Journal Article Review
Aim of this review: To support the importance of Pink Cross Foundation in Australia 2016
By Kim Lefebvre-Poirier, volunteer as a Board Member For Pink Cross Foundation
Throughout the literature, there is a clear uncertainty around the best way to understand, approach and deal with the sex industry in a society. A comparative study found that the oppression paradigm and the empowerment paradigm are both limiting in understanding the reality of sex workers (McCarthy, Benoit & Jansson, 2014). Another study concentrated on the impacts of political ideology on prostitution and human trafficking (O’Brien, 2015). The author highlighted the importance of the laws and the feminist movement on the criminalisation or legalisation as an ideology. In the context of legalisation of sex work in Australia, O’Brien (2015) demonstrated that decision makers decided to distance themselves from the matter as an attempt to preserve impartiality in the debate. Additionally, some authors argue that many researches aiming to understand better the reality of sex workers are biased, which means that the results may be neither representative nor reliable. (Burnes, Long & Schept, 2012; Sullivan, 2010).
Furthermore, a study looked at the impacts of laws around the sex industry in Australia (Sullivan, 2010). This study acknowledges that law reform in Queensland was intending to eradicate the organised crime, and their control over illegal prostitution (Sullivan, 2010). Unfortunately, the Crime and Misconduct Commission (cited in Sullivan, 2010) confirms that only 10% of sex workers in Queensland are actually working in legal brothels. This is of prime importance when looking at the statistics and results of researches conducted on this specific population because those settings are often referred as being safest working environment for sex workers.
From another point of view, such as the empowerment paradigm, limited education and limited employment opportunity have been associated with working in the sex industry (McCarthy, Benoit & Jansson, 2014). Simone de Beauvoir Institute (2012) highlighted the long-term consequences on women of increasing school fees of education. Since men and women are not earning the same money, even after university studies, Simone de Beauvoir Institute (2012) claimed that raising tuition fees would perpetuate gender inequality in the short and longer term. Therefore, more women would be inclined to consider working in the sex industry because of a lack of 3 options plus to be able to provide for themselves when studying. Burnes, Long and Schept (2012) confirm that an increasing number of female students are seeking alternative employment when studying at a University level because of the growing fees of education. The authors acknowledge that consequently, for many women, working in the sex industry become a viable option. Therefore, concerns can be raised in terms of recognising that working in the sex industry may be a result of gender inequality, which is promoted in our society as a social and acceptable norm with legalisation.
Different class of sex work
Burnes, Long and Schept (2012) describe five different classes of sex workers. The first class is considered as upper class, and mainly refers to escort work, call girls and is described as being a safer environment (Burnes, Long & Schept, 2012). At the same time, the Coalition Against Trafficking in Women Australia (2010) affirms in their report on the Strip Club Industry in Victoria that stripping is correlated with escorting and prostitution in brothels as owners often have strip clubs and brothels where they use women in both of their businesses. According to the Victorian State Government (cited in CATWA, 2010), physical and sexual violence is common in strip clubs. The second class of sex workers would be defined as middle class and would represent sex workers operating in an establishment (Burnes, Long & Schept, 2012). The third class would be the lower middle class, which are represented by sex workers that are on the street (Burnes, Long & Schept, 2012). Additionally, legalised brothels tend to not employ males, older women, transgender, or workers dependent on drugs (Sullivan, 2010). The commuter housewives that are contributing to family income characterize the fourth class of sex workers (Burnes, Long & Schept, 2012). Finally, the lower class is representing sex workers who are on the street with an addiction issue (Burnes, Long & Schept, 2012). It is important to highlight that a study amongst 1272 women found that drug abuse does not represent a risk factor for entering into the sex industry but rather a result of it (McClancham, McClelland, Abram & Teplin cited in Burnes, Long & Schept, 2012).
