Addressing Child Sexual Abuse Histories Within Boston’s Sex Trade Population


I am posting a literature review I recently completed for study I am doing in my Society of Health and Illness class. I usually do not post works-in-progress; however, I am incredibly proud of this piece. These ideas are the essence of my research and this is the first time I have articulated all of these concepts together within a singular piece. I will post the final study when I am done in May.


A history of child sexual abuse is the top risk factor for commercial sexual exploitation of children and adults. Upwards of 90% of commercially sexually exploited individuals have been sexually abused as children (Silbert and Pines 1981; Mitchell, Finkelhor and Wolak 2009; Tyler and Melander 2015). Additionally, 70% of 200 sexually exploited respondents in a landmark study stated enduring sexual abuse as children “directly affected” their entrance into the sex trade. A 2013 study of violence against children (aged 1 month to 17 years) discovered 2% of the sample population had been sexually abused in the last year (n=4503). Of those children, 10.7% of the girls aged 14 to 17 reported being sexually abused in the last year. (Finkelhor et al. 2013). The widespread prevalence of childhood sexual violence can, therefore, create a population vulnerable to revictimization, including being lured into commercial sexual exploitation. Commercially sexually exploited adults reported enduring more frequent and severe sexual abuse than non-exploited adults who were sexually abused as children, and entered into the sex trade at younger ages than sexually exploited adults who indicated they were not sexually abused as children (Lalor and McElvaney 2010; Steel and Herlitz 2005).

Commercial sexual exploitation relies on similar vulnerabilities as child sexual abuse, creating a continuation of violence for those who have endured earlier victimization. Patriarchal systems of dominance and control are central to sexual abuse and commercial sexual exploitation. Sociologist Nancy Whittier states, “Child sexual abuse is fundamentally shaped by intersectional inequalities of gender, race, and class, which structure individual-level experiences, prevalence, cultural representations, and state institutional responses. An intersectional feminist approach to sexual violence should also foreground age, recognizing children and adolescents as a group that is structurally unequal and subject control and domination by adults” (Whittier 2009: 104-105). The centrality of adult power, particularly in a heteronormative private family context, reinforces patriarchal norms of male dominance, which demands obedience from children within a social framework of paternal authority. This dominance allows for seclusion of child sexual abuse under the guise of “private family matters,” and is essential for sexual violence to persist (Johnson 2005). Further obfuscation is perpetuated because addressing child sexual abuse at the root level is a very low priority throughout society. Child sexual abuse offenders, just like buyers of sex, have very low prosecution and conviction rates (Corrigan 2009). Also similar to sexual exploitation, law enforcement state they do not want to arrest child sexual abuse offenders to save them from the embarrassment and stigma from having to register as sex offenders (Corrigan 2013).

These power dynamics of abuse and silence teach sexually abused children relational templates based on violence, isolation, and manipulation, which leave them vulnerable to commercially sexually exploitative adults. Such relational templates must be “unlearned” if a commercially exploited person is to exit exploitation, and service providers can help. A pimp describing his “ideal” prostitute states, “Beauty, yes. Sexual expertise, somewhat. That you can be taught easier than you think. What is important above all is obedience. And how do you get obedience? You get obedience if you get women who have had sex with their father, their uncles, their brothers—you know, someone they love and fear to lose so you do not dare to defy” (Kluft 1990: 25). By “recruiting” subservient sex workers, commercial sexual exploitation becomes a continuation child sexual abuse— a commodification of compliance and control. Commercial sexual exploitation can also exacerbate a sexually abused child’s identity and self-worth as only a sexual object. This self-objectification and isolation can leave sexually abused children vulnerable to exploiters’ manipulative tactics of promising love and protection, which is a key grooming tactic to luring vulnerable people into commercial sexual exploitation (Price 2012). Such relationally-based grooming, or “boyfriending,” is a particularly complex challenge for service organizations assisting people exit exploitation. A person may truly experience this connection to the exploiter as mutual love, not control, which can make leaving difficult. Therefore, a cycle of exit and re-entry back into exploitation is very common, and developmentally normal while a person builds new social networks and supports (Dalla 2011).

