Effects of Early Childhood Sexual Abuse and Involvement in Prostitution

¶ … CHILD SEXUAL ABUSE ON WOMEN INVOLVED IN PROSTITUTION

Conceptual Paper

Millions of children around the globe are sexually abused or exploited. This paper includes several descriptions of studies that relate sexual abuse during childhood to delinquency later in life. There are several difficulties with methodology and definitions that are inherent in the mentioned studies. These challenges make it somewhat difficult to compare and interpret the findings of the study. A framework is however provided to help in the understanding of how child abuse is correlated to delinquency later in life. This framework can also help to guide future studies into the issue. Two research tools were utilized for this study. They are questionnaires and interviews. The interviewers selected to help with the research were members of the Delancey Street Foundation -- a self-help group that is widely known for its work with drug addicts, criminals and sex workers. All the interviewers themselves had at one time been sex workers or juvenile. All of interviewers were taken through a 3-week comprehensive training program, which covered the fundamentals of the research methodology and interviewing. A new specific tool, the aptly named Sexual Assault Experiences Questionnaire, was made to achieve the objectives of the study. Repeated interview methodology was utilized to help remove eliminate social desirability bias and also to look for any inconsistencies in the statements made by the subjects. A total of 200 current and former prostitutes in San Francisco were the subjects of the study. Some of the major methods of recruitment were public announcements and the distribution of leaflets. Results revealed that over 60% of the women who were interviewed had been sexually abused as children by a mean of 2 men each. In 81% of the cases, some form of coercion was used. Some of the forms of coercion utilized during sexual assault included: physical force, emotional force, and both physical and emotional force. Similar to previous data, substance abuse was common among the subjects studied. Many of the subjects tested positive for marijuana, heroin, and crack cocaine. About half of the sex workers claimed the used drugs so as to cope. One of the best ways to address the issue of child sexual exploitation and drug use in sex trade is through strengthening the national childcare protection framework so that it targets and deals with childhood sexual exploitation and its effects more effectively. The framework should encompass the following intervention pillars: prevention; protection; policy and legislation; and Coordination and monitoring; rehabilitation and support services (MacWilliams, 2003; Silbert and Pines, 1983; Sinha, 2015; Prince, 2008).

WHAT EFFECT DOES CHILD SEXUAL ABUSE HAVE ON WOMEN INVOLVED IN PROSTITUTION

A CONCEPTUAL PAPER

TABLE OF CONTENTS

CHAPTER

I. Introduction #

Statement of the Problem #

Purpose of the Study #

Significance of the Study #

II. TITLE #

Historical Perspective #

Afrocentric Perspective #

Theoretical Framework #

III. TITLE #

Methods of the Study #

Limitations of the Study #

IV. Title #

V. Conclusion #

Summary of the Study #

Implications for Social Work #

REFERENCES #

Chapter 1:

Introduction

Sexual abuse of children is a widespread, disturbing aspect not only in the U.S., but across the world. In the U.S., reported child sexual abuse incidents depicted an increase by 322% in the 80s; the reported sexual attacks on kids were 1.3 million in the year 1995 alone. The U.S. population currently comprises around 60 million victims of child sexual assault. Globally, 150 million females and 73 million males aged below 18 years were, in 2002, subjected to coerced sexual subjugation and other forms of sexual violence (Sanders, 2006). What aggravates the issue is that in the vast majority (95%) of cases, victims are acquainted with the perpetrators, causing most cases to go unreported. Perpetrators who sexually abuse kids include members of the family, neighbors, friends, coaches, teachers, older youth, and clergy (Dove & Miller, 2007).

The stated fact about abusers indicates that those authorized with childcare (and whom society trusts) do not, always, respond to the faith entrusted in them. While the above statistics do highlight the issue's enormity, the community is, only recently, beginning to understand the actual pervasiveness and consequences of sexual assault to children (Heinzmann, 2005). Society's realization can be viewed in the latest attempts by multiple law enforcement organizations (such as the Federal Bureau of Investigation and National Center for Missing and Exploited Children), mental/physical health firms (like American Psychological Association and American Academy of Child and Adolescent Psychiatry), educational groups (such as Child Help USA and Kidscape) and child services companies (like National Juvenile Online Victimization Survey Publications and Child Welfare Information Gateway), towards creating awareness regarding the issue and coming up with strategies that may be employed by children, their parents, their educators, and other concerned parties for averting and effectively responding to instances of child sexual abuse (Dove & Miller, 2007; Beeks & Amir, 2006).

The most common, potential long-term behavioral repercussion, of suffering sexual abuse as a child manifests in the form of delinquency, according to common perception. The existence of a causal relationship appears naturally reasonable. Children who are victims of power-assertive aggression may, willingly embrace, an unsociable and violent mode via displaced anger or modeling as they grow up. Unfortunately, a majority of the large number of empirical efforts aiming to prove this causal linkage have mostly restricted themselves to retrospective research of delinquents, in addition to follow-up research on abused children. These researches hint at a link between delinquency and child abuse, but fail to shed light on causal relations and sequences involved. Therefore, they fail at determining whether abuse lead to delinquency, or vice versa, or whether there is another element or series of elements responsible for delinquency as well as abuse. There has been no prospective, large-scale, longitudinal research to set up a causal relationship. The question of whether delinquency, especially aggressive delinquency, arises due to physical abuse during childhood is an unanswered question and domain in most studies attempted (Howing, Wodarski, Kurtz, Gaudin & Herbst, 1990; Knight, 2002).

This paper covers short descriptions of research works linking child abuse with violent behaviors and subsequent delinquency. Major definition- and-approach- related problems are intrinsic to these studies and cause difficulties in making comparisons and interpreting research findings; and are hence addressed. A system for assisting with comprehension of child abuse's role in causing delinquency is created, which can drive further research into devising more in-depth, improved studies. The goal of the authors is exploring the present, tacitly-acknowledged model and identifying underlying myths, rather than proposing another model (Howing et al., 1990).

