasions which are equivalent to torture.

In prostitution, demand creates supply. Because men want to buy sex, prostitution is assumed to be inevitable, therefore 'normal.' Men's ambivalence about the purchase of women, however, is reflected in the relative scarcity of research interviews with johns, and their desire to remain hidden. In a series of interviews with johns conducted by women employed by massage brothels, Plumridge noted that on the one hand, they believed that commercial sex was a mutually pleasurable exchange, and on the other hand, they asserted that payment of money removed all social and ethical obligations (1997). One john said: "It's like going to have your car done, you tell them what you want done, they don't ask, you tell them you want so and so done ... " (McKeganey & Barnard, 1996, page 53) . The cultural context of sexism and racism must be understood in order to offer real choices to women who are at risk for prostitution (Alegria et al., 1994; Karim et al., 1995; Hardesty & Greif, 1994; Silbert and Pines 1983). The study of violence against women suggests that in order to predict sexually aggressive behavior, we must take into account mUltiple variables which connect the individual and cultural nature of sexual violence (Crowell 14525

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& Burgess, 1996). Pornography, for example, is a form of cultural propaganda which reifies the notion that women are prostitutes. One man said "I am a firm believer that all women... are prostitutes at one time or another" (Hite, 1981, page 760). To the extent that any woman is assumed to have freely chosen prostitution, then it follows that enjoyment of domination and rape are in her nature, that is to say, she is a prostitute (Dworkin, 1981). Discussing his experience in a strip club, one man said, "This is the part of me that can still go hunting" (Frank, 1999, page 22). Violent behaviors against women have been associated with attitudes which promote men's beliefs that they are entitled to sexual access to women, that they are superior to women, and that they are licensed as sexual aggressors (White & Koss, 1993). Prostitution myths are a crucial component of attitudes which normalize sexual violence. Monto (1999) found that johns' acceptance of commodified sexuality was strongly related to their acceptance of rape myths, violent sex, and less frequent use of condoms with women in prostitution. Arrested johns' level of acceptance of prostitution myths was the same as college men's and women's acceptance of prostitution myths (Farley et aI, 1998). Prostitution must be exposed for what it really is: a particularly lethal form of male violence against women. The focus of research, prevention, and law enforcement in the next decade must be on the demand side of prostitution.

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Table 1 Change in Content of References to Prostitution, 1980-199!

1980 - 1984 1992 -1996 Perc( •.'k.it Change Medline PsycINFO Medline PsycINFO Medline PsycINFO % (N} %(N) % (N} % (N} % % 1) STD/HIV 68% (81) 2% (1) 86% (476) 70% (146) +18% " ...::. +68% 2) Other Harmful Consequences 15% (18) 41% (21) 2% (10) 8% (18) ·%13 3) Legal/Demographic/ Psychoanalytic 17% (20) 57% (19) 12% (65) 22% (46) ·5%

Total 100%(119) 100%(41) 100%(551) 100%(210)

Definitions 1) STD/HIV: studies of at-risk sexual behaviors and drug-using practices 2) Other Harmful Consequences of Prostitution: studies of non-HIV -related harm, such as physical and sexual violence, antecedent childhood sexual assault 3) Legal/Demographic/Psychoanalytic: studies which focus on the psychology, or legalization of prostitution, without an emphasis on harmful consequences 14541

This is Exhibit I;JIl" mentioned and 14542

Attitudes Toward Prostitution and Acceptance of Rape Myths 1

ANN COTTON MELISSA FARLEy2 J/f.'terans ' AjliliJ:~ l'lIgel Souna' l'm8/itUlion Research & Edm':alivn Health Care System San Francisco, Cal~fomia St'clfrte, fIilshingum

ROBERT BARON University of Iowa, Iowa City

Rape myths and pmstitutiolllllyths are a component of culturally supported attitudes 111U! nonualizc violence against women. Prostitution mythsjustify ilieexistcilce of prostitution, promote misinformation about pro,StiWtion, and contribute to a social climate that exploits and harms not only prostituted women,bul all women. This study investigated the rela­ tionship between prostitution myth acceptance and rape myth ilcceptance in a sample of universi(y undergraduates. Rape myth acceptance was positively correlated wiih prostitu­ tion myth acceptance among 783 university Ilnd~rgradualcs from California, iowa, Ore­ gon, and Texas. College men were significantly more accepting of prostitution myths than were COllege wumen. Results suggest that acceptanct: (If prostitutin!l myths arc a compo­ nent flf attitudes that justify violence against women.

Violent behaviors against women are associated with culturaHy supported attitudes that encourage men to feel entitled to sexual aCcess to women, to fecI superior to women, or to feel that they have license as sexual aggressors (Crowell & Burgess, 1996; Koss, 1988; Malamuth, Sockloskie, Koss, & Tanaka, 1991: Marolla & Scully, 1986). Rape myths are a specific component of culturally sup­ ported altitudes that normalize rape (Farley, Becker, Cotton, Fitzgerald, & Jensen, 199R; Lonsway & Fitzgerald, 1994). ProstitutIon myths are beliefs thatjusti(y the existence of prostitution, that promote 111isinformation about prostitution, and that contribute to a social climate that exploits and harms not only prostituted women, but all women. Like rape myths, prostitution myths are hypothesized to be a component of attitudes toward women, gender roles, sexual interactions, and sexuality.

IThe authors wish to acknowledge the valuable contributions of Thomas Becker, Louise Fitzgerald, and Robert Jensen. 2Correspouticnce coneernmg this article should be addreSlied to i\1elissa Farley, Box 16254, San Francisco, CA 941 16·0254. E-mail: mfarlcy(ltJpmsritutionrcsearch.coJU

1790

Journal of Applied Social Psychology, 2002, 32, 9, pp. 1790-1796. Copyright <1:;; 2002 by V. H. Winston & Son, Inc. All rights reserved. 14543

ATTITUDES TOWARD PROST!TUTION 1791

Rape myths have been linked theoreticaHy and empirically to other attitudes regarding gender roles and interpersonal interactions (Hurt, 1980; Feild, 1978; Malamuth ct a!., 199 i). Rape myths and prostitution myths might be similarly associated. For example, three of Payne's (1993) rape myth items might also be viewed as statements about women as prostitutes: "If a man buys a woman things like expensive clothes and jewelry, he is entitled to sex from her," "If a husband pays all the bills, he has the right to sex with his wife \vhenever he wants;" and "If a woman lets a man pay for an expensive date, realistically she is agreeing to sleep with him." These statements impty that women in general are prostitutes and as H corollary, the belief that women's sexuality is a commodity. In addition to the rape myth that all women arc prostitutes, there are unique rape myths rele­ vant to prostitutes themselves. Miller and Schwartz (1995) interviewed prostituted women regarding the prevalence of rape myths among johns, police. and others whom they encoun­ tered on the street. Common themes reported by their interviewees were the prej­ udicial beliefs that (a) prostitutes are unrapablc; (b) no harm is done to prostitutes when they are assaulted or harassed; (c) prostitutes deserve to be raped; and (d) all prostitutes are the same. These rape myths about prostituted women have been upheld in judicial decisions in which women in prostitution were raped (Farley & Kelly, 2(00). There has been little study of attitudes toward prostitution in the general pop­ ulation. Two studies investigated attitudes toward prostitution among college stu­ dents. Basow and Campanile (1990) found that pro-feminist and anti-prostitutlon attitudes were positively correlated. A second study reported that 33% of a sample of college students believed that prostitutes "love sex, enjoy their work, are proud of their work, have high self-esteem, and like being on display" (Polk & Cowan, ! 996, p. 224) The current study investigates the relationShip between prostitution myths and rape myth acceptance in a large sample of university undergraduates.

Method

We used six items that reflect myths about prostitution from the attitudes sub­ set of the Prostitution Behavior Questionnaire (PBQ-A; Sawyer, Lewis, & Brucker, 1998). The six items are: "There is nothing wrong with prostitution"; "Prostitutes are victims of pimps"; "Most prostitutes make a lot of money"; "Women are prostitutes because they want tD be; it's their choice"; "Prostitutes enjoy their work"; and "Prostitutes genuinely like men." Students responded to each statement on a 4-point scale (ranging from strongly disagree to strong(v agree). Agreement with each statement indicated endorsernent ofthe myth, with the exception of the statement "Prostitutes are victims of pimps," in which case disagreement indicated prostitution myth endorsement. 14544

1792 COTTON ET AL.

Rape myth acceptance was measured hy the short form of the lHinois Rape Myth Acceptance scale (IRMA~SF; Payne, 1993). A Cronbach's alpha of .87 suggests strong internal reliability of the IRMA-SF (Payne, 1993). The rape myth scale contains seven subscales: Victim precipitation (VP); It wasil't really rape (NR); He didn't mean to/couldn't help it (MT); She really wanted it/enjoyed it (Wi); She lied (Ll); Rape is no big deal (BD); and Rape is a deviant event (DE). Written measures were collected anonymously from undergraduates emolled in introductory level courses at four universities (one university each in Califor­ nia, Iowa, Oregon, and Texas). Two of the universities were smali private institu­ tions, and two were large public institutions. Respondents Were instructed not to put their names on the surveys. Participants were 783 (507 females, 65%; 276 males, 35%) university under­ graduates. The participants ranging in age from 17 years to 46 years, with a mean of 19.5 years (SD~" 2.4). The ethnic composition of the sample was approxi­ matdy 67% \Vhitc European American, r l% Asian or Pacific Islander, 9% Lat- . ino, 5% Multicultural, 2t)/Q African American, J % Native Alt'l:erican, and 4% Other. Of the participants, 95% identified themsel ves as heterosexual, 2% as homosexual, and 3% as bisexuaL Of {he sample, 27% reported having had no sexual partners, 56% reported fewer than 5 sexual partners, 12% reported fewer than 10 sexual partners, 3% reported 11 to 15 sexual partners, and 3% reported more than t 6 sexual partners.

