Thread by @WilsonKM2

Sex work study live-tweet is starting now.

Tonight's study was published this month in the journal Addictive Behaviors by Gaines et al: ncbi.nlm.nih.gov/pmc/articles/P… (full text).

The topic: what predicts quitting sex work in a sample of highly vulnerable workers?

One of the most common methodological complaints in sex work research is that the samples are often heavily skewed towards higher-risk sex workers. This isn't itself a problem, unless the point of the study is to assess the overall risk level that sex workers experience.

(risk being potentially defined as anything from addictive behaviours, extreme poverty, exposure to violence, or sexually transmitted infections, etc).

Of course, if the point of the study is to evaluate outcomes specifically among high-risk workers, this isn't a problem. at all.

In contexts where sex work is criminalized (in whatever form that takes), the policy goal is to use the power of the state to *force* workers to exit

Morality of such a policy aside, this has numerous drawbacks: most notably that it tends to make sex workers more vulnerable to violence/exploitation by clients and/or police, and give them limited options for redress.

In more recent decades, criminalization policies have attempted to re-brand themselves as being for the benefit of sex workers (this may or may not be associated with an actual change in policy - often not).

A common refrain among sex workers' rights advocates is that, if policy-makers/advocates of various forms of criminalization actually cared about sex workers well being (and wanted them to quit sex work), they would focus their efforts on providing better alternatives.

Quality studies that try to figure out why sex workers do or do not quit sex work are relatively rare.

In the current study, the authors recruited a sample of 467 female sex workers who use injection drugs.

The main study, in a sense, isn't even about sex work: it's about a randomized trial to test an intervention aimed at increasing condom use, and reduce injection equipment sharing, but not to encourage exit from sex work.

The thing is, this gives the researchers the ability to watch a large group of relatively higher-risk sex workers change their behaviour in response to an active intervention/resources, even when those resources aren't encouraging exit from sex work.

Workers were followed-up numerous times over the course of a year following the intervention, and asked about whether they had quit sex work (and when). Overall, 45.2% never quit, 26.6% quit once, 17.8% quit twice, and 10.5% quit three times during follow-up.

Among those that quit sex work, the most common reason given (48%) was "Tired of trading sex/want a different life". Another quarter (25.4%) said "In drug treatment" as the reason. Many of the remaining comments were some version of health issues or fear.

The researchers looked at which factors predicted quitting sex work (separately by each of the two Mexican cities workers were recruited from: Tijuana and Juarez).

In Tijuana (after controlling for other factors), the following variables were associated with a *decreased* likelihood of quitting sex work: having financial dependents (-27% odds), meth use (-28%), ongoing injection drug use (-45%), started sex work before age 18 (-29%)...

...and having recently bribed police in order to avoid arrest (-48%).

Conversely, the following variables increased the odds of quitting sex work (in Tijuana): Monthly income > 3500 pesos (+35%, marginal), having income sources other than sex work (+283% - not a typo), recently increased access to health services (+48%)...

...and sexual abuse by police (+122%).

A similar pattern of results could be seen in Juarez: Remaining in sex work was predicted by ongoing injection drug use, ever having had a pimp, and recently increased police presence.

Meanwhile, having income sources other than sex work (+342%), increased access to health services (+229%), and receiving drug treatment (+243%).

In quick summary: ongoing substance use (particularly injection drug use) and exploitative interactions with police made exit less likely, while better income, access to health/drug treatment services and better/different income sources all increased the chances of exit.

The only police-related variable that increased the likelihood of exiting sex work was having experienced sexual abuse by police in lieu of arrest.

Comparatively, access to basic, relevant services and to other sources of income had large, consistent effects in terms of making exit from sex work more likely in this sample of injection drug using female sex workers.

Rather than attempting to force sex workers out, policy makers would seemingly be better placed attempting to alleviate the vulnerabilities of the most at-risk sex workers, by giving access to services, opportunities, and limiting police interactions.

Anyways, that's tonight's study. As always, thanks for the interactions and comments: it makes the whole process worthwhile.

If you have a topic or study that you'd like to see covered, just get in touch.

See you next Sunday!