Child Sexual Abuse and Its Effects on Women in Prostitution

Introduction

Sexual abuse of children is a widespread and deeply troubling problem not only in the United States but across the world. In the U.S., reported child sexual abuse incidents increased by 322% during the 1980s; reported sexual attacks on children numbered 1.3 million in 1995 alone. The U.S. population currently comprises approximately 60 million survivors of child sexual assault. Globally, 150 million females and 73 million males under the age of 18 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 of cases (95%), victims are acquainted with their perpetrators, causing most incidents to go unreported. Perpetrators who sexually abuse children include family members, neighbors, friends, coaches, teachers, older youth, and clergy (Dove & Miller, 2007).

This stated fact about abusers indicates that those entrusted with childcare — and whom society trusts — do not always honor that trust. While the statistics above highlight the enormity of the issue, the community has only recently begun to understand the true pervasiveness and consequences of sexual assault against children (Heinzmann, 2005). Society's growing awareness can be seen in recent efforts by multiple law enforcement organizations (such as the Federal Bureau of Investigation and the National Center for Missing and Exploited Children), mental and physical health organizations (such as the American Psychological Association and the American Academy of Child and Adolescent Psychiatry), educational groups (such as Child Help USA and Kidscape), and child services organizations (such as the National Juvenile Online Victimization Survey Publications and Child Welfare Information Gateway), all working toward creating awareness and developing strategies that children, parents, educators, and other concerned parties may use to prevent and effectively respond to child sexual abuse (Dove & Miller, 2007; Beeks & Amir, 2006).

The most commonly cited potential long-term behavioral consequence of childhood sexual abuse is delinquency. The existence of a causal relationship appears intuitively reasonable. Children who are victims of power-assertive aggression may willingly embrace antisocial and violent behavior through displaced anger or modeling as they grow older. Unfortunately, the large body of empirical work attempting to prove this causal link has mostly been restricted to retrospective studies of delinquents, along with follow-up studies of abused children. These studies hint at a link between delinquency and child abuse but fail to illuminate causal relationships and sequences. They therefore cannot determine whether abuse leads to delinquency, vice versa, or whether some other factor or set of factors is responsible for both. No prospective, large-scale, longitudinal study has established a causal relationship. Whether delinquency — especially aggressive delinquency — arises from childhood physical abuse remains an unanswered question in most studies (Howing, Wodarski, Kurtz, Gaudin, & Herbst, 1990; Knight, 2002).

This paper covers brief descriptions of research works linking child abuse with violent behaviors and subsequent delinquency. Major definition- and methodology-related problems are intrinsic to these studies and create difficulties in making comparisons and interpreting research findings; these challenges are addressed throughout. A framework for understanding child abuse's role in causing delinquency is developed, which can guide future research into more in-depth and improved studies. The goal of the authors is to explore the current, tacitly acknowledged model and identify underlying assumptions, rather than to propose an alternative model (Howing et al., 1990).

Statement of the Problem

Scholars have found that children who suffered physical abuse direct more aggression toward adults and peers (MacWilliams, 2003) and are more impulsive and considerably less compliant (Min Jung, Tajima, Herrenkohl, & Bu, 2009) than children who have not experienced abuse. Aggression has been observed even among children abused between ages one and three; it is more common among children exposed to more serious and frequent violence (Yancy, 2005). Based on these and similar findings, one may presume that aggression develops in children who suffer abuse regardless of the age at which the abuse occurred. The established correlation between aggression and child abuse should, however, be interpreted cautiously. Several researchers have noted that existing research cannot firmly establish whether aggression triggers abuse or results from it (Sorajjakool, 2003). Study outcomes reveal that not all children within a given family experience abuse (Farley, 2003), suggesting that certain child characteristics may contribute to eliciting maltreatment. Numerous studies have shown that low-birth-weight, sick, and premature infants face greater risks of being abused compared to healthy infants (Min Jung et al., 2009). Special demands on new parents created by a vulnerable infant can heighten parental stress. Additionally, several abused children display difficult temperaments from a very young age (Arcel & Kastrup, 2004); aversive stimuli such as infant crying are more likely to incite violence (Zapata, 2002). Evidence also exists that, in the case of older children, factors such as appearance, disposition, behavioral patterns, and activity level may prompt maltreatment (Min Jung et al., 2009).