Impact on intimate relationship
A study conducted on a small sample took place in Melbourne. The aim of this study was to understand better the impacts of the sex industry on women’s relationships 4 (Bellhouse, Crebbin, Fairley & Bilardi, 2015). This research highlighted that 78% of women claimed that their work had negative impacts on their loving relationships due to issues related with trust, guilt and lies (Bellhouse, Crebbin, Fairley & Bilardi, 2015). These negative impacts were related to fears of being rejected or judged, as a result of the stigma associated with the sex industry (Bellhouse, Crebbin, Fairley & Bilardi, 2015). Another study described the impacts of stigma, related to sex work. More specifically, the Sex Workers Education & Advocacy taskforce affirms that it can results in feelings of shame, helplessness, hopelessness and low self-esteem (as cited in Burnes, Long & Schept, 2012). Furthermore, Cohan et al. (2006) confirm that nearly 50% of sex workers are experiencing domestic violence in their intimate relationship, which makes this population highly vulnerable to violence and abuse. This represent an interesting statistic since the research conducted in Melbourne found that working in the sex industry have negative impacts on women’s intimate relationship (Bellhouse, Crebbin, Fairley & Bilardi, 2015). These authors report that less than half of the women in their sample were in an intimate relationship (Bellhouse, Crebbin, Fairley & Bilardi, 2015). Combining the proportion of women being involved in an intimate relationship while working in the sex industry with the one experiencing domestic violence in their intimate relationship may result in a percentage that would be much higher.
Impact on sexual health
Another study illustrates the importance of addressing addiction, mental health, and sexually transmitted infections when working with sex workers. As Ward & Aral (2006) demonstrate, they represent the main health problems encountered by sex workers. In this idea, even though sex workers may not be at high risk to transmit sexual infections due to the Sex Work Act (1994) that prohibits them to have unprotected sex or working while having a sexually transmitted infection, sex workers may still be at high risk of contracting sexually transmitted infections. The Department of Health of the Australian Government (2014) states that over than 1 in 10 Australians are infected by the virus that is responsible for genital herpes. This virus is incurable, which means that once contracted, a sex worker is no longer allowed to work legally in the sex industry. The herpes virus can be transmitted to someone when there are no symptoms present (Alfred Health, 2013). Furthermore, researches conducted on couples are showing that using condoms consistently may 5 only reduce the risk of contracting the infection by 50% when exposed to someone that is infected (Alfred Health, 2013). Those researches affirm that there is a transmission rate of 5% to 20% per year of being exposed to a partner that is infected (Alfred Health, 2013). Similarly to genital herpes, HPV virus can be spread by skinto-skin contact even though there are no symptoms present (Australian Government, Department of Health, 2014). Although condoms offer some protection, in the case of the HPV virus and genital herpes, condoms would protect only the skin that is covered by it, therefore there are some risks of infection when sexually exposed to an infected partner (Australian Government, Department of Health, 2014).
A study conducted on 600 sex workers in Canada and USA found that 80% of them had been victims of sexual abuse during their childhood, and 90% had been victims of physical abuse (as cited in McCarthy, Benoit & Jansson, 2014). In this idea, Briere and Scott (2015) described the Borderline Personality Disorder and the Complex Posttraumatic Stress as complex posttraumatic presentations. Those two concepts are relevant because they are both characterised by affect regulation issues (Briere & Scott, 2015). More specifically, the Complex Posttraumatic Stress may be rooted in frequent, stark and persistent trauma stemming from interpersonal childhood experiences of maltreatment (Briere & Scott, 2015). This chronic experience of revictimisation can result in a complex presentation, which may be observed by issues related with identity, a lack of boundaries awareness, trouble with interpersonal relatedness and problematic affect regulation (Briere & Scott, 2015). Some individuals presenting with a Complex Posttraumatic Stress tend to have difficulties with coping strategies that may result in behavioural problems as a manner to reduce the tension of their distress (Briere & Scott, 2015). For example, it can result in compulsive sexual behaviour, suicidality, drug and alcohol misuse, dissociation or other avoidance strategies that may be dysfunctional (Briere & Scott, 2015). In addition, the interpersonal relatedness combined with difficulties with self-identity can be strong predisposing factors for dysfunctional relationships, a lack of knowledge concerning personal rights and needs, which can also result in difficulties in communication and asserting relational boundaries (Briere & Scott, 2015). At the same time, Borderline Personality Disorder is also commonly rooted in stark and prolonged childhood trauma such as sexual abuse or neglect (Briere & Scott, 2015). 6 Therefore, the consequences are very similar to Complex Posttraumatic Stress (Briere & Scott, 2015). Trauma may represent a strong risk factor for substance abuse and posttraumatic stress disorder (Briere & Scott, 2015).
