THE PROCESS OF LEAVING SEX TRAFFICKING: USING LIFE HISTORY CALENDAR
METHODS TO UNDERSTAND THE ROLE OF FORMAL SYSTEMS AND SUPPORT
By
Lauren Vollinger
A DISSERTATION
Submitted to
Michigan State University
in partial fulfillment of the requirements
for the degree of
Psychology—Doctor of Philosophy
2022
ABSTRACT
THE PROCESS OF LEAVING SEX TRAFFICKING: USING LIFE HISTORY CALENDAR
METHODS TO UNDERSTAND THE ROLE OF FORMAL SYSTEMS AND SUPPORT
By
Lauren Vollinger
Sex trafficking (ST) is a serious and hidden social problem affecting thousands of people
in United States. ST is defined as “the recruitment, harboring, transportation, provision, or
obtaining of a person for the purposes of a commercial sex act†or when that person “has not
attained 18 years of age†(Trafficking Victims Protection Act, 2000). Given the violent, coercive,
and economic tactics used to control victims of this crime, it is challenging for individuals to
leave their trafficking situation. Thus, the purpose of this study was to understand how survivors
exit from ST and use formal systems or services to facilitate that exit. This study presents
findings from qualitative interviews with 34 survivors of domestic ST to understand the process
of exiting the sex industry over time. Life History Calendar methodology was used to guide
interviews about: 1) how participants conceptualized their experiences in the sex industry over
time: 2) what formal systems participants had contact with during their time in the sex industry:
and 3) the circumstances surrounding participants’ most recent exit from the sex industry.
Results revealed that participants were in and out of ST multiple times over the course of their
lives and had contact with many formal systems over time. However, what made the difference
in most survivors’ last exit from the sex industry was the collaboration between formal systems
to coordinate referrals and service provision. Findings from this study contribute to future
research on exiting from sex trafficking and provide recommendations for policy and practice.
This dissertation is dedicated to survivors of sex trafficking and exploitation, especially those
who contributed their voice to this project. Your resilience and commitment to fellow survivors
is an inspiring demonstration of your strength. I owe this project to you.
iii
ACKNOWLEDGEMENTS
To put it lightly, this dissertation would not have been possible without the patience,
trust, encouragement, and support of many people. First, to my advisor and chair, Dr. Rebecca
Campbell. I will re-iterate this point at every opportunity I am given -- you took a chance on
taking me in as an advisee with a different content focus and I could not be more grateful. Thank
you for the trust you put in me to venture out and do this work and for the knowledge and
mentorship you gave me to do this work well. To my committee, Drs. Ignacio Acevedo, Cris
Sullivan, and Lara Gerassi, thank you for serving as mentors and a support system for me as I
embarked on this project at the height of a pandemic. Your advice, trust, and encouragement
were instrumental in making this study what it became.
To my parents. You have never told me I couldn’t accomplish something I set my mind
to. Allison, Andrew, Elizabeth and I are the people we are because of what you consciously and
unconsciously instilled in us. From seeing mom writing grad school assignments in the basement
after a hospital shift, to seeing dad bring home and put on his firefighter gear in the middle of the
night during a snowstorm when he wasn’t even on shift -- there is no doubt in my mind that your
commitment to strangers, yourselves, and your family is how I made it to this point. To “the
grandmas.†Although only one of you is physically here to see this accomplishment, your
presence and love over the years kept me going to “finish the damn thing†when I didn’t think I
had anything left to give. To the rest of the Volldashians. Every text, phone call, and (resistant -
on my end) hug means the world to me, and I am so lucky to like and love you all.
To my friends and colleagues. The consistent support, wisdom, and enthusiasm you
provided throughout the many challenges this study presented was more appreciated than I can
express. Special thanks to Rachel, Dani, Madeline, Alexis, and Virginia – every brainstorming
iv
session, debrief, and conversation (usually over coffee) contributed to the development of this
study and to my growth as a researcher and person. To Hannah & Co. – our work “retreatsâ€
while productive, also never failed to fill my emotional cup and came at the most critical times
when I needed motivation most. To Sara, Bryant, and, of course, Atlas, whose friendship,
neighborhood walks, and family dinners kept me grounded throughout conducting this study
during the pandemic. And to Brittney. (This is the part where people usually thank their spouses
or partners and you’re the closest thing I have to that.) I could not imagine having a better friend
and confidant to have by my side throughout everything graduate school and life has thrown at
me. All I have to say is, damn, am I happy our moms went against their better judgement and
took us to that Nutcracker ballet audition over 20 years ago.
Finally, to the survivors who shared their stories with me during this project. I am
grateful you trusted me with your truth and I don’t take that responsibility lightly. This
dissertation is dedicated to you and others whose voices are yet to be heard or are no longer with
us. I am honored and humbled to walk beside you in this work.
v
TABLE OF CONTENTS
LIST OF TABLES ....................................................................................................................... viii
LIST OF FIGURES ....................................................................................................................... ix
INTRODUCTION .......................................................................................................................... 1
CHAPTER 1: LITERATURE REVIEW ........................................................................................ 3
Defining Sex Trafficking ............................................................................................................ 3
Entry into Sex Trafficking........................................................................................................... 5
Challenges Associated with Sex Trafficking .............................................................................. 6
Exiting Sex Trafficking ............................................................................................................... 9
Rethinking Exit from Sex Trafficking ...................................................................................... 17
The Current Study ..................................................................................................................... 21
The Life History Calendar (LHC) ......................................................................................... 22
LHC Strengths and Previous Applications with Qualitative Interviews ............................... 23
Research Questions................................................................................................................ 25
CHAPTER 2: METHOD .............................................................................................................. 29
Participants ................................................................................................................................ 29
Procedures ................................................................................................................................. 30
Measures.................................................................................................................................... 31
Data Analysis ............................................................................................................................ 34
Phase 1 (Data Condensation) ................................................................................................. 35
Phase 2 (Data Display) .......................................................................................................... 39
Phase 3 (Drawing and Verifying Conclusions) ..................................................................... 43
CHAPTER 3: RESULTS .............................................................................................................. 46
Sample Characteristics .............................................................................................................. 46
1970s / 1980s ......................................................................................................................... 51
1990s ...................................................................................................................................... 51
2000 - 2009 ............................................................................................................................ 52
2010 – 2021 ........................................................................................................................... 52
Research Question 1: Sex Trading Identities Over Time .......................................................... 54
1970s / 1980s ......................................................................................................................... 56
1990s ...................................................................................................................................... 58
2000 – 2009 ........................................................................................................................... 61
2010 – 2021 ........................................................................................................................... 63
Research Question 2: Formal System Contact Over Time ....................................................... 66
1970s / 1980s ......................................................................................................................... 67
1990s ...................................................................................................................................... 68
2000 - 2009 ............................................................................................................................ 69
2010 - 2021 ............................................................................................................................ 71
vi
Research Question 3: Circumstances of Most Recent Exit from Trafficking ........................... 72
1970s / 1980s ......................................................................................................................... 73
1990s ...................................................................................................................................... 76
2000 – 2009 ........................................................................................................................... 78
2010 – 2021 ........................................................................................................................... 80
CHAPTER 4: DISCUSSION ........................................................................................................ 84
Understanding Experiences in the Sex Industry Over Time ..................................................... 84
Formal System Contact Over Time ........................................................................................... 86
Circumstances of Most Recent Exit from Trafficking .............................................................. 87
Limitations of this Study and Directions for Future Research .................................................. 90
Implications for Policy & Practice ............................................................................................ 95
Conclusion............................................................................................................................... 100
APPENDICES ............................................................................................................................ 101
Appendix A. Researcher Characteristics and Reflexivity Statement ...................................... 102
Appendix B. Recruitment Script ............................................................................................. 104
Appendix C. Interview Protocol.............................................................................................. 105
Appendix D. LHC Protocol ..................................................................................................... 126
REFERENCES ........................................................................................................................... 127
vii
LIST OF TABLES
Table 1. Adapted Socioecological Model for Exiting from Sex Trafficking ................................13
Table 2. Research Questions and Corresponding Ecological Levels ............................................26
Table 3. Interview Items with Corresponding Research Question ................................................37
Table 4. Sex industry-related demographics - Full sample............................................................47
Table 5. Sex Industry-related Demographics by Cohort ...............................................................50
Table 6. Sample Demographics. ....................................................................................................53
Table 7. Sex Industry Identity Visual Coding Key ........................................................................54
Table 8. Simultaneous Sex Industry Identities Visual Coding Key...............................................55
Table 9. Formal System Visual Coding Key .................................................................................66
Table 10. LHC Protocol ...............................................................................................................126
viii
LIST OF FIGURES
Figure 1. Example of Visual Timeline for Participants’ Sex Trade Identities...............................40
Figure 2. Example of Visual Timeline for Participants’ Formal Service Engagement .................42
Figure 3. Example of Visual Timeline of Circumstances Around Participants’
Most Recent Exit............................................................................................................................43
Figure 4. Conceptualizations of Identities for Participants Who Entered the Sex Industry
in the 1970s and 1980s ...................................................................................................................57
Figure 5. Conceptualizations of Identities for Participants Who Entered the Sex Industry
in the 1990s ....................................................................................................................................60
Figure 6. Conceptualizations of Identities for Participants Who Entered the Sex Industry
Between 2000 and 2009. ................................................................................................................62
Figure 7. Conceptualizations of Identities for Participants Who Entered the Sex Industry
Between 2010 and 2021 .................................................................................................................65
Figure 8. Formal Systems Contact for Participants Who Entered the Sex Industry
in the 1970s and 1980s. ..................................................................................................................67
Figure 9. Formal Systems Contact for Participants Who Entered the Sex Industry
in the 1990s. ...................................................................................................................................69
Figure 10. Formal Systems Contact for Participants Who Entered the Sex Industry
Between 2000 and 2009 .................................................................................................................70
Figure 11. Formal Systems Contact for Participants Who Entered the Sex Industry
Between 2010 and 2021 .................................................................................................................71
Figure 12. Exiting Circumstances for Participants Who Entered the Sex Industry
in the 1970s and 1980s. ..................................................................................................................74
Figure 13. Exiting Circumstances for Participants Who Entered the Sex Industry
in the 1990s ....................................................................................................................................76
Figure 14. Exiting Circumstances for Participants Who Entered the Sex Industry
Between 2000 and 2009 .................................................................................................................79
Figure 15. Exiting Circumstances for Participants Who Entered the Sex Industry
Between 2010 and 2021 .................................................................................................................81
ix
INTRODUCTION
In the United States, sex trafficking is “the recruitment, harboring, transportation,
provision, or obtaining of a person for the purposes of a commercial sex act†or “in which the
person induced to perform such an act has not attained 18 years of age†(Trafficking Victims
Protection Act, 2000). Victims of this crime are often hidden in plain sight in communities,
which makes it challenging to determine the exact number of people affected (Bales et al., 2020;
Di Nicola, 2007; Farrell & Reichert, 2017). However, increased awareness and identification of
this crime has resulted in a consistent increase in reports or tips made to the National Human
Trafficking Hotline since 2015 (NHTRC, 2019). Although the exact number of trafficking
survivors is unknown, studies consistently show that thousands of individuals are being sexually
exploited or trafficked in the United States, and that survivors need extensive services and
support to rebuild their lives. For example, survivors of sex trafficking experience many health
and well-being problems as a consequence of being trafficked, such as substance use disorders,
mental health problems, housing instability, and financial insecurity (Baker & Grover, 2013;
Lederer & Wetzel, 2014; Lynch & Mason, 2014; Muftic & Finn, 2013; Turner-Moss et al.,
2014). These needs must be addressed to help survivors recover upon their escape.
Leaving or escaping from sex trafficking is not without its challenges. The hidden nature
of trafficking isolates many survivors from interpersonal and economic resources necessary for
rebuilding their lives (Barner et al., 2018; Hopper, 2017; Salami’ et al., 2021). Survivors must
seek out multiple service providers and organizations to address the diverse needs they
experience after leaving their trafficking situation (Powell et al., 2018). In response, sex
trafficking-specific organizations have opened to provide comprehensive wrap-around services
to address survivor needs in one place and support their exit from trafficking.
1
Most research on exiting sex trafficking has focused on individual-level factors and
examined how internal motivations, challenges, and factors are associated with a person’s
attempts to exit sex trafficking (Eldridge, 2017; Gonzalez et al., 2019; Hammond & McGlone,
2014; Hickle, 2017; Wilson, 2014). Although the literature addresses why survivors leave sex
trafficking, there is still little research on how survivors do this. Given the coercive and abusive
nature of the relationship survivors have with their traffickers, there are many barriers to exiting
and survivors often make several attempts to leave (Eldridge, 2017). This study was an in-depth
examination of the process of leaving sex trafficking to understand how survivors navigate this
process over time using formal systems and support.
2
CHAPTER 1: LITERATURE REVIEW
To contextualize the current study on how survivors exit sex trafficking, this literature
review begins with a brief discussion of sex trafficking and exploitation within the context of the
sex industry. Then, I discuss the factors that put individuals at risk of being trafficked and how
these factors affect their entry into trafficking and exploitation. I also review the conditions
survivors face as a result of being trafficked within the United States. Finally, I use Ecological
Systems Theory as a framework to conceptualize the contextual factors associated with
survivors’ decisions and ability to exit from sex trafficking.
Defining Sex Trafficking
The sex industry encompasses diverse experiences among diverse individuals. Within the
sex industry there are many different terms to refer to the act of exchanging sex for resources
depending on the context, reasons, and circumstances under which these acts occur. For
example, trading sex is a term often used to describe a situation where a sexual act or service is
traded for something of value such as food, clothing, shelter. Survival sex builds upon this
circumstance to describe a situation where a person must trade sex to meet their basic needs for
survival (McMillan et al., 2018). Trading sex and survival sex might occur in similar ways in
some circumstances and may also include or lead to commercialized forms of prostitution.
Prostitution is legally defined as “a sexual act or contact with another person in return for giving
or receiving a fee or a thing of value†and is criminalized in the United States except for some
counties in Nevada (U.S. Department of Justice, 2014). The term sex work describes a situation
that “involves the exchange of sexual services, performances, or products for material
compensation†and situates the exchange of sex as a legitimate profession (Weitzer, 2000, p. 1).
Overall, these terms describe the range of experiences within the sex industry that may be similar
3
in circumstance but can be difficult to distinguish through terminology in theoretical, legal, and
practical settings.
There are ongoing theoretical debates among scholars over whether sex work or
prostitution can exist as an agentic form of employment (see Gerassi, 2015a for review). One
school of thought, the Neo-abolitionists or radical feminists, argues that prostitution cannot be a
truly agentic choice as a form of labor since it is situated within patriarchal and oppressive
systems that commodify, abuse, and exploit female and gender non-binary bodies
disproportionate to male bodies (Farley, 2005). The other main argument comes from sex
positivists or liberal feminists who argue that it should be an individual’s choice to trade sex as a
means of generating income (Russell & Garcia, 2014). Although these theoretical arguments are
still ongoing in sex industry scholarship, recent research finds that individuals view their sex
trading identities on a continuum rather than a dichotomous conceptualization of forced
exploitation or free-will agency (Gerassi, 2020). Furthermore, individuals who trade sex
sometimes take ownership of their sex trading identities and see them as distinct experiences
(Gerassi et al., 2019; Oselin, 2014). These identities and experiences within the sex industry are
not stagnant and can change over time (Lutnick, 2016, p.40). For example, an individual who
trades sex may initially do so willingly (with or without third party involvement) for a certain
amount of time, and can also experience instances where coercive control or violence is involved
in their sex trading. Although sex trading can be an agentic, deliberate decision made by some,
there is a possibility for exploitation to occur when individuals who trade sex feel as though they
have no choice, have few economic resources, do not like their situation, or are being forced to
engage in sex work (Lutnick, 2016, p.14).
4
Any commercial sex act involving a person under the age of 18 or when someone is
forced to engage in commercial sex against their will it is considered sex trafficking (Trafficking
Victims Protection Act, 2000). Under the federal definition, sex trafficking or sexual exploitation
is “the recruitment, harboring, transportation, provision, or obtaining of a person for the purposes
of a commercial sex act†or “in which the person induced to perform such an act has not attained
18 years of age†(Trafficking Victims Protection Act, 2000). Sex trafficking is a well-hidden
crime and individuals that are being sexually exploited are often in plain sight throughout
communities (Di Nicola, 2007). Due to the hidden nature of this crime, exact prevalence rates are
difficult to calculate and are methodologically limited (Bales et al., 2020; Di Nicola, 2007;
Farrell & Reichert, 2017). Although there are not consistent statistics about the exact number of
people trafficked in the United States each year, tips made to the National Human Trafficking
Hotline have increased steadily from 5,714 tips in 2015 to 11,500 in 2019, which suggests
awareness and identification of this crime have increased (NHTRC, 2019).