Retrospective research on delinquents reveals extremely divergent prior maltreatment rates, partly due to methodological differences. For instance, several studies comparing medical and juvenile court records found that 9–15% of researched delinquents had suffered abuse (Nadon, Koverola, & Schludermann, 1998); one study that derived data from case files found a 26% abuse rate (Potterat, Rothenberg, Muth, Darrow, & Phillips-Plummer, 1998); and a pair of studies involving self-reports by delinquents revealed prior abuse rates of 69% (Gutierres & Van Puymbroeck, 2006) and 51% (Fang, 2005). Conversely, a couple of follow-up studies on abused children revealed subsequent delinquency rates of 20% and 14% (Luzadder, 2004). The significance of these figures hinges on maltreatment and delinquency incidence rates for comparable populations (Nadon et al., 1998; Potterat et al., 1998). Overall, prevalence estimates of both delinquency and maltreatment among the general public differ but are generally under 5% for each (Hill & Fietcher-Rogers, 1998).

Udegbe and Fajimolu (1992) conducted a systematic analysis of delinquency prediction research and found that inadequate family management strategies — such as poor discipline practices, low family cohesion, and insufficient parental oversight — predict delinquency more significantly than any other determinant; however, the role of child abuse was not taken into account. Various retrospective studies have established a strong correlation between different forms of abuse, including physical abuse, and delinquency. A study by Barnardos in 2000 reviewed more than 200 males three decades after their participation in a delinquency prevention intervention; findings revealed that abused, rejected, or neglected men were more prone to serious juvenile offenses (such as robbery, burglary, theft, and assault) compared to those who felt loved and cared for. Curiously, children rejected by parents — those 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 on more than 6,000 neglected and abused children (Shu-Ling & Bedford, 2003) uncovered an empirical link between juvenile delinquency and child maltreatment (both neglect and abuse), as well as a tendency for delinquents who suffered childhood abuse to commit more violent offenses (such as assault) compared to non-abused delinquents. In fact, many studies cite childhood physical abuse as the most critical factor distinguishing non-violent from violent delinquents (Jones, 2005). Bhana, Pluddemann, and Parry (2008) report, for example, that 44% of abused delinquents in their study committed assault, compared to 16% of delinquents who had not suffered abuse.

The aforementioned studies appear consistent with the general assumption that child maltreatment provokes juvenile delinquency. Nevertheless, as with research linking childhood aggression and child abuse, this assumption is grounded in correlational statistics that may signify causal effect in both directions (Baseman, Ross, & Williams, 1999). It is possible that early aggressive behavior and difficult temperament — which might be regarded as early forms of "delinquency" — brought on the maltreatment. Indeed, one study of more than 1,000 adopted males found that genetics was a more powerful contributory factor in later delinquency than childrearing approaches (Knight, 2002; Balsam, Lehavot, & Beadnell, 2011).

This study aims to gain a better understanding of the female population engaged in prostitution and their experiences of childhood sexual abuse. In particular, the study explores the impact of the sexual abuse of young girls on their entry into prostitution. The paper's focus will be on deducing the impact of sexual behavior in early childhood, comparing traits of teenage prostitutes, and examining the effects of drug use on prostitution. Only a limited number of studies have addressed this particular female population and examined potential factors triggering their engagement in prostitution. A review of the literature on the subject clearly indicates that prostitution victims experience innumerable problems; however, advances in rehabilitation are hindered by inadequate research specifying their precise needs (Adedoyin & Adegoke, 1995; Bagley, 1985; Bagley & Young, 1987). This study was conducted in San Francisco, which is considered an area with high prostitution rates, particularly in its Tenderloin neighborhood (Waters & Hudson, 1998; Longres, 1991; MacVicar & Dillon, 1980).