Commercially sexually exploited people have been abused, but they do have individual agency and “survival skills” that have kept them alive. Service providers need to support survivors in learning new ways of being in relationship, while honoring their strength. A primary location of healing for commercially sexually exploited individuals is addressing multiple traumas that exist along a “continuum of complexity” (Clawson, Salomon, Goldblatt Grace 2008). Often times child sexual abuse histories have neither been addressed nor healed for commercially sexually exploited individuals; therefore, this foundation of trauma must first be addressed while healing “co-concurring” additional locations of trauma such as rape and physical violence, as well as possible substance abuse. Additionally, these ways of healing are strongly informed by gender in that girls and boys can experience child sexual abuse very differently, because our culture fetishizes and polices girls’ and boys’ bodies in very gender-specific ways (Tolman 2005). Both girls and boys can be cast as the “seductive child” who “asked for it,” but girls with sexual knowledge at a young age can be labeled “promiscuous,” even if this knowing is obtained through sexual violence, and boys can feel fear and shame of homosexual labelling, particularly because most child sexual abuse is perpetrated by men (Bruhm and Hurley 2004). Therefore, a primary component for healing is learning to protect oneself, and to establish mutual relational contact, outside of a dynamic based on obedience and dissociation (Herman 2000).

Commercially sexually exploited children and adults of color can also have intersectional locations of trauma from discrimination of race/ethnicity and class that can strongly influence the type and amount of direct services needed. People of color experience commercial sexual exploitation very differently than white children and adults who have access to more privilege and, possibly, social capital, even though they have been exploited. Providing services within these intersections of multiple oppressions present issues of power and access to resources. Legal scholar Kimberlé Williams Crenshaw states, “The problem is not simply that [white] women who dominate the anti-violence movement are different from women of color, but that they frequently have the power to determine, either through material or rhetorical resources, whether the intersectional differences of women of color will be incorporated at all into the basic formulation of policy” (1994). Additionally, the historical context of subordination and objectification within people’s experiences must be acknowledged within service provision. For example, throughout history, Black women and girls have experienced violence such as rape, physical assault, and incest as the “visible dimensions” of a legacy that sexualizes, objectifies, and subordinates Black women’s bodies (Collins 2000: 146). Such tools of racial, gendered social control are also present for men of color in histories of lynching, particularly around the grounds of alleged rape of white women. Finally, the social location of women of color can keep them trapped in commercial sexual exploitation due to lack of educational opportunities and economic resources, as well as structural racism of governmental services such as welfare and housing assistance. This hindered social mobility, coupled with the historical objectification of Black women’s bodies viewed as “rapeable,” makes women of color vulnerable to remaining in the sex trade (Nelson 1993).  Therefore, the need for culturally-centered and inclusive services that address intersectional discrimination and sexual violence as a historical method of social control are necessary for people of color who have been commercially sexually exploited.

Additionally, providing services for commercially sexually exploited populations in an age of mass incarceration is even more complex. Access to housing is one of the key resources needed by commercially sexually exploited individuals. If a commercially sexually exploited people cannot afford housing, they can remain trapped in the sex trade by trading “survival sex” for a place to live; live with a trafficker or pimp; or make money through sexual exploitation to pay for housing (Silbert and Pines 1981). Commercially sexually exploited people receiving governmental housing assistance are in double bind. Federal law states tenants can be evicted if they participate in or have knowledge of criminal activity. While such policies may seem legitimate, this situation complicates the issue for commercially sexually exploited adults even further. “These vulnerable families have nowhere to go, and the impact is inevitably discriminatory…for countless poor people, particularly racial minorities who disproportionately rely on public assistance” (Alexander 2012). Here, the specter of homelessness looms large as incarceration rates, especially for communities of color, have risen dramatically in recent years. Girls, particularly girls of color, are being arrested at increased rates for actions that are all historically common symptoms of child sexual abuse – truancy, substance usage, and running away (Saada Saar et al. 2015: 9). Additionally, girls face further criminalization when they become emotionally dysregulated by trauma triggers, which can be viewed as a child being “non-compliant.”  Such disobedience is also viewed as deviance from “ladylike” gender norms, which can implicate girls even further (Tolman 2004; Saada Saar et al. 2015). Incarceration can be retraumazing due to control and confinement, and only builds on previous trauma without addressing the root cause of child sexual abuse.  Furthermore, detention facilities do not always provide social services, and available services are not always trauma-informed (Breslow 2015).