Statement of the problem

Scholars have discovered that children who suffered physical abuse, aim more violence at adults and peers (MacWilliams, 2003), and are more impulsive and considerably less compliant (Min Jung, Tajima, Herrenkohl & Bu, 2009) compared to children safe from abuse. Aggression has been observed even among those children abused at ages between 1 and 3 years, later in their lives; it is more common among kids exposed to more serious and frequent violence (Yancy, 2005). Inferring from the above and other parallel findings, one can presume that aggression develops in children suffering abuse irrespective of the age when the abuse occurred. The established correlation between aggression and child abuse should, however, be interpreted with caution. Several researchers have drawn attention to the fact that existing research work cannot establish firmly whether aggression triggers or arises out of abuse (Sorajjakool, 2003). Study outcomes reveal that not all children in a given family experience abuse (Farley, 2003) proposing thereby that possible child traits contribute to eliciting abuse. Numerous studies have proven that low-birth-weight, sick, and premature babies have greater risks of being abused compared to normal babies (Min Jung et al., 2009). Weak characteristics in a baby give rise to special demands for new parents, while furthering their stress of bringing another member into the family. Additionally, several abused children display difficult natures right from a very young age (Arcel & Kastrup, 2004); also, aversive-looking stimuli (like, infant crying) will more likely incite violence (Zapata, 2002). Lastly, evidence exists regarding the fact that, in case of older kids, aspects like looks, dispositions, behavioral patterns, and activity level may prompt maltreatment (Min Jung et al., 2009).

Retrospective research on delinquents reveals extremely divergent prior maltreatment rates, partially due to differences in methodology. For instance, many studies have made comparisons between medical and juvenile court records, and discovered that 9-15% researched delinquents had suffered abuse (Nandon, Koverola & Schludermann, 1998); another research that derived case-file data found a 26% abuse rate (Potterat Rothenberg, Muth, Darrow & Phillips-Plummer, 1998); and a couple of studies involving self-reports of delinquents on prior abuse revealed rates of 69% (Gutierres & Van Puymbroeck, 2006) and 51% (Fang, 2005). Conversely, a couple of follow-up researches on abused kids have revealed ensuing rates of delinquency at 20% and 14% (Luzadder, 2004). The significance of these figures (which are not supported in a majority of studies) hinges on maltreatment and delinquency incidence rates for an analogous population (Nadon et al., 1998; Potterat et al., 1998). Overall, delinquency and maltreatment prevalence estimations among the general society differ, but are positively well under 5% for both (Hill and Fietcher-Rogers, 1998).

Udegbe and Fajimolu (1992) conducted a systematic analysis of current prediction researches on delinquency, and learned that inadequate family management strategies adopted by parents (like, discipline usage, family cohesiveness and overseeing by mother) predict delinquency more significantly, compared to any other determinant; however, child abuse's role was not taken into account. Various retrospective works have established a powerful correlation between different forms of abuse (including physical abuse), and delinquency. A research in 2000 by Barnardos reviewed over 200 males three decades following their participation in an intervention for delinquency prevention; study findings revealed that abused, rejected or neglected men were more prone to major juvenile offenses (e.g., robbery, burglary, theft and assault) as compared to those who felt loved and cared for. However, curiously, children rejected by parents (i.e., repeatedly experiencing parental disapproval) were more prone to delinquency than neglected or abused children were.

Purpose of the Study

A thorough inspection of official reports of over 6,000 neglected and abused kids (Shu-Ling & Bedford, 2003) uncovered an empirical link between juvenile delinquency and child maltreatment (neglect and abuse), as well as the tendency of delinquents, subjected to abuse as children, to perpetrate more violent offenses (e.g., assault), when compared with un-abused delinquents. In fact, many research papers cite incidence of child physical abuse as the most critical factor in differentiating non-violent and violent delinquents (Jones, 2005). Bhana, Pluddemann, and Parry (2008), for example, report that 44% abused delinquents they studied perpetrated assault, as opposed to 16% of delinquents who did not suffer abuse.

The aforementioned studies seem to be consistent with the general assumption that juvenile delinquency is provoked by child maltreatment. Nevertheless, as with research that links childhood aggression and child abuse, this supposition is grounded on correlational statistics that may signify causal effect in both directions (Baseman, Ross & Williams, 1999). There is a possibility that early aggressive activities and problematic temperament (which can be regarded as forms of "delinquency"), brought on the maltreatment. In fact, a research performed on over 1,000 males who were adopted has revealed that genetics is a more powerful contributory factor in later delinquency, than childrearing approaches (Knight, 2002; Balsam, Lehavot & Beadnell, 2011).

This study intends to obtain a better grasp of the female population engaged in prostitution, and experiences of sexual abuse in childhood. In particular, the study aims at exploring the impact of sexual abuse of little girls on taking to prostitution as a living. This paper's emphasis will be deducing the impact of sexual behavior in early childhood, comparing traits of teenage prostitutes, and drug use effects on prostitution. There are only limited number of studies that have dealt with this particular female population and looked into potential factors triggering their engagement in prostitution. An analysis of literature on the subject clearly points out that prostitution victims experience innumerable problems; however, advances in rehabilitation are hindered due to inadequate research specifying their precise needs (Adedoyin and Adegoke, 1995; Bagley, 1985; Bagley and Loretta, 1987). This study will be performed in California's San Francisco city, which is believed to be an area with high prostitution rates, particularly in its Tenderloin neighborhood (Waters & Hudson, 1998; Longres, 1991; MacVicar and Dillon, 1980).

Significance of the study

Balsam and colleagues, in a 2011 work, pinpointed five key explanations that link child sexual abuse, prostitution and drug abuse. First comes the understanding that drug abuse and sexual abuse experiences in early childhood lead to prostitution. Pluddemann and coworkers (2008) put forward some instances of the above explanation. Secondly, prostitution is triggered by child sexual abuse which, in turn, ends in drug abuse (Dove & Miller, 2007). Thirdly, prostitution as well as drug abuse results from sexual abuse in early childhood (Beeks & Amir, 2006). Fourthly, there is a reciprocal association of prostitution with child sexual abuse and drug abuse (Luzadder, 2004). Lastly, sexual abuse at a young age, drugs and prostitution have no causal relationship, but merely co-occurring of a complex frame of events involving all three issues (Nadon et al., 1998). Numerous arguments analyze the causal link between crime and drug abuse. Some contend that a majority of drug addicts go for prostitution perforce- in order to pay for their drug stash, while others believe drug users to frequently engage them into prostitution.

Clearly, confusion exists with regard to the relation between child sexual exploitation and its impact on a woman's introduction to prostitution, and drug use's influence on prostitution (Bagley, 1991; Bell and Carol, 1998; Bracey, 1983; Deischer, Greg & Debra, 1982).