Entry into Sex Trafficking
As with other forms of sexual and physical violence, one’s social location influences
their risk of being trafficked (Bryant-Davis & Tummala-Narra, 2017; Chong, 2014). A person’s
social location is comprised of their position within social systems such as socioeconomic status
(SES), race/ethnicity, gender identity, sexual orientation (Kubiak, 2005; Pearlin, 1989). Racism,
ethnic bias, and oppression are connected to limited resource access and can make individuals
more vulnerable to being trafficked (Bryant-Davis & Tummala-Narra, 2017). Lack of safe
housing, gainful employment, legal protection, and education increases a person’s risk of being
trafficked (Lutnick, 2016; Macias-Konstantopoulos & Ma, 2017). A person’s risk of being
trafficked is further increased when these systemic factors intersect with individual-level factors,
5
such as prior abuse, poverty, and stigma (Bryant-Davis & Tummala-Narra, 2017; Macias-
Konstantopoulos & Ma, 2017). For example, a person’s age is a risk factor for being trafficked
as many survivors were recruited into trafficking before the age of 18 (Cole et al., 2016; Roe-
Sepowitz et al., 2014). This risk is exacerbated for girls and lesbian, gay, bisexual, transgender,
queer and/or questioning, intersex, and asexual (LGBTQIA+) youth who are at an even higher
risk of being trafficked for sex (Boukli & Renz, 2019; Martinez & Kelle, 2013). Taken alone, the
systems of oppression associated with these social identities pose risks for individuals but their
intersections, what comprise a person’s social location, make members of marginalized groups
even more vulnerable to trafficking.
Every survivor of sex trafficking belongs to multiple social identity groups that work
together to shape their daily interactions and trafficking experience (Twis & Preble, 2020).
Intersectionality theory posits that social identities are nested within systems of oppression that
are dependent on another (Crenshaw, 1991; Moradi, 2017; Moradi & Grzanka, 2017). When
examining identities within the context of a complex social issue, such as sex trafficking, it is
important to note that some social identities are more salient than others depending on the
individual and their particular experiences (Hill-Collins & Bilge, 2016; Robertson & Sgoutas,
2012). The combinations and intersections of multiple identities influence survivors’ trafficking
experience, consequences, and the ways they address their needs upon leaving their trafficking
situation (Bryant Davis & Tummala-Narra, 2017; Twis & Preble, 2020).
Challenges Associated with Sex Trafficking
Sex trafficking survivors have diverse and complex needs that affect their physical
health, mental health, and other aspects of their lives (Gerassi, 2015b; Lederer & Wetzel, 2014;
Powell et al., 2018). Most sex trafficking survivors suffer from physical health issues while
6
being trafficked that continue after they leave their trafficking situation (Lederer & Wetzel,
2014; Varma et al., 2015). These problems are often compounded for survivors with
marginalized social and cultural identities due to a disproportionate lack of resource access prior
to being trafficked and as they seek formal services (Bryant Davis & Tummala-Narra, 2017).
Survivors’ health conditions frequently go untreated unless the injury or condition is severe
enough to affect their ability to provide income for their trafficker (Lederer & Wetzel, 2014;
Muftic & Finn, 2013; Turner-Moss et al., 2014). As a result of being trafficked, survivors are
forced to seek treatment for sexually transmitted infections (STIs), unwanted pregnancies,
physical injuries, and overall poor health (Varma et al., 2015). Substance use disorders (SUD)
are extremely prevalent among sex trafficking survivors (Lederer & Wetzel, 2014; Muftic &
Finn, 2013; Cole et al., 2016). In addition, domestic trafficking victims have higher rates of drug
and alcohol abuse than international trafficking victims, which increases with the length of time
they spend in the sex industry (Muftic & Finn, 2013).
Survivors experience high rates of psychological problems such as depression, suicidal
ideation, addiction, anxiety, and post-traumatic stress disorder (PTSD) associated with their
experience of sex trafficking (Hickle & Roe-Sepowitz, 2014; Lederer & Wetzel, 2014; Muftic &
Finn, 2013; Sabella, 2011). In one study, 96% of survivors who exited their sex trafficking
situation reported an average of ten psychological problems with the most commonly reported
being depression, shame/guilt, flashbacks, and PTSD (Lederer & Wetzel, 2014). These
psychological symptoms and disorders are often worse for racially and ethnically marginalized
survivors due to the stigma both within and outside their cultural communities associated with
being trafficked (Bryant-Davis & Tummala-Narra, 2017).
7
In addition to psychological disorders, survivors also encounter numerous interpersonal
psychological challenges as a result of being trafficked (Bruhns et al., 2018; Gerassi et al., 2018).
For example, service providers indicated that many of the survivors they encounter have low
self-esteem, feelings of shame or guilt, and a general sense of fear (Gerassi et al., 2018). In
addition, feeling a sense of isolation and loneliness after being trafficked affects many survivors’
personal relationships and connections to their community (Bruhns, et al., 2018). For survivors
to reconcile other needs throughout their recovery, both psychological and interpersonal mental
health challenges must be addressed and done so in a way that incorporates racial and cultural-
specific practices when appropriate (Bryant-Davis & Gobin, 2019; Bryant Davis & Tummala-
Narra, 2017).
Safe and stable housing is one of the most immediate needs a survivor has after exiting
their trafficking situation (Aron et al., 2006; Baker & Grover, 2013; Clawson et al., 2009).
However, this is also one of the most challenging needs to address for this population given
some of the health conditions survivors experience. For example, substance use disorders and
relapse often exclude survivors from being able to access services or stay in shelters and is a
reason survivors may disengage from services (Clawson & Grace, 2007; Gerassi, 2020). The
process of finding stable housing is even more challenging for survivors who may not have had a
source of income to obtain basic needs prior to being trafficked. Survivors of sex trafficking will
typically need to obtain legal employment and many indicate that finding gainful employment is
a more important and immediate need than mental healthcare (Lynch & Mason, 2014). However,
survivors may not have the education, job training, and basic life skills necessary to obtain and
maintain gainful employment and/or have felony convictions on their criminal record that
disqualify them from employment (Bryant-Davis & Tummala-Narra, 2017; Cole et al., 2016;
8
Johnson, 2012). In addition, the T-visa process can also affect survivors’ ability to obtain
employment because legal immigration status is necessary for international trafficking survivors
(Aron, 2006; Health & Human Services USA, 2012). Therefore, when survivors exit their
trafficking situation, they must often navigate the help-seeking process in a way that addresses
their housing, legal, and employment needs simultaneously.
Exiting Sex Trafficking
Previous research on the exiting process reveals that there are numerous factors that
contribute to a survivor’s decision and ability to leave their sex trafficking situation. Because the
process of exiting sex trafficking is multi-faceted, it is necessary for researchers to use a
theoretical model that can guide inquiry at multiple levels of analysis. One model that has been
used in research on other forms of sexual violence is ecological systems theory (Campbell et al.,
2009). Ecological systems theory was established by developmental psychologist, Urie
Bronfenbrenner, to explain the multiple forces that influence a person’s development
(Bronfenbrenner, 1979). This theory moves beyond the individual as the unit of analysis and
takes other environmental elements, such as interpersonal interactions and cultural norms, into
account to provide a more wholistic interpretation of a person’s experience.
These additional environmental factors are divided into ecological levels that build upon
and influence each other. According to Bronfenbrenner (1979), the first level of analysis within
this theory is the individual. This level includes individual characteristics of a person such as
age, race/ethnicity, socioeconomic status, and personality characteristics. The next level is the
microsystem which is comprised of the settings and interactions in which individuals directly
participate. This level refers to informal interpersonal connections, such as friendships, family,
school, and neighborhood, as well as formal connections such as interactions with providers at
9
social service agencies and community organizations. The mesosystem refers to interactions
between microsystems, such as between an individual’s family, peers, and workplace. This level
can also include interactions between different community systems or service providers with
whom an individual interacts. The exosystem is the first ecological level where an individual
does not directly participate, but still feels the impact it has on the other parts of their life. This
level consists of formal systems, such as local and federal government, and the policies or
decisions that indirectly affect the individual. The macrosystem represents the societal and
cultural beliefs, systems, and norms. The chronosystem accounts for the changes over time
between an individual and their environment. This can include developmental changes across the
lifespan or the impact major life events have on a person’s subsequent experiences and world
view (e.g., experiencing a traumatic event).
Ecological systems theory has been adapted to underscore the importance of multilevel
interventions and aftercare for when survivors exit sex trafficking (Barner, et al., 2018; Hopper,
2017; Salami’ et al., 2021). Various models have been adapted to conceptualize specific
interventions to address the mental health and overall well being of survivors post-exit (Barner,
et al., 2018; Hopper, 2017) and how those factors may differ based on cultural influences and
social identities (Salami’ et al., 2021). Likewise, the process of exiting from trafficking can also
be conceptualized from multiple ecological levels. The process of engaging with the individual
level interventions described above during the exiting process is shaped by the dynamic interplay
of factors at multiple levels. These factors can influence survivor’s decisions about and ability to
engage with formal services as part of their exit from sex trafficking. Using an adapted version
of the socioecological model (Table 1), I present 1) a description of each ecological level as it
10
pertains to the process of exiting sex trafficking and 2) the factors associated with exiting
trafficking at these levels based on extant literature.
The Individual level of this adapted model includes individual motivators, challenges,
and factors associated with a person’s attempts to exit sex trafficking. This level also includes
internalized feelings and mentality about readiness or ability to exit and a person’s appraisal of
how to define their involvement in the sex industry (e.g., sex trading, prostitution, sex
trafficking, etc.). For example, stigma and shame were key individual-level barriers that
prevented or deterred survivors from leaving their trafficking situation and seeking support
(Eldridge, 2017; Wilson, 2014). Alternatively, strong internalized feelings of empowerment and
sense of self facilitated survivors to act upon their desire to exit (Hickle, 2017). Some survivors
may not recognize that they were victims rather than offenders or that their situation is
considered sex trafficking. Additionally, some survivors may not identify their situation as sex
trafficking at all. In turn, survivors may be less likely to engage with formal services upon exit
(Eldridge, 2017). Exhaustion from being trafficked and the overall danger of being in the life of
trafficking was a catalyst for survivors to contemplate and initiate their exit (Gonzalez et al 2019;
Hammond & McGlone, 2014). Becoming sober from substances and addressing other medical
and mental health concerns also drove survivors to exit trafficking (Cecchet & Thoburn, 2014;
Gonzalez et al., 2019). In particular, becoming pregnant was cited often as a strong motivator for
women to exit sex trafficking (Cecchet & Thoburn, 2014; Corbett, 2018; Eldridge, 2017;
Gonzalez et al., 2019).
The Microsystem involves the informal and formal interpersonal relationships. The
informal interpersonal relationships at this level are the interactions survivors have with friends,
family members, and peers that affect their decision and ability to exit sex trafficking. Informal
11
interpersonal facilitators to exiting were social support from other survivors who exited and
developing a network of social connections (Hickle, 2017). Survivors feeling connected to their
trafficker (i.e., viewing them as a romantic partner) was an interpersonal barrier to exiting
(Preble & Black, 2020). Informal interpersonal barriers between a survivor and their trafficker
are also dependent on how a survivor views the legitimacy of the power a trafficker holds over
them which can be affected but the gender of the trafficker and the length of their relationship
with the survivor (Preble & Black, 2020). This level also involves the interactions survivors have
with providers at organizations and systems that they engage with during the process of exiting
including medical systems, law enforcement agencies, (community) mental health systems,
nonprofits, and human services. Whether a survivor’s exit was assisted or not also factors into
the microsystem, particularly when they are assisted by law enforcement via stings, raids, or
arrest (Corbett, 2018; Preble & Black, 2020; Wilson, 2014). Although law enforcement
involvement and assistance often connects survivors to much needed services (Connell et al.,
2015), the power dynamics and distrust in the interpersonal relationships between officers and
survivors plays a large role in the exiting process (Corbett, 2018; Preble & Black, 2020; Wilson,
2014).
12
Table 1. Adapted Socioecological Model for Exiting from Sex Trafficking
Level Description Factors
The individual motivators, • Stigma / Shame (Eldridge, 2017; Wilson, 2014)
challenges, and factors associated • Exhaustion from being in the life of trafficking
with a person’s attempts to exit sex (Hammond & McGlone, 2014)
trafficking. This level also includes • Naming their experience as sex trafficking (Eldridge,
internalized feelings and mentality 2017)
Individual
about readiness or ability to exit and • Pregnancy (Cecchet & Thoburn, 2014; Corbett, 2018)
a person’s appraisal of how to define • Substance use disorders (Gonzalez et al., 2019)
their involvement in the sex industry • Overall medical and mental health (Cecchet & Thoburn,
(i.e., sex trading, prostitution, sex 2014)
trafficking, etc.). • Dangers of being in the life (Gonzalez et al., 2019)
Informal:
The interpersonal relationships and • Social support / networks (Hickle, 2017)
interactions with friends, family • Interpersonal or romantic relationships with trafficker
members, and peers that affect a (Preble & Black, 2020)
person’s decision and ability to exit • Power dynamics with trafficker (Preble & Black, 2020)
Microsystem sex trafficking.
Formal: • Medical systems, Law enforcement agencies,
The interactions with providers at (community) mental health systems, nonprofits, human
organizations and systems survivors services
engage with during the process of • If exit was externally assisted or was done themselves
exiting. (Corbett, 2018; Preble & Black, 2020; Wilson, 2014)
The connections between • Coalitions or task forces
Mesosystem organizations that link systems • Referrals networks among organizations (Connell et al.,
together. 2015; Corbett, 2018)
13
Table 1. (cont’d)
Level Description Factors
• Treating survivors as criminals (i.e., prostitution
charges) rather than victims due to lack of awareness and
policies (Rajaram & Tidball, 2018)
Community resources and • Misconceptions about who can be a victim of sex
awareness about sex trafficking. trafficking and the “perfect victim†narrative particularly
Exosystem This level also encompasses the in relation to prostitution or sex work (Gerassi et al,
policies regarding de/criminalization 2019; Rajaram & Tidball, 2018)
of the sex trade industry. • Providers who are uninformed about trafficking may
criminalize survivors or send them back to their
traffickers (Lederer & Wetzel, 2014; Rajaram & Tidball,
2018)
• Racism / Sexism / Heterosexism (Preble & Black,
2020; Wilson, 2014; Wilson & Butler, 2014)
• Prevalence of assisted exits from sex trafficking (e.g.,
Cultural and societal influences that
law enforcement stings / raids) (Preble & Black,
affect a person’s ability, decision,
Macrosystem 2020; Wilson, 2014)
and satisfaction with their exit route
• Distrust of law enforcement / authority (Eldridge,
from sex trafficking.
2017; Preble & Black, 2020)
• Policing prostitution and sex trafficking (Farrell &
Cronin, 2015)
The factors and events that occur • Leaving is not a single event, it’s an iterative process
Chronosystem over time that affect a person’s (Eldridge, 2017)
exiting process. • Cumulative trauma and experiences across lifespan
14
The Mesosystem consists of the connections between organizations that link systems
together. Relevant factors at this level are whether organizations and services exist in the
community to serve survivors, and survivors’ appraisal of the availability and relevance of these
services to meet their needs (Eldridge, 2017). This level also includes the referral networks
between systems and organizations to get survivors the comprehensive care they need and can
also include sex trafficking task forces and coalitions who collaborate to coordinate services
(Connell et al., 2015; Corbett, 2018; Powell et al., 2018). The Exosystem refers to community
resources and awareness about sex trafficking. Lack of awareness and misconceptions about sex
trafficking in the community creates barriers for survivors throughout their process of exiting,
including not being believed in their community or being treated by providers as if their
experiences were identical to sexual assault or IPV (Rajaram & Tidball, 2018). This level also
encompasses the policies regarding de/criminalization of the sex trade industry. Survivors of sex
trafficking are often treated as criminals rather than being seen as victims by law enforcement
despite legislation condoning this practice (Farrell & Cronin, 2015; Rajaram & Tidball, 2018).
Lack of training and awareness on how to identify coercion and exploitation in sex trafficking
survivors’ experiences means that providers can mistakenly criminalize survivors and even send
them back to their traffickers as they attempt to exit (Lederer & Wetzel, 2014; Rajaram &
Tidball, 2018).