Results

Of the college men, 6% (11 = 17) responded "Yes" to the question "Have you ever had sex of any kind (e.g., hand job, blow job, intercourse) with a profes­ sional sex worker (e.g., call girl. paid escort. massage parlor worker, prostitute)?" These students were not included in the subsequent analyses. Responses to the prostitution myth items by this group of male students-johns, or customers of prostitutes--wcrc compared to the rest of the sample in an exploratory manner, The IRMA-SF (rape myth scaJe; Payne, 1993) consists of seven subscales with two or four items loading on each subscale. Cronbach's alphas for the seven subscales were as follows: VP = .68, NR = .47, MT ,-" .55, WJ = .64, Ll = .70, Bf> "" .51, and DE "" .44. Cronbach's alpha for the 19-item scale was .80. Rates of endorsement of the six prostitution myths varied from 16% to 59%. More than half (59%) disagreed or strongly disagreed that "Prostitutes are victims of pimps"; 45% agreed or strongly agreed that "Women are prostitutes because they want to be; it's their choice"; 39% agreed or strongly that "Prostitutes genu­ inely like men"; and 16% of the students agreed or strongly agreed that "There is nothing wrong with prostitution" and that "Prostitutes enjoy their work." There "vere gender differences in prostitution and rape myth acceptance in this sample, More coHege men than college women endorsed prostitution and 14545

ATIITUDES TOWARD PROSTITunON 1793

Table i

Percetttage of Jfhmen and Men Who Agreed With Prostitution Myths (PDQ-A) Item Women Men

1. There is nothing wrong with prostitution. 10.0 26.7 .., ,,-, Prostitutes are victims of pimps.a 42.4 39.2 3. Most prostitutes make a lot of money. 41.2 37.8 4. Women are prostitutes because they want to be; it's their choice. 4L8 49.8 5. Prostitutes enjoy their work. 14.0 19.1 6. Prostitutes genuinely like men. 34.7 44.7 Note. 'Percentages reflect endorsements for agree and strongly agree response options. aDisagreement with this item is the prostitution myth. rape myths. The overall MANOVAby gender was significant for both prostitu­ tion myths, P(6, 662) "" 7.1, p < .001; and for rape myths, P(7, 706) = 22.0, p < ,(lOt. Gender differences were found on the following prostitution myth items: "There is nothing wrong with prostitution," F(1, 667) = 34.5, p < .001; "Prosti­ tutes enjoy their work," F(l, 667) "'" 5.3,p "'" .04; and "Prostitutes genuinely like men," FO, 667) = 6.7K, p ::::: .O!. Table 1 shows endorsement rate of prostitution myths by gender. We found a positive correlation between acceptance of prostitution myths and acceptance of rape myths. Overall prostitution myth endorsement was signifi­ cantly correlated with overall rape myth endorsement (r "" .27, P < .0001 ). Finally, we looked at the endorsement rates of prostitution myth items among the johns (n "'" 17) compared to the fest of the men in the sample. Results are shown in Table 2.

Discussion

Prostitution myth acceptance was positi'liely correlated with rape myth ac­ ceptance among the college undergraduates. Just as rape myths justify rape, prostitution myths rationalize sexual exploitation and violence in prostitution. College men were significantly more accepting of prostitution myths than were college women. This finding is consistent with previous research on gender dif­ ferences in sexual attitudes and rape myth acceptance (Hendrick, Hendrick, & Slapion-Foote, 1985; Lonsway & Fitzgerald, 1994). More men than women might support prostitution because men are more likely to believe that male sexual urges are an imperative, and that prostitution should exist a..') an institution to meet men '$ sexual needs. On the other hand, fewer women might support prostitution 14546

1794 conON ET AL.

Table 2

Percentage oJJolms and Other M(?1l Who Agreed f-flith Prostitution A{vths (PBQ-A)

Johns Other men Item (n ~ 17) (n "" 259) L There is nothing wrong with prostitution 29.4 26.7 2. Prostitutes are victims of pimpsa 41.2 39.2 3. Most prostitutes make a lot of money 29.3 37.8 4. Women are prostitutes because they want to be; it's their choice 35.4 49.8 5. Prostitutes enjoy their work 5.8 19.1 6. Prostitutes genuinely like men 29.4 44.7

NOle. Percentages reflect. endorsements for agree and str{)ng~)' agree response options. aDisagreement with this item is the prostitution myth. because they identify with the situation of prostituted women and view prostitu­ tion as exploitation, Nonprostituted college women might understand that con­ temptuous and misogynistic attitudes toward prostituted wome,n are only a thin line away from ,nisogynistic attitudes toward all women, Of the 276 college men, 17 reported being johns, Although the small size of this group prevented statistical analysis, it ~:vas noteworthy (hat they endorsed prostitution myths at a lower rate than men who were not johns on four of the six prostitution myth itt.~rns (make a lot (~rm()fleJ~ it:<; their choice. enjoy their work, and genuinely like men), Lower endorsement rates of prostitution myths among johns might be understood in terms of their direct experience with prostituted women, and their fact-based perspective from which to evaluate the myths. Future research might investigate the hypothesis that, over time, as men age and continue to purchase women in prostitution, their denial increases and prostitu­ tion myth acceptance increases. Monto and Hotaling (I998) reported that arrested johns who purchased prostitutes at least once a week strongly endorsed rape myths. Sawyer, Rosser, and Schroeder (1998) found varying degrees of acceptance of prostitution myths among arrested johns. A positive correlation between having used a prostituted woman and finding rape generally appealing was reported by Sullivan and Simon (1998). There is a grovving literature that documents the human-rights abuses intrinsic to prostitution, which include sexual harassment, economic servitude, educa­ tional deprivation, job discrimination, domestic violence, racism, classism, vu1- nembility to frequent physical and sexual assault, and being subjected to body 14547

ATTITUDES TOWARD PROSTITUTION 1795 invasions that are equivalent to torture (Farley & Barkan, 1998; Farley & Kelly, 2000; Silbert & Pines, 1982). Interviews with 475 people in prostitution indi­ cated that 92% wished to escape, but felt they had no other options (Farley, Baral, Kiremire, & Sezgin, 1998; Farley & Barkan, 1998), Housing, medical/psycholog­ ical care, treatment for drug/alcohol addiction, and job training are necessary in order to provide genuine options for those who wish to escape prostitution. Public education regarding the nature of the harms of prostitution is crucial in preventing violence against womcn. Frank dialogue regarding noncoercive sexu­ ality is urgently needed.

References

Basow, S. A., & Campanile, F. (1990). Attitudes toward prostitution as a function of attitudes toward feminism in college students. Psychology ojWomen Quar­ terly, 14, 13 5-J41. Burt, M. R. (1980). Cultural myths and support for rape. Journal of Persona/it}' and Social Psyc..1zo1ogy, 38, 217-230. Crowell, N., & Burgess, A. (1996). Understanding violence against ....'omen. Washington, DC: National Academy Press. Farley, M., Bara!, I., Kiremire, M.,& Sezgin, U. (1998). Prostitution in five coun­ tries: Violence and posttraumatic stress disorder. Feminism and Psychology, 8,415-426. Farley, M., & Barkan, H. (1998). Prostitution, violence, and posttraumatic stress disorder. ""'omen & Health, 27(3), 37-49. Farley, M., Becker, 1., Cotton, A., Sawyer, S" Fitzgerald, L., & Jensen, R. (1998, November). Attitudes Toward Prostitution Scale: College students' responses compared to responses of arrested johns. Poster session presented at the annual meeting of the International Society of Traumatic Stress Studies, Washington, DC. Farley, M., & Kelly, V. (2000). Prostitution: A critica.l review of the medical and social sciences literature. Women and Criminal Justice, I 1(4), 29~64, Feild, H. S. (1978). Attitudes toward rape: A comparative analysis of police, rap­ ists, crisis counselors, and citizens. Journal of Personality and Social Psy­ chology, 36, 156-! 79. Hendrick, S., Hendrick, c., & Slapion-Foote, S. L. (1986). Gender differences in sexual attitudes. Journal of Personality and Social Psychology, 48. 1630-1642. Koss, M. (1988). Hidden rape: Sexual aggression and victimization in a national sample of students in higher education. In A, W Burgess (Ed.), Rape and sex­ ual assault, If (pp. 3-25). New York, NY: Garland. Lonsway, K. A., & Fitzgeral(~ L F. (! 9(4). Rape myths: In review. Psychology 0/ I1hmen Quar!er~y, 18, 133-164. 14548

1796 conON ET AL.

Malamuth, N.M., Sockloskie, R. J., Koss, M. P., & Tanaka, J. S. (1991). Char­ acteristics of aggressors against women: Testing a model using a national sample of college students. Journal of Consulting and Clinical Psychology, 59, 670~68 i. Marolla, 1., & Scully, D. (1986). Attitudes toward women, violence, and rape: A comparison of convicted rapists and other felons. Deviant Behavior, 7, 337-355. Miller, 1., & Schwartz, M. D. (1995). Rape myths and violence against street prostitutes. Deviant Behavior: An fnterdisciplinaryJoumal, 16, 1-23. Monto, M., & Hotaling, N. (1998, April). Predictors of rape myth aCCepfllf1Ce among the male clients offemale street prostitutes. Paper presented at the annual meeting of the Pacific Sociological Association, San Francisco, CA. Payne, D. L. (1993). The assessment and structure u/rape myths. Unpublished doctoral dissertation, University of Illinois, Urbana-Champaign. Polk, R K" & Cowan, G. (1996). Perceptions of female pornography stars. Canadianlournal off/umon Sexuality, 5, 221-229. Sawyer. S., Lewis, 1. 0., & Brucker, R. A., Jr. (1998). Male customer attitudes. values, and belief, ahout prostitution and prostitures. Unpublished manu­ script Sawyer, S .• Rosser, B. R. S., & Schroeder, A. (t 998). Results from a brief treat­ ment program for men who use prostitutes. Journal of OJJender Rehabilita­ tion, 26, 111-125. Silbert, M. H., & Pines, A. M. (l982). Victimization of street prostitutes. Victi­ mology: An International Journal, 7, 122-133. Sullivan, E., & Simon, W. (1998). The client: A social. psychological, and behav­ iorallook at the unseen patron of prostitution. In 1 E. Elias, V. L. BuHogh, v: Elias, & G. Brewer (&is.), Prostitution: On }vhores. hustlers, and johns (pp. 134-154). New York, NY: Prometheus Books. 14549

/1 A ,/ ThislsExbibL:~mentioned and relerred 10 in IheaffidavHof .tJ r. /JJ 4,J'j>~" Swornbeforemelhis I~""dayol j11~1 A.D. 20 Pi"~-"""'F- IJ<-7 ACommissionerfortakingaffidaviis ~~

Dissociation Arnong Women in Prostitution

Colin A. Ross Melissa Farley Harvey L. Schwartz

SUMlVIARY. The authors summarize four studies on dissociation among women in prostitution, and discuss clinical aspects of the relationship be­ tween trauma. dissociation and prostitution. Dissociative disorders are common among those in escort, streel, massage, strip club and brothel prostilU[ion. and are frequently accompanied by posltraumatic stress dis­ order. depression,anci subsrance abuse. These in tum are linked to high rates of childhood physical and sexual abuse. and to violen[ victimiza­ tion while in prosritU[ion. The existing data suggest thm almost all \vho are in prostitution suffer from at least one of the following typc~ of disor­ ders; dissociative, posttraumatic, mood or substance abuse. Further re­ search [0 refine and replicate these findings is \'V'alTanted.