Law enforcement and service providers need trauma-informed training in how developmentally-appropriate reactions for people with severe trauma histories can be perceived as non-compliance. Trauma-informed policy must also be integrated into in state and federal legislation intending to support commercially sexually exploited individuals. The decision whether or not sexually exploited youth and adults are legally viewed as victims or criminals can be determined by federal and state legislation. Therefore, the state legislative process is a primary determinate if a commercially sexually exploited individual will receive services or will be arrested for prostitution. Furthermore, commercially sexually exploited individuals can be further victimized through physical restraint or being locked up if their interactions with law enforcement are viewed by police as being uncooperative (Halter 2010). Thus, not understanding traumatic triggers and reactions can have dire legal consequences for commercially sexually exploited individuals, because triggered individuals can labeled “non-compliant.” On a wider scale, these decisions placed on police officers actually begin with the state and federal legislation which determines whether commercially sexually exploited individuals will be arrested for prostitution or will receive much-needed services. A key debate surrounding the passage of the Trafficking in Victims Protection Act of 2000 (TVPA), a landmark federal bill aimed at protecting victims of human trafficking, is if the goal of the law is to prosecute traffickers and buyers or sex or to provide services to commercially sexually exploited individuals. Victims’ advocates urged legislators to “adopt a more victim-centered model,” particularly in terms of providing funding for victims services (Sheldon-Sherman 2012: 446).

This study will address the prevalence of child sexual abuse histories among sexually exploited juveniles and adults served by ten non-governmental organizations in Boston. This paper will also explore legislative and structural barriers to providing services addressing child sexual abuse in this population. Few in-depth studies of direct service provision within the sex trade have been completed, other than program evaluations and calls for “best practices” (Silbert and Pines 1981; Cohen, Edberg, and Steven 2011; President’s Interagency Task Force to Monitor and Combat Trafficking in Persons 2013).  This project aims to build on this analysis and to further the discussion on how to best address histories of child sexual abuse as a key component of commercial sexual exploitation. This study will also discuss structural barriers for commercially sexually exploited individuals to receive services, such as legislation that criminalizes commercially sexually exploited individuals and lack of funding for social services. Minimizing these obstacles for service provision are essential for healing cycles of child sexual abuse and commercial sexual exploitation.



Data stem from completed semi-structured in-depth interviews with ten direct service provider organizations. All organizations met the following criteria: 1) located in the Greater Boston area; and 2) serve commercially sexually exploited individuals in Boston’s sex trade. Data were collected through snowball sampling. Organization leaders who completed interviews provided the interviewer with contact information for additional groups. All organization leaders were interviewed once and no follow-up interviews will be conducted.

Interviews were conducted by a member of a research team in the sociology department at the University of Massachusetts Boston (UMass Boston). The team is studying the full scope of Boston’s sex trade, including commercially sexually exploited individuals, law enforcement, direct service provider organizations, traffickers, and sex buyers in collaboration with the Boston Mayor’s Office, Boston City Councilors, and area non-governmental organizations.

All IRB Human Subjects study approvals were obtained prior to data collection.


The study includes a qualitative measure investigating how child sexual abuse is addressed by service providers for commercially sexually exploited adults and juveniles in Boston. The interview guide was created by the UMass Boston research team studying the sex trade in Boston. Topics covered include: number of people served; specific services provided; changes in Boston’s sex trade over time; understanding of offenders (traffickers and buyers); pathways of entrance into and exit out of commercial sexual exploitation; and specific challenges to serving this vulnerable population.


            Data will be analyzed using the qualitative software package, NVivo. Interviews have already been transcribed, therefore, analysis will comprise of utilizing the software’s functionality to identify common themes and disparities in interviewees’ organizational experiences. Primary code identification will be utilized to articulate patterns and differences in how organizations address histories of child sexual abuse among commercially sexually exploited individuals in Boston, as well as identifying structural barriers to service provision. Analysis will be disseminated through a final research paper for Sociology of Health and Illness.


Alexander, Michelle. 2012. The New Jim Crow: Mass Incarceration in the Age of Colorblindness. New York: The New Press.

Breslow, Jason M. 2015. Frontline: Locked Up in America – Christel’s Story. Video. Boston, MA:  WGBH, Public Broadcasting System.

Bruhm, Steven and Natasha Hurely. Curiouser: On the Queerness of Children. Minneapolis, MN: University of Minnesota Press.

Clawson, Heather J., Amy Salomon, Lisa Goldblatt Grace. 2008. “Treating the Hidden Wounds: Trauma Treatment and Mental Health Recovery for Victims of Human Trafficking.” U.S. Department of Health and Human Services. Available at (last visited January 30, 2016).

Cohen, Marcia. I., Mark C. Edberg, Stephen V.Giese. 2011. “Final Report on the Evaluation of The SAGE Project’s LIFESKILLS and GRACE Programs.” Available at (last visited March 8, 2016).