The Macrosystem includes cultural and societal influences that affect a person’s ability,
decisions, and satisfaction with their exit route from sex trafficking. As with the factors that
make individuals particularly vulnerable to sex trafficking, systemic oppressions, including
racism, sexism, and heterosexism plays a role in a person’s exit from sex trafficking and how
they are treated immediately after (Bryant-Davis & Tummala-Narra, 2017). Societal factors may
15
influence the ways survivors are removed from their trafficking situations and/or connected to
services. For example, in one study, about half the survivors in the United States (US)-based
sample exited by themselves and about half exited through external interventions, such as stings
or raids, suggesting that law enforcement intervention is a likely event when exiting sex
trafficking (Wilson, 2014). However, Preble & Black (2020) identified that survivors had an
overall distrust of law enforcement which, in turn, affected their perceptions of other individuals
in places of authority such as social service providers. This underlying view of institutional
distrust affected survivors’ perceived sense of power upon exiting their trafficking situation.
The Chronosystem examines the factors and events that occur over time that affect a
person’s exiting process. This includes the cumulative effects of factors at all other ecological
levels throughout a survivor’s trafficking experience and their attempts at exiting. In a qualitative
study conducted with nine survivors, Eldridge (2017) found that exiting from sex trafficking is
not an isolated event, but rather a process that involves a series of attempts (Eldridge, 2017).
Survivors noted that being physically removed from their trafficking situation did not necessarily
mean they exited sex trafficking, and many went back into sex trafficking either because of their
trafficker or because of unaddressed substance use disorders. A major barrier survivors
experienced when trying to fully exit sex trafficking was the misunderstanding and
misidentification of their situation. That is, many participants did not identify with being a victim
or survivor and were made to believe that they chose to be abused and trafficked and therefore,
felt powerless to change their situation (Eldridge, 2017). However, all participants noted that,
over time, a person can change their understanding of their identity and agreed that "a survivor of
sex trafficking is someone who is fully out of the trafficking situation and who is on their road to
healing" (Eldridge, 2017).
16
Rethinking Exit from Sex Trafficking
Although recent findings suggest that exit from sex trafficking is a process consisting of
multiple attempts, there is little research that describes the process by which survivors are able to
leave their trafficking situations successfully and permanently. To address this gap, research on
the process of exiting sex trafficking should aim to understand how survivors leave, not just why
they decide to leave. Motivations for leaving and interpersonal strengths and challenges are at
the individual level, however, the reasons why a person may want or be able to leave are also
influenced by contextual factors that are part of their trafficking experience and environment
over time (Eldridge, 2017). Therefore, understanding how survivors navigate these contextual
factors and logistics can shed light on the systemic, structural conditions that must be addressed
to make the process of leaving trafficking less burdensome for survivors while simultaneously
taking their social location into account. This approach has been studied in related literature on
how survivors in coercive, abusive intimate partner relationships leave their abuser.
Although scholars have theorized about the intrinsic motivations and the iterative process
of exiting prostitution and sex work (Baker et al., 2010; Cimino, 2012; Oselin, 2010; Oselin,
2014; Preble et al., 2019), to frame this study I drew upon literature on the process of leaving
intimate partner violence (IPV) given a) the similar coercive, abusive relationship dynamics
inherent in most trafficker/victim relationships,1 and b) the similar methodological approaches
this body of literature utilizes to examine the process of leaving IPV over time (e.g., the Life
History Calendar). Research on the “process of leaving†intimate partner violence also supports
that leaving coercive, abusive situations is not a singular event and requires multiple attempts
1
The IPV literature I will be drawing upon in this review has been primarily, though not exclusively, focused on
cisgender women’s experiences with cisgender men in violent relationships.
17
(Anderson & Saunders, 2003; Keeling et al., 2016; Storer et al., 2018). Similar to literature on
exiting sex trafficking, much of the research on the process of leaving IPV has focused on the
individual level, namely internal cognitive processes and preparation (Anderson & Saunders,
2003; Khaw & Hardesty, 2007). However, research on the preparation stages for leaving are
more established in the IPV literature than in research on exiting sex trafficking. Much of the
IPV research examines a person’s readiness to leave their abusive partners, how they appraise
their situation, and the strategies people use to ultimately leave their partners and stay out of the
relationship (Anderson & Saunders, 2003; Keeling et al., 2016; Overstreet & Quinn, 2013).
Recent research has also shown that women engage in varying types of preparation during the
initiation of the leaving process. For example, in a study conducted by Bermea and colleagues
(2020), all mothers who were interviewed for the study indicated they did some form of mental
preparation as they began to consider leaving their abusive partner, often by emotionally
distancing themselves. Some of these women engaged in active planning strategies such as
saving money, making a safety plan and/or keeping important documents hidden, whereas other
mothers skipped active planning and went directly to leaving after mental preparation (Bermea et
al., 2020). An additional individual-level factor that influences planning during the process of
leaving is a woman’s age (Keeling et al., 2016). In a study conducted by Keeling and colleagues
(2016), researchers found that midlife women (ages 40 – 55) moved in a rapid and linear motion
through the process of leaving their abusive partners. That is, the time between a midlife
woman’s decision to break free from her relationship and her leaving was short and they were
less likely to make multiple attempts at leaving their partner (Keeling et al., 2016). Researchers
posit that midlife women have less familial obligations to consider while leaving an abusive
18
partner whereas younger women may be more likely to make multiple attempts at leaving
because they have young children to care for (Keeling et al., 2016).
Although earlier research has largely focused on individual-level factors, researchers
have since attended to the influence of external factors and examined the process of leaving from
other ecological levels. First, the presence of positive social support is an interpersonal factor
during a woman’s process of leaving her abuser (Anderson & Saunders, 2003; Barrios et al.,
2020; Khaw & Hardesty, 2009). Given the isolation that is inherent in most abusive
relationships, some women do not have the personal relationships to assist them in leaving
(Anderson & Saunders, 2003; Keeling et al., 2016; Storer et al., 2018). However, advocacy
interventions have been developed to build social support between survivors and advocates while
also connecting them to community resources (see Ogbe et al., 2020 for review). These advocacy
interventions have been shown to strengthen interpersonal relationships as survivors navigate the
process of leaving and improve their well-being over time (Beeble et al., 2009; Sullivan &
Goodman, 2019). Interpersonal and cultural barriers also intersect with a woman’s
socioeconomic status during the process of leaving (Barrios et al., 2020). In general, women with
more access to economic resources have less logistical barriers when trying to leave their abuser
(Barrios et al., 2020; Lacey et al., 2011). However, even though these women have fewer
logistical barriers, they can still face stigma, cultural, and lifestyle factors that deter them from
leaving their husbands (Barrios et al., 2020). Women also face community and system-level
factors during their process of leaving, often when they engage with formal services (Barrios et
al., 2020; Overstreet & Quinn, 2013). For example, survivors can experience interpersonal
stigma during negative interactions with individuals working within the formal systems they
access upon leaving their abuser, such as the legal system, law enforcement, or human services
19
(Overstreet & Quinn, 2013). These stigmatized experiences also connect to systemic factors that
affect a woman’s decision and ability to leave their spouses when legal matters, such as divorce
and child custody, are involved (Barrios et al., 2020). Racial identities and systemic racism also
influence these interactions and impacts a person’s process of leaving their abuser. For example,
in some cases, women of color refuse to formally engage with police due to the perpetuation of
racial stereotypes, distrust in the system, and/or concerns of being revictimized (Barrios et al.,
2020; Lacey et al., 2011; Storer et al., 2018).
Kennedy and colleagues (2012) built upon the work examining the process of leaving
IPV to create a theoretical framework of help-seeking and engaging with formal services. This
framework not only incorporates factors at multiple ecological levels but also acknowledges the
cumulative experiences of seeking help from formal supports over time and the effect this has on
a survivors’ recovery. For example, victimization is rarely a single event, and occurs over time
and its effects accumulate differently and disproportionately based on a person’s social location
(Kennedy et al., 2012). In turn, the ways in which victimization intersects with factors at each
ecological level affects a person’s appraisal of the formal help-seeking options available to them
and their decision to utilize those services. Most importantly, this framework emphasizes that
accessing formal help over time is an iterative process that can facilitate cumulative positive
outcomes for individuals when leaving their abusive partners (Kennedy et al., 2012).
The process of exiting sex trafficking, like the process of leaving IPV relationships, is
one that unfolds over time and is affected by multiple, cumulative, and intersecting factors. Yet
little is known about exiting sex trafficking as a process beyond physical removal from the
trafficking situation. Much of the research on exiting from sex trafficking is situated at the
individual level. However, research on the process of leaving IPV relationships underscores the
20
influence of factors at other ecological levels. Further, models of help-seeking during the process
of leaving IPV emphasizes the iterative nature of accessing formal services while leaving IPV.
Therefore, exiting from sex trafficking must be conceptualized as an ongoing process leading up
to a person’s final, sustained exit from their trafficking situation.
The Current Study
To study the process of exiting sex trafficking, it is ideal to ask survivors about their
experiences directly to capture the complexity and nuance associated with the process. However,
given the hidden nature of sex trafficking, survivors are often difficult to identify and engage
with to conduct research. One way to address this challenge is to recruit survivors who are
connected to organizations or service providers that work with trafficking survivors (Gerassi, et
al., 2017). Survivors have diverse needs that often cannot be met at one organization alone,
which requires them to navigate a patchwork of care across multiple organizations (Powell et al.,
2018). To address this challenge, online professional networks of service providers have been
developed to encourage referral networks and information sharing. In addition, specialized sex
trafficking organizations have been created to provide comprehensive, wrap-around services to
address survivors’ needs at multiple ecological levels. These online communities and service
organizations can be useful research partners because they have direct contact with survivors and
work with them throughout the process of leaving sex trafficking.
Studying the process of leaving sex trafficking also requires a research methodology that
is designed to truly capture a dynamic process over time. Although survivors may eventually
access services upon exiting their trafficking situation, it may not be the first or last time they do
so given the persistent and ongoing needs they experience during their time in the sex industry
and the iterative nature of the exiting process. Therefore, to understand the exiting process in its
21
entirety, data collection should focus on all efforts survivors make to leave their situation,
leading up to their most recent exit. The Life History Calendar (LHC) methodology is a useful
approach to study this dynamic process over time.
The Life History Calendar (LHC)
The LHC is a method designed to encourage a narrative approach to data collection by
having participants retrospectively recall events from their life (Freedman et al., 1988). The LHC
method was developed as a response to the growing interest in conducting life-course research
that examines the dynamic growth and change individuals experience throughout their lives
(Freedman et al., 1988). This method captures data from numerous years of a participant’s life by
identifying and mapping their key life events and other life domains, such as age, employment,
and relationships, on a calendar. This process helps participants’ memory in recalling other
detailed information related to the research study, and allows researchers to gather reliable,
retrospective data from multiple years of a person’s life (Belli & Callegaro, 2009).
Although the LHC is administered similarly across studies, the domains that are included
vary based on the demographics of the sample and the research questions being examined. These
domains represent factors that can co-occur and affect participants’ lives simultaneously, such as
their age, where they live, and their employment (Belli & Callegaro, 2009). The purpose of
including these domains is to provide additional context for memory retrieval during data
collection (Belli & Callegaro, 2009). In this way, the LHC method is a flexible process to help
participants accurately recall their memories and answer interview questions.
The LHC often serves as the first part of the data collection process and is followed by
structured or semi-structured interview protocols (Belli & Callegaro, 2009). When using this
method, interviewers co-construct a physical copy of the LHC with participants and have it in
22
their view throughout the subsequent semi-structured interview (Freedman et al., 1988). Having
the LHC visible during the entire interview helps collect accurate data on other measures by
serving as a reference for the participant when providing responses (Freedman et al., 1988). In
addition, the process of creating the calendar in collaboration with the researcher, particularly
during qualitative interviews, also helps to establish rapport and empower the participant to take
ownership of their narrative and the data collection process (Nelson, 2010).
LHC Strengths and Previous Applications with Qualitative Interviews
The LHC method has practical and methodological benefits. LHC provides a cost-
effective alternative approach to longitudinal data collection (Freedman et al., 1988). The risk of
attrition in longitudinal studies is a methodological challenge, especially when conducting
research with already hard-to-reach populations, such as sex trafficking survivors (Hayes, 2018).
In addition, this method can be adapted into online applications and produce more reliable data
than traditional online survey formats, thus providing an opportunity to reach more participants
(Morselli et al., 2016). The LHC has also been used with smaller samples to obtain in-depth data
to answer qualitative research questions (Nelson, 2010; Rimkeviciene et al., 2016). Conducting
the LHC in qualitative interviews allows participants to describe their experiences in a narrative
approach and showcases the dynamic ways different contexts, events, and social identities shape
their experiences over time (Hayes, 2018; Nelson, 2010).
The LHC has been particularly useful for studying the dynamic nature of IPV and the
process of leaving (Hayes, 2018). The most popular way the LHC is utilized by IPV researchers
is to determine the frequency of victimization participants experience in violent intimate partner
relationships throughout their life (Kennedy et al., 2018; Kennedy et al., 2017; Yoshihama et al.,
2005). Participants who experienced IPV were able to recall more instances of abuse, even when
23
they occurred earlier in their lifetime, when using the LHC method as compared to those who
were asked to provide this information through a traditional structured interview format
(Yoshihama et al., 2005). The flexibility of the LHC also allows intersecting and cumulative life
experiences to emerge, such as participants having numerous residential moves (Fowler et al.,
2009), participants being in multiple relationships or having contact with ex partners while
currently in a relationship (Kennedy et al., 2018), or participants holding multiple jobs for
employment.
These examples within the IPV literature provide a useful precedent to employ the LHC
method in research with sex trafficking survivors. For example, this method has been used to
identify factors associated with young Korean girls’ motivation to engage in “compensated
dating†(Song & Morash, 2016) and to understand the experiences of women who trade sex
when accessing social services (Gerassi et al., 2019; Gerassi et al., 2021). In these studies, the
LHC was used to guide qualitative interviews with participants by anchoring key life events on
the calendar for participants to reference throughout the interview. During the analysis process,
Gerassi and colleagues (2019; 2021) analyzed interview data using traditional qualitative
thematic coding methods. However, Song and Morash (2016) used events added to participants’
LHC and information from interview questions to construct a flowchart to display the sequence
of events that occurred in a girl’s life prior to engaging in “compensated dating†(e.g., episodes
of running away, their first time engaging in compensated dating). These flowcharts, in
combination with thematic coding of the interview data, were used to identify themes about
girls’ engagement in “compensated dating†(Song & Morash, 2016).
The use of the LHC in conjunction with qualitative data analysis allowed researchers in
these studies to portray a complete picture of what was happening in participants’ lives and how
24
this contributed to their experiences in the sex industry. These methods also allowed researchers
to identify multiple contextual factors about the complex topics of “compensated dating†and
trading sex. Given the previous effectiveness of the LHC in illuminating nuanced experiences in
the sex industry, it is well suited to examine the process leading up to survivors’ most recent exit
from sex trafficking and address the goals of the current study.
Research Questions
The overall purpose of the current study was to understand the process of exiting by
interviewing a sample of survivors who identified their experiences as sex trafficking (in part or
in its entirety) and were not actively involved in the sex industry. Because participants had
already exited sex trafficking at the time of their interview, I retrospectively explored the process
leading up to survivors’ most recent exit and what services and supports were instrumental to
that process. I accomplished this by using the LHC method to capture the dynamic experience of
individual survivors over time. My development of this study was informed by Ecological
Systems Theory and focused on the individual, microsystem, mesosystem, and chronosystem
levels. In this study, I examined the process of exiting trafficking including individual factors,
interpersonal interactions with systems (i.e., service providers), interactions between systems,
and how these factors evolved over time. Table 2 lists my research questions for this study and
the corresponding ecological levels they address.
25
Table 2. Research Questions and Corresponding Ecological Levels
Research Question Ecological Levels
RQ 1: How do survivors self-define their sex trade identities over time,
Individual
from when they first identify as being involved in the sex industry until
Chronosystem
their most recent exit?
RQ 2: What formal systems do survivors have contact with during their Microsystem
time in the sex industry? Chronosystem
Individual
RQ 3: What were the circumstances around participants’ most recent
Microsystem
exit from the sex industry as it relates to their self-defined sex trade
Mesosystem
identity (RQ1) and formal systems access (RQ2)?
Chronosystem
My first research question focused on the individual level of Bronfenbrenner’s ecological
framework to understand how participants conceptualize and define their experiences in the sex
industry, as well as the chronosystem to understand these identities over time. Previous
researchers suggests that the ways in which survivors view or name their experiences in the sex
industry affects their perceived access to services (Eldridge, 2017). If survivors do not identify
their experiences as being “sex trafficking,†they may not be able to identify or utilize
trafficking-specific services that can support or facilitate their exit. Additionally, for some
survivors, identifying and naming their experiences as “sex trafficking†can help reduce
internalized feelings of shame, guilt, and blame and instill a sense of empowerment (Eldridge,
2017). Therefore, this study aimed to understand survivors’ self-defined sex trading identities
over time. Previous research indicates that women conceptualize their identities within the sex
industry based on different contextual factors, such as the presence of exploitation and
acknowledgement of abuse (Eldridge, 2017; Gerassi, 2020). Additionally, these identities are on
26
a continuum, can fluctuate over time, and can be understood differently by survivors over time.