Significance of the Study

Balsam and colleagues (2011) identified five key explanations linking child sexual abuse, prostitution, and drug abuse. First, drug abuse and childhood sexual abuse experiences together lead to prostitution. Pluddemann and colleagues (2008) provided examples supporting this explanation. Second, prostitution is triggered by child sexual abuse, which in turn leads to drug abuse (Dove & Miller, 2007). Third, both prostitution and drug abuse result from childhood sexual abuse (Beeks & Amir, 2006). Fourth, there is a reciprocal association among prostitution, child sexual abuse, and drug abuse (Luzadder, 2004). Fifth, childhood sexual abuse, drug use, and prostitution have no direct causal relationship but co-occur as part of a complex cluster of events (Nadon et al., 1998). Numerous arguments analyze the causal link between crime and drug abuse. Some contend that most drug addicts turn to prostitution to finance their habit, while others believe that drug use frequently draws individuals into prostitution.

Clearly, considerable confusion exists regarding the relationship between childhood sexual exploitation and its impact on a woman's entry into prostitution, as well as the role of drug use in prostitution (Bagley, 1991; Bell & Todd, 1998; Bracey, 1983; Deischer, Robinson, & Boyer, 1982).

This study's findings may have significant implications for future services and programs designed to aid young girls victimized by prostitution. The study can also, to some extent, explain and offer a more comprehensive framework for understanding the range of problems facing the prostitute population. The study excludes female prostitutes who were not sexually abused in childhood (Edney, 1988; Gibson-Ainyette, Templer, Brown, & Veaco, 1988; Inciardi, 1989). Its outcomes can establish the importance of securing adequate funding for developing effective services and programs. Even if the results fail to reveal any appreciable impact of childhood sexual abuse on entry into prostitution, they will still prove valuable in establishing that integrated interventions would effectively support rehabilitation (Inciardi et al., 1991; James & Meyerding, 1977; Lau, 1989). If evidence points to an effect, combined interventions will be more effective in providing a clear path to recovery than separate interventions for individual groups. Either way, the study's fundamental aim is to gain a better understanding of teenage girls who are driven by circumstances into prostitution.

Objectives of the Study

1. To determine the impact of childhood sexual exploitation on women's engagement in prostitution.

2. To examine the impact of substance abuse on prostitutes.

Research Questions

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

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

Literature Review

A number of prostitutes report being victims of sexual exploitation during childhood. In order to cope with the stress of prostitution and the trauma of childhood sexual exploitation, several of them resort to alcohol and drugs, further complicating their situations. Society should condemn female sexual abuse in order to help prevent prostitution. A 1995 study found that victims of childhood sexual exploitation were 27.7 times more likely to be detained for prostitution than non-abused individuals. Women represent the fastest-growing prison population, with more than 91,000 held in federal and state prisons (not including jails), according to a 2000 estimate (Beeks & Amir, 2006). According to figures from the United States Department of Justice (DOJ), the imprisoned male population grew by 77% during the last decade of the 20th century, while the imprisoned female population grew by 108% (West, Williams, & Siegel, 2000). According to the DOJ, nearly 50% of incarcerated females were charged with nonviolent offenses, chiefly prostitution, minor fraud, theft, and drug-related violations. A large number of these women report having suffered sexual abuse as children. A study by the Chicago Coalition for the Homeless found that 41% of females detained for prostitution at the Cook County jail had suffered childhood sexual exploitation (Lydersen, 2007; Lalor & McElvaney, 2010).

A study conducted by the Illinois Coalition Against Sexual Assault (ICASA) reported that 57% of Illinois prostitutes had suffered sexual exploitation in childhood. Additionally, more than 90% of them lost their virginity through assault, while 70% reported that exposure to childhood sexual exploitation played a role in their decision to enter prostitution (Brooks-Gordon, 2006; Gangoli, 2006). Similarly, a National Criminal Justice Reference Service study conducted in 1995 observed that victims of childhood sexual exploitation were 27.7 times more likely to be detained for prostitution than non-abused individuals. Several prostitutes report having turned to paid sexual encounters as a means of reclaiming control over their sexuality following its forcible loss. Others report that their abusers left them no choice but to enter prostitution; a Center for Impact Research (CIR) study conducted in 2001 recorded that adults in extremely dire circumstances commonly forced children into prostitution to buy drugs or pay rent (Lydersen, 2007; Arata, Langhinrichsen-Rohling, Bowers, & O'Brien, 2007).