This study's findings can have major implications for upcoming services and programs developed for aiding young girls victimized by prostitution. Moreover, this study can, to some extent, explain and offer a more in-depth framework on different problems that the prostitute population is exposed to. The study excludes female prostitutes sexually un-abused in childhood (Edney, 1988; Gibson-Ainyette, Templer, Brown and Veaco, 1988; Inciardi, 1989). Its outcomes can establish the importance of raising requisite finance for developing effective services and programs. However, even if the results fail to reveal any appreciable impact of child sexual abuse and prostitution entry, they will still prove valuable in establishing that consolidated interventions would effectively aid rehabilitation (Inciardi, Pottieger, Forney, Chitwood and McBride 1991; James and Meyerding, 1977; Lau, 1989). If evidence points to an effect, combined interventions will be more effectual in providing a clear road to recovery, compared to separate interventions for individual groups. Either way, this study's fundamental aim is acquiring a better comprehension of teenage girls forced by circumstances into prostitution.

Objectives of the Study

1. To ascertain the impact of child sexual exploitation and women's engagement in prostitution

1. To deduce substance abuse's impact on prostitutes

Research questions

R.Q.1. In what way does child sexual abuse impact women engaged in prostitution.

R.Q.2. What is the effect of substance abuse on women engaged in prostitution?

Chapter 2:

Literature Review

A number of prostitutes claim to be victims of sexual exploitation in their childhood. In order to deal with prostitution-related stress and their childhood trauma of being sexually-exploited, several of them resort to alcohol and drugs, further complicating issues for them. Society should abhor female sexual abuse, towards preventing prostitution. A research in 1995 proved that victims of child sexual exploitation were 27.7 times more liable to be detained for prostitution than others. Women represent the quickest growing prison segment, with over 91,000 being inmates of federal and state prisons (not including jails), as per a 2000 estimate (Beeks & Amir, 2006). As per figures reported by the United States Department of Justice (DOJ), the imprisoned male population rose by 77% in the last decade of the 20th century, while the imprisoned female population rose by 108% (West, Williams & Siegel, 2000). Nearly 50% of the females imprisoned have been charged with nonviolent offenses, chiefly prostitution, minor frauds and theft, and drug-related breaches of law, as per the DOJ. An extensively large number of these women report to suffering sexual abuse as children. A new research conducted by charity organization, Chicago Coalition for the Homeless found that 41% of females detained for prostitution at the Cook County jail suffered childhood sexual exploitation (Lydersen, 2007; Lalor & McElvaney, 2010).

A research performed by the ICASA (Illinois Coalition Against Sexual Assault) reported 57% Illinois prostitutes having suffered sexual exploitation in childhood. Also, over 90% of them lost their virginity via assault, while 70% reported that exposure to sexual exploitation in childhood played a part in their decision of resorting to prostitution (Brooks-Gordon, 2006; Gangoli, 2006). Similarly, a National Criminal Justice Reference Service study carried out in 1995 observed that victims of child sexual exploitation were 27.7 times more liable to be detained for prostitution than other, non-abused persons. Several prostitutes claim to having resorted to paid trysts for assuming control over their sexuality, following its forcible loss. Others claim that their abusers left them no option but to enter prostitution; a Center for Impact Research (CIR) study conducted in the year 2001 recorded that adults in exceptionally dire situations commonly forced kids into prostitution for buying drugs or paying their rents (Lydersen, 2007; Arata, Langhinrichsen-Rohling, Bowers & O'Brien, 2007).

Several women interrogated in Chicago relate similar tales of their incarceration on prostitution- and drug-related charges (Gorkoff & Runner, 2003; Inciardi, Surratt, Kurtz & Weaver, 2005). Their descent into the world of prostitution begins with sexual exploitation in childhood by their mother's boyfriend or some relative; the permanent psychological trauma they undergo usually goes uncured. Females who were raised in a setting wherein prostitution and substance abuse are rife, begin resorting to both at an early age. The CIR research revealed 62% of females resorting to prostitution having had their very first "date" prior to becoming legal adults (Ehrenreich & Hochschild, 2003; Farley, 2003; Waldrop, Santa Ana, Saladin, McRae & Brady, 2007). Further, literature in the field depicts that nearly all prostitutes rely on alcohol and drugs heavily. Scores of them begin consuming substances or using more quantities or increasing frequency of usage for coping with emotional problems and stress associated with the trade. Some women go into prostitution to pay for drug, either for themselves, their family members, or their partners (Lydersen, 2007; Kempadoo, 2005; Lau and Kristensen, 2010).

The ghost of sexual exploitation forms the basis of many women's plunge into prostitution and drug dependency, from which they strive to acquire release or solace; this complicates their attempts at recovery and leading a better life (Kurtz, Surratt, Kiley & Inciardi, 2005). A number of former prostitutes from the city of Chicago self-report ultimate quitting of the lifestyle following their discovery of support programs and groups, which handle cases of drug abuse as well as psychological/physical problems of childhood sexual abuse (King, 2004; Kuo, 2002; Desai, Arias, Thompson & Basile, 2002).

Background of the problem

Child sexual abuse takes several forms. It may entail seduction of the child by any adored relative, or a violent deed perpetrated by a total stranger. It is not easy to give a definition for sexual abuse, as it can assume various forms, has different incidence levels, is linked to different relationships, and can take place in any number of differing circumstances. Maltz (2002) defines sexual abuse as occurring whenever an individual dictates and takes advantage of another individual through sexual suggestion or activity (p. 321). Child sexual abuse as defined by Ratican (1992) is any covert or obvious sexual act between an adult/older child and a child, in which the younger participant is coerced or seduced into the act. Regardless of the manner in which one defines child sexual abuse, the act typically poses major adverse and long-term psychological effects on the child. (p. 33).

The major part of sexual exploitation occurs in the childhood phase; ironically and shockingly, incest constitutes the most prevalent form of abuse (Maltz, 2002). Child sexual exploitation's effect is unique to each individual and case. One research undertook a comparison of the ordeals faced by women sexually abused by a family member with those abused by someone outside the family. The former category were found to experience higher current anxiety and depression levels upon recollection of the traumatic events (Meyerson, Long, Miranda & Marx, 2002). The other variables reported as anguish enhancers were abuse events involving profounder sexual abuse, high frequency of sexual exploitation experiences, and first exposure to sexual abuse at a very tender age (Hall & Hall, 2011). The severity and nature of abuse may have a more severe effect, but several other elements influence the extent of damage felt by the victim.