Col in A. Ross. MD. is affiliated with Ross Institute for Psychological Trauma. 1701 CJa1t.­ way, Suire 349, Richard~on, TX 75080-3644. He can be reached ar:([email protected]). Melissa Farley, PhD. is arProsdtution Research &. Education, Box 16254. San Fran­ cisco. CA 941 J6-0:254, ·She can be contacted at ([email protected]). Harvey L. Schwartz. PhD, is in private practice of psychotherapy. He can be con­ lacted at 257 Connecticut Avenue. San Francisco. CA 94107. jVkli,s

Il-Iuwc'rt.h c()·indexing emTY note I: 'd sjmuJ(:meou~ly in Jou.mal a/Trauma Pra('ricc' (The l-hlworrh M.itrcatl11CIlI 8: Trauma Press. an imprinl afTh. Hnwol1h Press.illc.) Vol. 1. No. 3/4,1003. pp. 19<}·1 11: 'lnd: Pros/illllion. Trajj7.ckJng, und Tr(lummic 51rt'SS (ed: 1Vklissa farley) The Haworch Malrr¢.ilrmenl & Traum:) Pres:.;. ~m imprinl of The liav.:nrth Pre.~:-;. Inc .. 20()3. pp. 199<~ 12. Single or rnultiple ('·(Jpie~ of this article ;Ir<.: ''''"il"blc fM a fcc fr(lm The Howorth Documen. Deliver), Service fl-HUO-HAWORTH, 9:0U a.m. - 5:(10 p.m. lEST'}. E·m!1il address: dlli·(lelivery0'lh"worthpre.f\~,c(lrn1. Imp:/lwww.ilaworrhpress.comlsrorc./prodllct.asp?:;].:u=J189 I 0.1300/JI89v02nO:U ! !'IV 14550

20() PROST/TUT/Ol'l, TRAFFfCKING, AND TRA UMATIC STRESS

Dissociation among women in prostitution has been examined in four stud­ ies: from Winnipeg, Canada (Ross, Anderson. Heber, & Norton. 1990), from Vancouver. Canada (Cooper, Kennedy, & Yuille. 200 I), from Istanbul, Tur­ key (Yargic, Sevim, Arabul, & Ozden, 2000), and from several cities in the United States (Farley. 2003). This report summarizes the findings from these four studies and calls for further research regarding the psychological hanu re­ sulting from prostitution in general. The reader is refeLTed to Farley.and Kelly (2000) for a recent revievi of the medical and social sciences literature on pros­ titution, and to Ross (1997, 1999, :WOO) and for a review of the literature on pathological and non-pathological dissociation. According [() the trauma model of dissociation (Ross, 1997, 1999, 2000), pathological dissociation is a core element of t.he response to chronic, severe childhood trauma which includes physical, sexual, emotional, and verbal abuse. neglect, loss of primary caretakers through death, divorce, addiction, melllal illness or imprisonment, family chaos and violence, violence outside the home, medical and surgi'cal trauma, and severely disturbed family dynam­ ics. Traumatic events include war, famine, poverty, hunger, endemic disease, and natural disasters. These events interact wit.h biological endowment and with other compounding and restorative influences in the environment in a complex fashion. In clinical populations, pathological dissociation is only one element of the trauma response, and is accompanied by extensive co-morbidity including anxiety, mood, substance abuse, psychotic, eating and personality disorders. Since women in street and brothel prostitution report high rates of childhood trauma in addition to violence 'vvhile prostituting (Farley & Kelly, 2000; Farley, Bar'll, Kiremire, & Sezgin, 1998), one would predict elevated levels of pathological dissociation and of other forms of co-morbidity. One wou ld make the same prediction for other types of prostitution, including exotic dancers and pornographic film actors.

FOUR RESEARCH STUDIES OF DISSOCIATION AMONG WOMEN IN PROSTITUTION

The Winnipeg, Canada Study

In the Winnipeg, Canada study, we interviewed three groups of 20 women each: mulriple personality patients, women in street prostitution, and exotic dancers. Women were approached while working on the street and were inter­ viewed without permission or interference by their pimps. Their average age 14551

Ross, Farley, alLd Schwanz 201 was 24.5 years (SD = 5.3), and (hey had an average of 1.2 children (SD = 0.9). The exotic dancers were interviewed (without permission or interference by their employers) in the dining room of the hotel where they were stIipping. All were female, their average age was 22.9 years (SD =2.2), and they had an aver­ age of 0.6 children (SD = 0.8). The racial backgrounds of the respondents were not recorded. Research participants completed the Dissociati ve Experiences Scale (DES). (Bemstein & Putnam, 1986; Waller, Putnam & Carlson, 1996) aDd the Dissociative Disorders Interview Schedule (DDIS, Ross, 1997). The DES is a widely used self-report measure of dissociation that yields a score from zero to one hundred. The DDIS is a structured interview that permits DSM-IV diagnoses of somatization disorder, major depressive disorder, borderline personality disorder, and each of the five dissociative disorders (i .e., psychogenic amnesia, psychogenic fugue, depersonalization disorder. dissociative disorder not otherwise specified, and dissociative identity dis­ order-previously known as multiple personality disorder). It also inquires about substance abuse, psychotic symptoms and history of childhood phys­ ical and sexual abuse. In the Winnipeg study, the DS1\·1-III-R version of the DDIS was used: there­ fore DSM-fII-R nomenclal-ure for the dissociative disorders was reported. Rates of reported childhood sexual abuse were: multiple personality patients, 80%; women in street prostitution, 55%; and, exotic dancers, 65%. Rates ofre­ ported· childhood physical abuse were: mUltiple personality patients, 75%; women in street prostitution, 40%; and exotic dancers, 50%. There were no statistically signifIcant differences between the three groups on rates of child­ hood physical and sexual abuse. Rates of major depressive disorder were: mUltiple personality parients, 85%; \vomen in street prostitution, 60%; and exotic dancers, 60'}o. Rates of borderline personality disorder were: multiple personality patients. 60%; women in street prostitution, 35%; aDd exotic dancers. 55%. Rates of sub­ stance abuse were: mUltiple personality patients. 55%: women in street prosti­ tution, 80%; and exotic dancers, 40%. None of the differences between groups on rales of these disorders were statistically significant. The mUltiple personality patients all had a dissociative disorder by defini­ tion. Among the 20 respondents in street prostitution there were 7 diagnoses of psychogenic amnesia, 3 diagnoses of depersonalization disorder ,md one diag­ nosis of multiple personality disorder. Among tbe exotic dancers, there were 5 diagnoses of psychogenic amnesia, 4 diagnoses of depersonalization disorder and 7 diagnoses of multiple personality disorder. The exotic dancers were 14552

202 PROSTITUTION. TRAFFICKING, AND TRAUMATIC STRESS queslioned carefully to determine that they were not refening simply to stage names when endorsing diagnostic criteria for multiple personality disorder. The average DES scores were: multiple personality patiel1ls, 39.3; women in street prostitution, 13.2; and exotic dancers, 17.6. The mean DES score for the general population of Winnipeg is 10.8 (Ross, 1997i. The DES scores of the patients were significantly higher than those of the women in street prosti­ tution or in exotic d3!1cing:

The Vancouver, Canada Study

In the Vancouver. Canada study, 33 women primarily in street prostitution were given the DES and an unstructured interview. The interviews were con­ ducted at a safe house for prostitutes in the Downtown Eastside of Vancouver. Their average age was 35.2 years (SD = 7.8). two thirds \vere Native Ameri­ can, and one third were (white) European-American. Ninety-seven percenL of these respondents reported lifetime sexual abuse, much of which had occurred while in prostiwtion. They reported an average of 16.2 episodes of sexual vic­ timization prior ro entering prostitution. Ninety-seven percent reported drug or alcohol dependence. Their average DES score was 32.6, which is in the range of dissociative disorder not ot.herwise specified.

The Istanbul, Turkey Study

The Turkish investigators interviewed 50 women in prostitution and 50 non-prostituting women with the DES and DDIS. They were asked additional questions about trauma. The women were interviewed at a legal brothel in Is­ tanbul. Demographic data were not available and the researchers did not state whether the women were interviewed alone or in the presence of pimps. DSM-IV nomenclature for the dissociative disorders was reported. RaLes of childhood trauma among the 'women in brothel prostitution were: physical abuse, 48%; sexual abuse overall, 20%; incest, 8%; emotional abuse, 34%; and family violence. 64%. Rates of psychiatric disorders among the women in prostitution were: depression, .50%; alcohol abuse, 46%; otber substance abuse, 20%; and borderline personality disorder, 8%. Rates of dissociative dis­ orders were: dissociative amnesia, 20%; dissociative fugue, 4%; depersomll­ ization disorder. 18%; dissociative identity disorder, 18%; and dissociative disorder not otherwise specified. 12%. The average DES score was 19.5 in contrast to 8.2 among women who were not prost.iruting. Rates of o'auma and psychiaoic disorders were far higher among those in prostitution than among the control respondents. 14553

Ross, Farley, and Schwanz ]03

The United States Study

Farley (2002) intervi.ewed 37 women who had previously prostituted, but who had been out of prostitution for at leastl.S years, with some having left prostitution as long as J5 years before the time of the interview. Each of the ,,'omen had prostituted in vmious combinations of escort, massage, brothel, stlip club, and street prostitution. The women were interviewed in 5 cities in the United States. As part of a clinical interview. they were asked questions about childhood trauma and about experiences in prostitution. The DES was also administered. The women's mean current age was 38.9 years. Tn order of frequency ofrace/ethnicity, 46% were (white) European Amelican, 24% were African American, 11 % were Native Amelican, and 19% idemified as Arme­ nian/Portuguese, Italian, Japanese, Samoan, Biracial, or Multicultural. Eighty-seven percent of these interviewees reported a history of childhood sexual abuse, with an average 01'3 perpetrators of sexual abuse. With respect to violence in prostitution, 97% had been physically assaulted while prostituting, 92% had been raped in prostitution, and 73% had pornography made of them while in prostitution. The mean DES score of the 37 women was 24.1. Sixteen percent were in tbe normal adult range of dissociative response. Twenty-two percent of the women had DES scores of 30 or above. indicative of abnormal levels of dissociation, with 16% at 50 or above, a score which Bernstein and PUlnam (19£6) suggest is indicative of a dissociative identity disorder diag­ nosis. An identical mean DES score (24.1) was found in a 1999 study of dissociative responses of treatment-se.eking French rape survivors, with 330/(' of the DES scores of this sample of rape survivors higher than 3D (Darves-Bornoz, Degiovanni, & Gai lJard, 1999).

CONCLUSIONS

The evidence is clear: Those in prostitution have experienced extremely high rates of childhood trauma, violent victimization while in prostitution, substance abuse, and psychiatric disorders. Vi/hi]e there are some cultural vari­ ation and sampling differences, the overall pattern is consistent (Cooper et a1., 2001; Farley, Baral, Sezgin, & Kiremire, 1998; Hoigard & Finstad, 1986; Nadon, Koverola, & Schludermann. 1998; Phoenix, 1999; Ross et aI., 1990; Silbert & Pines, 1981 ; 1982; 1983; 1984; Yargic et ai., 2000). ResulL<; of the \Iilinnipeg study dispel some misconceptions about prostitu­ tion. It has long been assumed that street prostitution is the most harmful type of prostitution. With tbe exception of substance abuse (which was higher among those in street prostitution), the Winnipeg study found that childhoo.d 14554

204 PROSTITUTION, TRAFFfCKING, AND TRAUMATIC STRESS trauma preceding strip club prostitution (where the exotic dancers worked) was greater than that repOlied by those in street prostitution. Furthermore, the dissociative and other psychiatric symptoms of women prostituting in stlip clubs exceeded those of women in sU'eet prostitution. The low rate of childhood sexual abuse in the Turkish sample reported here (8%) might not be representative of overall rates among women prostituting in Turkey. Farley et a1. (1998), for instance, found a rate of reported childbood sexual abuse of 34% in a sample of 50 Turkish women in prostitution. This percentage may also be lower than is actually the case because of the hostile sett.ing in which the research took place. The women described their histories of abuse to researchers after having been transpOJ1ed by police from brothels co an STD clinic. Nevertheless. the Yargic (2000) and Farley (1998) data suggest that childhood sexual abuse is not the only pathway into prostitution. in some cultures, poverty and normalized sexual exploitation may also be crit.ical fac­ tors in channeling women into prostitution. Other traumatic events sucb as childhood physical abuse direct women toward prostitution, as do economic, political, and cultural factors that are beyond the scope of this discussion. Dissociation is a core element of the response to both acute and chronic childhood trauma. Dissociative disorders, anxiety disorders, substance abuse and depression are common among those in prostitution. High levels of inter­ personal violence are directed at women in prostitution, \vhich compounds the psychological problems stemming from childhood lTauma. Prelimi~ary results from the U.S. study suggest that dissociative symptoms persist many years af­ ter exit from prostitution (Farley, 2002). Those who are diagnosed with dissoci.ative identity disorder, on average, meet lifetime criteria for another ten to fifteen psychiatric disorders (Ross, 1997). One would therefore expect that women in prostitution would meel cri­ teria for rn

Ross, Farley, llIui Sclr>l'cm~ ~05

Based on tbe data and our clinical experience, we predict that future re­ search will demonstrate tbat entry into prostitution as a child. and/{)r long-term employment/exploit.acion in prostitution, cause severe t.rauma and severe men­ tal health problems. Such dat.a might help to form public policy. and \.vould in­ form intervention programs for those in prostitution.