Several women interviewed in Chicago share similar accounts of their incarceration on prostitution- and drug-related charges (Gorkoff & Runner, 2003; Inciardi, Surratt, Kurtz, & Weaver, 2005). Their descent into prostitution often begins with sexual exploitation in childhood by a mother's boyfriend or a relative; the permanent psychological trauma they experience typically goes untreated. Females raised in environments where prostitution and substance abuse are common begin engaging in both at an early age. The CIR study found that 62% of females who resorted to prostitution had their very first "date" before reaching legal adulthood (Ehrenreich & Hochschild, 2003; Farley, 2003; Waldrop, Santa Ana, Saladin, McRae, & Brady, 2007). Furthermore, literature in the field indicates that nearly all prostitutes rely heavily on alcohol and drugs. Many begin using substances, or increase their usage, to cope with the emotional problems and stress associated with the trade. Some women enter prostitution to pay for drugs, either for themselves, their family members, or their partners (Lydersen, 2007; Kempadoo, 2005; Lau & Kristensen, 2010).

The legacy of sexual exploitation underlies many women's plunge into prostitution and drug dependency, from which they struggle to find release or relief; this complicates their attempts at recovery and building a better life (Kurtz, Surratt, Kiley, & Inciardi, 2005). A number of former prostitutes from Chicago self-report ultimately leaving the lifestyle after discovering support programs and groups that address both drug abuse and the psychological and physical effects 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 involve the seduction of a child by a beloved relative or a violent act perpetrated by a total stranger. It is not easy to define sexual abuse precisely, as it can take various forms, occurs at different levels of frequency, involves different relationship dynamics, and can take place under a wide range of circumstances. Maltz (2002) defines sexual abuse as occurring whenever an individual dictates and exploits another through sexual suggestion or activity (p. 321). Ratican (1992) defines child sexual abuse as any covert or overt sexual act between an adult or older child and a child, in which the younger participant is coerced or seduced into the act. Regardless of how child sexual abuse is defined, the act typically produces serious and long-term adverse psychological effects on the child (p. 33).

The majority of sexual exploitation occurs during childhood; ironically, incest constitutes the most prevalent form of abuse (Maltz, 2002). The effects of childhood sexual exploitation are unique to each individual and case. One study compared the experiences of women sexually abused by a family member with those abused by someone outside the family. The former group was found to experience higher levels of current anxiety and depression when recalling the traumatic events (Meyerson, Long, Miranda, & Marx, 2002). Other variables reported as intensifying distress included abuse involving more severe sexual acts, a high frequency of sexual exploitation experiences, and first exposure to sexual abuse at a very young age (Hall & Hall, 2011). While the severity and nature of the abuse may have a pronounced effect, several other factors influence the degree of harm experienced by the victim.

Other determinants may include the individual's perception of events, available support, and internal resources (Ratican, 1992; Brooke, Taylor, Gunn, & Maden, 1998). While not all forms of child sexual abuse involve direct physical contact, therapists need to understand the various forms it may take, all of which can sexually victimize the child and inflict psychological damage (Barnardos, 2000; Bluett, Walker, Goodman, & Adeyemo, 2000; Carr et al., 1996). For instance, an offender may abuse a child through premature exposure to pornographic material, internet-based assault, or manipulation of the child into producing photographs of a pornographic nature. This category of offense violates fundamental human rights. Children need to discover and experience sexuality within their own choice and control, at the appropriate stage of development. The dynamics and nature of sexual exploitation and relationships involving sexual abuse are generally harrowing. Childhood experiences of sexual abuse can impede normal social development and result in a range of psychosocial problems (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 on a victim. While an incident need not necessarily cause considerable adverse consequences in a child's teenage years or adulthood, common long-term impacts include the development of mental health, physical, sexual, social, interpersonal, and educational problems (Lindsay, 2003). The following social and interpersonal difficulties develop among adults who were sexually exploited as children: (a) lower self-image; (b) disorganized and insecure adult attachments; (c) unstable intimate relationships with low satisfaction levels; (d) higher rates of divorce and separation; and (e) greater likelihood of committing assault, property offenses, and domestic violence (Dove & Miller, 2007; Gisle et al., 2010).

