Love and Sex in the Time of Misogyny

“Woman in Love” stainless steel, 1983, Bob Haozous at the Heard Museum, Phoenix, Arizona. Photo credit: Josephine Ensign/2016

Prostitution is commercial sexual exploitation and no, I’m not throwing women under the bus by stating this, and yes, I am a feminist. Prostitution is not a victimless crime. Prostitution is a public health issue. Prostitution is a significant part of continued and even accelerated violence against women and children. Amnesty International‘s prostitution policy, which was enacted on May 26, 2016, frames prostitution as sex work, pimps as legitimate sex business operators, and johns as deserving customers. Did Amnesty International sell its human rights soul to the highly lucrative and heavily male-dominated sex industry?

Consider this: “The commercial sex industry is sustained through violence and exploitation. Prostituted people live with the daily threat of violence. Traffickers and pimps are not the only abusers—buyers cause tremendous harm through the repeated sexual use of women and children and other physical and psychological violence. Sex buying exploits vulnerable people and hurts our communities.” (source citations at Ending Exploitation.)  The vast majority of women and children who are prostituted come from poor and marginalized communities and have histories of childhood sexual abuse. The typical age of entry into prostitution is 12-15 years of age and upwards of 90% of all prostituted women and children want to leave “the life.” And in countries that legalize/decriminalize/regulate prostitution, the demand increases as does the number of women and children (typically, again, from impoverished and marginalized communities) trafficked into prostitution.

And consider this innovative Seattle-based program on men’s accountability (and misogyny and perpetuation of the patriarchy): The Buyer Beware partnership to end commercial sexual exploitation, coordinated by the King County Prosecuting Attorney’s Office and the Organization for Prostitution Survivors (OPS).  The Buyer Beware model emphasizes prosecuting (and educating) sex buyers and connecting prostituted women and children to services. The goal of the program is to reduce demand for commercial sex, thereby decreasing harm to prostituted persons, reducing self-destructive (toxic masculinity) behaviors of buyers, and curbing sex trafficking in our region. This is a highly enlightened approach and one that our health system—including public health—should support. For instance, standard screening questions on sexual health for health care providers to use with patients can include ones pertinent to sexual exploitation and the buying of sex, along with appropriate referrals for assistance.

In the Seattle area we have YouthCare’s Bridge Program for prostituted teens, the OPS programs for adult women seeking to exit commercial sex exploitation, and the OPS men’s accountability program “Stopping Sexual Exploitation: A Program for Men.” There is a recent and fascinating GQ article “Can we ‘cure’ the men who pay for sex?” about this program by Brooke Jarvis (February 2, 2017). In the article, Jarvis avoids straying into the current political climate as it relates to the fueling of toxic masculinity and violence against women, but she does write this tagline: “Inside a two-month program that aims to end prostitution—and help dismantle the patriarchy—by rehabilitating the men who perpetuate it.” It should be abundantly clear that this is a lofty—and essential—goal for all of us to be working towards.

Prostitution: The Oldest Oppression

Gloria Steinem/Sponsored by Hedgebrook at Seattle’s Benaroya Hall, 11-8-15. Photo credit: Josephine Ensign/2015

Gloria Steinem reminds us that prostitution is not the oldest profession for women, but rather it is the oldest oppression of women. This is not just some catchy, smart play on words by a feminist icon. It contains powerful truths. It contains powerful truths that affect public health and policy. It contains powerful truths that affect all of us, even if we prefer to think that it doesn’t.

I’m writing this post the morning after TV actor Charlie Sheen publicly announced he is HIV positive, and linked his infection to his history of alcohol/drug use combined with his ‘use’ of prostitutes. (See NYT article “Charlie Sheen says he has HIV and has paid millions to keep it secret,” by Emily Steel, 11-17-15.) Considering the fact that ‘use’ of female prostitutes by heterosexual men is correlated with high scores for men on different masculine hostility measures, it strikes me as ironic that Sheen’s last–and now cancelled– TV series was titled Anger Management.

