Commercial Sexual Exploitation - gbv.scot.nhs.uk

1 What heal thworkersneedto knowaboutgender-base d violenceCo mm erc ia lSex ualExpl oitatio nTh e Sco tti sh Gov ernment has introduced a nationalpr ogr ammeof wor k acro ss NHSScot land to improve the identificationand managem ent of ge nder -basedvio national teamhas beenestab lish ed to su pp or t its im pl eme guide is one of a seriesdev elopedby the programme to sup por t hea lth st aff. It hasbeenwritt en and co mpil ed by ShirleyHenderson(Shirley Hen der son -writing,editingandcons ul tanc y, ww ) and Ka tie Cosgrove, Pro grammeManager(GB VPro gramme,NHS Scotland).Thanksto th e Natio nal GBV Reference grou p whoal so con tr ibutedto its is this gui defor?2 What iscom merc ial sex ual exp lo itation?3 Who is atri sk?4 Howcomm erc ial sex ualexpl oita ti onaffec ts he alt h5 Your rol easahealth wo rker7 What every heal th profes si onal can do8 Suppor tfor staf f10 Role of local health boa rds10 Further inf orm ati on and tra ini ng11 Refe rence s12 Local inf or ma ti on and no tes12 Contents1 COMMERCIALSEXUALEXPLOITATIONThis guide is on eofaser ies desig ned to su pporthea lt hwor ker sto wo rkef fectiv ely wi th th evi ct ims of gen der -bas ed vi olen cein li ne withna ti ona lgu idan ce is sued to health boa rds ,a,band the Scot tis hGo ver nment ssh ar edappr oa chto ta ck lin gvio le nc eagai ns two ahea lth wo rker yo uare in auniqu epos itionto res pond to su ch exp ectedto be anex pe rtorto pr ovi de ev er yth ing apati ent needs.

2 But you can pla yacru cial part inimp rov ing th eim medi at eand lon g-te rmheal thimp act on al lth ose af fe ct ser ies of pr actic egui de sco ver sth efoll owi ng as pects ofge nder-b as ed violen ce:d Wha thealt hwor ke rs nee dto know ab ou tgende r-b ase dvio lence: an ove rview Domest ic abu se Rapean dsex ual as saul t Chil dhood sex ual abuse (adu lt su rv ivor s) Comme rci al sex ual exploi tat ion Stalk ing an dhar as sment Harmf ul tr adit ional prac tices (fo rex ample,for ced mar riag e, femal egeni tal muti lati on,and so- cal led honour cr im es)Not e: Giv en pre val ence stat istic s, theter mino lo gy used in this guid eass um es vi ctim sare fem al ean dper pet rator sare ma le. Th is isnot alway sthe case, howe ver, and th eprin ciplesof the health car eres pons eapply to both wom enand as ed vi ol ence encompassesa ra ngeofabusemostoftenperpetratedbymen against womenand includesdomesti c abuse,ra peand Sexual assault,childhoodse xual abuse, Commercial sexualexploi tation, stalking andharassment andhar mfu l tr aditi onal practices,suchasfo rcedmarri age andfemale genital Executive s Letter tohealt h boardsonidentifyin g andrespondingtogender-basedvi ol Safe r Lives: Changed SharedApproachtoTac kl ingVi ol ence again stWomenin Scotland e areavai lable at is thisgui defor?

3 2 COMMERCIALSEXUALEXPLOITATION3 Whatis commer ci al sexualexplo itation?Com mercialsexualexp loit ation (C SE) inclu des awid era nge of often linke dsex ua lactivi tie swhich(t yp ica lly) me npr ofit from orbuy from wo men and whichob jec tif yand har clud es prost itutio n, phonesex ,int ernet sex/chatroom s,str ipp ing, pole dancing,lapdan cing, peepshows,porn ography,tr afficking,se xto urism and mail order bride womeninvolvedareof tenon lowincomes,substanceusersandvictims ofotherfo rmsof lackof alternativesand oftenoncoercion, suchactivi ti esarerarelya free or v ocational is it explo itat ion?TheSc ot tis h Governmentincludesprostit ut ion, pornographyandotherformsof involvement inthe sexindustry in itsdefinitio n th atthe Exploitation of womenthroughtheseformsof entertain ment legit imisesnegative attitudesto ward swomenandis in extricablylinkedtogenderinequality and Sexual re cently,societaldisapproval hasfocused onwomeninvolvedin pro stitution,with thebuyersbeinglargelyin vi , manypeoplebelievethat womenchooseto getinvolvedin prosti ct , mostwomen enterprostitutionbecauseofla ckof choic belie veth at pr ostitutionis ju fac t, thesin glemost har mfulas pect of pr ostitutionishavin g torepeate dl y endure unwanted se ar e agreeingtose xualactivity,it is unwanted se xualact iv peopleconsid erthat pr ostitutionis work , th atit shouldbelegalised, and thattr adeunionsshould offe r employment prote ction.