PTSD and trauma
In the Diagnostic and Statistical Manual of mental disorders (2013), the authors affirm that a posttraumatic stress disorder can originate from an experience of sexual violence when a person directly experienced the traumatic event. The American Psychiatric Association (2013) demonstrates that survivors of rape represent one out of the three groups that have the highest rates in developing a posttraumatic stress disorder. These survivors will meet the criteria for PTSD in 33% to 50% of the cases (APA, 2013). Siegel (2003) illustrates that cortisol is secreted as a stress hormone, which can be associated with neural loss. Van der Kolk (2014) explains that stress hormones would keep circulating when individuals are incapable to reach a recovery state after their trauma. Anderson and al. (2008) recognise that a prolonged experience of sexual abuse during childhood would affect the maturation and development of the brain.
PTSD and trauma within the sex industry
A study compared the psychological symptoms of women working in the sex industry with veterans from Vietnam (Burnes, Long & Schept, 2012). Researchers found that about two-thirds of sex workers experienced a posttraumatic stress disorder (Burnes, Long & Schept, 2012). The psychological symptoms that women would experience are flashbacks, depression, anxiety, nightmares and an inability to concentrate or focus. Another study conducted on sex workers in the first class category, such as regulated brothels, discovered that 17% of sex workers were meeting the criteria for PTSD (Burnes, Long & Schept, 2012). These statistics demonstrate the powerful damaging impacts of sex work on psychological health and wellbeing. According to Sullivan (2010), brothels may represent the safest environment for sex workers as there is less violence, less sexual assault, and it can be seen as easier to increase health and safety of sex workers. Seib, Fischer and Najman, (2009) estimate that depending of their work environment, 35% to 94% of sex workers are experiencing violence at their workplace. Although harm minimisation can be seen as a good option in reducing the negative consequences of sex work at the same time than 7 reaching for the most vulnerable, such as offering brothel work for street workers; it should not be seen as the only option available. For example, when treating addiction issues, harm minimisation is one of the many services to help people that are in different stages of change. Services need to be available to support sex workers who would like to transition out of the sex industry. Otherwise a lack of services and support may maintain them in a dysfunctional environment. This is very similar to other problematic related to violence against women. For example, women that experience domestic violence can decide to stay in this environment, as a choice. Nonetheless, services need to be put in place to help the ones that would like to quit their partner, refuge are offered to prevent homelessness, group support, psychoeducation, and individual support are also offered to help them. Law plays an important facet, as well as support line that can refer if needed, and so on. Similar to child sexual abuse, history showed us that ignoring the problem perpetuate victimisation, negative consequences and harm among victims. The Prostitution and Research Education Project of San Francisco’s Women Center conducted a research on 475 individuals working in the sex industry from five different countries, such as Zambia, Thailand, Turkey, South Africa and the United States (Burnes, Long & Schept, 2012). The authors discovered that across the five countries, an average of 66% of these workers were suffering from PTSD (Burnes, Long & Schept, 2012). Moreover, this same research center conducted another research amongst 854 individuals working in the sex industry throughout nine different countries, which were the same five from their first study, joint with Canada, Colombia, Germany and Mexico (Farley et al., 2003).Throughout the nine countries, 65% to 95% of the sex workers experienced sexual abuse during their childhood, an average of 71% have been physically assaulted while working, and an average of 63% have been raped by a client (Farley et al., 2003). Furthermore, an average of 68% met the posttraumatic stress disorder criteria (Farley et al., 2003). Therefore, it could be possible to conclude that working in the sex industry may have stronger harmful psychological impacts than survivors of rape, wars or genocide. It could be possible to argue that because of the differences of legislations in Australia, the reality could be different. Unfortunately, as Sullivan (2010) demonstrates, after nearly 35 years of trying to eliminate the organised crime and their involvement in prostitution, only a small proportion of 10% are actually working legally in Queensland. Illegal sex work 8 has been correlated with childhood sexual abuse (Seib, Fischer & Najman, 2009).