Other determinants may include individual perception, support level, and internal resources (Ratican, 1992; Brooke, Taylor, Gunn & Maden, 1998). While all child-sexual-abuse forms do not involve direct touch, therapists need to understand the various forms assumed by it which may still sexually maltreat the victim and inflict psychological damage (Barnardos, 2000; Bluett, Walker, Goodman & Adeyemo, 2000; Carr, Goldberg, Elliott, Green, Mackie & Gruer, 1996). For instance, the offender may abuse the child through premature introduction of pornographic content, internet-based assault, or child manipulation into clicking photographs of a pornographic nature. This category of offense violates fundamental human rights. Children need to learn about, and gain exposure to, sexual experiences within their choice and control, at the right phase of development. The underlying forces and nature of sexual exploitation and relationships that involve sexual abuse are generally harrowing. Childhood experiences of sexual abuse can impede normal social development of individuals and result in a number of psychosocial illnesses (Maltz, 2002; Hall & Hall, 2011).

First Study Issue: Effects of child sexual abuse on women involved in prostitution

Child sexual exploitation can have intensely damaging short-term effects for a victim. While the incident need not necessarily cause a child to suffer considerable adverse consequences in his/her teenage years or adulthood, frequent long-run impacts involve development of mental health, physical, sexual, social, interpersonal and educational issues (Lindsay, 2003). The following social and interpersonal issues develop among adults who were subjected to sexual exploitation as children: (a) lower self-image; (b) disorganized and insecure adulthood attachments: (c) unstable intimate relationships, with low satisfaction levels; (d) higher divorce/separation rates; and (e) greater chances of committing felony assault, property offences, and domestic violence (Dove & Miller, 2007; Gisle, Hesse, Drieskens, Demarest, Van der Heyden & Tafforeau, 2010).

Kids, who face sexual abuse display higher behavioral issues, delinquency rates, and academic/school-related issues, compared to un-abused kids (Sanders, 2005). Psychological effects of childhood sexual abuse in teenage years and adulthood include high anxiety and depression rates, greater tendency of developing eating disorders and substance dependency/abuse issues, suicide, self-mutilation, and PTSD (post-traumatic stress disorder) (Malarek, 2004; Duffin & Beech, 2000). Sexually exploited kids will be more prone to engaging in promiscuous activities (like prostitution), and thrice as prone to getting pregnant before becoming legal adults as un-abused children (Dove & Miller, 2007; Lydersen, 2007).

Sexual abuse experiences at a tender age can cause widely varying effects among victims after reaching adulthood- while some face minimal mental health issues, others suffer numerous mental disorders. Abuse denotes a form of trauma- an event that is stressful, shocking and intense (Baron & Hartnagel, 1998; Maher, 1997). Its effects involve a complex blend of factors like: extent of prior experienced trauma, its harshness, nature of relationship between victim and offender, duration of abuse, reaction of trusted individuals to the incident, if the victim informs them of it (i.e., whether they had faith in, and supported the victim, or dismissed the issue) (Outshoorn, 2004).

Childhood experiences of sexual exploitation can impact an individual's health and happiness in the following ways: (a) Trust -- being sexually victimized ruins the individual's perception of a safe world; she will find it hard to trust people. A close bond with the perpetrator (prior to abusive incident) will render this especially difficult. (b) Self-esteem -- despite the incident not being their fault, victims may descend into an abyss of self-recrimination, and may face difficulties envisioning a bright future for themselves or viewing themselves in a positive light. (c) Handling stress -- a horde of negative emotions may suffocate the victim, making it tough to handle routine stressful events (Mairo, Trupin and James, 1983; Michaud, 1988). (d) Impulsivity -- this implies acting impetuously without assessing the outcomes of one's actions or decisions, resulting in risky activities. (e) Anger -- abused individuals may be unable to keep their anger under check. (f) Dissociation -- the survivor's mind "detaches" itself from the traumatic events as a defense mechanism. She may find it hard to remember the details of the incident, feel unconnected with her body, or perceive the surrounding world as unreal. This reaction is common to fear and pain. (g) Self-harm -- victims may contemplate self-harm, while not intending suicide. This may represent a mechanism for dealing with painful feelings or thoughts (Ozawa, 2003; Lydersen, 2007; Rennell, 2004).

The abovementioned reactions are common in cases of trauma; they may, however, instigate problems when the victim's lifestyle starts getting impacted. Difficulties in handling past traumatic experiences necessitates expert aid. Lydersen (2007) states that there are other issues related to child sexual abuse; these are: (i) Mental illness -- while childhood exposure to sexual abuse does not necessarily lead to mental ailments, it does count among the numerous risk factors. Individuals abused sexually in their childhood days may be more prone to developing depressive disorders, anxiety disorders (e.g. PTSD), personality disorders, eating disorders, and dissociative disorders. (ii) Substance use issues -- child sexual abuse victims will more likely develop substance dependency/abuse issues (Choi, Klein, Shin and Lee, 2009) and be more inclined to begin consumption of alcohol and drugs at an earlier age (Schwartz, Rendon & Chang-Ming, 1994). An individual's reaction (e.g., PTSD, depression, or low self-worth) to a sexual abuse incident that occurred during childhood can also be linked to risks of substance dependency/abuse; victims may turn to substances as a coping means (Choi et al., 2009; Schwartz et al., 1994).

There is a correlation between child sexual abuse and elevated depression, shame, guilt, self-recrimination, anxiety, repression, eating disorders, denial, somatic concerns, dissociative patterns, relationship issues and sexual issues (Mansson & Hedin, 1999; Skidmore, 2000). The most pervasive of long-term sexual abuse issues is depression. Victims may be unable to express what happened with them, thereby ending up having pessimistic self-thoughts (Kessler, Nelson, Jurich & White, 2004). Several years of dwelling on such thoughts make survivors feel worthless; they begin withdrawing from society because of the belief that they do not possess anything worthy of offering (Long, Burnett & Thomas, 2006). According to Ratican (1992), indicators of depression linked to childhood sexual exploitation include feeling persistently low, contemplating suicide, and possessing disturbed, irregular eating and sleeping patterns. They typically feel guilty, ashamed, and blame themselves. Survivors are known to commonly hold themselves responsible for what occurred (Ayre & Barrett, 2000; Gilchrist, Gruer & Atkinson, 2005). If the abuser is a trusted, admired, and respected individual, children will be less disposed to consider them blame worthy and will, therefore, be unable to view the incident as not occurring from a personal fault. Victims frequently resort to self-recrimination, internalizing negative self-directed messages. They tend to exhibit more self-destructive conducts and suicidal ideas compared to un-abused persons (Kessler et al., 2004; Hall & Hall, 2011).