Thus, my first research question was: How do survivors self-define their sex trade identities over
time, from when they first identify as being involved in the sex industry until their most recent
exit?
My second research question focused on the microsystem and the chronosystem to
identify what formal services participants engaged with throughout their time in the sex industry
and their process of exiting sex trafficking. Given the multitude of needs survivors experience
due to their involvement with the sex industry and sex trafficking, they must engage with
multiple systems to receive care (Powell et al., 2018). In addition, survivors may access formal
systems for different reasons. For example, it is possible for someone to access a service to meet
one of their personal needs (such as substance use disorder treatment, hospitalization, etc.) and
do not have the intent of exiting sex trafficking at that time. Additionally, survivors may have
involuntary contact with formal systems that they did not seek out such as emergency
hospitalizations or law enforcement contact and/or arrest. The second research question was:
What formal systems do survivors have contact with during their time in the sex industry?
Finally, my third research question encompassed the individual, microsystem,
mesosystem, and chronosystem. With this question, I sought to explore the role of formal
systems during participants’ most recent exit from the sex industry. Experiences with formal
systems while being trafficked vary greatly by individual. For example, some survivors access
services themselves while others are assisted through interagency collaboration, such as referrals,
mandates, or court orders (Preble & Black, 2020; Wilson, 2014). Individual factors can also
intersect with the informal and formal interpersonal experiences survivors have at the time of
their most recent exit. For example, some individuals may consider their situation to be sex
27
trafficking at the time of their most recent exit, while others may define their situation in the sex
industry to be something different, such as prostitution or trading. Given this variability, my third
research question was: What were the circumstances around participants’ most recent exit from
the sex industry as it relates to their self-defined sex trade identity (RQ1) and formal systems
access (RQ2)?
28
CHAPTER 2: METHOD
Participants
Survivors were eligible for inclusion in this study if they were: 1) currently age 18 or
older; 2) self-identified their experience as sex trafficking (in part or in its entirety); 3) were
trafficked in the United States; 4) currently reside in the United States; 5) were not currently
being sexually exploited/trafficked at the time of the interview; and 6) were connected to
organizations and service programs at some point in their experiences of being trafficked and/or
exiting trafficking. I used two recruitment strategies to identify eligible participants for this
study. First, I developed a research partnership with Selah Freedom, which is a residential
treatment program for adult women (primarily cisgender) survivors of sex trafficking. The
director of programming shared a short synopsis describing this study (Appendix A) with
members of their Survivor Advisory Board. All members of this Board have exited trafficking
and have not been trafficked and/or involved with the sex industry for at least one year.
Survivors who were interested in participating in the study contacted me directly via email.
Working with Selah Freedom to recruit survivors yielded n = 3 eligible participants.
Second, I developed a partnership with Shared Hope International, an organization that
coordinates prevention strategies, restoration programs, and justice initiatives to address sex
trafficking in the United States and abroad. Shared Hope International runs an anti-human
trafficking service provider online listserv including governmental organizations, non-
governmental organizations, law enforcement agencies, non-profit organizations, survivor
leaders, and individual mental health providers who serve survivors of sex trafficking. With the
permission of Shared Hope International, I sent an email to this listserv that included information
about the study (e.g., purpose, incentive amount, and interview format and length) and eligibility
29
requirements referenced above. Members of the listserv were encouraged to share the study
information with their personal and professional networks. Individuals interested in participating
were invited to email me directly to schedule their interview. I sent two emails to the listserv: an
initial email and one follow-up five weeks later. Interviews were conducted for three months.
This strategy yielded n = 31 eligible participants. Taken together, these two recruitment
strategies produced a final study sample size of N = 34 participants.
Procedures
Before each interview, every participant was sent a consent form via email to review
ahead of time. Interviews were conducted in a password-protected Zoom video meeting. Before
beginning the interview and recording, I explained the purpose of the study, assured their
information would be kept confidential, reiterated that they were not obligated to participate,
they could decline to answer any question, they could choose to stop the interview at any time,
and that their individual information would not be shared in the dissemination of the findings.
Each participant was asked for their consent to participate and to audio record the interview.
Participants had the choice whether to share their own video image of themselves during the
interview. Regardless of their decision, there was no video recording of the interviews and only
the audio was captured using Camtasia software. At the end of the interview participants were
given a list of national resources for sex trafficking survivors and $50 via Venmo, Cash App,
Zelle, PayPal, or Western Union for their time and expertise. Interviews lasted between 31 and
129 minutes and were an average of 50.55 minutes long. Audio recordings form these interviews
were transcribed verbatim using Rev.com transcription services.
Because these interviews were conducted remotely over Zoom, the health, wellness, and
safety of participants were protected in the following ways. As previously mentioned, all
30
participants received a resource guide with contacts of national organizations that could provide
support following the interview. I reminded participants before and during the interview that
their participation was completely voluntary and that they could skip any questions they felt
uncomfortable answering or stop participating at any time. I checked in with participants
periodically during the interview to see if they needed any breaks and if they felt comfortable
continuing with the interview. For all participants, I took note of their tone of voice and whether
they took consistent long pauses when giving their responses to determine if offering a check-in
or break was necessary. For participants who had their video turned on during the interview, I
also checked in by observing their facial expressions and body language. At the end of every
interview, I invited participants to give feedback or provide suggestions for improving the
interview process. The main suggestion I implemented was giving participants the option to have
their LHC displayed on the screen for the entirety of the interview or not. This feedback was
given because some participants felt overwhelmed by having their entire history displayed in
front of them. I applied this feedback during subsequent interviews by offering the option for the
LHC screen to be taken down at any point. Although I offered this option, all participants
declined and had their LHCs displayed throughout the interview and most commented on its
usefulness during the interview. No other crisis-intervention strategies had to be used with any
participants during or after their interviews.
Measures
I developed a semi-structured interview protocol in partnership with staff at Selah
Freedom (Appendix B). This interview was based on the Life History Calendar (LHC) method
(Belli & Callegaro, 2009), which guides participants through the process of creating a timeline of
key events (and the date of those events) in their lives (e.g., birthdays, holidays, death of a loved
31
one, etc.). The creation of the calendar helps participants recall details about other life
experiences more accurately by anchoring them to the identified key events (e.g., trying to recall
the first time a participant sought help for substance use disorder, the calendar can help remind
the participant of key events near that time, and the interviewer can ask follow-up questions,
such as ‘Do you recall whether that was before or after your birthday that year?’).
Applying this method to the current study, the interview unfolded in three primary steps.
First, the interview began by asking all participants basic demographic information (e.g.,
participant age, race, gender, sexual orientation, education level, number of children – if
applicable – and their ages).
Second, I followed the Life History Calendar (LHC) method to guide the participants
through the process of creating a calendar of key events in their lives. To do this, I shared my
screen on Zoom to display a blank calendar (Appendix C) and then asked participants what year
and age they were when they entered or were introduced to the sex industry (e.g., the first time
they traded sex for something they needed, when they were first recruited into trafficking, or
when they met their trafficker, etc.). This date marked the beginning of the calendar and time
period that would be the focus of the study (i.e., first entry into the sex industry to the current
day/time of the interview). With that start date established, I then asked participants to recall key
life events that occurred during these timeframes (e.g., birthdays, holidays, death of a loved one,
etc.) and added those markers to the calendar. At the end of this step, we had co-created a visual
timeline of key events in the survivor’s life since they had first started in the sex industry.
Third, with this visual timeline established and viewable by the participant, I conducted a
qualitative interview that explored participants’: 1) Housing History (i.e., where they lived and
moved during this timeframe); 2) Substance Use throughout the time on the calendar; 3) Self-
32
Defined Identity or Experiences within the Sex Industry over time (e.g., whether they defined
their experiences at that point in time as prostitution, domestic violence, sex trafficking, etc.); 4)
Hospitalizations or Medical Care during this time (e.g., emergency care, sexual assault kit (SAK)
collection, reproductive health care, substance use disorder treatment, chronic illness care); 5)
Arrests or Law Enforcement Involvement during this time; and 6) Formal Help-Seeking they
accessed during this time, including residential programs, street outreach, shelters, residential
facilities, community organizations, social workers, therapists. This information was added to the
calendar in real-time throughout the interview. During this portion of the interview, I asked
participants to clarify whether their contact with the medical system (#4 above), legal system (#5
above), and formal help-seeking/social service agencies (#6 above) was freely chosen or was
forced, coerced, or court mandated.
Also as part of the third step in the interview process, I asked participants to re-review
their calendar to discuss in more detail the events surrounding their most recent exit.
Specifically, I asked participants how they were able to get out of their situation during the year
they said they exited the sex industry (i.e., how they exited). Participants elaborated on whether
their exiting process was initiated or assisted by formal systems (i.e., law enforcement,
healthcare, etc.), informal assistance (i.e., friends or family helped them), and/or if there was no
external assistance (i.e., they were able to get out of their situation entirely on their own).
As the final discussion point in the third step in the interview process, I asked participants
to revisit their experiences with formal services marked on the Life History Calendar through the
lens of their social location. This included questions about how their sex trade identity, racial /
ethnic identity, gender identity, sexual identity, economic status, and geographic location /
33
community affected their access to and experiences with services and the events that initiated
their most recent exiting process.
Data Analysis
I used Miles, Huberman, and Saldana’s (2020) model to analyze the two types of data
that emerged from the interviews: the visual calendars for each participant that were co-created
and the narrative transcripts of entire interview process, including the calendar creation and all
follow-up questions. I chose Miles et al.’s (2020) analytic process for three primary reasons.
First, Miles et al. (2020) provide an expansive definition of what constitutes qualitative data, and
the method has the flexibility to analyze both visual data (e.g., a calendar) as well as narrative
data (e.g., an interview transcript). Second, their method guides the analyst through a rigorous
process of examining patterns in the data both within and across cases. In the context of this
study, these methods are well-suited for identifying themes within a participant’s life history
calendar, and then common patterns across calendars that speak to the key questions in this study
regarding the process of exiting. Third, Miles et al.’s (2020) approach offers options for visually-
based analyses and presentations of the findings (e.g., timelines, graphs, other visuals), which is
a natural fit for data collected with the Life History Calendar (LHC) method.
Miles et al. (2020) outlined an iterative process consists of three concurrent phases. Phase
1, Data Condensation, refers to “the process of selecting, focusing, simplifying, abstracting,
and/or transforming the data†that appear in the empirical materials (i.e., interviews) (Miles,
Huberman, Saldana, 2020, p. 8). This phase includes coding, writing summaries, generating
categories and themes, and writing analytic memos. In Phase 2, Data Display, data are organized
and condensed into a display that “allows for analytic reflection and action†(Miles, Huberman,
Saldana, 2020, p. 9). Displays can be in the form of matrices, networks, or graphics and are used
34
to help the analyst understand and draw conclusions from large amounts of data. Phase 3,
Drawing and Verifying Conclusions, is when the analyst concludes findings from the data and
tests their validity. Below describes how I applied this process to answer the research questions
for this study.
Phase 1 (Data Condensation)
I familiarized myself with the transcripts, interviewer notes, and LHCs created during
participant interviews. I referenced memos created after each interview to reflect on noteworthy
parts of the interviews and how they connected to and/or differed from other participants. This
process allowed me to immerse myself in the data to identify variation across interview data in
the study. I also studied the LHCs documents that were co-created with participants during the
interview. Using interview transcripts, I cross-referenced the data included on the LHCs and the
years participants said events occurred for accuracy, particularly their identities and formal
systems contact.
During my extensive reading of the transcripts, I tagged and thematically coded parts of
the interviews that corresponded to each research question (Table 3) to identify themes, patterns,
and trends in the data. For Research Question 1, I focused on parts of the interview where
participants discussed how they defined their experiences in the sex industry. I used transcripts
and LHC documents to establish the year these situations began and when they changed or
ended. I also noted how participants labeled their experiences differently based on how they
conceptualized their experiences at the time they occurred versus how they conceptualize them
now. For example, some survivors identified periods in their lives when they—at the time—
defined what was happening to them as child abuse or domestic violence, and now, they look
back at those times and realize they were being trafficked. As such, I generated codes to reflect
35
participants’ conceptualizations of their identities “then†and identities “now.†For Research
Question 2, I reviewed parts of the interview that corresponded to when participants had contact
with formal systems. Again, I used LHC documents in conjunction with interview transcripts to
confirm the years participants had contact with these systems. Finally, for Research Question 3, I
examined parts of the interview already reviewed for Research Questions 1 and 2 but specifically
focused on participants’ identities and formal systems contact at the time of their most recent
exit. I also used interview transcripts to identify themes around how participants were able to
leave their situation in the sex industry during their exiting process. Throughout this phase, I
refined themes and patterns about participants’ experiences in the sex industry.
36
Table 3. Interview Items with Corresponding Research Question
Research Question Interview Items Example Codes
RQ 1: How do survivors self- • “How would you describe your situation best • Sex trafficking
during that time?†• Domestic Violence
define their sex trade identities over • Prostitution
• “Why did you choose to describe this point in • Trading
time, from when they first identify your life this way? What did / does that term • Child Sexual Abuse
mean to you?â€
as being involved in the sex
• “Looking back on it, what was going on in
industry until their most recent your life when you started calling it ___
instead of ___?â€
exit?
RQ 2: What formal systems do • “Did you go to the hospital or get any medical • Healthcare
care during this time? (e.g., emergency care, • Law enforcement
survivors have contact with during SAK collection, reproductive health care, • Substance use disorder treatment
substance use disorder treatment, chronic • Mental health services
their time in the sex industry? illness care)â€
• “Were you arrested or did you have any law
enforcement involvement during this time?â€
• “What (formal) services did you utilize or
come into contact with? (e.g., Selah Freedom,
street outreach, shelters, residential facilities,
community organizations, social workers,
therapists, etc.)
• “How did you get to [formal system]?â€
37
Table 3. (cont’d)
Research Question Interview Items Example Codes
RQ3: What were the circumstances • “How did you get out of your situation?†• Arrest
• Opportunity (to run or get away)
around participants’ most recent • Perpetrator arrested
• Informal assistance
exit from the sex industry as it • Hospitalization
relates to their self-defined sex
trade identity (RQ1) and formal
systems access (RQ2)?
38
Phase 2 (Data Display)
In this phase, I reconstructed participants’ LHCs using the themes and codes generated
in Phase 1. Each LHC illustrates qualitative data in a timeline format to reflect participants’
experiences in the sex industry over time. These visualizations display data that was condensed
and organized to address each research question. The analytic process of creating visualizations
for each research question is further explained below.
The visualizations for Research Question 1 (How do survivors self-define their sex trade
identities over time, from when they first identify as being involved in the sex industry until their
most recent exit?) display timelines of how participants defined their experiences during their
time in the sex industry at the time it occurred (i.e., then) and when reflecting back on their
experience at the time of the interview (i.e., now). For example, participants may have
considered their experience as domestic violence at the time it occurred whereas now, looking
back on it, realize it was sex trafficking. Participants’ descriptions about their experiences were
identified in Phase 1 of analysis and taken verbatim from interview transcripts to be color coded
for inclusion on the timeline visualizations. Figure 1 is an example of one participant’s LHC
timeline visualization with their self-defined sex trade identities. The x-axis contains the years
participants were in the sex industry. In this example, this participant entered the sex industry in
1996 and exited in 2005. The top line of the timeline represents how the participant classified
their experience or identity within the sex industry at the time it occurred (i.e., “Thenâ€) and the
bottom line represents how participants conceptualize that experience reflecting back on it (i.e.,
“Now). Each color along this timeline indicates how participants described their experience in
the interview and reflects any changes in those experiences over time. In this example, this
participant conceptualized their experience as “trading sex†(coded in orange in the figure) when
39
they first entered the sex industry in 1996 until that situation changed in 1997. At that time, the
participant considered their experience to be “domestic violence†(coded in purple in the figure);
however, when reflecting back on it during the interview, the participant identified this situation
as “sex trafficking†(coded in red). The end of this example timeline depicts how this participant
identified a change in their situation in 2002 and identified this as “prostitution†(coded in blue),
both at the time it occurred and retrospectively during the interview, until their most recent exit
from the sex industry in 2005.
Figure 1. Example of Visual Timeline for Participants’ Sex Trade Identities
For Research Question 2 (What formal systems do survivors have contact with during
their time in the sex industry?), I mapped participants’ contact with formal systems onto their
timeline visualizations created in Research Question 1. This information was identified in the
interview transcripts and LHC documents I reviewed in Phase 1. Figure 2 is an example of one
participant’s LHC timeline visualization with their formal systems engagement. The
visualizations created for this research question display formal system contact participants had
during their time in the sex industry regardless of their self-defined sex trade identities.