The Victorian Government Department of Human Services Melbourne (2013) affirms that promiscuity, prostitution, issues with intimate relationships, isolation, marital problems, depression, drug and alcohol abuse, suicide, eating disorders and sexual dysfunction represent the main long-term effects of child sexual abuse. According to Seib, Fischer and Najman (2009), 83% of street workers experienced maltreatment during their childhood, 45% of sex workers working in licensed brothels and 48% among private sex workers. Some authors noticed that women sex workers experience a form of paralysis that is preventing them from taking an active role in their life, and this paralysis would be linked with their past experience of abuse, sexual, emotional or from witnessing domestic violence (cited in Burnes, Long & Schept, 2012).
Is sex work a form of ‘Sexual violence’?
The dilemma is around the legitimacy of sex work. The real questions in this debate should be: is sex work a form of sexual violence perpetrated against women? Does it promote unhealthy gender stereotypes as a norm in a society? This is of extreme importance in regard to legalisation, in offering support and in the type of services to offer for this population. Since the promotion of gender equality is of prime importance as a framework for the prevention of violence against women, domestic violence, and the promotion of healthy relationships, Pink Cross Foundation Australia aims to tackle the harmful impacts of legalisation of sex work and how it undermines all women in Australian society.
Violence against women perspective
According to Webster & Flood (2015), violence is caused by gender inequality, and is a consequence of it. They also advance that gender inequality is connected to social inequality. Within their framework, violence against women is described as any action of violence that can cause physical, sexual or psychological distress or harm to women (Webster & Flood, 2015). The World Health Organization (2016) defines the multiple psychological consequences of sexual violence as withdrawal that results in isolation, suicidal ideation, sleep disturbances, psychosomatic symptoms, substance abuse, sexual dysfunction, depression, anxiety, post-traumatic stress disorder, feelings of anger, and guilt. These can be experienced immediately or in the longer term (WHO, 2016).
Predisposing factors/ exploitation of sex workers vulnerability?
As explained earlier, Briere & Scott (2015) defined two specific circumstances for rape: the use of threat or physical force; and when a victim is not able to give consent such as being under the influence of drugs or alcohol or cognitively impaired (Briere & Scott, 2015). In this idea, Seib, Fischer and Najma (2009) highlight the high prevalence of maltreatment during childhood, leaving the family home at an early age, being exposed to a high level of violence, and having a history of drug injection, especially common amongst street-based sex workers. The authors also recognise that illegal sex workers often have poor mental health before they begin to work in the sex industry, and resulting from their involvement in working in the industry (Seib, Fischer & Najma, 2009).