Eating disorders and body-related problems are also found to be a long-run consequence of childhood experiences of sexual exploitation. As per a work by Ratican (1992), body image-linked ailment symptoms among those sexually-abused as children include feeling ugly or dirty, obesity, displeasure with one's appearance/body, and eating disorders. Somatic concerns may also emerge from distress. One research indicated that abused individuals reported a considerably greater number of health problems than sexually un-abused people, with pelvic pain being the most common complaint (Van Velsor & Cox, 2001; Mairo, Trupin and James, 1983; Michaud, 1988). Symptoms of somatization in sexually-abused people involve pelvic pain, difficulty swallowing, gastrointestinal issues, and headaches (Ratican, 1992). Often, anxiety and stress affect those who suffered sexual abuse as children (Miller and Schwartz, 1995).

Sexual exploitation in childhood can be terrifying and trigger stress several years after cessation of the abusive experience(s). Victims often undergo chronic anxiety, phobias, tension, and panic attacks (Ratican, 1992). One research that compared PTSD symptoms among adults, sexually-exploited in childhood, and Vietnam veterans showed that the trauma inherent in the former category can instigate symptoms similar to the latter's trauma-induced symptoms (Hall & Hall, 2011; Nandon, Koverola and Schludermann, 1998; Pawar, 1991). A few of the early-age victims use dissociation to defend themselves against experiencing the abusive act and may continue adopting this coping technique as adults, whenever they feel vulnerable or insecure (King, 2009). This may include flashbacks, nightmares, confusion, disorientation, and challenges with experiencing feelings. Some believe repressing or denying the incident to be one of the long-term impacts of sexual abuse in childhood. Repression/denial symptoms include amnesia with regards to certain parts of one's childhood, believing they must forget it ever happened, and negating sexual abuse's impacts/effects (Ratican, 1992; King, 2009; Hall & Hall, 2011).

Whether survivors are able to forget prior childhood experiences of sexual exploitation and, at a later age, recover the memories represents a debatable matter. While some experts in the field are of the view that the trauma inflicted by sexual abuse is intense enough for the victim to repress/forget what happened as a means to cope, others perceive the recaptured memories to be false or fabricated by the client (King, 2009; Brecht, Huang, Evans & Hser, 2008); sexual abuse survivors may face hardships in cultivating interpersonal relationships. Correlated symptoms of the abuse experience may hamper growth and development of relationships. Some of the frequent relationship challenges faced by child sexual abuse victims include phobia of intimacy, trust-related issues, passive behaviors, fear that they are weird or different, involvement in abusive relationships, and problems with setting up interpersonal boundaries (Ratican, 1992; Pellebon, 2008; Pennbridge, Freese and MacKenzie, 1992). Callahan, Hilton and Feinauer (1996) explored the association between an individual's depression, childhood abusive incidents' severity, and ability of adjustment with a partner. Findings indicated that increased severity of abusive events was linked to decreased ability of individual's adjustment with partner. Usually, sexual abuse is instigated by an individual loved and trusted by the child, thus resulting in breaking of trust and a belief that those they love may end up hurting them (McGill, 2003). Bieschke and Kessler, in a 1999 research, established a significant link between adult victimization and women sexually-abused as children (Schaffer and DeBlassie, 1984; Seng, 1989; Shaw and Butler, 1998).

Several of the survivors face sexual challenges. The abuse's long-run impacts, like dissociative patterns and depression, hinder sexual functioning of victims. Maltz (2002) enumerates the ten most prevalent sexual symptoms arising from sexual abuse: avoidance, fear, or lack of interest in sexual activities; perception of sex as being a duty/requirement; adverse feelings towards intimate touch (e.g. anger, guilt, or disgust); difficulties in feeling sensation or becoming aroused; emotional detachment during intercourse; disturbing or intrusive sexual images/thoughts; participation in inappropriate or compulsive sexual activities; orgasmic problems/vaginal pain in women; erectile, orgasmic, or ejaculatory problems in men; and problems with forming and maintaining intimate relationships (p. 323). One U.S. research on sexual dysfunction factors and incidence discovered that sexual abuse victims faced more sexual challenges than non-abused individuals (Folch, Esteve, Sanclemente, Martro', Lugo, Molinos, & Casabona, 2008).

One must note that though literature indicates significant linkages between child sexual exploitation and long-run influences, the experiences and reaction of victims will not be identical (Harcourt, van Beek, Heslop, McMahon & Donovan, 2001). While sexual abuse is generally perceived to be a traumatic event, no lone symptom exists among survivors; clinicians need to concentrate on clients' individual needs (Hall & Hall, 2011; Silbert and Pines, 1981; Silbert, 1982; Silbert and Pines, 1982a; Silbert and Pines, 1982b).

Second Study Issue: Effects of substance abuse on women involved in prostitution

Drugs and prostitution are related to an increasing extent; however, this linkage's nature has not been wholly comprehended. One work on the subject addresses drug use effects as facilitators or hindrances to the trade (Miller, 1995; Cusick, 2002);prostitutes use substances, particularly amphetamines, for dealing with the late, long hours that are a characteristic of the trade. Then again, research has also indicated that drug use by prostitutes can make them more susceptible to violence. It has been revealed by Cusick (1998) that aggression towards prostitutes during work hours is prevalent, and linked more intensely with the situations wherein they have least liberty.

Another work on the subject addresses order of women's involvement in prostitution and substance abuse (Miller, 1995). It has been put forth by Hodge (2003) that they might merely occur concurrently in an irregular setting, and that their common standing as unlawful/clandestine activities is what truly links them. Alternatively, researchers have suggested that drug usage before prostitution and prostitution before using of drugs are equally prevalent. However, Brodie, Barrett and Melrose (1999) contend that, often, younger prostitutes used drugs before taking up the trade. Further, Helen (2003) reveals that younger and adult prostitutes, working to finance a habit can, many a times, be discovered in the very same neighborhoods across London. These neighborhoods are labeled 'dark' and receptive to drug users (Kendlei, Cardner & Prescott, 2002; Gossop, Powis, Griffiths & Strang, 1994, 1995; Logan, Leukefeld & Farabee, 1998).

Melrose and colleagues (1999) and Deprez, Asueta-Lorente, Antoine, Bollaerts, van Bussel and Van der Linden (2011) found that amphetamine, heroin, and 'crack' use is more dominant in younger prostitutes compared to prostitutes aged 26 and above. The constantly-reiterated advice that one mustn't confuse causation with correlation requires repeating here. The rational view that dependency on drugs induces acquisitive offenses has been increasingly coming up among the drug-related policies of the UK, inciting indiscriminating recommendations that those who use drugs must receive treatment, at least to safeguard the public (Stimson, 2000; Day & Ward, 1997; Earls, Christopher, & Helene1989, 1990). It has been asserted by Toby Seddon in his 2000 work that these plain explanations do not deal with the more important causes of drug use as well as crime; consequently, drug use therapy will likely be unsuccessful until social exclusion issues remain unsolved (Simons and Whitbeck, 1991; Sullivan, 1988; Udegbe and Fajimolu, 1992).