4 Formostwomenandmeninvolved inprosti tution,however, thi s issur viv al behaviour, and th e result ofvul nerablility. Refer rin g topr ostitutionas sex wor k masksthenature of pr ostitution,andminimises th e harmthat it causestoth ose is theref or e morehel pfulandsensitive touse th e term women andmeninvol vedin pro stitution rather than sex wor kers or prostit utes .Inarecen tsurv ey ,overha lf (53%) ofres pon den ts ag ree dtha tso me mennee d the ser vic es th atpro stitut esoff er in ord er tomeet the ir sex ua lnee ds . Ho wev er, 74% ofthe sam eres pon den ts think ituna ccepta blefor afemal efamily mem ber to beinvo lv ed in pr os ti tu tio mo st two infive (39%) peo ple thi nkitaccep table foramanto purc has esex fromawoma nbu tover hal f(58% )wo uld fin dthis una cceptable if thei rsister ,mo th er or da ug hter so ld sex .3 COMMERCIALSEXUALEXPLOITATION4 Whois at risk?The ke yri sk factor for beingab used thro ug hcomm ercialse xual ex ploitation is beingfe male.

5 It is difficult toquantif y th e numbersofwomeninvolved incommercial sexualexploitation,partl y because some activities,such as pole dancing, areseenas normal and ot hers, suchas traffi ckingint opro stitution,ar e, by their verynature,crimin al andhid str ongevidence that womenabuse d th roughcommercial sexualexploitationhaveexperienceofother formsof abuse. Forexample,Routes OutOfPr ostit ut ionPar tn ers hip in Glasgowreporte d in 2003thatchil dhoodse xualabuse , trauma and sexualvi ol ence inpro stitutionweresignifi cant factorsforwomencontactingtheservice. Womeninvol ved in pr osti tutionreportmuchhigherlevels ofvi ol ence thanotherwomen,includin g muchhi gherlevels ofchildhoodsexual searchbytheWomen sSupportPr oject in Gl as gow surveyi ngmen whousewomen in prostitution foundthata quartertoa third of themen inte rviewedendor sedrape-to ler ninvo lved inpr os ti tut io nAlthough much fewer men areinvolved inpr ostitution thanwomen, theevi dencesuggeststh at th ose invol ved becomesoforreasons lac k of optionsavai la bl e,pr eviousexperi enceof abuse,dr ugmisuse, s involvementinpr ostit ution is alsolessvis ible,th ro ughescort serv icesandinternet n th e advers e impactof male pr ostitution is mini mised oroverlooked since it is morelikely tobeconsi deredin thecontextof conse nsualhomosexual ac ti vi ty,rather thanrecognisedasexploitative.

6 Evid enc esu gg ests that many dan cer sbeg inwor kinginlap-danc eclub sthrou gh lack of real ch oi ce6 Inasur vey ofwom en involvedinpros ti tuti on infi vecount rie s, 92% said that the ywanted to leave pros titu ti onim me dia te ly7 Itis est im ate dthat th ere are 4,000 victi ms of traf fickin gforpro st it ut io nand se xual exp loitati on inth eUK8 70% oftho se in stree tprosti tuti on becamein volved aschild re norte enag ers9 85% rep ort edph ysi cal abus ein th eir fami ly and 45% reportedse xua labuse in the ir fam ily10 COMMERCIALSEXUALEXPLOITATION5 How Commercial sexualexplo itationaffect s healthComm ercial sex ual exp loi tat io nadve rsel yaf fect sphy sic al,sexua land menta lhealt hand isaser io us pub li cheal th is ,bothasa re sultofcopingwithth econse quencesof exploitationandbecauseofthegreaterexposu retoviolenceandot herforms ofabuseinhere ntinthisac ti Despitetheissueof consent tosex ualactivity,it is stillunwantedse xualact ivi tocopewi ththis,many womenhavetolearntodi ssociate,whichinturncancauselastingpsych ol arenotableto di ssociateof te n reportusing drugsand/oral cohol toachieve thesameef whythereisof te n anescalationofsubstancemisusefollowing involvementinprostitu ti recent studyofwomen trafficked in Europefound that women typicallyreported physicalsymptomssuchasheadaches,fatigue, dizzyspellsandbackpain;44%hadbeen tre alsonotedprominentpsychol ogicalreactionssuch asdepression,anxi etyandhostilitywith56%exhibitingsigns ofposttraumaticstressdi sorder(P TSD).