A comparative study found that negative experiences during childhood might be a predisposing factor to enter into the sex industry, whereas specific circumstances may trigger or motivate individuals to start working in the sex industry (McCarthy, Benoit & Jansson, 2014). Therefore, it can be argued that sex workers may not be able to provide an informed consent when choosing to work in the sex industry. This could be explained by their vulnerabilities, a lack of opportunity or a lack of favourable other options due to poor mental health, particularly when combined with a current drug or alcohol issue, or past experiences of trauma. Cases where victims are not able to give consent are of particular importance. More specifically, Seib, Fischer & Najman (2009) demonstrated a strong link between illegal sex work, poor mental health and negative experiences before entering the sex industry and as a consequence of it. The authors highlighted an increased level of psychological distress amongst illegal sex workers in Queensland, Australia, which was also correlated with experience of sexual abuse during childhood (Seib, Fischer & Najman, 2009). More specifically, 83% of illegal sex workers in the Queensland sample reported experiencing maltreatment during their childhood and 52% reported being bashed or sexually assaulted by a client in the last 12 months (Seib, Fischer & Najman, 2009). Furthermore, 3% of sex workers working legally in brothel has been raped or bashed in the last 12 months and 15% of sex workers working privately (Seib, Fischer & Najman, 2009). The Coalition Against Trafficking in Women Australia (2013) affirms that clients are predominantly men whereas sex workers are predominantly women. It is important to remember here that the United Nations 10 (1993) also described violence against women as any act of violence that is gender based, which may cause physical, sexual or psychological harm or distress. In addition, it has been shown that sexual violence is correlated with a higher number of sexual partners, a preference for impersonal sexual relationships, a preference for individualist sexual gratification at the expense of the partner, coercive sexual fantasies that are generated by pornography, and hostility towards women (WHO, 2016). Interestingly, it is exactly what the sex industry is offering.
As described, working in the sex industry has strong negative impacts on the physical, sexual and psychological health of sex workers. The consequences are very similar to the ones caused by sexual violence. As in the sex industry, victims of sexual violence are profoundly affected and can be stigmatized by their family and others as a consequence (WHO, 2016). As in the sex industry, sexual violence is strongly connected to mental health issues, domestic violence and problems in intimate relationships (WHO, 2016). These are the reasons Pink Cross Foundation Australia stands against the legalisation of sex work in Australia. At Pink Cross Foundation Australia, we think that the promotion of the sex industry has multiple destructive impacts on individuals in the industry, is promoting an unacceptable social norm, and is promoting violence against women. Therefore, Pink Cross Foundation Australia is a not for-profit organisation that exists to support women transition out of the sex industry, including those who are trafficked and those who have an addiction by offering emotional and psychological support. According to World Health Organization (2016), health professionals are playing a central role in offering psychological support. The World Health Organisation (2016) also acknowledges the importance to address, in psychotherapy, the consequences of sexual violence because some victims can blame themselves for the event, which is seen as an important factor to take in consideration for their recovery. A comparative study found that negative experiences throughout the lifespan combined with immediate circumstances are correlated with working in the sex industry (McCarthy, Benoit & Jansson, 2014). More specifically, these negative 11 experiences referred to poverty; physical, emotional or sexual abuse; risk of homelessness and family instability whereas the immediate circumstances referred to limited education and limited employment opportunity (McCarthy, Benoit & Jansson, 2014). Those immediate triggers were especially important when emerging into adulthood. Within their framework to provide some guidelines for prevention of violence against women, Webster and Flood (2015) acknowledge that turning a human being into a thing, such as objectifying and sexualising women, is almost always the first step to justify violence against that person. A human being is turned into a thing when this person is sexually objectified for others sexual use (Webster & Flood, 2015). Sexualisation of women is deeply rooted in gender inequality. Recent studies are demonstrating that sexual objectification of women is correlated with violence against them (cited in Webster & Flood, 2015). Also, aggression and degradation of women is commonly eroticised, especially in pornography (cited in Webster & Flood, 2015). These perpetuate the rapist myth that violence against women is normal, sexy acceptable, that women likes it and want it (Webster & Flood, 2015). Malamuth et al. (cited in Webster & Flood, 2015) found that exposure or consumption of pornography is correlated to men sexual aggression of women.