Therefore, the horizontal bar representing their time and identities in the industry is greyed out.
40
Again, in this example, this participant was in the sex industry from 1996 – 2005. The vertical
hash mark lines on their timeline indicate any contact with a formal system in that year. These
lines do not indicate the frequency or duration of contact with that formal system during that
year. That level of detail was not systematically collected during the interviews, particularly with
participants who had numerous contacts with formal systems in a year (e.g., multiple arrests
and/or substance use treatment); however, it was possible to determine which systems
participants had contact with at any time during each year of their calendar. These lines are
color-coded to indicate they type of formal system with which participants had contact. In this
example, this participant had contact with healthcare (coded in red on the figure), law
enforcement (coded in blue), and mental health services (coded in green) at some point in 1996.
The spaces between these hash marks indicate that these contacts were not connected to each
other and happened at separate timepoints throughout the year. However, some formal system
contacts occurred in clusters with participants being directly referred from one system to another.
These collaborations are indicated on timelines with a circle around clusters of formal systems
contact. In this example, in the year 2005, this participant had contact with law enforcement
(coded in blue) who then referred the participant to substance use disorder treatment (SUD Tx;
coded in orange) prior to them engaging with an additional “Other†formal system (coded in
yellow). This cluster of system contact is marked with an oval that bundles these contacts
together to communicate there was coordination across systems.
41
Figure 2. Example of Visual Timeline for Participants’ Formal Service Engagement
For Research Question 3 (What were the circumstances around participants’ most recent
exit from the sex industry as it relates to their self-defined sex trade identity (RQ1) and formal
systems access (RQ2)?) I combined components from the timelines created in Research
Questions 1 and 2 to create a visual representation of participants’ sex trade identities and formal
systems contact at the time of their most recent exit. Using interview transcripts and LHC
documents in Phase 1 of analysis, I identified the year participants stated their most recent exit
from the sex industry began and indicated this on the timelines for Research Question 3. Figure 3
is an example of a visual timeline showing circumstances around a participant’s most recent exit
from the sex industry. This timeline contains the sex trade identities identified in Research
Question 1 and the formal systems participants had contact with at the end of their time in the
sex industry identified in Research Question 2. The visual for Research Question 3 only presents
the formal system contact participants had during the process of their most recent exit from the
sex industry (if any) (i.e., it is simplified/reduced visual of their help-seeking experiences to
focus only on those that occurred during their most recent exit). Grey boxes are included on the
visuals for this research question to indicate the year participants stated they exited the sex
industry in their interview. As shown in the example in Figure 3, this participant stated they
exited the sex industry in 2005, as indicated by the grey box around that year, and identified their
42
situation as “prostitution†(coded in light blue) at the time. In the box are the hash marks
presented in Research Question 2 showing the cluster of formal systems this participant had
contact with (law enforcement, SUD Tx, and “otherâ€) at the time of their exit from the sex
industry.
Figure 3. Example of Visual Timeline of Circumstances Around Participants’ Most Recent Exit
Phase 3 (Drawing and Verifying Conclusions)
In Phase 3 of analysis, I used the data displays (i.e., visual timelines) created in Phase 2
and the interview transcripts, when necessary, to draw conclusions about participants’
experiences in the sex industry. This phase utilized three main analytic tactics to draw
conclusions from the data displays created in Phase 2: noting patterns & themes; counting, and
partitioning variables (Miles, Huberman, & Saldana, 2020, p. 274). Noting patterns and themes
in the data began in Phase 1 of analysis and continued throughout Phase 3. I used this tactic to
identify commonalities in the data across participants while being mindful of disconfirming
evidence to generate themes. These patterns and themes were regularly subjected to skepticism
by being discussed and tested with three outside experts on sexual violence and sex trafficking
before being established as conclusions in Phase 3. Counting was used to identify the frequency
of themes in the data such as identifying how often participants utilized each sex trade identity to
describe their experiences (i.e., Research Question 1). Counting was also used to verify themes
43
and support conclusions, such as confirming trends in the type of formal systems participants had
contact with throughout their time in the sex industry and as they began the exiting process (i.e.,
Research Questions 2 and 3). Finally, partitioning variables refers to separating variables to
account for important differentiation in the data. This tactic was utilized to “see differences that
might otherwise be blurred or buried†particularly when refining the organization of the data
displays in Phase 2 and drawing conclusions resulting from that analytic tactic (Miles,
Huberman, & Saldana, 2020, p. 281). In this study, the year when participants entered the sex
industry was the variable that was partitioned. Prior to partitioning this variable, it was difficult
to draw meaningful conclusions about survivors’ experiences with formal systems while in the
sex industry when looking across all participants in the study. However, once this variable was
partitioned by the decade participants entered the sex industry, clear patterns and themes
emerged. These three main tactics were utilized throughout the analytical process to consistently
refine interpretations about the data and resulted in the conclusions developed in Phase 3.
To verify these conclusions, I followed recommend strategies established by Lincoln and
Guba (1985) for assessing the trustworthiness of set of qualitative findings. Prolonged
engagement is “spending sufficient time in the field to learn the culture, setting, and phenomenon
of interest. Spending considerable time observing various aspects of the setting, talking with
people at all levels of organizations, and developing relationships and rapport with setting
members†(p. 301). Prior to data collection, I had a two-year partnership with Selah Freedom.
During this time, I consulted with multiple staff members including the co-founder, the director
of research, and the director of programming about their program and this project. Given the
multiple sites in different geographic areas, this engagement was all virtual and long-distance
leading up to and including time during the COVID-19 pandemic. I also previously worked with
44
the moderator and other members of Shared Hope International’s listserv I utilized in the second
recruitment strategy and have been in contact with them about the progress of this project. Peer
debriefing is “working with disinterested peers to test/defend the emergent hypotheses and to
help illuminate implicit assumptions†(p. 308). I addressed this standard by meeting with my
advisor and two other content experts regularly to discuss the interviews and to test and refine
the themes that emerged from the data. Member checks are “sharing preliminary findings with
participants to explore the extent to which the researchers’ interpretations resonate with their
understanding of the issues†(p. 314). I addressed this standard by sharing my preliminary
findings with participants who were interested in and consented to being contacted about sharing
their perspective on my conclusions. I emailed interested participants a summary brief with a
short synopsis of study findings and invited them to provide feedback and/or additional
considerations for interpreting the data. Participants who provided feedback accepted the study
findings and some shared how the results were reflective of what they have seen in their work as
survivor leaders and professionals in the field.
45
CHAPTER 3: RESULTS
Sample Characteristics
As I familiarized myself with the data during the first phase of the analytic process (Data
Condensation), it became clear that participants’ responses varied tremendously by when they
started and how long they worked in the sex industry. As seen in Table 4, the survivors
interviewed for this study were an average age of 38.29 years old (SD = 10.86) and ranged from
26 – 66 years old at the time of the interview. These descriptive statistics underscore there was
considerable variability, as evidenced by a large standard deviation (relative to the mean) and a
wide range. Similarly, the age participants were first introduced to the sex industry ranged from
4 to 34 years old and was on average 16.56 years old (SD = 7.58). When I was conducting the
interviews, I noted that participants who were introduced to the sex industry before the year 2000
were often children or teens at the time and were largely exploited by family members or other
adults, whereas participants who entered the industry in the past 10 years almost exclusively did
so through trading sex as adults. There was also substantial variability with respect to how long
the survivors interviewed in this study were in sex industry: an average of 9.06 years (SD = 6.71,
Mdn = 8.00) ranging from 1 to 25 years. Participants’ most recent exit from the sex industry was
an average of 12.82 years ago (Mdn = 11.00, and SD = 8.50) and ranged from 2 to 41 years ago.
Again, these descriptive results highlight considerable variability within the sample (as
evidenced by large standard deviations and ranges).
46
Table 4. Sex industry-related demographics - Full sample
Mean SD Median Range Min Max
Age at time of interview 38.29 10.86 34.00 40.00 26.00 66.00
Age of Entry 16.56 7.58 15.50 30.00 4.00 34.00
Years in the industry (until
9.06 6.71 8.00 24.00 1.00 25.00
most recent exit)
Years since most recent exit 12.82 8.50 11.00 39.00 2.00 41.00
These variations in when participants entered and spent time in the sex industry seemed
to shape survivors’ answers to the interview questions. For example, participants who entered the
sex industry in the 1970s and 1980s tended to be older and noted that there was far less societal
awareness about sexual exploitation in that era than there is today. Given that the term “sex
trafficking†and the formalization of that act as a crime did not emerge until 2000, participants
who entered in the 1970s, 1980s, and 1990s often defined their experiences using different
language. By contrast, those who entered the sex industry more recently had an understanding of
sex trafficking and were able to identify their situation as such while it was occurring. These
variations in how participants described their experiences are pertinent for Research Question 1,
which focuses on how participants defined their experiences in the sex industry over time.
These patterns also appeared when survivors described their experiences engaging with
formal systems during their time in the sex industry, which is relevant for Research Question 2.
During the interview process and my initial stages of data analysis, it became clear that the
public perception of people in the sex industry and the state of legislative recognition of sex
trafficking influenced participants’ formal systems engagement. For example, some survivors
who entered the sex industry in the 1970s, 1980s, and 1990s commented that many organizations
did not know how to address their experiences of sex trafficking at the time they received
services and /or law enforcement treated them like criminals by arresting them on prostitution-
47
related charges. By contrast, in the interviews with participants who entered the sex industry
more recently, survivors discussed how law enforcement and other formal systems they engaged
with understood what sex trafficking was and connected them to services specifically for
survivors of sex trafficking, which were not available to most participants who spent time in the
sex industry in previous years.
Given these emerging patterns in the data, conducting the planned analyses at the level of
the overall sample seemed problematic as doing so would ignore the influence of key contextual
factors that affected participants’ experiences within the sex industry and their exiting process.
Participants’ narratives were strikingly different based on which decade they entered the sex
industry. Therefore, the analysis plan was modified to include Miles, Huberman, & Saldana’s
(2020, p. 281) analytic tactic of partitioning variables to examine each research question by
cohort according to the decade participants entered the sex industry (see Data Analysis Plan,
Phase 3 discussed above). This grouping was done to account for trends in how and when
participants were introduced to the sex industry, as well as nuances in the macrosystemic
generational influences and exosystemic factors, namely the existence of policies and laws
around the sex industry and sex trafficking. Therefore, findings are presented for each research
question in four cohort groups based on the decade participants first entered the sex industry: 1)
1970s /1980s; 2) 1990s; 3) 2000 – 2009; and 4) 2010 – 2021.
Table 5 presents the descriptive variables regarding when participants entered and spent
time in the sex industry (reported as in Table 4) separated by cohort group. As can be seen in
Table 5, these cohort groupings are a sensible organization of the data, as the means, standard
deviations, and ranges within cohort are tighter. For example, participants who entered the sex
industry in the 1970s /1980s ranged in age from 46 to 62 at the time of the interview and were 54
48
years old on average (SD = 6.45, Mdn = 54.00) and participants who entered the sex industry in
the 2010s ranged in age from 27 to 36 and were 32 years old on average (SD = 6.45, Mdn =
32.00). Similarly, for Age of Entry in Table 5, participants who entered the industry in the 1970s
/ 1980s did so between the ages of 4 and 27 and were an average of 14.33 years old at the time
(SD = 7.47, Mdn = 14.50) whereas participants who entered in the 2010s did so between the ages
of 17 and 30 years old and were an average of 23.17 years old at the time (SD = 4.71, Mdn =
23.00). When looking at the amount of time participants spent in the sex industry, participants
who entered the sex industry in the 1970s / 1980s spent an average of 15.50 years in the industry
(SD = 8.55, Mdn = 17.50) ranging from 2 to 25 years and participants who initially entered the
sex industry in the 2010s spent an average of 3.50 years in the industry (SD = 2.81, Mdn = 2.00)
ranging from 1 to 8 years. Finally, for Time Since Most Recent Exit, participants who entered
the sex industry in the 1970s / 1980s exited between 15 and 41 years ago with an average of
24.67 years ago (SD = 10.50, Mdn = 21.00) and participants who initially entered the sex
industry in the 2010s exited an average of 5.33 years ago (SD = 2.25, Mdn = 4.50) ranging
between 3 and 9 years ago. When looking at these variables by cohort, the underlying variability
in the data sorts by decade, therefore doing the focal analyses by cohort is an appropriate analytic
choice.
49
Table 5. Sex Industry-related Demographics by Cohort
2000 – 2010 –
1970/1980s 1990s 2009 2021
n=6 n=8 n = 14 n=6
Age at time of interview
Mean 54.00 54.00 32.14 32.00
Standard Deviation 6.45 12.47 3.84 3.10
Median 54.00 37.00 32.00 32.00
Range 16.00 33.00 14.00 9.00
Minimum 46.00 33.00 26.00 27.00
Maximum 62.00 66.00 40.00 36.00
Age of Entry
Mean 14.33 14.88 15.64 23.17
Standard Deviation 7.47 11.73 4.09 4.71
Median 14.50 11.00 16.00 23.00
Range 23.00 29.00 16.00 13.00
Minimum 4.00 5.00 7.00 17.00
Maximum 27.00 34.00 23.00 30.00
Years in the industry (until most recent exit)
Mean 15.50 13.25 6.29 3.50
Standard Deviation 8.55 5.39 3.85 2.81
Median 17.50 12.50 6.00 2.00
Range 23.00 14.00 11.00 7.00
Minimum 2.00 8.00 1.00 1.00
Maximum 25.00 22.00 12.00 8.00
2000 – 2010 –
1970/1980s 1990s 2009 2021
n=6 n=8 n = 14 n=6
Years since most recent exit
Mean 24.67 13.88 10.36 5.33
Standard Deviation 10.50 6.31 4.45 2.25
Median 21.00 14.00 10.00 4.50
Range 26.00 20.00 13.00 6.00
Minimum 15.00 2.00 3.00 3.00
Maximum 41.00 22.00 16.00 9.00
50
With this decision to move forward with the analyses by cohort groupings, Table 6
presents sample demographics by decade cohort. For reference, Table 6 also presents
demographics at the level of the overall sample. As shown in Table 6, the variability within the
data is clearer by cohort grouping, rather than at the level of the overall sample.
1970s / 1980s
There were 6 participants who entered the sex industry in the 1970s and 1980s.
Participants who entered the sex industry in the 1970s and 1980s were group together because
there were very few (n = 3; 50% of the participants in this decade group) participants who
entered the sex industry during each of these decades. All participants in this group identified as
female and were predominately White (n = 4, 66.70%). At the time of the interview, participants
were an average of 54 years old (SD = 6.45) and had been out of the sex industry for 24.67 years
(SD = 10.50). Participants were, on average, 14.33 years old (SD = 7.47) when they entered the
sex industry and stayed in the industry for an average of 15.50 years (SD = 8.55, Mdn = 17.50)
ranging between 2 – 25 years.
1990s
There were 8 participants who entered the sex industry in the 1990s. All participants in
this group identified as female and were predominately White (n = 6, 75.00%). At the time of the
interview, participants were an average of 42 years old (SD = 12.47) and had been out of the sex
industry for 13.88 years (SD = 6.31). Participants were, on average, 14.88 years old (SD = 7.47)
when they entered the sex industry and stayed in the industry for an average of 13.25 years (SD =
5.39, Mdn = 12) ranging between 8 – 22 years.
51
2000 - 2009
There were 14 participants who entered the sex industry between 2000 and 2009. Most
participants in this group identified as female (n = 12; 85.71%) with two participants (14.29%)
identifying as transgender or gender non-conforming. Participants were 42.90% White, 21.40%
Black / African American, 21.40% Multiracial, and 14.30% Hispanic / Latinx. At the time of the
interview, participants were an average of 32.14 years old (SD = 3.84) and had been out of the
sex industry for 10.36 years (SD = 4.45). Participants were, on average, 15.64 years old (SD =
4.09) when they entered the sex industry and stayed in the industry for an average of 6.29 years
(SD = 3.85, Mdn = 6.00) ranging between 1 – 12 years.
2010 – 2021
There were 6 participants who entered the sex industry from 2010 - 2021. All participants
in this group identified as female and were all White. At the time of the interview, participants
were an average of 32 years old (SD = 3.10) and had been out of the sex industry for 5.33 years
(SD = 2.25). Participants were, on average, 23.17 years old (SD = 4.71) when they entered the
sex industry and stayed in the industry for an average of 3.50 years (SD = 2.81, Mdn = 2.00)
ranging between 1 – 8 years.