Not much attention was paid, until recent times, to South African drug users, and the link between sex trade and drug use (Parry and Pithey, 2006). Empirical information from other places around the world, however, proves a connection between the two. Additionally, it is now clear that drug type and kinds of sexual connections influence sexual risk linked to drug use (Celentano, Latimore, and Mehta, 2008; Degraaf, Vanwesenbeeck, Vanzessen, Straver & Visser, 1995). There is, for instance, a surfeit of international research which establishes that crack cociane's extremely addictive nature compounds transactional sex and other such risky sexual behaviors (Baseman et al., 1999; Celentano et al., 2008; Leggett, 1999; McCoy et al., 2004; Parry et al., 2008a; Parry et al., 2008b; Shannon et al., 2007; Wechsberg et al., 2006).

On the contrary, there is a less reliable association between risky sexual activities and heroin consumption; the relation is more situational. Strathdee and Sherman (2003), for instance, discovered that heroin use was related to higher STD acquisition in U.S. women, who consumed heroin with their main sexual partner (Strathdee and Sherman, 2003; Gossop, Marsden, & Stewart, 2002). With a rise in rate of illegal drug use among the black population of South Africa, it is crucial to understand the link of sex trade and other such high-risk activities with drug use. Historically, among sub-Saharan African nations (such as South Africa), teenagers and young women have been forced to resort to prostitution for paying for basic necessities like food and shelter, owing to their countries' economic and social circumstances. Therefore, prostitutes and the men who visit brothels have contributed significantly to HIV's spread and prevalence of high rates of HIV infection in the region (Chen, Jha, Stirling, Sgaier, Daid&Kaul, 2007; Ramjee and Gouws 2007; Ramjee, Karim & Sturm, 1998; Voeten, Egesall, Varkevisser & Habbema, 2007; Wang, Hawes, Gaye, Sow & Ndoye, 2007; Williams, Taljaard, Campbell, Gouws, Ndhlovu & van Dam, 2003).

Recent research has recorded a 34-69% rate of substance abuse among prostitutes in South Africa's mining and urban regions (Dunkle et al., 2005; Parry et al., 2008b; Wojcicki and Malala, 2001). Bearing in mind the firm link between sexually-transmitted AIDS/HIV and drug use epidemics across the world, designing of successful interventions aimed at high-risk groups is critical. But prior to development of such programs, scholars need to ascertain protective and risk factors linked to risky sexual behaviors and substance use, and comprehend the interaction between the factors that augment HIV risks among South Africans (Floyd, Hedden, Lawson, Salama, Moleko & Latimer, 2010).

Afrocentric Perspective

Researchers Graham (2006) and Pellebon (2008) revealed that, relative to other racial groups the health needs of people of African-American community had not been adequately addressed. The lack of attention was also noted by researchers (Graham, 2005; Borum, 2007; Reviere, 2001). There were also gaps in research on African-American youth particularly in the issue of substance abuse treatment.

Afrocentricity, for all practical purposes, has three objectives: (a) its main aim is to bring about a different social science model that is more specific to the political and cultural reality of people of African origin; (b) it attempts to remove any negative stereotypes and misrepresentations of African-Americans; (c) it seeks to bring about a different global perspective that will enable societal and human transformation towards humanistic, spiritual and moral ends, that will persuade individuals of diverse backgrounds of the fact that they all have a common goal with regards to this matter (Schiele. 1996, p. 286). There is an assumption in Afrocentricity that the spiritual element of a person is as important and the tangible dimension. In Afrocentricity, the underlying causes of social problems in the United States (U.S.) are alienation and oppression (Schiele, 1997). In a capitalist country like the U.S., individuals grow up with the view that they are goods to be traded around for their labor. This view is incongruent with the long held values of sharing, collectivity, and spirituality among Africans. There is a belief of unity of things among African societies, which stresses on the importance of both horizontal and vertical relationships (relationships with other human beings and with a higher power above) (Prince, 2008; Manning, Cornelius & Okundaye, 2004; Valandra, 2007).

An Afrocentric-based drug use treatment also stresses on the strong community links and survival strategies that exist in communities of African origin. For many decades African-American beauty salons, barbers, churches and other social institutions have offered very important social support systems within African-American communities (Pellebon, 2008; Borum, 2007; Manning et al., 2004). These social organizations have helped bring about social cohesion among African-Americans and fostered the African belief of "protecting the tribe" (Moore & Lott Collins, 2002; Prince, 2008). Moreover, these organizations formed social settings, which allowed African-Americans to talk and relate about the marginalization and oppression they were undergoing in the American society (Manning et al., 2004).

Theoretical framework

Heider's (1958) model and other similar models by other researchers (Jones & Davis, 1965; Kelley, 1973; Weiner, 1995) provided us with a useful outline for studying the issue of prostitution and sexual abuse among young children. The model or otherwise known as attribution theory provides an explanation on how one may have a natural tendency to (a) find out the origin of occurrences or behavior, (b) understand if the occurrence or the behavior has been caused by the environment or one's character, and (c) predict whether or not the occurrence can repeat itself in the future (Heider, 1958; Vitaliano, James and Boyer, 1981; Widom and Ames, 1994; Widom and Kuhns, 1996). In this paper, the understanding of the origins, interpretations and future inferences of the behaviors of young ones who have been sexually abused are studied to provide crucial insight into the manner which females come up with judgments, apportion blame or responsibility, and make choices about getting into prostitution.

The literature reviewed had several studies that showed the main constructs of Heider's attribution theory and how they relate with the choice to get into prostitution. The theory also provided us with an approach framework for the study and the main research questions. The attribution theory has also been used previously in several studies to explain the decision-making processes of law enforcement officers with regard to minorities (Foley & Terrill, 2008; Watson, Corrigan, & Ottati, 2004a, 2004b).