Explanatory model proposed
All human are dependant on others to have their needs met during childhood. Those needs are fundamentally essential to a child’ development. When those needs are not met, it can influence our thoughts, emotions and behaviours later in life. As Young (2011) explains: the development of early maladaptive schemas result of our unmet needs during childhood. A child would understand that his needs could not be met and try to solve the problem cognitively (Rafaeli, Bernstein & Young, 2011). Therefore, the environment would be predictable. Those early maladaptive schemas are learnt from early dysfunctional experiences and they have destructive effects (Rafaeli, Bernstein & Young, 2011). Early maladaptive schemas co-occur with memories, body sensations and emotions. Although schemas can develop later in life, they would not be as powerful as the ones developed in response of problems originated within the family unit. Maladaptive perceptions would maintain the early maladaptive responses, which would perpetuate situations where the person’ needs would be constantly 12 unmet during their adulthood (Rafaeli, Bernstein & Young, 2011). In response to these life experiences, a person would develop some coping strategies (Rafaeli, Bernstein & Young, 2011). Although those coping strategies may be appropriate in the context of their childhood experiences; they would be inappropriate responses later in life because the person would keep defend against their conflict of origin rather than resolve it and be able to have their needs met. A person’ inflexibility in their coping styles may explain the maintenance of the early maladaptive schemas. Through the inflexibility of the coping strategy used, a person would be enabled to have their needs met in adulthood by constantly re-experiencing their conflict of origin. The creation of these dysfunctional coping strategies would bring the individual to recreate the same kind of unadapted relationships from their past into their present and future. Even when a relationship could be different, the person’s inflexible coping style could prevent them to have their needs met over and over again (Rafaeli, Bernstein & Young, 2011). The Diagnostic and Statistical Manual of mental disorders (2013) recognises the importance of dissociative symptoms in PTSD, which is characterise by a detachment from one’s mind, self or body. This coping strategy to avoid or numb feelings may explain a part of sex workers ability to work in this kind of environment. It is possible to advance that sex workers may have learnt throughout their early relationships that no one could answer their needs. Therefore they maintain superficial relationships to protect themselves for not being hurt again. Rather than experiencing secure and trustworthy relationships, it looks like if sex workers are forgetting their psychological, emotional, sexual and physical needs at the expense of their clients. This could be put into perspective that 80% experienced sexual abuse and 90% physical abuse (as cited in McCarthy, Benoit & Jansson, 2014). Therefore, sex workers may have learnt from early abusive relationships that they had to forget their needs at the expense of the perpetrators’ ones, as a way to survive. By dissociating themselves from their mind, self and body as a coping strategy, it may maintain them in dysfunctional relationships such as within the reality of sex workers-clients relationships where someone is used for someone else desire. Bowlby’s attachment theory is rooted in the concept that we would develop a specific style of attachment during our early developmental stage. This style of attachment 13 would define our subsequent relationships (Prochaska & Norcross, 2014). In this idea, prostitution could be seen as a result of early maladaptive relational patterns, where sex workers may perpetuate that early dysfunctional relatedness in their subsequent relationships. Those early dysfunctional relationships may represent a predisposing factor to enter sex work. A lack of other opportunity, lack of employment and education seems to characterise the precipitating factors to enter the industry. As the Chicago Coalition For The Homeless state, 84% of sex workers acknowledge a present or past history of homelessness (Goswami & Schoot, 2001). Perpetuating factors may be represented by money, poor mental health and a lack of social support, which all seem to play an important role. Also, Briere and Scott (2015) state that social support is central to alter the negative effects of trauma. It represents one of the most powerful factors on the outcome of trauma. In this idea, social support could be use as a protective factor to help sex workers transition out of the sex industry. Therefore, it is primordial to offer support and resources to sex workers who would hope of a better future. This is what Pink Cross Foundation in Australia is aiming to provide.
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