52
Table 6. Sample Demographics
Year of Entry (by decade)
Overall 1970s / 2000 – 2010 –
1990s
Sample 1980s 2009 2021
n=8
n = 34 n=6 n = 14 n=6
Race / Ethnicity
Black / African
8.80% 21.40%
American -- -- --
(n = 3) (n = 3)
White 64.70% 66.70% 75.00% 42.90% 100.00%
(n = 22) (n=4) (n = 6) (n = 6) (n = 6)
Hispanic / Latinx 14.70% 16.70% 25.00% 14.30%
--
(n = 5) (n = 1) (n = 2) (n = 2)
Multiracial 11.80% 16.70% 21.40%
-- --
(n = 4) (n = 1) (n = 3)
Education Level
Less than High
2.90% 12.50%
School -- -- --
(n = 1) (n = 1)
(K – 8th)
Some High School 2.90% 7.10%
-- -- --
(9th – 12th) (n = 1) (n = 1)
High School Diploma 5.90% 14.30%
-- -- --
/ GED (n = 2) (n = 2)
Some College 32.40% 33.30% 25.00% 21.40% 66.70%
(n = 11) (n = 2) (n = 2) (n = 3) (n = 4)
Trade School 2.90% 16.70%
-- -- --
(n = 1) (n = 1)
Associate’s Degree 8.80% 12.50% 14.30%
-- --
(n = 3) (n = 1) (n = 2)
Bachelor’s Degree 29.40% 16.70% 25.00% 42.90% 16.70%
(n = 10) (n = 1) (n = 2) (n = 6) (n = 1)
Advanced Degree 14.70% 50.00% 25.00%
-- --
(n = 5) (n = 3) (n = 2)
Gender
Cisgender Woman / 94.10% 100.00% 100.00% 85.70% 100.00%
Female (n = 32) (n = 6) (n = 8) (n = 12) (n = 6)
Transgender / Gender 5.90% 14.30%
-- -- --
Non-Conforming (n = 2) (n = 2)
Substance Use (while in sex industry)
Yes 73.50% 66.70% 75.00% 78.60% 66.70%
(n = 25) (n = 4) (n = 6) (n = 11) (n = 4)
53
Research Question 1: Sex Trading Identities Over Time
When asked to describe their situation in the sex industry, participants provided the year
a particular situation started and when that situation changed or ended. Participants used seven
terms to describe their experiences within the sex industry (Table 7). The sex industry identities
listed in Table 7 reflect participants’ own words and conceptualizations from the interview.
Table 8 displays the coding for periods of time where participants identified having multiple
experiences during portions or simultaneously throughout the year.
Table 7. Sex Industry Identity Visual Coding Key
Color Sex Industry Identity Participant Definition / Conceptualization
Included being physically held against their will, not
Sex Trafficking receiving money for sex acts, being physically abused,
and/or having commercial aspect become part of abuse.
Included street prostitution, escort services, or third-
party (i.e., pimp or drug dealer) facilitated commercial
Prostitution sex acts where money was exchanged. Can also include
times when participant sold themselves to make ends
meet financially.
Trading for drugs, a place to stay, or to get something in
Trading return. Could be with or without a third-party (i.e., pimp,
romantic partner etc.).
Trading that is directly related to obtaining basic needs or
Survival Sex
income to support themselves.
Experienced sexual abuse at the hands of family or
Child Sexual Abuse neighbors including child sexual abuse material (CSAM)
(i.e., child pornography) and exploitation.
Included experiences dancing in clubs and/or massage
Sexual Exploitation
parlors.
Romantically involved with person who abused and
Domestic Violence
sexually exploited them.
54
Table 8. Simultaneous Sex Industry Identities Visual Coding Key
As previously noted, participants discussed their experiences differently depending on
when they spent time in the sex industry. In Phase 1 of the data analysis, it became apparent that
participants made clear distinctions between these identities when discussing how they viewed
their experiences at the time they were happening and how they conceptualized their experiences
in the sex industry retrospectively. Given this distinction, I included two visual representations of
participants’ self-defined sex trade identities, one to represent how they viewed their experiences
then (i.e., when it was occurring) and one to reflect how they define their experiences looking
back at them now (i.e., at the time of the interview). Below are the descriptions of each group’s
a) past conceptualizations of their experiences in the sex industry, and b) current
conceptualizations of their experiences in the sex industry.
55
1970s / 1980s
Then. As seen on the top line on the timeline visualization in Figure 4, no participants in
this group identified their experiences as “sex trafficking†(red) at the time they were in the sex
industry. Overall, many conceptualized their experiences as abusive relationships, either as
“child sexual abuse†(grey) or “domestic violence†(purple). Most participants in this group
(n=4; 66.70% of the participants in this decade group) were first introduced to the sex industry
through child sexual abuse, at the hands of family or neighbors, or through abusive intimate
partner relationships. Although half of the participants who entered the sex industry in the 1970s
and 1980s had no changes in the ways they identified their experiences in the sex industry (i.e.,
Participants 607017, 606035, and 605031), the other half did have transitions between different
experiences. For example, when looking at Participant 606027’s timeline, she defined her
experience as “child sexual abuse†(grey), “prostitution†(blue), domestic violence (purple), and
finally “prostitution†(blue). For participants who had multiple transitions like this, changes in
their experiences were salient both at the time they occurred and looking back at the time of the
interview. Every participant in this group stayed in the industry once they entered. That is, there
were no intermittent periods where participants were either fully or partially out of the industry.
In addition, once these participants exited the sex industry, they stayed out (at least until the time
the interview) and at the time of their most recent exit, half the participants defined their
situation as “prostitution.â€
56
Figure 4. Conceptualizations of Identities for Participants Who Entered the Sex Industry in the
1970s and 1980s
Now. When participants who entered the sex industry in the 1970s and 1980s were asked
to look back on their experiences within the sex industry, almost all participants explicitly
identified parts of their experiences as “sex trafficking†as evidenced by the red on the bottom
line of the visualization in Figure 4.2 Age, namely being under the age of 18, was a major factor
for this group in distinguishing their previous experiences as “sex trafficking†because they were
under the legal age to consent to sex. For example, Participant 605024 described part of her
experience of “sexual exploitation†as “sex trafficking†because she was under 18 years old at
the time and was clear about her distinction between the two:
For me, there is a difference, yeah. Like, I can say I was involved in commercial
sexual exploitation as a dancer, at a massage parlor… Was I trafficked? No. Was I
2
Participant 605031 did not explicitly use the terminology “sex trafficking†when discussing her experience during
the interview however, this participant still fits the inclusion criteria for this study because she 1) self-identified as a
survivor of sex trafficking during recruitment and 2) accessed formal services for women who were sexually
exploited and/or trafficked.
57
commercially, sexually exploited? Yes. There were periods of time that, no I wasn't sex
trafficked. Now there was a period of time, 15 through 17, where they were
threatening me, force, fraud, coercion, where I was practicing in the definitions that
exist.
This participant is referencing the definition of sex trafficking outlined in the TVPA which was
not passed until a year after her most recent exit from the sex industry. For her, having that legal
definition affected how she described part of her experience.
Age also affected how participants who identified their experiences of “child sexual
abuse†in the past came to understand their situation as “sex trafficking†when they were older.
These participants recognized that being under the age of 18, coupled with the commercial or
monetary element that accompanied their abuse, qualified their experience as “sex trafficking.â€
For example, one participant later discovered that the child sexual abuse materials (i.e., child
pornography) she was subjected to participating in were being sold by her abuser and he profited
from them. This exchange of money changed how she viewed her abuse later in life, particularly
after learning about the definition of sex trafficking at a work training event. Finally, all
participants in this group who reported “child sexual abuse†later identified this specifically as
“familial sex trafficking†since it was a member of their family who was abusing and exploiting
them.
1990s
Then. Similar to the participants who entered the sex industry in 1970s and 1980s, many
of the participants who entered in the 1990s were first introduced to the industry through “child
sexual abuse, represented in grey on the timeline visualization in Figure 5 (n = 4; 50.00% of the
participants in this decade group). All participants who identified their experiences as “child
sexual abuse†were abused by family members. The remaining participants in this group entered
the sex industry through “trading†(orange) or “prostitution†(blue). As seen with participants
58
who entered the sex industry in the 1970s and 1980s, once participants entered the sex industry,
they tended to stay in.
In contrast to participants who entered the sex industry in the 1970s / 1980s, some
participants who entered the sex industry in the 1990s identified some experiences as “sex
trafficking†at the time they occurred. For example, in 2006 Participant 606037 was able to
distinguish a change in the way she was being exploited as a minor,
When I turned 18, the way I was trafficked shifted a little bit, like it was much more
extreme, I guess you could say. It became very much - so, it's familial - but… my dad
pulled me out of school at 17 to be just doing things full time so that it became just like a
full-time job.
Being taken out of school indicated a shift in this participant’s experience which also increased
the frequency and extremity of her exploitation. Participant 605004 was able to briefly separate
from her family who was abusing and exploiting her by seeking services at an anti-trafficking
safe house. However, when this organization shut down soon after she arrived, she was left
homeless, “in a vulnerable place and ended up being recruited by another pimp, a female who
recruited me from a church and ended up trafficking me during the [major sporting event].†This
sudden loss of resources, particularly so soon after this participant was able to escape her
previous situation, put her at an increased risk of being re-exploited and back in the sex industry.
59
Figure 5. Conceptualizations of Identities for Participants Who Entered the Sex Industry in the
1990s
Now. Almost all participants identified part of their experience in the sex industry as “sex
trafficking†(coded red on the bottom line of the timeline visualization).3 Again, similar to the
1970s / 1980s group, participants who identified their experiences as “child sexual abuse†(grey)
at the time it occurred later identified these experiences as “familial sex trafficking†since it was
a family member who abused and exploited them. Additionally, when looking back, participants
defined the entirety of all periods of “child sexual abuse†and “domestic violence†as “sex
trafficking.†Some participants who previously defined their situation as “prostitution†later
defined part of their experience as “sex trafficking†due to changes in their situation, such as the
3
Participant 605022 did not explicitly use the terminology “sex trafficking†when discussing her experience during
the interview however, this participant still fits the inclusion criteria for this study because she 1) self-identified as a
survivor of sex trafficking during recruitment and 2) accessed formal services for women who were sexually
exploited and/or trafficked.
60
introduction of physical abuse and withholding money (Participant 605009) and “being trappedâ€
and forced to meet a quota (Participant 604001).
2000 – 2009
Then. In contrast to previous groups, participants in this group did not necessarily stay in
the sex industry once they became involved as seen with the gaps in the timeline visualization in
Figure 6. Unlike any other groups in this study, there were multiple participants who entered the
sex industry in the early 2000s who had periods of time of no involvement, either entirely or
partially, with the sex industry before becoming involved again. Entry back into the sex industry
was defined by participants as “prostitution†(blue on the timeline visualizations), “survival sexâ€
(orange), a combination of “survival sex and sex trafficking†(green and red pattern) or
intermittent “domestic violence†(purple and white pattern) after being out of the sex industry for
at least a year. One participant described a period where a) her experiences led her in and out of
the industry and b) she identified rapid changes in her experiences within the industry:
It would kind of fluctuate between like survival sex and being trafficked. To give some
context around that, I would be, I'd be pimped and then I would get mad. Like, I would be
upset by what was happening and want to leave, and I would leave. But then there was
nothing for me and nowhere for me to go. So, I would engage in survival sex to just get
my basic needs met. And then after a while of doing that, I would be, like, recruited by a
different pimp. So, every time I was in survival sex, for me, was an opportunity I wanted
to exit, but I didn't have the resources to access it. (Participant 605012)
This quote demonstrates how this participant’s experiences and ability to exit were greatly
impacted by both interpersonal and economic factors and suggests that exiting the sex industry
for some participants in this group was, indeed, an iterative process.
61
Figure 6. Conceptualizations of Identities for Participants Who Entered the Sex Industry
Between 2000 and 2009
Now. Every participant identified at least part of their time within the sex industry as sex
trafficking with 64.29% (n = 9) identifying the entirety of their experiences as such which can be
seen with the red coding on the bottom, “now,†line in visual timeline in Figure 6. All
participants who identified their situation as “domestic violence†(purple) now call the entirety of
those time periods “sex trafficking.†This was also the case for the participant who previously
identified their experience as “child sexual abuse†(grey). As seen in past conceptualizations of
their identities, participants who spent time out of the sex industry at some point defined their
experience of re-engaging with the industry in multiple ways. One participant described their
situation as “survival sex†because it was directly related to the lack of support they received as a
survivor still dealing with the effects of being trafficked 8 years after they exited:
62
There is very little help to help you stay stable if like you're dealing with the long-term
ramifications. So, you’re like, 5, 10 years out, and you're still dealing with mental health
things. …There's so many things that take so long and there's no basic financial support.
Like, here's some rent assistance. Here's some food assistance, like the basics. So that
survivors can focus on more than just basically surviving or ending up back in the sex
trade. Because that's why I did survival sex. I didn't have any sort of financial support at
the time. Um, so, you know, I was like, ‘Okay, well I'm at least a little familiar with how,
the sex trade works.’ … And, fortunately that did help me financially survive, but also that
wasn't the job that I wanted because it was retraumatizing. (Participant 605019)
Another participant stated, “I just knew leaving would be better than what I was experiencing at
that time,†when describing her re-entry experience as “prostitution†and how it was a way to
leave a traumatic living situation with a former abuser (Participant 605014). Finally, participants
defined their re-entry experience as “sex trafficking†when their situations were facilitated or
forced onto them by a previous or new trafficker and/or romantic partner.
2010 – 2021
Then. Unlike any other decade, none of the participants in this group defined any of their
experiences as “child sexual abuse†(coded grey on the timeline visualization) or “domestic
violence†(purple) at the time they were occurring, which can be seen on the timeline
visualization in Figure 7. Additionally, this is the only group who did not have any participants
describe any of their experiences as “survival sex†(green). Most participants in this group
described their first experiences in the sex industry as “trading†(orange) (n = 4). These
participants also described their experiences of trading sex to specifically get drugs and, for one
participant, this was how her trafficker “lured her in†because he was also “a low-level drug
dealer†(Participant 604002).
Almost all participants defined part of their experience in the sex industry as “sex
trafficking†at the time it occurred, which is strikingly different from the other groups in this
study. One participant “wasn't trafficked until, like, right at the end†and clearly made this
63
distinction at the time because she had previously been trading sex for drugs but was eventually
forced into a car and held against her will while being trafficked (Participant 606029). One
participant was able to eventually identify her situation as trafficking because she had multiple
points of contact with an advocate from an anti-sex trafficking street outreach program who “got
me their card, but they were always around because there was the house where a lot of the girls
would hang out and just kind of come in and out†(Participant 606030). She described this
process of fully realizing what her situation was while having a conversation with an outreach
advocate:
It really wasn't even until I was on my way to [sex trafficking organization] and [the
outreach advocate] asked me a few different questions. But I was still like, “Yeah, I'm
really excited about this opportunity. I just don't know if I’ll fit in there. You know? I
don't know if I've been ‘trafficked’ or whatnot.†I thought, “This never happened to me.â€
Then she asked me these questions [about my experience] and I said, “Yes†to all of
them. Then I thought, “Okay, have I been trafficked? Have I been exploited?†That's
when it really started hitting me. And I was like, “Oh, wow.â€
Although this participant began to identify her situation as sex trafficking in previous
conversations with this outreach advocate, it was not until this conversation on her way to
receive services that she really came to terms with how to name her experience.
64
Figure 7. Conceptualizations of Identities for Participants Who Entered the Sex Industry
Between 2010 and 2021
Now. Looking back, almost all the participants who originally described their entry into
the sex industry as “trading†(orange) still described it as such. Half the participants did not
change their definition of their experiences from the time it was occurring to the time of the
interview looking back on it. These same participants all originally identified part of their
experience as “sex trafficking.†As previously mentioned, these participants described a clear
distinction between their experiences of either “trading†or “prostitution†and “sex trafficking.â€
In addition to the time frames previously described as “sex trafficking,†one participant identified
additional parts of their time in the sex industry as “sex trafficking†stating that, looking back,
her experience working for a limo company was exploitive and she was recruited into it
(Participant 606030).
65
Research Question 2: Formal System Contact Over Time
To answer Research Question 2, I mapped participants’ contact with formal systems onto
their LHC timeline visualizations created during their interview. The horizontal grey bar on the
visualizations in Figures 8 - 11 represents each participant’s time in the sex industry. Each
hashmark or vertical line on a participant’s timeline indicates they had at least one contact with
that system at any point during that year. These markings do not reflect frequency or duration of
the contact participants had with a given system or service provider. Table 9 reflects the
associated color coding for the formal systems participants reported accessing during their time
in the sex industry and a brief description of each category. Circles around a cluster of
hashmarks indicate a collaboration between multiple formal systems.