Children who face sexual abuse display higher rates of behavioral problems, delinquency, and academic difficulties compared to children who have not been abused (Sanders, 2005). Psychological effects of childhood sexual abuse in the teenage years and adulthood include elevated rates of anxiety and depression, a greater tendency to develop eating disorders and substance dependency or abuse, suicide, self-mutilation, and post-traumatic stress disorder (PTSD) (Malarek, 2004; Duffin & Beech, 2000). Sexually exploited children are more prone to engaging in promiscuous behaviors such as prostitution, and are three times as likely to become pregnant before adulthood as non-abused children (Dove & Miller, 2007; Lydersen, 2007).

Sexual abuse experiences in early life can produce widely varying effects among survivors in adulthood — while some face minimal mental health issues, others suffer numerous mental disorders. Abuse constitutes 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 including the extent of prior trauma experienced, its severity, the nature of the relationship between victim and offender, the duration of the abuse, and the reaction of trusted individuals when informed of the incident (Outshoorn, 2004).

Childhood experiences of sexual exploitation can affect an individual's health and well-being in the following ways:

(a) Trust — being sexually victimized damages the individual's sense of safety in the world; she will find it difficult to trust others. A close bond with the perpetrator prior to the abusive incident makes this particularly difficult. (b) Self-esteem — despite the incident not being their fault, victims may descend into self-recrimination and find it difficult to envision a positive future or view themselves in a favorable light. (c) Handling stress — a flood of negative emotions may overwhelm the victim, making it difficult to cope with ordinary stressful events (Mairo, Trupin, & James, 1983; Michaud, 1988). (d) Impulsivity — this involves acting impulsively without assessing the consequences of one's actions or decisions, resulting in risk-taking behavior. (e) Anger — abused individuals may be unable to manage their anger. (f) Dissociation — the survivor's mind "detaches" from the traumatic events as a defense mechanism. She may find it difficult to remember details of the incident, feel disconnected from 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 without intending suicide. This may represent a means of coping with painful feelings or thoughts (Ozawa, 2003; Lydersen, 2007; Rennell, 2004).

The reactions described above are common following trauma; however, they may generate serious problems when they begin to impair the victim's daily functioning. Difficulty processing past traumatic experiences necessitates professional help. Lydersen (2007) identifies additional issues related to child sexual abuse: (i) Mental illness — while childhood sexual abuse does not inevitably lead to mental illness, it is among the recognized risk factors. Individuals abused sexually in childhood may be more prone to developing depressive disorders, anxiety disorders (including PTSD), personality disorders, eating disorders, and dissociative disorders. (ii) Substance use problems — child sexual abuse victims are more likely to develop substance dependency or abuse (Choi, Klein, Shin, & Lee, 2009) and more inclined to begin consuming alcohol and drugs at an earlier age (Schwartz, Rendon, & Chang-Ming, 1994). An individual's reaction to childhood sexual abuse — whether PTSD, depression, or low self-worth — can also be linked to risks of substance dependency; victims may turn to substances as a coping mechanism (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 difficulties, and sexual problems (Mansson & Hedin, 1999; Skidmore, 2000). The most pervasive long-term consequence of sexual abuse is depression. Victims may be unable to articulate what happened to them, ultimately developing persistently negative self-thoughts (Kessler, Nelson, Jurich, & White, 2004). Years of dwelling on such thoughts cause survivors to feel worthless; they begin withdrawing from society because they believe they have nothing of value to offer (Long, Burnett, & Thomas, 2006). According to Ratican (1992), indicators of depression linked to childhood sexual exploitation include persistent low mood, contemplation of suicide, and disturbed, irregular eating and sleeping patterns. Survivors typically feel guilty and ashamed and tend to blame themselves. If the abuser is a trusted, admired, and respected individual, children are less inclined to hold the abuser responsible and consequently cannot view the incident as something that occurred through no personal fault of their own. Victims frequently engage in self-recrimination, internalizing negative self-directed messages, and tend to exhibit more self-destructive behavior and suicidal ideation than non-abused persons (Kessler et al., 2004; Hall & Hall, 2011).