Chapter 3: Research method

The Delancey Street Foundation (a self-help movement) provided the interviewers. The Foundation is widely known for the help it has provided to drug abusers, prostitutes, and criminals. All the interviewers were at one point in their lives involved in either crime or prostitution. Given the sensitive nature of the questions that were to be asked as also the lack of trust among the targeted interviewees, there was a need to have interviewers who could be trusted and who could look credible to the target population (Cusick, 2006). As such, since the interviewers were themselves once involved in those activities, their credibility was not an issue. Furthermore, the interviewers could easily understand and interpret the target population's slang and thus they could easily create rapport with the subjects and encourage them to speak about emotive issues and experiences. All the interviewers were first taken through a 3-week comprehensive training, which encompassed learning about interviewing skills and the fundamentals of research methodology. During the training, the need for uniformity of presentation, definition of terms, scoring uniformity and the call for sensitivity towards the interviewees' needs, were stressed upon (Gisle et al., 2010).

A new specific tool, the aptly named Sexual Assault Experiences Questionnaire, was made to achieve the objectives of the study. The questionnaire was made up of the following components: (1) background data, (2) History of sexual violence as an adult, (3) history of sexual abuse as a child and (4) future plans. The second part of the questionnaire was given to all the respondents assuming that their entry into prostitution effectively made them to start acting as adults instead of children. The third component of the questionnaire was given only to respondents who had earlier revealed that they had been sexually assaulted during their childhood. For each case of sexual assault or abuse, the following set of questions were posed: (1) what was the victim's age when they were first assaulted, how frequent was the sexual abuse, who were the people who witnessed the abuse, was there a report made, and what action was taken because of the report; (2) what relationship did the victim have with the perpetrator, what was his approximate age, and if he or she used drugs and alcohol; (3) what type of force was utilized during the assault and what sexual acts were used; and finally (4) what were the emotional and physical conditions of the victims and their view of men, sex and themselves after the abuse and the influence if any the exploitation had on the victim's decision to get into prostitution (Dove & Miller, 2007; Gisle et al., 2010).

To obliterate or reduce the effect of social desirability-bias, repeated interview methodology was employed. The methodology also helped to check for the presence of any contradictions, inconsistencies, and falsities in the statements made by the participants, as the frequent encounters between the researcher and the participants allowed more time together. Forty-six sets of data (about the lives of the respondents) were collected as contact summary sheets (Blanchard, O'Neil, Ramesh, Bhattacharjee, Orchard & Moses, 2005). The sheets included the following data: demographics (age, education level, marital status, employment history, the period that one has worked as a prostitute, number of children, organization/institution that one is a member of); sex work structures (whether independent or through a middleman); background information and the reasons for getting into prostitution (Sinha, 2015; Decorte, Mortelmans, Tieberghien & De Moor, 2009).

Semi-structured interviews were used. The summary sheets were used as guides to conduct the interviews. The questions were however, not in a standard format. The question, "How did end up in the place you're right now?" was always utilized to begin the interviews. This open-ended question gave the participants room to talk about the factors that led them to consider and entry into sex work. Before any interview commenced, informed consent was obtained from each of the women. Each time the women were asked questions, they were told about the objectives of the study. The women were also given sufficient time to ask any questions for clarifications (Sinha, 2015; Wolff and Geissel, 1993; Greene, Ennett & Ringwalt, 1999; Browne & Finkelhor, 1986).

Sample Description

In this research, 200 former and current female sex workers in San Francisco formed the respondents for the study. The sex workers were recruited for the interviews using cards, leaflets, and public service announcements. However, many of the participants were informed of the study through word of mouth. All of the participants were volunteers. Each of the sex workers were personally given the questionnaires. Their answers to the questions asked by the interviewers were immediately transcribed in the course of the interview deciphered into the language used in the questionnaire; all responses were recorded on tape and later transcribed. Interviews lasted between 2 and 4 hours, based on the range and quantity of incidents of sexual abuse revealed by the respondent (Gisle et al., 2010; Sinha, 2015). The average age of the participants was twenty-two. The youngest respondent was ten and the oldest forty six. 70% of the sex workers were twenty-one years old and above, the remaining were sixteen and under. About 78% of the respondents became sex workers before they had reached the age of eighteen. 68% of the interviewed sex workers were Caucasian; 18% were African-American; eleven percent were Hispanic; native Americans and Asians formed two percent and one percent respectively. About twenty two percent of the respondents were separated, divorced or widowed, the majority sixty eight percent had never married before and only a paltry ten percent were either married or in a committed relationship. Even though, the majority of the sex workers (66%) interviewed came from relatively well-off families, they all reported their current financial situation as "barely breaking even" (Wang et al., 2007; Chen et al., 2007)

Limitations of the Study

The study in its current form has several limitations that must be taken into account when making conclusions. The first limitation is that since the study data is cross-sectional, it makes it less clear for one to authoritatively conclude that sexual abuse at a very early age was an influencing factor that made the girls to get into prostitution. The second limitation is that, it is difficult to find causality between sex work and substance abuse for the 2nd study. It is not clear whether drug abuse is the driving force of prostitution or whether it is just a way to cope with the involvement in prostitution (Finkelhor, 1991; Finkelhor & Browne, 1985; McClanahan, McClelland, Abram & Teplin, 1999). However, it was also discovered that the low education levels (only one quarter of the women who were interviewed finished high school), and high rates of unemployment meant that the women would probably be stressed by not only economic hardships but also social deprivation. Finally, there is no control group that can be used to compare results; this lack was regarded as a huge methodological disadvantage in the research (Kramer & Berg, 2003; Coy, Wakeling & Garner, 2011; Potterat et al., 1998).

Chapter 4: Results and analysis

The study revealed higher levels of discrimination for the sex workers prior to and after they got into sex trade. 60% of the respondents were sexually abused in their childhood by an average of two men each. Over a period of 20 months, each child was sexually exploited about 2 or 3 times. About 66% of the women were sexually abused by either their biological or surrogate fathers. Roughly 4% of the women were exploited by their mother's common law husbands. About 28%, 17% and 15% of the women were exploited by their brothers, uncles, and other relatives respectively. Thirty one percent of the women were exploited by people they know such as family friends or neighbors, while the remaining ten percent were sexually exploited by strangers (Sinha, 2015; Silbert & Pines, 1983).

The average perpetrator of sexual crimes was a male in his 30s. About 58% of the subjects of the study narrated that the people who abused them were using alcohol or other substances during the incident. A further 14% was unsure about whether the perpetrator was using any substances during the assault. 54% of the subject reported that the assault occurred at night while 7% were unsure. Out of the 17% who revealed that someone witnessed the abuse take place, only 62% of them indicated that the witness helped them. When the women were queried on why they were assaulted with no protection, they frequently responded that it was the abuser who was supposed to do the protecting (Silbert & Pines, 1983; Hall & Hall, 2011).