Table 9. Formal System Visual Coding Key
Color Formal System Definition
Healthcare Hospitalizations, doctor’s visits, prenatal care, dental care
Substance Use Inpatient and outpatient treatment programming, detox,
Disorder Treatment Alcoholics Anonymous (AA), Narcotics Anonymous (NA)
(SUD Tx)
Law Enforcement Arrests, assisting in criminal investigations
Mental Health Individual or group therapy, counselors, social workers
Organizations that specifically serve survivors of sex
Sex Trafficking
trafficking or other forms of sexual exploitation (particularly
Organization (Org)
before the year 2000 when the TVPA was passed)
Rape crisis centers, domestic violence shelters, human
Other service organizations, homeless shelters, transitional
housing, Child Protective Services (CPS)
66
1970s / 1980s
All participants who entered the sex industry in the 1970s or 1980s had contact with at
least one formal system (Figure 8). Most participants in this group had contact with multiple
formal systems (n = 4; 66.67% of the participants in this group) with two participants reporting
contact with a single system. All but two participants (33.33% of the participants in this group)
had contact with law enforcement during their time in the sex industry. Those who did have
contact with law enforcement had multiple contacts over the years. Half of the participants in this
group (n = 3) accessed substance use disorder treatment or detox during this time and there were
only two mentions of mental health services. The “other†systems participants in this group had
contact with included a domestic violence safe house, and a women’s resource center.
Figure 8. Formal Systems Contact for Participants Who Entered the Sex Industry in the 1970s
and 1980s
Most participants in this group had contact with a one system at a time with a few
experiencing collaboration across multiple systems by being referred, mandated, or connected to
67
another system immediately after being at another. Collaborations across formal systems were all
initiated after contact with law enforcement to either a substance use treatment, women’s service
organization, mental health services, and/or sex trafficking organization (or for this decade,
organizations serving people who have experienced sexual exploitation). All of these cross-
system collaborations occurred within the year of participants’ most recent exit from the sex
industry.
1990s
All participants who entered the sex industry in the 1990s had contact with two or more
formal systems (Figure 9). Most participants (n = 5; 62.50% of the participants in this group) had
contact with healthcare and/or substance use disorder treatment at least once during their time in
the sex industry. Mental health services were mentioned four times across all participants in this
group. All but two participants had contact with law enforcement and three of those participants
had multiple contacts over the years. The “other†systems participants in this group had contact
with included child protective services, a rape crisis center, and a domestic violence resource
center.
68
Figure 9. Formal Systems Contact for Participants Who Entered the Sex Industry in the 1990s
As seen in the previous group, most collaborations across systems occurred immediately
before participants’ most recent exit. However, one participant experienced collaboration among
services early in their time in the sex industry in addition to when they exited most recently. Half
of the participants in this group had at least one contact with a sex trafficking organization and
all did so within a year of their most recent exit. In addition, these participants were often
directly connected to these organizations by another formal system such as law enforcement or
substance use treatment.
2000 - 2009
Every participant who entered the sex industry in the early 2000s had contact with at least
one formal system (Figure 10). Most participants in this group (n = 11; 78.57%) had contact with
healthcare while few participants (n = 5; 35.71% of people in this group) had contact with
substance use disorder treatment and/or detox. Four participants in this group (28.57%) accessed
69
mental health services while in the sex industry. Nine participants (64.29%) had contact with law
enforcement, with five having single points of contact or arrests while the remaining participants
had multiple encounters. The “other†systems participants in this group had contact with
included domestic violence shelter, general housing shelter, and comprehensive basic needs
service providers (e.g., Salvation Army).
Figure 10. Formal Systems Contact for Participants Who Entered the Sex Industry Between 2000
and 2009
Only three participants in this group (21.43%) experienced collaborations across different
formal systems. Two of these collaborations were initiated by substance use treatment services
with one referring the participant to transitional housing and the other to a sex trafficking
organization. The other two collaborations were initiated by law enforcement with one referring
the participant to medical care then mental health services and the other to a basic needs service
provider who connected her to substance use treatment.
70
2010 - 2021
All but one participant who entered the sex industry in the 2010s had contact with at least
two formal systems (n = 5; 83.33% of participants in this group). Every participant who had
contact with formal systems in this group had contact with law enforcement and a sex trafficking
organization (Figure 11). Most participants in this group (n = 4; 66.67%) had contact with
substance use treatment and/or detox. No participants in this group had contact with mental
health services during their time in the sex industry. The “other†systems participants in this
group had contact with included transitional housing, a mothers & infants’ residential program,
and organizations who provided housing vouchers.
Figure 11. Formal Systems Contact for Participants Who Entered the Sex Industry Between 2010
and 2021
Participants in this group experienced the most collaborations among formal systems.
Some collaborations occurred early in participants’ time in the industry and all included law
enforcement. Collaborations that happened earlier in participants’ time in the sex industry
71
included a combination of two formal systems: all with law enforcement and one other system
(i.e., SUD Tx, “other,†or sex trafficking organization). All collaborations that included three
formal systems occurred at the end of a participant’s time in the sex industry and were mostly
between law enforcement, SUD Tx, and sex trafficking organizations. In addition, every
participant who had formal system contact in this group experienced a multi-system
collaboration immediately before their most recent exit from the sex industry and all included
law enforcement and sex trafficking organizations.
Research Question 3: Circumstances of Most Recent Exit from Trafficking
To answer this research question, I thematically coded qualitative data after asking
participants “How were you able to get out of your situation?†during the year they said they
exited the sex industry (i.e., how they exited). Analysis resulted in five categories participants
experienced as the method that initiated their most recent exiting process: arrest, hospitalization,
opportunity, informal assistance, and perpetrator arrested. Arrest indicates that the participant
was arrested and either served jail time only or was connected to other formal services or
diversion programming. Hospitalization refers to participants being hospitalized as the initiating
event for their exiting process. Opportunity refers to participants being able to leave their
situation when ideal circumstances presented themselves. This category includes participants
sneaking or running away from their abuser or trafficker, by making a life decision to leave the
sex industry, and by an abuser or perpetrator cutting off contact with the participant. Informal
assistance refers to participants seeking help from another person, such as a friend or family
member, to help them leave their situation. And finally, perpetrator arrested means the
participant was able to being the exiting process because their abuser or trafficker was arrested
and no longer able to harm them.
72
To illustrate these qualitative findings, I created timeline visualizations (Figures 12 - 15)
to show: 1) participants’ identities at the time of their most recent exit; and 2) any formal
systems contact they may have experienced at the beginning of their exiting process. Gray boxes
are displayed on each participant’s timeline to indicate when they began their most recent exiting
process. As with previous research questions, findings are presented by decade participants
entered the sex industry. For each group, I provide an overview of how participants identified
their experiences in the sex industry prior to their most recent exit and the methods that initiated
their exiting process.
1970s / 1980s
Identities. Half of the participants who entered the sex industry in the 1970s or 1980s (n
= 3; 50.00%) identified their experiences as “prostitution†at the time they exited (Figure 12).
This was the case both at the time they exited, and now looking back at their experiences. The
other participants in this group decribed their experiences as “child sexual abuse†(n = 2;
66.67%) and “domestic violence†(n = 1; 33.33%) at the time of their most recent exit. All
participants who identified their experiences as “child sexual abuse†and “domestic violence†at
the time of exit now identify those experiences as “sex trafficking.â€
73
Figure 12. Exiting Circumstances for Participants Who Entered the Sex Industry in the 1970s
and 1980s
Methods of initiating the exiting process. Arrest was the event that initiated the exiting
process for all participants in this group who identified their experience as “prostitution†at the
time of exit. One participant served jail time for her arrest while the other two participants’ arrest
led to coordination among law enforcement and organizations serving survivors of sexual
exploitation. For one participant, this connection led to her being set up with another human
services organization who provided shelter, long term service provision, and networking that
eventually led to employment.
We had a really progressive CEO who happened to be on the board of [sexual
exploitation / trafficking organization] who watched me grow up, who became one of my
mentors. So I went to work for [organization] and when the position opened up to
manage the programs, my friend said, “You need to apply.†I said, “Well, I've got too
much wreckage in my past.†She said, “This is exactly what the girls need, someone like
you.â€
This coordination of formal systems at the beginning of this participant’s exiting process set her
up for opportunities later, but she goes on to note that her criminal record from her time in the
74
sex industry was always a concern of hers after exiting, particularly when finding employment.
Although this coordination of services was beneficial to this participant, it was rare for formal
systems to provide this type of support for participants in this decade group.
The other half of participants in this group identified some type of informal method as the
way of initiating their physical removal from the sex industry. Participants who identified their
experience as “child sexual abuse†were removed from their situation either by their perpetrator
being arrested or by informal assistance from a trusted person in their life. For example, one
participant described how telling a church counselor about the abuse she experienced at the
hands of her father led to the end of her exploitation:
He [counselor] was the only person who knew what was going on and that's who I went
to. And I left home that day and never went back. He said, “Your dad has a problem. I'm
going to go talk to your mom. You go ahead and pack your bag and your have your older
sister go home and pack your bag and her bag in the bag of your brother and go to your
grandmother's house and I'm going to talk to your mom, but I want you to plan to stay
away.â€
Although this participant exited through informal support, she was directly connected to a formal
system in the form of a domestic violence family shelter to remove her from her situation.
The participant who identified her experience as “domestic violence†before exiting, left
her abuser when the opportunity presented itself with the support from one of her coworkers:
So [DJ at the strip club] helped me register for school and encouraged me over and over
and over to leave. All he knew was that I was being abused. He didn't know exactly how
bad everything was and kept encouraging me to leave. And so I did. I worked at the
clubs. I pulled doubles for a while, stockpiled money that he didn't recognize. And then
one day while he was out, I don't even know where he was, but I packed up me and the
kids in our clothes and we left.
After she initially left her situation, this participant’s abuser continuously harassed her through
numerous phone calls and threats. He eventually stopped and she did not get back involved in the
sex industry after that. Overall, there were two trends in how participants in this group initiated
75
their exiting process. Participants who identified their experiences as “child sexual abuse†and
“domestic violence†at the time of their most recent exit had their exit initiated through informal
ways (i.e., perpetrator arrested, informal assistance, opportunity), whereas all participants who
identified their experiences as “prostitution†had their exiting process intiated by law
enforcement contact.
1990s
Identities. Most participants who entered the sex industry in the 1990s (n = 5; 62.50% of
participants in this group) identified their experience as “prostitution†at the time of their most
recent exit with three of those participants still identifying their experience as such at the time of
interview (Figure 13). The remaining participants in this group identified their experience as
“child sexual abuse†(n = 1; 12.50% of participants in this group) or “sex trafficking†(n = 2;
25.00% of participants in this group) at the time of their exit and all considered those situations
as “sex trafficking†when looking back.
Figure 13. Exiting Circumstances for Participants Who Entered the Sex Industry in the 1990s
76
Methods of initiating the exiting process. The most common way participants in this
group initiated their exit from the sex industry was through arrest, either of themselves or of their
perpetrator. One participant, who identified her situation as “prostitution†at the time, stated that
her trafficker being arrested initiated her ability to begin her exit from the sex industry but he
still manipulated her when she visited him in jail. She was arrested shortly after her trafficker on
drug-related charges and mandated to substance use disorder treatment and narcotics anonymous
meetings as part of her sentencing.
Of the five participants who identified their experience as “prostitution†at the time of
their most recent exit, two were arrested and connected to organizations that serve survivors of
sexual exploitation. One participant recalled reaching out to an advocate from a sex trafficking
organization after running into her at the police station where she and her trafficker were being
held on unrelated charges:
I actually reached out to [advocate] because my trafficker got locked up and I guess
[advocate] came to visit my friend who was with him when he was arrested. So they
flagged her right away but I didn't get screened because I didn't get caught with them. …
The prosecutor wanted to give me, I believe eight years for my charges. And after telling
[advocate] my story, she said she knew that I was done when she saw me and that she
needed to fight for me.
After this encounter, this participant served a reduced sentence and continued her recovery at the
sex trafficking organization the advocate worked for.
As seen in the timeline visualization in Figure 13, participants in this group also had
significant contact with organizations that serve people who have experienced sexual
exploitation / trafficking at the beginning of their most recent exiting process. Participants who
accessed these organizations early in their exiting process did so through several ways. Although
some were connected to these organizations through arrest, as noted above, other participants
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physically left their situation by safety planning or seizing an opportunity to leave. One
participant became connected with an organization through street outreach efforts:
They approached me, they gave me a flyer. They told me if I got in the van
right now, I didn't ever have to live like that. Again, one of my friends from the
street was in the van. And if she could do it, I told myself, “I know I can do it.â€
Although she did not get into the van after this encounter, multiple contacts with this outreach
van and seeing a peer working for the organization made her feel ready to make a change.
Although arrest was the most prevalent method of initiating exit from the sex industry for
participants in this group (either though participants being arrested or their perpetrator being
arrested), overall, this group still had the most variety in the methods that initiated participants’
most recent exiting process when compared to the other decade groups in this study.
2000 – 2009
Identities. Although five participants (35.71% of participants in this group) defined their
experience as “prostitution†at the time they exited the sex industry, there was more variability in
how others in this group conceptualized their experiences when they exited (Figure 14). Five
participants (35.71% of participants in this group) also described their experience at their most
recent exit as “domestic violence.†Other participants in this group defined their experiences as
“trading,†“child sexual abuse,†and intermittent “survival sex†and “sex trafficking†at the time
of their most recent exit. Aside from two participants who considered their experience/situation
to be “prostitution†both at the time of their most recent exit and at the time of their interview, all
participants in this group recognized their situation at the time of their exit as “sex traffickingâ€
when reflecting on it during their interview.
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Figure 14. Exiting Circumstances for Participants Who Entered the Sex Industry Between 2000
and 2009
Methods of initiating the exiting process. Overall, there was more variability in the
ways participants in this group initiated their most recent exiting process. Compared to other
groups, there were relatively few arrests (n = 2; 14.30% of participants in this group) as the event
that initiated their most recent exit from the sex industry. It should be noted that one of these
participants specifically stated that, although this arrest began the exiting process, the “caveat to
this is, I do not credit jail for my exit.â€
When looking at the timeline visual in Figure 14, there was less formal systems contact at
the end of this group’s time in the sex industry. This is also reflected in this group’s use of
opportunity as the most common method to initiate the exiting process (n = 8; 57.10% of
participants in this group). Participants who initiated their exit through this method mostly
identified their experience as “prostitution†or “domestic violence†at the time of their exit.
Participants who identified their situation as “prostitution†and exited through opportunity did so
after making a life decision to change their lives. One participant made the decision to drastically
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alter her life to try and find employment outside the sex industry but recalls the emotional and
logistical struggle of doing so, “I shut all my social media down for like, a year. and I just
stopped answering the phone. And it was just, it was really hard. I just pretended I was a
different person.†Despite these challenges, this participant was in a situation where she was able
to consciously cut off contact and physically distance herself from the sex industry as a way to
begin her exiting process.
Participants in this group who initiated their exit through opportunity and identified their
situation as “domestic violence†at the time they began the exiting process ran or snuck away
from their abuser. One participant recounted her initial escape:
I had $40 saved in the back of a Blackberry where the battery would go and I hid it in my
closet. I was smart. Something in me… I think he left to go to the laundry or something
like that? So I grabbed that phone and my dog and I just started pretending to walk him.
At that time, I wasn't able to even walk my dogs very much. Like, I could bring them
outside the back, but that was it. I just felt God told me to leave and I left. I ran to a store
on the corner.
Similar to others in a similar situation, this participant planned ahead by saving money in
addition to seizing an opportunity to sneak away from her abuser when he was not
present.Overall, this group engaged with formal systems less than any other decade group when
initiating their exit from the sex industry and, instead, siezed opportunities or used informal
supports to get out of their situation.
2010 – 2021
Identities. Unlike previous groups, “prostitution†was not one of the most common
descriptions participants who entered the sex industry in 2010 or later used to explain their
situation at the time they exited the sex industry (Figure 15). Most participants (n = 4; 66.67% of
participants in this group) identified their experiences as “sex trafficking†both at the time of
their most recent exit and when reflecting on it during their interview. Two participants (33.33%)
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identified their experience as “prostitution†at the time of their most recent exit from the sex
industry in this group and later identified these expereiences as “sex trafficking.â€
Figure 15. Exiting Circumstances for Participants Who Entered the Sex Industry Between 2010
and 2021
Methods of initiating the exiting process. As seen in the visual in Figure 15, the way all
but one participant in this group initiated the exiting process was through arrest immediately
followed by a coordinated service provision response by organizations serving survivors of
sexual exploitation / trafficking. These participants all had the same pattern of being referred to a
sexual exploitation / trafficking organization after being arrested. However, some participants
also attended treatment for substance use disorders prior to being admitted into those sexual
exploitation / trafficking organizations. This pattern of collaboration was by far more common in
this group than in any other decade group in this study. The only participant to not exit in this
way did so by seizing an opportunity to leave when her trafficker was not around after stealing
her ID, money, and car while she was sleeping.