Eating disorders and body-related problems are also found to be long-term consequences of childhood sexual exploitation. According to Ratican (1992), body image-related symptoms among those sexually abused as children include feelings of ugliness or dirtiness, obesity, dissatisfaction with one's appearance or body, and eating disorders. Somatic concerns may also emerge from distress. One study found that abused individuals reported a considerably greater number of health problems than those who had not been sexually abused, with pelvic pain being the most common complaint (Van Velsor & Cox, 2001; Mairo et al., 1983; Michaud, 1988). Somatization symptoms in sexually abused individuals include pelvic pain, difficulty swallowing, gastrointestinal problems, and headaches (Ratican, 1992). Anxiety and stress commonly affect those who suffered sexual abuse during childhood (Miller & Schwartz, 1995).

Childhood sexual exploitation can be terrifying and trigger distress many years after the abuse has ended. Victims often experience chronic anxiety, phobias, tension, and panic attacks (Ratican, 1992). One study comparing PTSD symptoms among adults sexually exploited in childhood and Vietnam veterans found that the trauma experienced by the former group can produce symptoms similar to those experienced by combat veterans (Hall & Hall, 2011; Nadon et al., 1998; Pawar, 1991). Some early-age victims use dissociation to protect themselves from fully experiencing the abusive act and may continue using this coping technique as adults whenever they feel vulnerable or insecure (King, 2009). This may include flashbacks, nightmares, confusion, disorientation, and difficulty connecting with emotions. Some survivors repress or deny the incident entirely. Repression and denial symptoms include amnesia concerning certain parts of one's childhood, a belief that one must forget the incident ever happened, and denial of the effects and impacts of sexual abuse (Ratican, 1992; King, 2009; Hall & Hall, 2011).

Whether survivors are able to suppress memories of childhood sexual exploitation and later recover them remains a debated matter. While some experts believe the trauma of sexual abuse is intense enough that victims repress what happened as a means of coping, others regard such recovered memories as false or fabricated (King, 2009; Brecht, Huang, Evans, & Hser, 2008). Sexual abuse survivors may encounter difficulties cultivating interpersonal relationships. Symptoms associated with the abuse experience may impede the growth and development of relationships. Common relationship challenges faced by child sexual abuse victims include fear of intimacy, trust-related difficulties, passive behavior, fear of being "strange" or different, involvement in abusive relationships, and problems establishing interpersonal boundaries (Ratican, 1992; Pellebon, 2008; Pennbridge, Freese, & MacKenzie, 1992). Callahan, Hilton, and Feinauer (1996) explored the association between an individual's depression, the severity of childhood abusive incidents, and the ability to adjust in a partnership. Findings indicated that greater severity of abusive events was linked to diminished ability to adjust within a relationship. Because sexual abuse is typically perpetrated by someone loved and trusted by the child, it results in a broken sense of trust and the belief that those they love may end up hurting them (McGill, 2003). Bieschke and Kessler (1999) established a significant link between adult victimization and women who had been sexually abused as children (Schaffer & DeBlassie, 1984; Seng, 1989; Shaw & Butler, 1998).