CLINICAL OBSERVATIONS AND THEORY REGARDING DISSOCIATION IN PROSTITUTION

Proscitution has been clesclibed as one type of slavery (Barry, 1979). Writ­ ing about the psychological trauma of being enslaved, W. E. B. DuBois (1903/ 1961) described a

double-consciousness, this sense of always .looking at one's self through the eyes of others, of measuring one's soul by the tape of a world thal looks on in amused contempt and pity. One ever feels this twoness ... two souls. two thoughts, two unreconciled strivings, two warring ideals in one dark body whose dogged strength alone keeps it from being torn asunder. (p. 16-17)

Dissociation permits psychological survival, whether the repeated trauma is slavery, military combat, incest, or prostitution. Dissociation is an elaborate escape and avoidance strategy i.n which overwhelming human cruelty results in fragmentation of the mind into di Herent parts of the self that observe, expe­ rience, react, as well as those that do not know about .the harm. Given the bur.­ den of lifetime trauma experienced by women in prostitution. the extended use of dissociation is easy t.o understand. One survivor proposed that we view the many parts of bel' self as "a small army fighting for the rights of women" (Dworkin, 2002, p. 211). Paradoxically, although the dissociative adaptation protects the person from the emotional impact of trauma, it increases the risk of further victimiza­ tion since the survi vor tends to dissoci.ate in response to actual danger cues that are similar to the original trauma. For example, even though she knows she is about to be betrayed, hit, or raped, she may not be able to mobilize other, healthier defensi ve strategies. Like other dissociative trauma survivors, many in prostitution have encap­ sulated personified internal child parts of tbe self, prostitute ego states, adult protectors and a pantheon of otber identi.t.ies. The psychological device of spli{'[ing the self into parts serves many functions. These parts of the self are variously present, absent. and co-conscious. each with varying combinations 14556

206 PROSTITUTiON, TRAFFfCK1NG, AND TRA(J;'v1ATIC STRESS of amnesia. depersonalization and derealization for the prostitution when they are in otber social settings (Klufe 1987). A primary function of dissociation is to handle the overwhelming fear, pain and to deal with the encounter with sys­ tematized cruelty that is experienced during prostitution (and earlier abuse), by splitting tJ1at off from me rest of the self. Dissociation also reduces internal conflict and cognitive dissonance. The dissociatiye solution to prostitution is an extreme version of the denial that occurs daily in all sectors of society: Bad mings are ignored, or vie pretend they will go away, or we call them by another name (Schwartz, 2000, p. 122). An understanding of the internal logic and structure of the dissociative dis­ orders is useful for the understanding and treatment of a majority of those in prostitution. Dissociation occurs on a continuum from nonnal daydreaming to dissociative identity disorder (DID), in which discrete parts of the self are amnestic for each other. In our clinical experience, most of the women in prostitution we have interviewed do not meet formal criteria for dissociative identity disorder (DID). Those who dissociate would likely be diagnosed as baving dissociative disorder not otherwise specified (DDNOS), a less severe form of dissociation than DID, in which there arc alterations of integrated con­ sciousness, but with fewer discrete personified parts of the self. Drugs, alcollol, and other addiclive behaviors potentiate dissociation, and they obscure the reality of prostitution from the dissociated person. The high rates of depression among prostituted \>;iomen tell us, however. that neme of tbese strategies fully shield the traumatized person from despair, demoraliza­ tion, and hopelessness. Shutting down the naturally-occurring tTauffia re­ sponse to prostitution requires disconnection and internal fragmentation. A woman who prostituted at a strip club desclibed an increasing degree offrag­ mentation, and consolidation of distinct identities: "I tum into a totally differ­ ent personality [at the club] ... and it's getting to where it's realJy .hard to find Sandra again. I'm becoming this other person completely:' Another woman described a dissociative response to prostitution, which had its origin in childhood sexual assault:

Prostitution is like rape. It's like when I was 15 years old and I was raped. I used to expelience leaving my body. I mean that's wbat I did when that man raped me. r went to the ceiling and I numbed myselfbecause I didn't want to feel what I was feeling. I was very frightened. And while I was a prostitute I used to do that all the time. I would numb my feelings. I wouldn't even feel like J was in my body. I would actually leave my body and go somewhere else with my thoughts and with my feelings until he got off me and it was over with. I don't know how else to explain it ex­ cept that it felt like rape. It was rape to me. (Giobbe, 1991, p. 144) 14557

Ross, Farley, and Sch],varr~ 207

A third woman described both her depression and the origins of her prosti­ tution in childhood trauma:

... all I kne,\' \vas how to be raped, and how to be attacked, and how to be beaten up, and that's all I knew. So when he put me in the game [pimped her] I was too dmvn in the dumps to do anything. All I kne\v was the abuse. (Phoenix, 1999)

A gradual depersonalization resulting from stripclub prostitution was elo­ quently surnm31ized by this person:

You start changing yourself to fit a fantasy role of what they think a woman should be. In the real world, these women don't exist. And they stare at you with this starving hunger. It just sucks you dry; you become this empty shell. They're not reany looking at you. You're not YOll. You're not even there. (Farley, 1998, unpublished intervie\v)

Dissociative symptoms are frequently somatic in nature (Nijenhuis, 1999). A woman who was prostituting in a massage parlor made clear the process of dissociating those parts of her body that were being sold in prostitution:

The first time a guy tried to feel up my breasts, I got really angry

A woman who worked in peep show prostitution (where there was no physi­ cal contact between herself and customers) described how prostitution seeped into her relationship with her partner, and the somatic dissociation contribut­ ing to that process:

At work, what my hands find when they touch my body is 'product.' Away from work, my body has continuity, integrity ... Last night, lying in bed after work, I touched my belly, my breasts. They felt like Capri's [her peep show name] and they refused to switch back. When [her part­ ner] kissed me t inadvertently shrunk [Tom his touch. Shocked, we both 14558

:lOS PROSTITUTION. TRAFFfCKING. AND TRA u/v1A TIC STRESS

jerked away and stared at each other. Somehow the glass had dissolved and he had become one of them. (Funari, 1997, p. 32)

Although prostitution provides only an illusion of power, control and mas­ tery, these illusions can be compelling. The Jack of physical safety, lack of aJ­ tematives for equal pay. and lack of eqLwl social and economic resources -- preclude her having any real control in the prostitution transaction. Still, the il­ lusions of love, money, and power in prostitution have a cultmally-sanctioned appeaL Many \vomen with dissociative disorders who have been prostituted appear to be fe-enacting and masteling some aspects of childhood trauma. Sometimes women feel that in prostitution they are in control of when sex acts (which are oft.en tantamount to rape) take place, with whom, and where, and fLu·tbennore. they are paid for it. One woman said that at age 17, she felt safer and more in control turning tricks all the street than she did at home with her stepfather raping her (Farley, 2003). The prostitution appears to place her in a position of control. Another ',\loman said

From my incest experiences. lleamed that sex was associated with deg­ radation, humiliation. powerlessness and pain .... By turning tricks, I was re-enacting my trauma .... The encounters I had as a prostitute were . secret , like my incest experience; they were degrading. and in the end. I was abandoned. My father would just leave me there after sexually mo­ lesting me and act like nothing happened the next day. (Williams, 199 I, p. I I I)

In order to survive the brutal commodification of their sexuality in prostitu­ tion, women dissociate, and appear to accept the view of themselves as sexual commodities. Healing from prostitution is a lengthy process of re-connecting all parts of the self. As one woman said:

That was probably one of the hardest things to get over-re-attaching with feelings and re-attaching with myself and my physical body .... The goal of [the program she participated in] is to slowly take every shattered piece of your life and build you back up. (Hartman, 1999, p. 2)

In the dissociative disorders, there is a failure of protective behavior, a fail­ ure to recognize (and occas.ional misperception of) cues for interpersonal con­ flict and danger, and a leamed mistrust of her own intuition. The therapeutic relationship and other social supports begin to rebuild the battered self-esteem of the survivor, and in the early phase of therapy. even before the dissociation is addressed. there is an urgent need for teaching basic self-care such as eating. 14559

Ross, Farley, and SchwCln~ 209 sleeping. exercise, cessation of self-injurious behaviors, learning to trust her own instincts, and leaming to separate the intemal voice which promotes self-care from the self-sabotage voice internalized from perpetrators. Unless screening questions are asked, prostitution will remain invisible. Just as clinicians sC/"een for sexual abuse and subst.ance abuse history, prostitu­ tion history should be addressed at intake, and also at a later point in treatment after a therapeutic relationship is established, since an initial denial of prostitu­ tion is not unusuaL The questions "have you ever exchanged sex for money, drugs, housing, food, or clothesT and "have you ever worked in the sex indus­ try: for example, dancing, escort, massage, prostitution, pornography, phone sex?" are routine in the authors' intak~ inquiry. 1'reatl11ent approacheR that are u~ed by those Who work wi\h battered and raped women are also applicable. to prostituted women. The first goal must be to establish physical safety. Thus both client and therapist agree on the goal of ultimately leaving prostitution. Only after that has occllLTed (often by locating safe housing) can the initial stage of therapy proceed, in '.",hich chemical de­ pendence. acute and chronic PTSD, and dissociative symptoms are addressed. This goal of physical safety may take longer to achieve when neither therapist nor patient are aware of the prostitution until later in therapy. Another goal of therapy is to enable the different parts of her self to see the past. present and future from a \'.'hole person perspective, rather than from the perspective of insulated, separate identities. For example, by prostituting, sbe exposes her body to the same treatment it received from pedophiles in child­ hood. Not only is prostitution similar to incest, but the converse is also true: to incestuously assault a child is to prostitute her. Yet the dissociated part of the self who prostitutes may not be aware of the h,mll to the body, which is often itself dissociated as a separate part of the self. The therapist working with survivors of prostitution must be vigilant re­ garding countertransference. The therapy cannot proceed unless the therapist has an ongoing means of addressing his/her own reactions to the survivor's tJ:auma (Elsass, 1997; Herman, 1992; Schwartz, 2001). Therapists who work with survi vors of extreme violence, such as prostitution, are well advised to obtain supervision, not only to address their own symptoms of vicarious traumatization. but to ensure that these responses do not inteTfere with the survi vor's healing. A range of responses to extreme trauma are common in therapists working with survivoTs-from minimization, avoidance, denial and under-diagnosis to outrage, oveneaction, and over-politicization of the trear­ ment setting. The possibilities of therapist voyeurism and other sexual exploi­ tation of the survivor must be carefully monitored. Clinicians treating prostitution survivors for dissociative and other trauma related syrnptoms must be familiar with 14560

210 PROSTITUTION, TRAFFfCKfNG, AND TRA UMA TIC STRESS

.. , not only memory and its vicissitudes but also about the dynamics of incesruous families, of perpetrators and perpetrator groups, of coercive thought-reform [as used by pimps and possibly others in her life] and its social influences, of complicity, collusion, and coHaborationism, about the psychobiology of trauma and dissociation, and about the relationship between the abusive power arrangements in the culture [such as the abuse of power which occurs in the john-prostitute transaction] ... (Schwartz, 2000, p. 212)

The purpose of this paper has been. to review four studies of dissociation in those in prostituted women, and to present some clinical and anecdotal evi­ dence that suggests that dissociation is a common psychological defense in response to the trauma of prostitution. For more extensive literature on treat­ ment of dissociative disorders, the reader is referred to Herman (I 992), Ross (1997), or Schv/artz (2000). The high rates of childhood trauma, depression, posttraumatic stress disorder, and dissociation among the prostituted indicate that they are often struggling "vith previous trauma, or are mired in tbe unre­ solved consequences of childhood trauma. This cycle is compounded by the beatings, rapes, verbal abuse and other fonns of trauma that are intrinsic to prostitution. Public policy should take into account the pervasive trauma in prostitut.ion.