Hopefully, most people know that prostitution is not the twisted Cinderella Hollywood version Julia Roberts portrays in the movie Pretty Woman. But Pretty Woman was written and directed by two fairly macho men, and it was released in the dark ages of 1990. Surely the portrayal of prostitution is much improved today. But no. Even the women’s rights advocate, TV screenwriter and producer Shonda Rhimes, is woefully disappointing on this issue. I recently watched the first season of Scandal (which Rhimes wrote and produced) in which the main character–the professional ‘fixer’ played admirably by Kerry Washington–puts on her white hat/gladiator woman power suit and successfully defends a Washington, DC high-class escort/prostitution madame, allowing her to retire as a rich grandmother in Boca Raton, Florida.

In my thirty-plus years work as a nurse, I have worked with many young women involved in prostitution. I was always clear that it was sexual exploitation for underage girls, but within the progressive subculture of clinics/agencies I worked in, we called adult prostitution ‘sex work,’ and erred on the side of harm reduction: trying to help minimize the harms of prostitution to the patient and the public. In many ways–as I view it now–we were supporting their lifestyle, enabling it, and becoming part of the problem. I remain a strong advocate of harm reduction, especially as it pertains to drug/alcohol addiction, but not applied to prostitution.

I know prostitutes who call it a profession, who say they freely choose their work. I’d like to believe them because it would make my work easier. But so many prostitutes (female, male, transgender) have histories of previous sexual abuse as children. Their bodies are not their own; their bodies have been stolen from them. In such situations free choice is not possible. This, combined with the growing evidence that prostitution–even in countries where it is legal and regulated (including health screens/care)–is one of the most hazardous ‘jobs’ in the world, has led me to the conclusion that prostitution is the oldest form of oppression. Prostitution is part of violence against women.

So, what to do about it? In my hometown of Seattle, we have begun to adopt the ‘Nordic Model’ of intervention: decriminalizing (and diverting to supportive care, including housing, health care, counseling, job training) prostitution for the women/transgender people involved, and stepping up criminalization efforts directed towards the customers–or ‘Johns’–and the pimps/BackPages/brokers in whatever forms they take. And along with stepping up legal ramifications for the buyers and the brokers, Seattle has innovative programs, such as OPS: The Organization for Prostitution Survivors. OPS has a drop-in center for women, survivor support groups, art workshops for survivors, as well as community-based service provider trainings, and the new Stopping Sexual Exploitation: A Program for Men (SSE).

Last week I visited OPS and talked with OPS co-founder (with survivor/activist Noel Gomez) Peter Qualliotine. Peter has taken the lead in designing and facilitating the SSE workshops. He explained that the SSE program was designed and piloted for two years and then began full operation in January 2015. He receives self-referrals as well as court referrals, and he’s hoping to be able to move it more heavily towards referrals. As he put it “8,000 men a day in King County are customers on BackPage,” so waiting for men to be ‘caught’ by either their wives/partners or the police and referred in to a ‘John’s School’ such as SSE, will not be very effective.

The SSE consists of a telephone intake conversation that Peter has with the men. He uses a motivational interviewing technique and asks the men, “How has this been a challenging time for you?” He said that with the rare exception of a man with psychopathic tendencies (my term here), the vast majority of men soliciting sex feel at least some qualms about it and also suffer negative consequences (sexually transmitted infections, guilt, relationship/legal/money issues).

The SSE program is based on the social-ecological model of violence prevention, and includes information and role-play on gender socialization and manhood training. It’s a support group model of three hour sessions over eight weeks, and is purposefully limited to ten men at a time. So far this year they have had sixty men complete the program, with some of the men so positively affected/changed by it that they have volunteered to help with further advocacy. (Stay tuned, because local and national news coverage on SSE is coming soon.)

Meanwhile, I know many people who work within public health realms in Seattle/King County who continue to advocate for legalizing prostitution, as if it is similar to ‘legalizing’ marijuana. And the otherwise admirable social justice/human rights organization, Amnesty International, is also advocating this stance–although they cleverly call it “protecting the human rights of sex workers.”

