To explore sexually exploited
youths’ perspectives of how street outreach workers can effectively provide
outreach and connections to services, we conducted qualitative interviews with
13 female participants, ages 14–22, in a Midwestern U.S. city. Participants
reported multiple types of exploitation, most first exploited by age 13, plus
substance use, and recurrent homelessness. Nearly all had a pimp, and all used
the internet as a venue for sexual exploitation. Participants wanted outreach
workers to use “soft words” to refer to exploitation. They expressed
contradictory images of their “boyfriend” pimps and their exploitation. They
wanted outreach workers to “provide resources,” “be non-judgmental,” ”listen,”
and “care.” Street outreach can be one way to support sexually exploited youth,
but should occur in multiple settings.
Four main themes described the experiences of exploitation
and service needs of these sexually exploited girls. Pathways into prostitution started
early, often by age 13 and included past history of family violence and running
away. The juxtapositions and illusions of
“sex work” revealed the coercion and control behind the
rationalization of pimps as “boyfriends” and exploitation as lucrative “sex
work.” Despite these illusionary positive perspectives, nearly all the
participants had been homeless, were coerced into using alcohol and drugs to
cope with their exploitation, and had been seriously assaulted by pimps or
others. Regardless of orientation, they were pressured into sexual acts with
either gender. These young women reported multiple, diverse venues as locations of exploitation, including
social networking sites on the internet. Because of the pervasive stigma of
sexual exploitation, the participants wanted “soft words” from street outreach workers, by which
they meant both euphemistic terms for exploitation as well as respectful,
non-judgmental and caring interactions with street outreach workers.
Many of our findings were mirrored in other
qualitative studies with women involved in prostitution (Kennedy et al., 2007). In most cases, it
seemed as though the participants involved in our study used the illusion they
were earning money through “sex work” to mask the painful truth that they were
being exploited, because they felt they had no other choices. This illusion,
that being exploited can bring opportunities many girls on the streets do not
have--money, a place to live, food and love from a “boyfriend”/pimp--may make
it difficult for them to escape exploitation.
Street outreach is a type of intervention that is
rooted in harm reduction and “meeting people where they are,” which is why it
may be a successful method of identifying, approaching and engaging with
sexually exploited girls and young women. In street outreach approaches, they
may feel a greater sense of control, because the approach and interaction is
taking place on their “turf.” Street outreach workers are often some of the
first people that sexually exploited young women may ask for help, and need to
listen carefully for the subtle disclosures and requests. If an outreach worker
or service provider does not recognize that exploited young women may use other
“soft words” to describe their involvement in the sex trade, they may miss this
completely, and not be able to provide the appropriate approach and support.
As with other research (Young & Rice 2010)
the settings where exploitation occurred varied widely, from street to strip
club to the internet. Street-outreach efforts to locate youth and provide
supplies, linkage to shelters and community services, are primarily limited to
the street and not these other venues. Outreach workers may need to consider
novel venues and internet outreach as strategies for connecting with sexually
exploited young women.
There were many potential lost opportunities for these
young women to have received help, in the foster care system, mental health
system, and juvenile detention, yet none of these systems seemed able to offer
a clear path for preventing exploitation or helping teens exit ongoing
exploitation or homelessness. The participants also did not identify these
systems as places that provided them sensitive, personalized care or targeted
services meeting their individualized needs. A public health nursing model
using advanced practice nurses working directly with street outreach workers
might be an additional useful approach, helping to connect teens to health
care, social services, and housing (Saewyc & Edinburgh, 2010).
While it may seem counterintuitive to help sexually
exploited girls and young women by providing supplies that may allow them to
continue being exploited, meeting their identified needs is an important means
of establishing trust. Such nonjudgmental care may encourage them to seek out
street outreach workers again for referrals to other services. This can be
likened to the “pre-contemplation stage” in Baker, Dalla, and Williamson’s model of women exiting
prostitution (2010), which was adapted from the transtheoretical
stages of change theory. In the earliest “pre-contemplation” stage, outreach
workers connect with youth who may not be considering leaving situations where
they are exploited. During this time, providers can assist with meeting their
immediate needs, providing health education, and engaging them in safety
planning.
Beth Holger-Ambrose, Minnesota Department of Human Services, St. Paul, Minnesota, USA;
Address correspondence to:
Beth Holger-Ambrose, Minnesota Department of Human Services, Office of Economic
Opportunity, 444 Lafayette Rd., St. Paul, MN 55155. Email: su.nm.etats@esorbma-regloh.hteb
Beth Holger-Ambrose, MA, is
the homeless youth services coordinator at the Minnesota Department of Human
Services in St. Paul, Minnesota.
Cheree Langmade, BSN, RN, is
a doctor of nursing practice student at the University of Minnesota in
Minneapolis.
Laurel D. Edinburgh, MSN,
PNP, is a nurse practitioner at the Midwest Children’s Resource Center in St.
Paul, Minnesota, and is a cofounder of the Runaway Intervention Program in St.
Paul.
Elizabeth Saewyc, PhD, RN,
FSAHM, is a professor in nursing and adolescent medicine and founding director
of the Stigma and Resilience Among Vulnerable Youth Centre at the University of
British Columbia in Vancouver, Canada. She holds one of Canada’s 15 national
applied public health research chairs, hers focused on adolescent health.