REFERENCES

Barry. K. (1979). Female sexu~!l slavery. NeVi York: New York University Press. Belton, R. (1992). Prostitution as traumatic reenactment. Paper presented at 8th An­ nllal Meeting of International Society for Traumatic Stress Studies, Los Angeles, CA. October:22, 1992. Bernstein, E.M., & Putnam, F. W. (1986). Development, reliability_ and validity of a dissociation scale. Journal (~fNen'ous and Men.tal Disease 174: 727-735. Cooper, B.S., Kennedy, M.A., & Yuille, ,I,e. (2001), Dissociation and scx.ual trauma in prostitUles: Variability of responses. Jou.nuli ofTrauma and Dissociation 2: 27-36. Darves-Bomoz, 1.M .. Degiovanni, A., & Gaillard. P. (1999), Validation of a French version of the Dissociative Experiences Scale in a rape-victim population. Cana­ dian Journal of PsychiaTry 44(3): 271-275. DuBois, W.E.B. (1961). The souls of blackfolk. New York: Fawcett. (Originally pub­ lished 1903). Dworkin, A. (2002). Heartbreak: The political melnoir of a feminist militant. New York, Basic Books. Edelstein, 1. (1986). In the massage parlor. In F. Delacoste & P. Alexander (Eds.). Sex 11Jork: Writings hy women in lhe sex in.dustry (p.p. 62-69). Pittsburgh, PA: Cleis Press. 14561

Ross, Farley, ami Sclrwarrz

Elsass, P. (l997). Treating victims of torwre and violence. New York: University Press. Farley, M. (2003). Prostirution and the invisibility of harm. Women & Therapy 26(3/4): 247-280. Farley, M., & Barkan. H. (l998). Prostitution, violence against women, and post­ mlllmatic srress disorder. Women and HealTh 27: 37-49. Farley, M., & Kelly; V. (2000). Prostitution: A critical review of the medical and social sciences literature. lYomen & Criminal Justice 1J '29-64. Farley, M., Bara] , I., Kiremire. M .. & Sezgin, U. (! 998). Prostitution in five counu'ies: Violence and post-traumatic stress disorder. Feminism and Psychol.ogy 8: 405-426. Funari. V. (1997). Naked. naughty. nasty: Peepshow reflections. In J. Nagle (cd.). Whores and orherfemil1isls .. New York: Routledge. Giobbe, E. (1991). Pn;stitution: B'uying the right to rape. In A. Burgess (Ed.), Rape and sexual assault Ill: A handbook. New York: Garland Press. Goodman, L. & Fallot, R. (1998). HlV risk-behavior in poor urban women with serious mental disorders: Association with childhood physical and sexual abuse. American Journal ofOrrhopsychiarry. 68: 73-83. Hartman. A. (1999). Survivor pursues real re.covery. The StopLighl. 1901 P0l1land Ave. S. Minneapolis, MN 55404. Herman, J.L. (1992). Trauma and Recovery. New York: Basic Books. Hoigard, C., & Finstad, L. (J 986). Backs/reelS: ProstiIUIion., money an.d love. Univer­ sity Park, PA: Pennsylvania State University Press. Kluft, R.P. (1987). The simulation and dissimulation of mu1tiple personality disorder. Journal (~fClinical Hypnosis 30: 104-118. Nadon, S.M., Kovero1a, C .. & Schludennann, E.H. (1998). Antecedents to prostitu­ Lion: Childhood victimization . .Journal of Interpersonal \fiolence, 13. 206-22l. Nijenhuis, E.R.S. (1999). Somatoform dissocimioll: Phenomena. measurel1'l.ent. and theoretical issues. Assen, The Netherlands: Van Gorcum. Phoenix, J. (1999). Making sense (~fprostiTuri(ln. London: MacMillan Press. Ross. C.A. (1997). Dissociative idemil), disorder: Diagnosis, clinical features. and rrearmem ofmitlriple personality. New York: Wiley. Ross, C.A. (1999). Dissociative disorders. In T. Millon, P.H. Blaney. & R.D. Davis, (his). Oxford Textbook of Psychopathology (pp. 466-48] J. New York: Oxford Uni­ versity Press. ,..", Ross, C.A. (200C)). The trauma model: A solution to the problem ofcomorbidi(v ill psy­ chiatry. Richardson, TX: Manitou Commuriications. Ross. C.A., Anderson, G., I-leber, S., & Norton, G.R. (1990). Dissociation and abuse among multiple personality patients, prostitutes, and exotic dancers. Hospital and Commu.nity PJ)'chiaTiY. 41,328-330. SchWaI1Z. H. (2000). Dialogues withforgotren voices: RelaTiona.l perspectives on. child abuse r.rauma and treatmenr of dissociative disordel~~. New York: Basic Books. Silbel1, M.H., & Pines, A.M. (1981 J. Child sexual abuse as an antecedent to prostitu­ tion. Child Abuse and Neg/eel 5: 407-411. Silbert. M.H., & Pines, A.M. (1982). Entrance into prostitution. Youth and Soderv 13: 471-500. 14562

212 PROSTITUTION. TRAFFICKING, AND TRAWviATlC STRESS

SilbcrL M.H., & Pines, A.M. (1983). Early sexual exploitation as an influence in pros­ ti{ution. Sochr1 'Work 28: 285-289. Silhert, M.H .. & Pines, A.M. (1984). Pornography and sexual abuse of women. Sex Roles 10: 857-868. Waller. N.G .. Putnam, F.W .. & Carlson. E.B, (1996). The types of dissociation and dissociative types: A taxornetric analysis of dissociative experiences. Psych%gi­ "cal MeThods J: 300-321. Williams. J.L. (1991). Sold Out: A Recovery Guide for Prostitutes Anonymous. P.O. Box 3279 North Las Vegas. NV, 89036 USA. Wood, Marianne. (1995). JUSI a proslilllle. Queensland: University of Queensland Press. Yargic. L.I., Sevim. M" Arabul, G., & Ozden, S.Y. (2000). Childhood trauma histories and dissociative disorders among prostitutes in Turkey. Paper presentation at An­ o.ual Conference of the International Society for tbe Study of Dissociation. San An­ tonio. Texas. 14563

This is Exhibit 1/ () "mentioned and relerred 10 in IhealfidaVl1~'P'~~ 1 r /I? .. ~'" "'e..--7/";~9 Sworn be!ore me this-Ldayo! ii' ~D~~Jf r;:,r/~)' ACommissionerfortakingaftidavils ~~

Prostitution and Trafficking of Women and Children from Mexico to the United States

Marisa B . Ugarte Laura Zarate Melissa Farley

SUMMARY. The historical background of sex trafficking from the United States to Mexico is briefly described. We also summarize two case examples that illustrate the complexity of providing physical and emotional safety, as well as immigration protection to victims of traf­ ficking. We emphasize the importance of understanding the varied cultural contexts in which sexual exploitation, rape, prostitution and trafficking occur. Two agencies: Arte Sana in Dripping Springs, Texas and the Bilateral Safety Corridor Coalition in San Diego, California, of-

Marisa B. Ugarte is affiliated with the Bilateral Safety Conidor Coalition, 5348 University Avenue, Suite 119, San Diego, CA 92105 (Email: [email protected]). Laura Zarate is affiliated with Arte Sana, Austin, Texas (Email: lazarate@ yahoo.com). Melissa Farley is at Prostitution Research & Education, San Francisco (Email: [email protected]). The authors thank Wendy Freed, MD, Gloria Gonzales-Lopez, PhD, and Frank Lostaunau, LCSW, for their thoughtful reviews of this paper and their helpful com­ ments. They also thank Chuck Goolsby for his assistance in providing references for the paper. {Haworth co-indexing entry note]: "Prostitution and Trafficking of Women and Children from Mexico to the United States." Ugarte, Marisa B., Laura Zarate, and Melissa Farley. Co-published simultaneously in Journal o/Trauma PraCTice (The Hawonh Maltreatment & Trauma Press. an imprint of The Haworth Press, Inc.) VoL 2, No. 3/4, 2003, pp. 147-165; and: Prostitution, Trafficking, aruf Tmumatic Stress (ed: Melissa Farley) The Haworth Maltreatment & Trauma Press, an imprint of The Haworth Press, Inc., 2003, pp. 147-165. Single or multiple copies of this article are available for a fee from The Haworth Document Delivery Service [1-800-HA WORTII, 9:00 a.m. - 5:00 p.m. (ESn. E-mail address: [email protected]. http://www.haworthpress.com!storeiproduct.asp?sku=J 189 10. 13oo/J I 89v02n03_08 J47 14564

148 PROSTITUTION, TRAFFICKING, AND TRAUMATIC STRESS

fer a range of culturally appropriate services to Latina survivors of sex­ ual assault, sexual exploitation, prostitution, and trafficking.

INTRODUCTION

Prostitution and trafficking are sexual violence that result in economic profit for perpetrators. Other types of gender violence such as incest, rape and wife-beating are hidden and frequently denied but they are not sources of mass revenue. Described by survivors as "paid rape," prostitution provides buyers Uohns, tricks, dates) constant sexual access to women and children. Prostitu­ tion and trafficking can take place in massage parlors, strip clubs, escort agen­ cies, lap dance clubs, on the street, in a car or motel, or in a tent set up at the edge of a field being cultivated by migrant workers. Women are trafficked (moved) by pimps to wherever there is ademand for prostitution, for example military bases, tourist destinations, conven­ tions or migrant communities. The current US trafficking law places the burden of proof on the victim to show evidence of force, fraud or coercion. I Since pimps/traffickers move people to wherever they are sold for sex, we think a better definition of trafficking would include movement of people within a country as well as across international borders for the purpose of sexual exploitation. Trafficking is a direct result of cultural and economic forces which sweep a woman or child into prostitution including not only coercion, manipulation, deception, initial consent, family pressure-but also past or present family and community violence, economic deprivation, racism, and conditions of inequality between the sexes. This broader defi­ nition of trafficking is appropriate if governments seek to decrease sex businesses, taking into account the range of forces that channel people into prostitution.