Many survivors face significant sexual challenges. Long-term impacts of abuse, such as dissociative patterns and depression, hinder the 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; perceiving sex as an obligation; adverse feelings toward intimate touch such as anger, guilt, or disgust; difficulty experiencing sensation or becoming aroused; emotional detachment during intercourse; disturbing or intrusive sexual images or thoughts; participation in inappropriate or compulsive sexual activities; orgasmic problems or vaginal pain in women; erectile, orgasmic, or ejaculatory problems in men; and problems forming and maintaining intimate relationships (p. 323). One U.S. study on the incidence of sexual dysfunction found that sexual abuse survivors faced significantly more sexual challenges than non-abused individuals (Folch et al., 2008).

It must be noted that, while literature indicates significant links between childhood sexual exploitation and its long-term effects, the experiences and reactions of victims will not be identical (Harcourt et al., 2001). While sexual abuse is generally considered a traumatic event, no single symptom is universal among survivors; clinicians need to focus on each client's individual needs (Hall & Hall, 2011; Silbert & Pines, 1981, 1982a, 1982b; Silbert, 1982).

Second Study Issue: Effects of Substance Abuse on Women Involved in Prostitution

Drugs and prostitution are increasingly interrelated; however, the nature of this link has not been fully understood. One body of work addresses drug use's effects as a facilitator or hindrance to sex work (Miller, 1995; Cusick, 2002): prostitutes use substances, particularly amphetamines, to cope with the late and long hours characteristic of the trade. Research has also indicated that drug use by prostitutes can make them more vulnerable to violence. Cusick (1998) found that aggression toward prostitutes during working hours is prevalent and most strongly linked to situations in which they have the least autonomy.

Another body of work addresses the order of women's involvement in prostitution and substance abuse (Miller, 1995). Hodge (2003) suggests that the two may simply co-occur in irregular settings and that their shared status as unlawful or clandestine activities is what truly links them. Alternatively, researchers have suggested that drug use preceding prostitution and prostitution preceding drug use are equally prevalent. However, Brodie, Barrett, and Melrose (1999) contend that younger prostitutes more often used drugs before taking up the trade. Helen (2003) further reveals that younger and adult prostitutes working to finance a drug habit can often be found in the same neighborhoods across London — neighborhoods labeled as "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 and colleagues (2011) found that amphetamine, heroin, and crack use is more prevalent among younger prostitutes compared to those aged 26 and above. The frequently reiterated caution against confusing causation with correlation bears repeating here. The view that drug dependency drives acquisitive offenses has increasingly shaped UK drug policy, prompting broad recommendations that drug users receive treatment, at least to safeguard the public (Stimson, 2000; Day & Ward, 1997; Earls, Christopher, & Helene, 1989, 1990). Toby Seddon argued in his 2000 work that these straightforward explanations do not adequately address the deeper causes of drug use and crime; consequently, drug use therapy is likely to fail as long as social exclusion issues remain unresolved (Simons & Whitbeck, 1991; Sullivan, 1988; Udegbe & Fajimolu, 1992).

Until recently, relatively little attention was paid to drug use among South Africans and the link between the sex trade and drug use (Parry & Pithey, 2006). Empirical data from elsewhere in the world, however, establishes a connection between the two. Additionally, it is now understood that drug type and the nature of sexual relationships influence sexual risk associated with drug use (Celentano, Latimore, & Mehta, 2008; Degraaf et al., 1995). There is, for instance, a substantial body of international research establishing that crack cocaine's highly addictive nature is strongly associated with transactional sex and other risky sexual behaviors (Baseman et al., 1999; Celentano et al., 2008; Leggett, 1999; McCoy et al., 2004; Parry et al., 2008a, 2008b; Shannon et al., 2007; Wechsberg et al., 2006).

Conversely, there is a less reliable association between risky sexual behavior and heroin use; the relationship is more situational. Strathdee and Sherman (2003) found that heroin use was associated with higher STD acquisition among U.S. women who used heroin with their primary sexual partner. With rising rates of illegal drug use among the Black population of South Africa, it is crucial to understand the link between the sex trade and other high-risk behaviors. Historically, in sub-Saharan African nations such as South Africa, teenagers and young women have been driven to prostitution to pay for basic necessities such as food and shelter, owing to their countries' economic and social circumstances. As a result, prostitutes and the men who visit brothels have contributed significantly to HIV's spread and the prevalence of high HIV infection rates in the region (Chen et al., 2007; Ramjee & Gouws, 2007; Ramjee, Karim, & Sturm, 1998; Voeten et al., 2007; Wang et al., 2007; Williams et al., 2003).