New Zealand Postcards: Misogyny In Sheep’s Clothing (with a G-String)

DSC01009I preface this by saying: I know the Biblical quote that it’s easier to see the speck in another person’s eye than to see the plank in your own. In the U.S. we have a lot of work to do in terms of overcoming misogyny in all its ugly forms (including commercial sex trade/exploitation or perhaps even all the books by Philip Roth?) We have a very large plank, especially in places like Nevada.

But I have to say that one of the most surprising things I’ve learned while in New Zealand these past months is the country’s level of violence against women. Before coming here I mainly knew that New Zealand was rightly proud of the fact that it was the first country in the world to give women the right to vote (in 1893). I also knew that there was a healthy cadre of New Zealand feminists at work influencing national policy through research, direct service, and the arts. What I had not realized was how deeply ingrained the sexism is here, perhaps as yet another direct descendant of British colonialism? That is what one of my Maori female informants and experts on this topic asked somewhat rhetorically in answer to my question to her about this topic. I had not realized that prostitution is legal in New Zealand (the photo here is of the Calendar Girls strip club/’gentleman’s club/brothel left standing in the Red Zone of Christchurch.) I had not realized that New Zealand is one of the worst industrialized countries in terms of violence against women. (See: Facts on Violence Against Women, by Janet Fanslow, New Zealand Herald, 11-25-11.)  Of course, those issues are all interrelated.

A society’s level of sexism and misogyny, plus tolerance of violence, plus racism, plus poverty, plus sexualization of girls, plus a high level of commoditization and commercialism, are all documented risk factors for commercial sexual exploitation (CSE) of girls and women. Additional environmental risk factors for CSE include: open presence of the adult sex industry, transient male populations, and proximity to borders/ports.

I have spent many decades as a nurse working with homeless and prostituted teens and young adults on both coasts of the U.S., as well as in Thailand. There was a time during the early part of the HIV/AIDS epidemic when I bought the idea of sex trade as potentially being empowering work for women, along the idea that legalizing and regulating (including health screens) prostitution/sex work were all good things. But that belief was short-lived when I realized how dangerous the work is, no matter how ‘upscale’ or regulated or sanitized. And when I realized (from both credible research reports and stories from young women I worked with) that the women and children in prostitution anywhere in the world come from the most marginalized and oppressed groups in society. And how many (upwards of 90% in many studies) have untreated PTSD and histories of sexual abuse as children. And there is mounting evidence that legalizing prostitution only increases human/sex trafficking.

Efforts like those in my home state of Washington to decriminalize prostitution for the women/men/girls/trans in sex work (and refer them to appropriate services), while simultaneously stepping up the severity of prosecution of the buyers (‘Johns’) and the traders (‘Pimps’), make the most sense to me. Meanwhile, Nevada has counties near places like Las Vegas where prostitution is not only legal. They lock women inside barbed-wire secured brothels called ‘ranches,’ and then busloads of ‘customers’ arrive to be serviced. Like I said, we have planks in our own eyes.

Nurses and other front-line primary care providers need education and training in how to identify and effectively work with children and adults involved in CSE. Similar to gaining skills in working with victims of intimate partner violence, any screening or intervention is based on building rapport, maintaining appropriate professional boundaries (including not ‘rushing in to the rescue’), understanding PTSD and trauma bonding, using the principles of harm reduction to help the client build a safety plan, and knowing good community resources for appropriate referrals. One important health component I’ve found to be essential is having culturally-clued in positive body work (like yoga) to refer people to. It helps them get cued in to what the body can do, instead of what is done to the body (body as object). And for anyone who doesn’t know how to ask a patient about this topic, here’s the standard screening question: “Have you ever traded sex for money or other things needed to survive?”

And remember the words of Gloria Steinem: “Prostitution isn’t the world’s oldest profession. It’s the oldest oppression.”


Polaris Project: For a World Without Slavery

The Washington Anti-Trafficking Response Network: 206-245-0782

National Center for Missing and Exploited Children: 1-800-THE-LOST

National Human Trafficking Resource Center Hotline: 1-888-373-7888

An excellent 5-minute training/education video about the process of ‘grooming’ that can draw young women into prostitution: GEMS The Making of Girl.