SEX TRAFFICKING FROM MEXICO TO THE UNITED STATES

Mexico-to-United States immigration has been described as the longest­ running labor migration in the world (Ehrenreich & Hochschild, 2002). The 7.9 million Mexicans living in the United States comprise 27% of all foreign born persons (Chiquiar & Hanson, 2(02). However, restrictions against illegal immigrants, combined with anti-immigrant hostility in the United States, have created an economy that consists of generally undesirable jobs. In addition to exploited Jabor, this illegal economy includes both prostitution and trafficking. 14565

Ugarte, Zarate, and Farley 149

Non-Latino US men, as well as men from immigrant communities, are cus­ tomers of prostitutes supplied by Mexican traffickers (Heinzl, 2003). Every day, thousands of male tourists enter Mexico from the United States to pur­ chase women and girls in prostitution. Of the 50,000 people annually trafficked to the United States, a third are Latin Americans (Richard, 2000). Women and youth seeking work in the USA must rely on labor traffickers (coyotes) to help them cross the border in search of work. Sex traffickers lure poor women and youth with false promises of jobs, sometimes kidnapping those they transport and selling them. Mexico is both an origination and destination point for trafficking women and children, as well as being a stopover for transportation of people along sev­ eral trafficking routes (for example, from Brazil or Guatemala to the United States) (Lederer, 2001). Although accurate numbers are impossible to obtain, one report noted that 16,000 girls in Mexico were sexually exploited through networks involving immigrants, military personnel, police, governmental offi­ cials, and businessmen (Azaola, 2(01). There is great danger of sex trafficking occurs along the Mexican-U.S. border, where unemployment is high and thou­ sands of US citizens cross into Mexico daily for the purpose of buying Mexi­ can youth in prostitution (British Broadcasting Report, 2002; Taino, 1998). Castillo, Gomez & Delgado (1999) estimate that there are 15,000 women in street prostitution in Tijuana with many more working in the city's more than 200 c1ublbrothels.

THE SAN DIEGO TRAFFICKING CORRIDOR

According to health workers interviewed by the first author, trafficking of women and children for prostitution in San Diego is common but is rarely re­ ported to US or Mexican police. Although prostitution/trafficking are in fact human rights violations based on sex, race, and class, they have been prejudi­ cially dismissed as "the problems of illegal immigrants." As a result, traf­ ficking of people across the Mexico/US border has become a lucrative business. When women and children migrate illegally, they are at the mercy of traf­ fickers. Many are raped or murdered in transit. If their families are known to have money, migrants may be held for ransom. Coyotes who transport people across the Mexico/USA border are aware that neither victims nor their families will report these crimes, since the victims themselves would risk felony charges for illegal entry into the United States. Pimps often work in concert with coyotes. In a scenario of brutal exploita­ tion, coyotes transport victims from Mexico to the United States for a reduced 14566

150 PROSTITUTION, TRAFFICKING, AND TRAUMATIC STRESS

fee, sexually assaulting and prostituting the women as payment for passage. Instead of being reunited with families across the border, children may be con­ sidered saleable by coyotes and may never arrive at their intended destination. Children may be sold to gangs who prostitute them. Their families are then told that they died during the border crossing. Children who are unaccompanied or who have run away from abusive homes are at especially high risk for prostitu­ tion/trafficking. Women and girls are often moved from the Mexico/California border to northern San Diego County, where they are placed in apartments controlled by women pimps hired by the traffickers. Brothels have been identified in com­ munities from San Diego to as far north as Canada. Prostitutes are transported in a sex trafficking corridor that supplies them to the shifting locations of mi­ grant labor communities (sometimes caBed camps) near Fresno, Barstow, Sac­ ramento, and Seattle. In San Diego, a wide range of commercial sexual exploitation exists, including adult prostitution, child and youth sex tourism, mail order brides, pornography, peonage, and bondage. Hernandez (2003) investigated the trafficking of Mexican girls to brothels near San Diego. Over a ten-year period, hundreds of girls aged ] 2 to 18 from rural Mexico were either kidnapped or tricked into US border crossings by traffickers/pimps. Criminal networks in San Diego county control more than 50 brothels and outdoor farm labor sexual exploitation camps. Trafficked girls are sold to migrant farm workers, US tourists, and US military personnel. In one typical case, caves made of reeds served as brothels at the edge of the fields. Many of the girls had even younger children of their own, who were then held as hostages so their mothers would not try to escape. Hundreds of farm workers were transported each day to these sexual slavery camps, where they sexually assaulted girls in prostitution. A US physician who worked for a clinic that provided health care to mi­ grant workers said, "The first time I went to the camps I didn't vomit only be­ cause I had nothing in my stomach. It was truly grotesque and unimaginable." Many of the girls were 9 to 10 years old. On one occasion the physician counted 35 men raping a girl for money during a single hour. When police raided the brothels, they found dozens of empty boxes of condoms, each box having held a thousand condoms (Hernandez, 2003). Under instruction from her supervisor, the physician worked with the pimps for five years. After she reported the girls' sexual assaults in prostitution the physician was instructed by US officials that prostitution was "not a migrant health concern." Advised by her superiors to work with the pimps, she limited - her practice to "prevent[ing] HIV / AIDS and other venereal diseases in the ex­ ploited minor girls" (Hernandez, 2003). This tunnel vision regarding the health of those in prostitution is commonly seen in clinics and in AIDS organi- 14567

Ugarte, Zilrate, and Farley 151 zations. Although at first glance the public health attention to HIV and SID in­ cludes the prostituted woman herself, on closer inspection it becomes apparent that the overarching concern is to decrease the customer's exposure to disease (Farley & Kelly, 2000). The overwhelming health consequences to the victim of captivity, terrorization, traumatic psychological stress and violence are offi­ cially ignored, as in this case.

CASE EXAMPLE: SOFIA, AGE 15

A child protective officer brought Sofia, a victim of prostitution and traf­ ficking, to the Bilateral Safety Corridor Coalition (BSCC). Her sexual abuse did not fit the guidelines for receiving assistance from California Child Protec­ tive Services because the abuse had not been perpetrated by a family member, relative or family friend. Furthennore, Child Protective Services declared that they did not have the resources to assist Sofia. Sofia attended an initial interview with a representative of the BSCC, a rep­ resentative of the sheriffs department and a child protective service worker. Sofia stated that her pimp had kidnapped her one-year-old son in Mexico. The pimp then forced her to work in the field brothels under threat that her son would be killed if she refused to prostitute. She described seven prostitution camps where women and girls were rotated weekly. Although she was paid, she did not actually keep any of the money. She was prostituted to migrant la­ borers without condoms, used by 20-30 men in four hour shifts. The sheriff s department intervened when her pimp beat her after Sofia refused to go to one of the field camps. The first goal was to provide Sofia with safe housing and crisis services. Since there was no emergency housing for minors in San Diego, Sofia was ad­ mitted to a battered women's shelter where she remained for six months. Coordinated case management was crucial in order to assist Sofia, as it of­ ten is with members of marginalized populations who do not have comfortable access to social, medical and legal services. With the battered women's shelter and the BSCC functioning as advocates, Sofia's needs were addressed by more than twenty agencies, including:

• Bilateral Safety Corridor Coalition (victim advocacy and coordination of services) • Battered Women's Shelter (housing, group counseling, case manage­ ment) • San Diego Sheriff s Department (investigation of the crime) • Planned Parenthood (gynecological care) 14568

152 PROSTITUTION, TRAFFICKING, AND TRAUMATIC STRESS

• Community Health Clinic (other medical treatment and lab tests) • Catholic Charities (certified victim's needs, vaccinations, management of funds through Office of Refugee Resettlement, Health and Human Services) • Mexican Judicial Federal Police (legal charges in Mexico, assistance in rescue of the baby) • DIF (Desarrollo Integral de la Familia: Mexican Social Services) (inves­ tigation of victim's family, rescue and shelter for Sofia's child) • Federal Bureau of Investigation (investigation, administration of Office of Victim Services funding) • Immigration and Naturalization Service (investigation, legal documen­ tation provided to victim) • Mexican Consulate Minor Protection (supervision of victim's rights, in­ vestigation and retrieval of Sofia's child) • Pre-trial Services (legal advice, case monitoring, payment for psycho­ logical evaluation, supervision of court appearances) • Criminal attorney • Immigration attorney (functioned as legal guardian, coordinated T-Visa application and humanitarian visa application) • US Attorney (prosecution of traffickers) • Services for Youth (shelter and case management) • Psychologist (evaluation) • Children's Hospital (trauma counseling) • Human Rights Mexico (public denunciation of the crime) • Group home in Georgia (placement of Sofia's rescued child) • Juvenile Justice system in Georgia (victim became ward of the court).

Because it was physically unsafe to remain in San Diego, Sofia was moved out of California, and services for her were managed by another state's social service agency, along with continued coordination of services by BSCC. Her child was rescued, and Sofia was given a US visa for victims of trafficking.

CASE EXAMPLE: GUADALUPE, AGE 12

In an Immigration and Naturalization Service (INS) exit interview during the process of deportation to Mexico, this transgender youth stated that she had been trafficked into the United States for the purpose of prostitution by a crimi­ nal gang that operated in her home town in Mexico. They had transported her to a number of cities on both US coasts, selling her on the gay/transgender prostitution circuit. In the INS interview where she was identified as a boy, she 14569

Ugarte, Zarate, and Farley 153 reported extensive family violence and abandonment at a young age by her fa­ ther, at which time her mother permitted (and probably took in money from) the child's prostitution. Although it was not known whether she had been sexu­ ally assaulted by family and neighbors, her prostitution was child sexual abuse. The US Justice Department and DIF (Mexican Social Services) deter­ mined that Guadalupe should remain in the United States pending further in­ vestigation of her home environment. As with Sofia, many agencies in both the United States and Mexico were involved and the BSCC functioned as an advo­ cate and coordinator of services for the child. Guadalupe was traumatized as a preadolescent by a homophobic social en­ vironment in which she was surrounded with contempt and physical violence, including rape. Gender roles are narrowly defined in Mexico, and when a boy is perceived as feminine (derisively calledjoto or maricon), he is loathed, so­ cially shunned and often banned from family events such as weddings, funer­ als, and holiday gatherings. There is confusion regarding the difference between sexual orientation and gender identity in both Mexico and the United States. Because those who iden­ tify as transgender often do not hide their birth gender, they are stigmatized not only by homophobia, but also by prejudice within gay communities against those who do not "pass" as sufficiently masculine.2 In addition to being gay, Guadalupe openly expressed her identity as female, which resulted not only in social stigma but escalated to contempt and physical violence. This violence is sometimes extended even to the family of the transgender person (Lostaunau, 2(03). Homelessness may be a consequence of family violence including homo­ phobia. Transgender adolescents prostitute for food and shelter and also as a way to send money home to families. At an emergency shelter Guadalupe was retraumatized by other children's prejudice toward gay and transgendered youth. The humiliation and social isolation were intolerable and she ran away from the shelter. Shortly afterward the US border patrol arrested Guadalupe as an undocu­ mented minor, identifying her this time as a girl, unaware that she had been previously trafficked and prostituted. Guadalupe was placed in custody of Child Protective Services and deported to Mexico. At that point her history of trauma, neglect, abuse, and trafficking was discovered. Out of concern for the child's safety Guadalupe was returned to the United States. There she was taken to a specialized facility where she received support for both her sexual orientation and gender identity. Angry that her child was out of her control, Guadalupe's mother filed a complaint against DIF (Mexican Social Services) with the Mexican Human 14570