7 11 Vul nerabilitytootherformsofvi olence is alsogreaterfo r womeninprostitutio n. Variousresearchershave documented andanalysedthesexual andphysicalviolence whi chis thenormativeexperience that70%ofwomensufferedrapeinprostitut io n,with65% havingbeenphysicallyassault edbycustomersand66% a study ofprostitutionin five countri es,73% reportedphysicalassaultin prostitu tion,62% reportedhavingbeen rapedsinceente ringprostitution,and67%met thecriteriafo r a y to common belief , indoorprostit ut iondoesnot af fo rdprotecti onfromabuse. A re portin theBritishMedica l Journalfound th at48%of women in in doorprostit ut ioncontacted had experiencedarangeofviolencefro m c lie nts , inclu dingphysical assaults,attemptedra pe,st rangulation, ki dnapping,vaginal and analrape and being forcedto performoral impacton menhas of tenfocusedon gr eater exposuretoHI V andotherSTIswithle ssconsiderati on ofthementa l andemotionaldi fficultiesthey experiencebecauseofin volvementinprostitutio SI CAL AND SEX UAL HEALT H Untrea te dhe alth pr ob le ms Rep rod ucti ve pr ob le ms HIV,ST Is.

8 Ute rin einf ec tio ns Mens tr ual pain Chroni che patiti s Cer vic alcan ce r Gastro -inte sti nal diso rd ers Sy mp tom softrau mati cbrai ninj ur y Rep ea tte rm in atio ns of pre gn anc yME NT AL HEAL TH Depr ess ion Mood swin gs Low se lf- es te em Sui ci dality Depe nde nce on drugs/alcoh ol PTSD andco mp le xPT SD Dissoc iati onCom me rci alsexu alexploi ta tion is li nk edwith ch ron ic hea lthpr oble ms:COMMERCIALSEXUALEXPLOITATION6Gi ve nthe inv isi bi lit yofcom mer ci alse xual exp loit atio n(ofte nit is see nas consensualor norm al or bec ause it ishi dde n) itma ybehar dforhe alth work ers to fullyun de rst and or see th eex tent ofthe ab us havebeensexuallyexploitedcoul d pre sent in anyprimar y aware ofhowwomenmightprese ntinyour se rv ice, parti cularlyif youworkinaddictions ormentalhealth ser vices sincethere is a signif ic antlinkbetween streetpro stitu ti onand be particul ar presentationsin sexualand reproductivecarewithvaginal andurin arytr actin fe ctions, STIs , pelv ic painandinj urytothegenit al on to these healthproblems, otherfa ctors mayal er t you tothepossibi lityofsexual vi olence andabusewithi n th econtextof commerc ial Sexual exploi ta tion.

9 Di ffi cul tyingetti ngto healthse rv ic esdur ingnormalwor ki nghours Inabilit y tokeepappointments (th roughdrugaddic ti on/intoxi ca ti on) Lack of money to travel toappoint mentsorpayforpr escriptions Di sc lo sure of chi ld sexualabuseordomes ti c abuse Homelessness Evidence tosuggestcontrol ordominati onbya partneror pi mpId entifyingcommercial se xualexploitationCOMMERCIALSEXUALEXPLOITA TION7 All heal th wor kers shoul d: Be aware ofth e possibilitythat pati entsmaybeexperiencingCSE Recognisepossibleindica torsofabuse Init iate discussionwhereappropriate Li st enandmaketime Givecorrectinformation aboutsourcesofhelpMa ny wo men are reluctanttosa ytha tthey are invo lv ed inpro st it ution, or ot her forms ofCS E, bec ause of fear of repr isalsfrom pimps/partn ers orthatth eywill be ost racisedby familyand frie theywill bereportedtoth e policeor immigrationauthoriti es ,and/orthatth eir childrenwill enthestigma th atsurroundsCSE, theywil l alsofear bein g judged.

10 Inal l encounterswit h patients, you bringyourownbeliefs,valu e systemsandculturalexperiences .Beingawareof th es e andofhowyouunderstandCSEis crucialin howyourespondto maybeabletoimprovethelong-termhealt h andwell-beingof those af fectedifyou intervenese candoth is by:Unde rsta ndi ng the na tu re ofCS EIf yousharetheassumptionscommon insociety aboutpr ostitutionandsexualviolence(f orexamplethat rapeis an occupati onal hazard ),thenyoumay beunaware oftheexperiencesof someof yourpat ients. Beawareof anybi as andwhetherthis may pr eventyoufromidenti fyingabuse andfr omunderstandingtheharmca used bypr osti tu ti maybeeasi erfor womentodi sc usstheirin volvementin pr ostitution if yourservic ecl earlydef in esit assurvival behaviour andadopts a non-judgemental approac in gsensit ive to diff ere ntnee dsAta practical level , thi s canmeanensuringpat ientsca n accessse rvicesequally, forexample bypr ovidi ngcogniti veorlanguagesuppor t.