First study issue findings

In 81% of the cases, some form of coercion was used. For instance, in 25% of the cases physical coercion was used. In 23% of the cases, emotional coercion was used. Thirty three percent of the subjects reported that both physical and emotional coercion was used. During each case of sexual exploitation, about 4 acts of force were used, the subjects reported. The main act of force was the perpetrator holding the child down. This happened in about 61% of the cases. Other common acts of force utilized included: the perpetrator promising love or indicating that sexual penetration was a demonstration of that love (48% of the cases); the abuser implying that sexual intercourse was the duty of the girl if she really did love the perpetrator (44%); and the abuser using words to threaten the girl (40%). In 31% of the cases, the perpetrators hit the children; in 29% of the cases, the abusers twisted the victims' arms. In 25%, 22% and 1% of the cases the abusers: threatened to withdraw love; locked the victims up; and used some kind of weapons respectively (Hall & Hall, 2011; McGill, 2003).

59% and 6% reported that there was vaginal penetration with penis and an object respectively while 10% and 5% reported that the assault was anal penetration with penis and an object respectively. The subjects reported the incidences of sexual exploitation as follows: 36% reported it entailed fellatio; 43% and 32% masturbating the man and the girl respectively; 13% reported cunnilingus; 49% reported sexual stimulation (fondling of breasts or private parts); 20% reported kissing lips and lastly 2% reported taking of nude photographs (Blanchard et al., 2005; Decorte et al., 2009).

The study also revealed that the incidences of sexual abuse resulted in different types of physical harm. 68% of the subjects ended up with bruises, 51% cuts, 19% shock, 3% suffered fractured bones and finally 3% suffered serious head injuries. The biggest chunk of the subjects lost their virginity via the incidences of exploitation. 5% of the subjects became pregnant, 10% acquired a sexually transmitted disease, 26% required treatment and a further 26% required more medical attention (Silbert & Pines, 1983; King, 2009).

The emotional harm suffered by the girls was also acute. Most of them reported feeling terrible, dirty or disgusted by sex after the incidents. Only 1% of the women stated that they felt loved. During the incident 73% of the women reported that they felt frightened, 53% reported feeling disgusted by the act of sex, 56% were shocked and didn't know how to respond, 49% hated the men who assaulted them, 4.4% reported feeling guilty and thus felt hate for their own selves and 4.1% cried during the ordeal. The study also revealed that 40% of the women became fearful of men, 11% reported trying to forget the ordeal while 9% revealed feeling nothing. Moreover, a staggering 91% of the subjects were of the belief that nothing could be done to stop the abuse (Lydersen, 2007; Brooks-Gordon, 2006).

Several sets of questions were also developed to determine the long-term impacts of the incident on how the victims felt about men, sex and their mothers. Only 2% reported positive feelings about each of the three sets of questions. Moreover, with respect to the question on whether the incident influenced the subject's decision to get into prostitution, 70% reported that it did (Seddon, 2000; Maltz, 2002).

Of all the cases of sexual abuse, 17% of the girls ran away from home to prevent further sexual abuse, 2% attempted to commit suicide, 1% went to court, 5% tried to hurt the perpetrator in some way. Out of all the cases, only 37% of the victims told anyone about the ordeals. Of this number, 68% reported to their mothers, 26% to their brothers, sisters, or other relatives, 2% to their teachers, 2% to the police, and 1% to social workers. The subjects reported that of the individuals who were told 12% reacted with sympathy, 45% with anger towards the perpetrators, 32% responded with hostility towards the assaulted girls, 26% were skeptic and 9% were embarrassed of the subjects and lastly in 9% of the cases, the individual to whom the incident was reported did not respond (Balsam et al., 2011; Beeks & Amir, 2006; Silbert & Pines, 1983).

58% of the subjects reported the act of telling someone about the ordeal soured their relationship with the individual they told. In fact it is only in 21% of the cases that the sexual exploitation stopped after they told someone about it (Kramer & Berg, 2003; Coy Wakeling & Garner, 2011; Potterat, Rothenberg, Muth, Darrow & Phillips-Plummer, 1998; West, Williams & Siegel, 2000; Wilson & Widom, 2009; Widom & Kuhns, 1996). In the majority of the cases (42%), there was inaction from the person who was told. Even in terms of conviction, only 4% of the perpetrators were punished by the courts. Therefore, the small number of victims, who decided to report their abuse to someone, were frequently faced with shame and blame and also lack of action (Min Jung et al., 2009; Fang, 2005; Luzadder, 2004).

Second study issue findings

Similar to several previous studies, multiple substance use was quite common (Parry et al., 2008b). To be specific, about 27% of the samples taken came back positive for 2 drugs (most often heroin and marijuana), 35% came back positive for 3 drugs (usually heroin, marijuana and cocaine). About half of the respondents reported that they used drugs to cope. Roughly, 33% of the respondents revealed that they had been involved in sex trade. The study also revealed that the rate of buying and selling of sex among individuals who utilized drugs to cope was higher relative to those who did not utilize drugs to cope (Waldrop et al., 2007).

The most commonly used drugs among prostitutes were heroin, crack and methadone. Eighty-one percent of the prostitutes reported having substance abuse problems. Many of the subjects of the study reported having started using drugs at a very early age (a mean of about 16.2%). The early start of substance abuse was correlated with the similarly early start of prostitution. The mean starting age of women who drug abuse problems was 5 younger than of those women who did not have such problems. Drug use problems were strongly associated with 'outdoor' sex work environments (the streets and crack houses) relative to those who were involved in 'indoor-related' sex work environments (escort agencies, sauna, or massage parlours) (Wilson & Widom, 2009; West, Williams & Siegel, 2000).

Chapter 5: Discussion

In our study only 10% of the subjects reported being sexually abused during their childhood by strangers. Yet, in several similar studies an average of 25% of the women revealed that they were sexually abused by strangers as children. The fact that the number of women who revealed sexual exploitation by strangers in the current study was significantly lower compared to the average, is important, since it reveals that revealing sexual abuses by a stranger seemingly results in less psychological issues for the girl (Stewart, 1996; Arellano, 1996). One of the reasons proposed to explain this observation is that sexual abuse by a stranger is usually a one-time incident. On the contrary, intra-familial sexual exploitation is likely to continue for some time. Authors Silbert & Pines (1983) noted in their work that usually the sexual assault only ends when: the victim tells someone about it; authorities intervene; the victim leaves the home or marries. In our study, the only way the victim could escape intra-familial abuse, was running away from home frequently. Indeed, most of the subjects in the study never revealed to anyone that they had been sexually abused until the interview. Only 2% reported the abuse to law enforcement (Lorvick et al., 2006).