154 PROSTITUTION, TRAFFICKING, AND TRAUMATIC STRESS

Rights Commission demanding the return of her son. Guadalupe was emotion­ ally blackmaiJed into silence by her mother and she denied her history of ne­ glect, violence, and prostitution. Bowing to political and legal pressure, US and Mexican law enforcement agencies permitted Guadalupe to be returned to her mother in Mexico. Subsequent reports from DIF noted that Guadalupe did not attend school. Instead, she worked in a restaurant at her mother's request, supporting the family. DIP again filed a complaint against the mother. In the meantime, Guadalupe ran away from her mother's home to a large city in Mexico. At age 12, she ob­ tained identification that listed her age as 18. She is currently working in a strip club as a female table dancer, which almost always involves prostitution (Farley, Cotton, Lynne, Zumbeck, Spiwak, Reyes, Alvarez, & Sezgin, 2(03). The fetishized sexuality in strip club prostitution may have provided a social niche that Guadalupe failed to find elsewhere. BSCC monitored Guadalupe's status via messages from other street children. BSCC staff felt that it would further harm the child to offer her services that would not adequately address her complex needs. Treatment for Guadalupe should necessarily include: long term housing, medical care, safety planning to protect her from violence by pimps, addiction treatment, and voca­ tional training. Psychotherapy would address childhood trauma, prostitution/traf­ ficking trauma, and at the same time address race and cultural prejudice, traumatic homophobia, prejudice against transgender persons, and repeated betrayals by so­ cial and legal systems, as well as betrayals by friends and family. Peer support should be an integral part of the healing process (Hotaling, Burris, Johnson, Bird, & Melbye, 2003; Rabinovitch, 2(03).

HISTORICAL BACKGROUND OF THE SEXUAL EXPWITATION OF MEXICAN AND LATIN AMERICAN WOMEN AND CHIWREN IN PROSTITUTION

Most women in prostitution in Mexico come from rural areas, having sur­ vived extreme poverty, family violence, and often leaving abusive homes to migrate to cities (Castillo, Gomez, & Delgado, 1999). A conservati ve estimate of the prevalence of trafficking is that 100,000 women are moved across Latin American states' borders annuaJly for the purpose of prostitution (Kovaleski, 2000; Maki & Park, 2000). For centuries, religious and legal institutions in Mexico and across Latin America have reinforced male supremacy. Fueled by belief in the subordina­ tion of women, the Spanish conquest of the peoples of Latin America included 14571

Ugarte, Zarate, and Farley 155 the colonization of indigenous women. These attitudes toward women persist as for example in Mexico's granting women the right to vote only as recently as 1953 (Jordan, 2(02). Across Latin America, 20% to 40% of women are raped each year (Casteneda, 2000), yet rape is often treated as a lesser crime than stealing a cow, with only 1% of rapes resulting in criminal charges (Jor­ dan, 2002).3 In some Mexican states, a girl who brings charges of rape against an adult is required to first prove her chastity. Kidnapping and rape are ac­ cepted methods of obtaining marital partners in some regions (Jordan, 2002). Prostitution occurs throughout Latin America (as elsewhere) in contexts of brutal poverty and family violence. A girl's first "sexual" experience is of­ ten sexual abuse by an adult family member, co-worker or acquaintance (UNICEF, 1999). Sexual and physical abuse in their homes often lead children to run away, with homelessness documented as a risk factor for prostitution of both children and adults (Tyler, Hoyt, & Whitbeck, 2000). According to one estimate, 16,000 children are prostituted in Mexico (Azaola, 2(01). Approxi­ mately 135,000 Mexican children have been kidnapped and were presumed to have been trafficked into illegal adoption, prostitution, and pornography from 2000-2002 (Hadden, 2002). Mexican federal law prohibits procuring, thus making prostitution techni­ cally illegal. However, most states have legalized and regulated prostitution in zonas de tolerancia (red light districts) (Gonzalez de la Vega, 1968). The sexual exploitation faced by women and girls worsens considerably during national and regional conflict. For example, the conflict between the Mayan people and the Mexican state (also called the Zapatista uprising) in­ volved widespread rape and prostitution of indigenous women and girls by the Mexican Army (SIPAZ, 1999).4 Throughout the 1980s thousands of indige­ nous and other poor, mostly rural women were raped and many were murdered in Central American civil wars (Harbury, 1997). During the civil wars in El Salvador and Nicaragua, women were sexually assaulted by army personnel and civil police. Following these assaults, the women themselves as welJ as their families viewed them as mujeres marcadas (dirty, tainted, or ruined). As a result, women migrated not only to escape conditions of war, but also to es­ cape family shame.

MUJERES DECENTES: THE INTERNALIZATION OF MALE SUPREMACY IN LATIN AMERICA

While Olmec gender roles are considered to have been nonhierarchical and even "fluid" two thousand years ago (Joyce, 2(00), sexist beliefs in female in- 14572

156 PROSTITUTION, TRAFFICKING. AND TRAUMATIC STRESS feriority have affected all people in Mexico today, including indigenous peo­ ple. In many Latino cultures, the influence of the Catholic Church controls women's and girls' lives through dogma that controls sexuality and reproduc­ tion. Just as Franciscan Catholics urged Nahua parents to instruct daughters not to go out in public, not to laugh, not to enjoy themselves, not to look or smile at men-Latina girls today are warned about the disastrous consequences of being a 'bad' girl (Overmyer-Velazquez, 1998). Mexican and other Latin American men generally assume the right to sexu­ ally exploit any female. A consequence of this attitude has been a deliberate lack of educational opportunity for women that has increased their dependence on men. If domestic violence precipitates escape from a marriage or if they are abandoned by men, women and girls become vulnerable to further sexual ex­ ploitation, including prostitution. According to Latina participants of Arte Sana workshops (see below) dichos (popular sayings) are passed down through generations, delivering the message that girls are worth less than boys. When daughters are born it is still common to hear them referred to as carne para los gallotes (meat for the roost­ ers). For the girl, being labeled as meat will affect everything in her life; her mother's duty will be to protect her daughter from the inevitable dangers that her gender poses until she leaves home, hopefully 'in tact.' The Mexican say­ ing tengo suerte que me ha durado (I am lucky that she has lasted) reflects a mother's intention to both preserve/her daughter's virginity and to prevent pregnancy before marriage. The sexist assumptions are that a sexually active woman is invariably promiscuous and thus damaged. Once damaged, the con­ cept of rape does not apply to her (Domecq, 1992, Zarate, 2002a). A sexually active woman may be referred to as a "eaten bread/' piruja (whore) or cancha reglamentaria (regulation soccer field) upon which many have "played" or "scored." So extreme is the pressure to remain a virgin that there have even been attempts to medically restore virginity. In Northern Mex­ ico for the past 30 years, a physician conducted plastic surgery to restore Latinas' ruptured hymens. Advertising her services para reparar la virginidad with hymenoplasty, women were guaranteed to bleed after the hymen was rup­ tured (Gonzalez-Lopez, in press). Shame is a common reaction to sexual assault, including the sexual vio­ lence of prostitution and trafficking. Survivors may see themselves as dam- . aged, unworthy of marriage, and as bringing shame to their families. Shame limits the victim's capacity to acknowledge the responsibility of the perpetra­ tor/so Sexual assault survivors often feel that they failed to sufficiently resist. They may feel especialJy responsible for sexual violence if they were pres­ sured by poverty or previous abuse to "consent" to a work agreement which in- 14573

Ugarte, Zarate, and Farley 157

c1uded illegal border crossing or smuggling even if they were deceived about what the 'work' really was. H has been estimated that 80% of Mexican women in prostitution are moth­ ers (Ojeda, 1994). In spite of their exhaustion and in spite of the physical and verbal violence in prostitution, they maintain a separate life which includes family and children, and in which the prostitution, for the most part, remains secret (Castillo, Gomez, & Delgado, 1999). A lengthy history of patriarchal domination, cultural influences and the resulting internalization of oppressive moral codes may hinder immigrant women (and all women) from reporting sexual assault and prevent them from seeking protection from pimps and traf­ fickers. This silence results from shame about having been sexually harmed. The emphasis on virginity before marriage may compound the emotional pain suffered by a Latina victim of sexual exploitation, rape, or prostitution. Family and community may collude with the victim's self-blame if they view her as damaged or responsible for her own victimization.

THE NEED FOR COMPETENT BIUNGUAL AND MULTICULTURAL SERVICES FOR PROSTITUTEDffRAFFICKED WOMEN AND CHIWREN

As the diversity of the United States grows, so do the needs of sexual assault survivors for culturally appropriate treatment, including services for those who are victims of sex trafficking (Rodriguez & O'Donnell, 1995). Undocu­ mented immigrant women tend to avoid seeking social services for fear of be­ ing reported to the Immigration and Naturalization Service (INS). Once involved in the sex trade, immigrant victims may not attempt to escape for fear of violence or even torture by pimps/traffickers, as well as for fear that traffick­ ers will harm relatives. Culturally appropriate services are especially important for Latina survi­ vors of prostitution, trafficking and other sexual violence. Not only language, but country and regional nuances need to be addressed in order to meet the needs of Latin American victims of all forms of sexual exploitation. Limited English language skills restricts access to information about rights, services and options, thus increasing a feeling of dependency. A lack of translators, lack of biculturallbilingual professionals, and lack of reading materials in the client's native language all pose barriers for victims of sexual exploitation. At some battered women's shelters, for example, other Latina survivors or residents have been inappropriately asked to interpret,just because they happened to be in the agency at the time. The use of resident in­ terpreters may cause embarrassment and silence when sexual violence is ad- 14574

158 PROSTITUTION, TRAFFICKING, AND TRAUMATIC STRESS dressed. Rather than sharing personal or shameful information with shelter roommates or worse yet-bilingual child residents-a survivor may simply choose not to discuss her sexual exploitation (Zarate, 2002b). While some Spanish language materials are better than none, the message is lost or distorted when dialect, differences in attitude/awareness of sexual ex­ ploitation and class differences are ignored. Materials offered to survivors must take into account race discrimination, socioeconomic segregation, Span­ ish language limitations, and immigrant women's lack of knowledge about US laws. If a victim does not define her experience as abusive, no matter how ad­ verse her experience, she will not seek help from violence prevention pro­ grams. Furthermore, the very label 'victim' may exacerbate her feelings of shame and self-blame. Culturally sensitive screening that incorporates a range of references to sexual abuse can be helpful in reframing the abuse and shifting the responsibility to the perpetrator/so The phrases me abusaron (they abused me), mefalto el respeto (he disrespected me), me obligaron a salir con otros (they made me go out with others) are some of the many ways that Latinas may refer to sexual assault and sexual exploitation. We briefly describe two agencies which offer very different services to Latin American victims of sexual violence.