Recent research has recorded substance abuse rates of 34–69% among prostitutes in South Africa's mining and urban regions (Dunkle et al., 2005; Parry et al., 2008b; Wojcicki & Malala, 2001). Given the strong link between sexually transmitted HIV/AIDS and drug use epidemics around the world, designing effective interventions targeting high-risk groups is critical. Prior to developing such programs, however, scholars must identify both protective and risk factors associated with risky sexual behaviors and substance use, and understand the interactions among factors that amplify HIV risk among South Africans (Floyd et al., 2010).

Afrocentric Perspective and Theoretical Framework

Researchers Graham (2006) and Pellebon (2008) found that, relative to other racial groups, the health needs of African Americans had not been adequately addressed. This lack of attention was also noted by other researchers (Graham, 2005; Borum, 2007; Reviere, 2001). Gaps also existed in research on African American youth, particularly with respect to substance abuse treatment.

Afrocentricity has three primary objectives for practical purposes: (a) its main aim is to develop an alternative social science model more specific to the political and cultural reality of people of African origin; (b) it aims to eliminate negative stereotypes and misrepresentations of African Americans; and (c) it seeks to advance a global perspective that will enable societal and human transformation toward humanistic, spiritual, and moral ends — persuading individuals of diverse backgrounds that they share a common goal in this regard (Schiele, 1996, p. 286). Afrocentricity assumes that the spiritual dimension of a person is as significant as the tangible dimension. Within this framework, the underlying causes of social problems in the United States are alienation and oppression (Schiele, 1997). In a capitalist society such as the U.S., individuals may grow up with the view that they are commodities valued for their labor — a view incongruent with African values of sharing, collectivity, and spirituality. African societies traditionally hold a belief in the unity of all things, emphasizing the importance of both horizontal and vertical relationships — with other human beings and with a higher power (Prince, 2008; Manning, Cornelius, & Okundaye, 2004; Valandra, 2007).

An Afrocentric-based approach to drug use treatment also emphasizes the strong community ties and survival strategies that exist in communities of African origin. For many decades, African American beauty salons, barbershops, churches, and other social institutions have provided vital social support systems within African American communities (Pellebon, 2008; Borum, 2007; Manning et al., 2004). These social organizations have promoted cohesion among African Americans and fostered the African principle of "protecting the tribe" (Moore & Lott Collins, 2002; Prince, 2008). Moreover, these organizations have created social settings where African Americans could speak about and process the marginalization and oppression they experienced in American society (Manning et al., 2004).

Theoretical Framework

Heider's (1958) attribution theory and similar models developed by other researchers (Jones & Davis, 1965; Kelley, 1973; Weiner, 1995) provided a useful framework for studying prostitution and sexual abuse among young children. Attribution theory explains how individuals have a natural tendency to (a) seek the origins of events or behaviors, (b) determine whether an event or behavior was caused by the environment or by a person's character, and (c) predict whether the event is likely to recur (Heider, 1958; Vitaliano, James, & Boyer, 1981; Widom & Ames, 1994; Widom & Kuhns, 1996). In this paper, the origins, interpretations, and future implications of behaviors among children who have been sexually abused are studied to provide insight into how females form judgments, assign blame or responsibility, and make choices about entering prostitution.

The literature reviewed included several studies demonstrating the key constructs of Heider's attribution theory and their relationship to the choice to enter prostitution. The theory also provided an approach framework for the study and its primary research questions. Attribution theory has been applied in previous studies to explain decision-making processes among law enforcement officers with regard to minority populations (Foley & Terrill, 2008; Watson, Corrigan, & Ottati, 2004a, 2004b).