Collins, Patricia Hill. 2000 (rev.ed.). Black Feminist Thought: Knowledge, Consciousness, and the Politics of Empowerment. New York: Routledge.

Corrigan, Rose. 2006. “Making Meaning of Megan’s Law.” Law & Social Inquiry 31: 267-312.

Corrigan, Rose. 2013. Up against a Wall: Rape Reform and the Failure of Success. New York: New York University Press.

Crenshaw, Kimberlé Williams. 1991. “Mapping the Margins: Intersectionality, Identity Politics, and Violence against Women of Color.” Stanford Law Review 43 (6): 1241-1299.

Dalla, Rochelle L. 2011. “You Can’t Hustle All Your Life.” Prostitution and Human Sex Trafficking Conference. Lecture conducted from University of Toledo, Toledo, OH.

Finkelhor, David, Heather Turner, Anne Shattuck, and Sherry Hamby. 2013. “Violence, Crime, and Abuse Exposure in a National Sample of Children and Youth.” JAMA Pediatrics 167 (7): 614-621.

Halter, Stephanie. 2010. “Factors that Influence the Conceptualization of Girls Involved in Prostitution in Six U.S. Cities: Child Sexual Exploitation Victims or Delinquents?” Child Maltreatment 15(2) 152-160.

Herman, Judith Lewis. 1997 (rev. ed.). Trauma and Recovery. New York: Basic Books.

Johnson, Allan G. 2005. The Gender Knot: Unraveling Our Patriarchal Legacy. Philadelphia, PA: Temple University Press.

Kluft, Richard. 1990. “On the Apparent Invisibility of Incest.” Pp. 11-34 in Incest-Related Syndromes of Adult Psychopathology edited by R. Kluft. Washington, D.C.: American Psychiatric Press.

Lalor, Kevin and Rosaleen McElvaney. 2010. “Child Sexual Abuse, Links to Later Sexual Exploitation/High-Risk Sexual Behavior, and Prevention/Treatment Programs.” Trauma, Violence, and Abuse 11 (4):159-177.

Mitchell, Kimberly, David Finkelhor, and Janis Wolak. 2009. “Conceptualizing Juvenile Prostitution as Child Maltreatment: Findings from the National Juvenile Prostitution Study.” Child Maltreatment 15 (1): 18-36.

Nelson, Vednita. 1993. “Prostitution: Where Racism and Sexism Intersect.” Michigan Journal of Gender & Law 1: 81-89.

President’s Interagency Task Force to Monitor and Combat Trafficking in Persons. 2013. Federal Strategic Action Plan on Services for Victims of Human Trafficking in the United States 2013-2017. Available at (last visited March 8, 2016).

Price, Kate. 2012. “Longing to Belong: Relational Risks and Resilience of Commercially Sexually Exploited Children in the U.S.” Wellesley Centers for Women, paper 111.

Saada Saar, Malika, Rebecca Epstein, Lindsay Rosenthal, Yasmin Vafa. 2015. “The Sexual Abuse to Prison Pipeline: A Girl’s Story.” Human Rights Project for Girls, Georgetown Law Center for Poverty and Inequality, and Ms. Foundation for Women. Available at (last visited February 16, 2016).

Silbert, Mimi and Ayala Pines. 1981. “Sexual Child Abuse as an Antecedent to Prostitution.” Child Abuse and Neglect 5 (4): 407-411.

Sheldon-Sherman, Jennifer A.L. 2012. “The Missing ‘P’: Prosecution, Prevention, Protection, and Partnership in the Trafficking Victims Protection Act.” Penn State Law Review 117 (2): 443-501.

Steel, Jennifer L. and Claes A. Herlitz. 2005. “The Association between Childhood and Adolescent Sexual Abuse and Proxies for Sexual Risk Behavior. A Random Sample of the General Population of Sweden.” Child Abuse & Neglect 29 (10): 1141-1153.

Tolman, Deborah. 2005. Dilemmas of Desire: Teenage Girls Talk about Sexuality. Cambridge, MA: Harvard University Press.

Tyler, Kimberly A. and Lisa A. Melander. 2015 “Child Abuse, Street Victimization, and Substance Abuse Among Homeless Young Adults.” Youth & Society 47 (4): 502-519.

Whittier, Nancy. 2016. “Where are the Children? Theorizing the Missing Piece in Gendered Sexual Violence.” Gender & Society 30 (1): 95-108 1995. Victims of Childhood Sexual Abuse: Later Criminal Consequences. Washington, D.C.: National Institute of Justice, U.S. Department of Justice.