Arte Sana (Art Heals)

Arte Sana, based in Dripping Springs and Austin, Texas, offers programs that empower survivors of sex and race-based violence including prostitution and trafficking, through the arts, popular culture, community education, and professional training. Founded by the second author, Arte Sana utilizes the arts and educacion popular to address issues that are culturally taboo for Latinas such as sexual assault. Arte Sana addresses the lack of specific infor­ mation for Latinas via Spanish language materials (such as a bilingual website www.arte-sana.com) and professional training regarding cultural competence and prevention of violence against women to other agencies in the United States and Mexico. The agency promotes collaborations for cyber resource sharing and the development of ongoing theme-based art exhibits in galleries, such as the Coraz6n Lastimado (Healing the Wounded Heart) sexual assault survivor art exhibit. Survivors of rape, sexual exploitation, prostitution, or trafficking may find themselves in an abusive intimate partner relationship. At her first contact with a battered women's shelter or other women's services, she may not reveal the extent of her experience of sexual exploitation. Maria exemplifies the critical importance of culturally relevant education for Latina survivors of intimate partner violence, including prostitution and trafficking. 14575

Ugane, Zarate, and Farley 159

Maria graduated from a program that addressed issues ranging from fi­ nances to assertiveness. Only after attending an additional psycho­ educational presentation on sexual assault and the needs of survivors was she able to define her experience as sexual assault. At the program's graduation Maria expressed her appreciation for the session on sexual assault and wanted to know if she could address that issue in her life. Two years previously she had been raped as "additional payment" by the man who smuggled her across the Mexico/US border. Maria's question hay ayuda para este tipo de problema? (Is there help for this type of problem?) arose only after she was offered a culturally relevant vehicle to address her shame, self-blame, and lack of sexual autonomy.

Arte Sana utilizes popular songs to promote gender equality, positive rela­ tionships, and sexual autonomy. By deconstructing popular songs, platicas (heart-to-heart talks) expose the narrowly defined subordinate roles for women that exist in many Latino cultures. For example, the song Taco Placero de­ scribes sexual relationships as food, one being a full course, while the other is cheap and quick. In contrast, the song lnvitame a Pecar (Invite Me to Sin), questions the notion of sex as sinful and promotes female sexual autonomy as in the song's line: invitame 0 te invito (invite me or I will invite you). The Arte Sana support groups expose the sexism in songs that promote the notion of mala mujer (woman as intrinsically evil).

The Bilateral Safety Corridor Coalition-A Collaborative Service Agency for Provision of All Forms of Assistance to Trafficking Victims

At a homeless shelter in San Diego county, the first author observed that 90% of the clients seeking services were Mexican or Mexican-American women and girls who had been raped or coerced into survival sex with gangs after becoming homeless. Some were legal and some were undocumented im­ migrants, but many of these young women were involved in prostitution. Although local medical clinics and specialized services for adolescents were aware of their clients' prostitution and trafficking, abuse reports were not filed. This may have resulted from a differentiation between "good" child abuse victims (stranger abductions) and "bad" child abuse victims (those pros­ tituted or trafficked). In 2001, the local sheriff and other county agencies did not have resources to work with trafficking victims. UNICEF, the first author, and Mexican Social Services together arrived at a strategic plan for service provision and prevention of prostitution/trafficking in a southern California trafficking corridor. 14576

160 PROSTITUTION. TRAFFICKING, AND TRAUMATIC STRESS

The Bilateral Safety Corridor Coalition (BSCC) was initially composed of a legal task force led by the local US Attorney's office, an education task force comprising University of San Diego and United Nations/San Diego, a commu­ nications task force composed of media, and a health task force with public health agencies. Goals of BSCC are to identify prostituted/trafficked children and adolescents, to establish liaisons between border regions, and to analyze the regional extent of trafficking in order to establish a network of services aimed at stopping trafficking. The BSCC encourages the involvement of hu­ man rights advocates, consulates, criminal justice and social services agencies on both sides of the border. Bilateral approaches to prostitution and trafficking have been implemented in other regions, such as Sweden and Finland.

NEEDS ASSESSMENT IS CRITICAL

Assessment of the mental and physical health status of transnationally traf­ ficked women and girls is similar to evaluation of the needs of domestically trafficked (prostituted) women. The following must be evaluated: immediate physical safety', housing, legal or immigration status, physical injury, chronic illness or disability, malnutrition, acuity of psychological distress, access to social services, access to nonexploitive social support, literacy, education,job skills, and level of awareness of human rights. Once the survivor of prostitution/trafficking is removed from immediate danger, crisis intervention is necessary. Effective intervention depends on es­ tablishing rapport and on acknowledging the victim's strengths. A supportive relationship with the provider of crisis services will help the victim cope with the stress of meeting with INS and law enforcement. Service providers must become educated about the systematic methods of brainwashing, indoctrina­ tion and control that are used against trafficked/prostituted women. In order to assist in prosecuting pimps and traffickers, women must be protected from physical danger. However, they are rarely offered sufficient protection. Pimps often threaten them with death and have told women that they can be arrested at any moment because they lack legal documents. As in the case of Sofia, pimps threaten to kill her family at home if she discloses criminal activity. In order to survive, the victim has had to comply with all of the trafficker's de­ mands. It is difficult to establish trust with victims of trafficking. Because of re­ peated betrayals by pimps, family, police, and government officials, many vic­ tims do not trust institutions such as the INS, other law enforcement and social service agencies. Informational errors during initial contacts with victims or in 14577

Ugarte, Zarate, and Farley 161 basic language interpretation have confused the police and resulted in failures to prosecute pimps and traffickers. Because young women are without resources, and because they are paid more for not using condoms, STDs are the rule rather than the exception. In ad­ dition to hepatitis C and HIV, poverty-related diseases such as tuberculosis are common but rarely assessed in medical examinations of prostituted/trafficked girls. Sensitively delivered sex education should be standard practice when working with survivors of prostitution and trafficking. It should not be as­ sumed that because women or adolescents are performing sex acts, they there­ fore understand STD and pregnancy prevention (Freed, 2(03). Those who have received education about sex and STDs may later become sources of in­ fonnation, referral and support for others. Trafficking and prostitution survivors experience multiple layers of trauma. The healing process is lengthy since survivors suffer psychological damage from captivity, terrorization, physical violence, and brainwashing and in many cases a long history of family and community violence (Stark & Hodgson, 2003; Farley et aI., 2003). Survivors often feel indebted to pimps/traffickers for not kiJling them, in a psychological dynamic which has been described as the Stockholm Syndrome (Graham, 1994). Drug/alcohol detoxification and mood stabilization require medical management. Dissociative disorders are common, since hiding or forgetting one's real self makes it possible to survive atrocities (Ross, Farley, & Schwartz, 2003). Trafficked women and girls have lived in a world of verbal abuse, lies, and physical danger, making adversariallaw enforcement efforts an additional threat to their survival. Additional fear and mistrust is generated when women are sent to detention centers or locked medical facilities. Above all, the survivor's dig­ nity must be preserved, and her legal rights must not be violated, especially if she is held as a material witness. An advocate should always be present to sup­ port her. Most victims will need to consult with both criminal and immigration attorneys. They may be vulnerable to a number of criminal charges such as ille­ gally entering a country (a felony), prostitution (a misdemeanor), possession of false identification (a felony), or pandering (a misdemeanor). Ideally the local consulate of the victim's country of origin will assist in protecting the victim's rights. Collaboration with the criminal justice system of the victim's country of origin may be needed to investigate a trafficking case.

CONCLUSION

Women and children in Mexico and Latin America are profoundly harmed by the convergence of traditional and modern forms of sexual exploitation. Sex in- 14578

162 PROSTITUTION, TRAFFICKING, AND TRAUMATIC STRESS equality, poverty, lack of educational opportunity, racism, rural-to-urban mi­ gration, state governments which protect the rich, tourism, and other struc­ tural social factors contribute to the harms of prostitution and trafficking. The expectation across cultures that women must always be sexually available to men leaves women vulnerable to the organized sexual exploitation of prostitu­ tion and trafficking. In order to gain control, traffickers and pimps exploit exist­ ing views of women as subordinate to men. Traffickers calculatedly reinforce the vulnerabilities of victims who have been neglected, abandoned or previously sexually abused. Traffickers lie to victims about their immigration status. Exploitive working conditions in border factories place women and girls in extremely vulnerable positions, away from their home communities and vul­ nerable to sexual exploitation, including prostitution and trafficking. Sex busi­ nesses are the largest sector of employment for women who have lost jobs as a result of globalization.5 Pimps and traffickers take advantage of the subordi­ nate status of women and girls in both the United States and Mexico by ex­ ploiting sexist and racist stereotypes of women as property, commodities, servants, and sexual objects (Hernandez, 200 I). Traffickers also take advan­ tage of institutional inexperience regarding trafficking by criminal justice, health care, and social services within Latin America and the United States. Trafficked women experience vulnerability, lack of resources, fears, and lack of control of their own lives that follow patterns similar to those of battered women (Stark & Hodgson, 2(03). Additionally, trafficked/prostituted women have been uprooted from their home communities and are often in legal jeopardy due to their immigration status. Until special shelters for trafficking/prostitution survivors are available, battered women's shelters should be used for housing and safety. Resources to assist victims of domestic and international trafficking must be tailored to meet the needs of people who are culturally and ethnically di­ verse and whose experiences of harm may differ. Although we are here ad­ dressing trafficking between Mexico and the United States, much of what is discussed is relevant to trafficking for prostitution between any sending and receiving country and also between sending and receiving communities within the same country. Meeting the challenge of serving survivors of prostitution and trafficking will require multicultural education regarding the complex is­ sues involved, development of specialized treatment protocols for victims and collaboration across agencies, disciplines and borders.

NOTES

1. The United States defined trafficking in 2000 as occurring when "a commercial sex act is induced by force, fraud, or coercion, or in which the person induced to per­ form such act has not attained 18 years of age; or (b) the recruitment, harboring, trans­ portation, provision, or obtaining of a person for labor or services, through the use of 14579

Ugarte, Zarate, and Farley 163 force, fraud or coercion for the purpose of subjection to involuntary servitude, peon~ age, debt bondage, or slavery." US Dept of State, July 2001 Trafficking in Persons Re~ port . 2. Many Mexican gay men are married, even if they are not bisexual, to hide their sexual orientation and to protect themselves from intense homophobia. 3. See also Anderson, this volume, regarding similar attitudes toward rape of prosti~ tutes under US law. 4. One Guatemalan official commented that given the mass rapes of Mayan girls by military personnel, it would be difficult to find a girl of II to 15 who had not been raped (Rich, 1996). See also Farley et al. (2003) (in this volume) for a description of the effect of Colombia's civil general1y, and women and girls in prostitution. 5. The international trafficking of human beings, especially prostituted women, is the world's third largest area of organized crime, and a business that produces $7 bil~ lion annually. Greater illegal profits are found only in the drugs and arms trades, ac­ cording to data from the United Nations Office for Drug Control and Crime Prevention (ODCCP), released during the International Seminar on Trafficking in Human Beings, in the Brazilian capital. (Osava, 2(00).

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