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Most participants in this group were arrested by undercover officers and/or through law
enforcement sting operations at locations where people engage in commercial sex. Some of these
stings were conducted in partnership with a local anti-trafficking organization so survivors could
be connected to diversion programming if they chose. Participants whose arrest was not directly
connected to a sting operation were given the choice between jail time and court-facilitated
diversion programming. As seen in other groups, some participants had multiple contacts with
advocates doing outreach for anti-trafficking organizations prior to their most recent exit. One
participant discussed the impact this persistence had on her:
They [sex trafficking organization] were looking for me before I ever knew anything
about them. Like they knew what I was going through and that they were trying to find
me. I mean, that's… that makes the difference.
For this participant, being aware of and having multiple contacts with this anti-trafficking
organization helped her determine if she was ready to go into treatment for her substance use and
begin her exiting process. Similarly, Participant 604003 had multiple contacts with an advocate
from an anti-trafficking organization. Although this participant had seen this outreach advocate
in the community multiple times, the most meaningful contact came when she was hospitalized.
She [the advocate] told me, “The offer still stands if you change your mind.†I had
periodically talked to her here and there, but I don't think that I saw her again until I was
in the hospital. … When I was there for like the long time, she came and saw me. I swear
it was like every day someone from [the sex trafficking organization] came and saw me
while I was in the hospital. Like, they brought me an Easter basket, they brought me
books, just, you know, to just show me that they were there for me and build that rapport.
After this participants’ last arrest, she made the decision to enter that organization’s
residential program for survivors of sex trafficking. Again, multiple contacts with this advocate
were key to building trust which ultimately contributed to this participant’s recognition of her
experience as sex trafficking at the time and her decision to begin her exiting process. Overall,
participants in this group experienced the most multi-system collaboration during their most
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recent exit from the sex industry, particularly between law enforcement and sex trafficking
organizations.
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CHAPTER 4: DISCUSSION
Understanding Experiences in the Sex Industry Over Time
In this study, participants used many different terms to define their experiences in the sex
industry. This finding is consistent with previous research in which women have conceptualized
their identities within the sex industry based on different contextual factors, such as the presence
of exploitation and acknowledgement of abuse (Eldridge, 2017; Gerassi, 2020). For example,
Gerrasi (2020) documented that people who traded sex self-identified in three distinct ways: 1)
sex traders, 2) independent prostitutes, or 3) prostitutes with a pimp. Participants in the current
study did not always directly relate their experiences to their personal identity (e.g., identify as
an “independent prostituteâ€), but consistent with Gerassi (2020), they did discuss their
experiences with trading sex as distinctive from engaging in prostitution. Some drew a
distinction between trading sex and survival sex, whereby the latter term tended to be used when
they were encountering severe economic instability and scarcity. Participants also explicitly
defined some of their experiences as sex trafficking, and this was more typical among survivors
who entered the sex industry during or after the 2000s. Interestingly, many survivors included
child sexual abuse and domestic violence in their LHC timelines. Prior research has found that
survivors of sex trafficking often have histories of interpersonal trauma (Bruhns et al., 2018;
Gerassi et al., 2018; Hickle & Roe-Sepowitz, 2014; Lederer & Wetzel, 2014), but the survivors
in this study specifically mentioned these forms of trauma because the violence they experienced
from family/partners was exploitive in its own right, and/or it created vulnerabilities that led to
survival sex or trafficking. Thus, all of the participants in this study identified at least some of
their experiences in the sex industry as sex trafficking, but they also engaged in other forms of
volitional sex work and also experienced other forms of coercive sex work/sexual abuse. Thus,
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these findings contribute to and complicate the ongoing theoretical commentary on the agency
and choice involved in individuals’ experiences in the sex industry.
This study also found that participants’ conceptualizations of their experiences in the sex
industry often change over time. Lutnik (2016) found that minors associated with a third party
(e.g., pimp, trafficker) did not necessarily stay with that person throughout their involvement
trading sex and also experienced periods where they had no sex trade involvement at all. Adult
survivors interviewed by Eldridge (2017) also experienced periods of going in and out of the sex
industry. Similarly, participants in this study had periods where they were associated with
different third-parties, had no association with a third-party, or were out of the sex industry all
together before re-entering. These changes were salient for participants, in that, even when
changes happened a decade or more ago, participants were able to clearly remember the timing
of changes in their situation when creating their LHC during the interview. These findings add to
the literature by demonstrating the dynamic nature of individuals’ experiences in the sex industry
over time.
Not only do findings from this study show changes in survivors’ experiences in the sex
industry over time, they also highlight the distinction between how participants conceptualized
their experiences at the time they occurred and how they view them retrospectively (i.e., then v.
now). Participants in this study often did not identify their experiences as sex trafficking at the
time it occurred. Prior research has found that victims in the United States tend to apply the term
‘sex trafficking’ primarily to foreign-born individuals and children (Eldridge, 2017; Gerassi,
2020). This study also documented participants’ reticence to use this term, but for different
reasons. The survivors in this study did not identify their experiences as sex trafficking largely
due to historical cohort effects. That is, participants who were introduced to and spent time in the
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sex industry prior to the passage of the TVPA in 2000 did not have the terminology available to
be able to name their experiences as sex trafficking at the time they occurred. Looking back over
those experiences now, they recognized and identified that those periods of time would constitute
sex trafficking, and thus they re-labeled their experiences as such. Taken together, the findings of
this study suggest that survivors have different labels and terms to refer to their experiences and
the meaning of those terms changes over time. As such, researchers and practitioners should not
assume universality in the meaning of these terms, and should seek to understand the
behaviors/interactions themselves and the context of those experiences in order to clarify
survivors’ subjective definitions of the labels they self-apply.
Formal System Contact Over Time
The survivors interviewed in this study had contact with multiple formal systems
throughout their time in sex industry. As seen in other studies, participants’ contact with formal
services was initiated in different ways and for varying reasons (Preble & Black, 2020; Wilson,
2014). For example, some contacts were initiated by participants to get their immediate needs
met throughout their time in the sex industry, such as receiving medical care or staying at
shelters. However, some of these contacts, such as SUD treatment and arrests, were mandated by
the legal or other formal systems (see also Corbett, 2018; Preble & Black, 2020). These findings
suggest that the formal systems participants accessed on their own accord (i.e., were not
mandated to attend) can serve as an opportunity for intervention and identification of behaviors
that characterize sex trafficking. Furthermore, these opportunities for intervention can be acted
upon earlier in a person’s time in the sex industry given the numerous contacts survivors had
with formal systems. However, as previous literature has noted, this requires that service
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providers be trained to recognize the behaviors and experiences of sex trafficking survivors in
order to appropriately and adequately address and understand their needs (Eldridge, 2017).
Most participants in this study had contact with one primary formal system over time
(e.g., the police) and if they had contact with other systems, those interactions tended to be
discrete and unconnected. However, many survivors described that their more recent interactions
with formal systems tended to be more coordinated, and it was clear system personnel were in
communication with each other and sought to collaborate to support survivors’ needs. Previous
research underscores the importance of interagency collaboration and referral networks when
serving survivors of sex trafficking to address their numerous needs upon exit (Baker & Grover,
2013; Connell et al., 2015; Corbett, 2018; Powell et al., 2018). When collaboration among
formal systems occurred for participants in this study, it was usually at the end of their time in
the sex industry prior to their most recent and/or sustained exit. This finding suggests that formal
systems or services working in isolation may not be as impactful or helpful to survivors
compared to multiple systems collaborating to address the gaps in service provision at their
organization.
Circumstances of Most Recent Exit from Trafficking
This study focused on survivors’ most recent exit from trafficking, and a clear pattern
emerged such that an arrest in conjunction with inter-agency connections and collaborations with
other systems (e.g., anti-trafficking organizations, SUD, health care) was a typical exit pathway.
Previous research has also found that law enforcement contact and/or arrest is a common method
for survivors to exit sex trafficking, particularly when police connect survivors to other formal
systems or services (Connell et al., 2015; Corbett, 2018; Preble & Black, 2020; Wilson, 2014).
The current study builds upon this finding in the literature by examining both the system contract
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that preceded their exit and survivors self-defined identities at the time of their exit to understand
how these two features interact to create different exiting pathways for survivors.
For those who identified their experiences as sex trafficking at the time of their exit, most
exited through arrest coupled with collaboration with sex trafficking organizations. Many
experienced this collaboration through court-based sex trafficking and prostitution diversion
programs where they were mandated to or given the option of SUD treatment and/or services at
sex trafficking organizations in lieu of jail time. Despite the supportive intentions of these
collaborative relationships, survivors of sex trafficking often do not trust law enforcement and
people in positions of authority, and thus these “supports†may not always feel supportive
(Eldridge, 2017; Preble & Black, 2020). This was true of some participants in the current study
who were connected to services after their arrest, as they acknowledged that the arrest was a
factor that helped them exit, but they did not want to give law enforcement credit for their exit
from the sex industry. By contrast, other participants identified law enforcement as a helpful
resource that connected them to other services, such as sex trafficking organizations, which
facilitated their most recent exit from the sex industry.
Participants who identified their situation as prostitution at the time of their exit also
predominantly experienced arrest as the method to initiate their exit. These findings were
expected given the criminalization of prostitution in most of the United States. Previous research
has found that arrest served as a turning point for people to exit prostitution (Oselin, 2014), but
those who are engaged in prostitution are not consistently connected to formal survivor support
services following their arrest. In other words, those who identified their experiences as
prostitution, rather than trafficking, were treated differently by community service providers.
Those who identified their experiences as trafficking—and likewise, system personnel identified
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their experiences as trafficking—were diverted from the criminal justice system and connected to
help services, but those who defined as engaging in prostitution did not always get that same
type of help. Thus, those engaged in prostitution had to find their own connections and pathways
post-arrest, or find other opportunities to leave.
Participants who identified their experience as domestic violence at the time of their most
recent exit predominantly exited the sex industry through means of opportunity. These
participants discussed exiting strategies that mirrored strategies of women leaving abusive
intimate partner relationships, such as saving or hiding money and safety planning (Bermea et
al., 2020). Although previous research has highlighted the challenge interpersonal isolation poses
for women attempting to leave domestic violence situations (Anderson & Saunders, 2003;
Keeling et al., 2016; Storer et al., 2018), participants in this study were able to draw upon
external personal connections to assist them when they acted upon an opportunity to exit. That is,
those who saw their situation as domestic violence and escaped their situation by seizing
opportunities to leave were more likely to immediately reach out to a person (e.g., clerk at a
nearby store, a regular buyer they trusted, a family member) for help; by contrast, those who
identified their situation as prostitution did not tend to seek external support during their exit. In
other words, when participants who saw their situation as prostitution seized an opportunity to
physically leave their situation, they began rebuilding their lives on their own, without formal or
informal support. Taken together, this study contributes to the field by demonstrating how a
person’s interpretation of their experience can impact the method they use to exit the sex
industry.
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Limitations of this Study and Directions for Future Research
As with any study, this project was not without limitations. First, the participants in this
study were recruited via convenience sampling in collaboration with an established survivor
service program and/or an online anti-trafficking community. Because trafficking is often hidden
from public view and remains highly stigmatized, it is challenging for researchers to connect
with survivors who are not already engaged with service programs and advocacy networks.
However, those who are connected to such networks are a unique subset of survivors and likely
are not representative of the larger population of trafficking survivors. Although universal
generalizability is not a focal concern in qualitative research (Denzin & Lincoln, 2017), it is
important to consider how these sampling methods affected who was able to participate and
ultimately what was learned in this study. It is likely that these survivors had more contact with
trafficking organizations (see Research Questions 2), and therefore the role of those agencies and
their coordination and collaboration with other systems (see Research Question 3) may not be as
salient a factor for other survivors in their exiting process. Thus, how the process of exiting
unfolds for survivors who did not have any connections with anti-trafficking organizations is
largely unknown. To address this limitation, future studies could consider using respondent-
driven sampling strategies (Gerassi et al., 2017) to reach survivors who are not connected to
services or anti-trafficking community spaces. However, an important advantage of working in
collaboration with service agencies is that they are able to provide support and advocacy to
participants in the event they become distressed during or after a research interview. Alternative
sampling methods would need additional trauma-informed protocols for addressing potential
distress during the interview and thereafter.
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Second, given that this project was conducted during COVID, study procedures were
modified such that all interviews were conducted via remote technology. One positive
consequence of this change was the opportunity to interview survivors from a larger geographic
area than would have been possible if interviews were conducted in-person. This study includes
perspectives from survivors living in fifteen states, including Hawaii. A notable disadvantage of
remote data collection is that participants needed have access to Zoom, a device to connect to
Zoom, reliable cellular or internet service to connect to Zoom, and the financial means to stay
connected for up to 2 hours. In other words, participants needed to be relatively well-resourced
to participate in this study, which therefore limited the socio-economic diversity of the sample.
Future studies should expand options for remote data collection for individuals who may have
fewer resources and/or access to technology. One possible strategy would be partnering with
services agencies whereby survivors could use their onsite technology, but as noted above, that
approach may continue the problem of over-sampling survivors connected to community
services. Utilizing referral chain sampling, such as respondent driven sampling (as described
above), may be a way to connect survivors who are not already in contact with community
agencies by sending them to these sites for onsite data collection, thereby also creating an
opportunity for service provision.
Third, the sampling strategy utilized in this study yielded a sample of predominantly
white, cisgender women. This is likely a reflection of the demographics represented on the
listserv used to invite survivors to participate in the study. Given the lack of diversity in this
sample, I was not able to examine the impact of participants’ social location and intersectional
identities to the extent and with the same complexity I had hoped. To avoid this limitation in
future studies, researchers could utilize respondent driven sampling and/or specifically engage in
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outreach activities with groups that are traditionally underrepresented in sex trafficking research
including but not limited to Native/Indigenous, Black /African American, LGBTQIA+, gender-
diverse, male, and immigrant survivors. An additional factor that likely contributed to the limited
analysis of intersectional identities was the placement of the social location analysis items in the
interview protocol. These questions were at the end of the interview protocol as a way for
participants to reflect back on the topics discussed on their LHCs (see Methods). However, by
the time these questions were asked, participants had already spent an extensive amount of time
being interviewed, were likely fatigued, and did not provide much additional detail about their
experiences in relation to their identities. Given the length and complexity of the interviews in
this study, future researchers interested in examining the influence of survivors’ social identities
on their experiences in the sex industry should consider inter-weaving such questions and
reflections throughout the interview, which may yield richer data.
Fourth, LHC methodology has many key strengths, but there are some limitations of the
method when interviewing participants about events that spanned long periods of time. Given
how long some participants spent in the sex industry, calendar-focused interviewing became
somewhat taxing. When asked to describe their contact with formal systems, survivors were able
to confidently recall how many times they had contact with a formal system or service (“I went
to detox __ times before I became sober in [year]â€) and/or the year or span of years they
occurred, but to minimize the cognitive and emotional load for participants, it was not feasible to
ask participants to discuss each of these system contacts in detail. Therefore, the formal systems
contact described in this study (see Research Question 2) does not capture the frequency or
duration of those contacts, nor does it reflective their narrative experiences and impressions of
those contacts. However, this level of detail was feasible to collect for participants’ most recent
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exit from the sex industry and any contact they received from formal systems at that time, which
became the focus of Research Question 3. Using LHC methods to study events that span long
periods of time is certainly feasible, but researchers likely need to prioritize what topics they
want to explore in depth. In future studies on trafficking survivors’ experiences with formal
systems, it may be helpful to conduct multiple shorter interviews whereby each data collection
segment focuses on a specific period of time and explore experiences in that era in more depth.
Fifth, a related concern with LHC methodology is that it presumes participants can
identify a date or date range for key events in their lives. For example, in this study, many
participants were able to clearly identify the year they first thought about or attempted to leave
the sex industry, but for others, this was a more amorphous process. Some participants said they
did not even consider leaving as a feasible or safe option for themselves while they were in their
situation. This was especially true of participants whose experiences in the sex industry occurred
when they were young children and/or who experienced exploitation at the hands of family
members. Other participants were also unable to pinpoint when their thoughts about and/or
attempts to exit the sex industry began. These participants were aware they were in a negative
situation they wanted to leave but could not definitively say when that thought process began.
Given these challenges, this study could not describe the process of exiting across all attempts to
leave the sex industry, and instead focused on the process for the most recent exit. Researchers
conducting future research on the process of exiting should aim to examine the entire process by
explicitly asking questions about participants’ first and subsequent thoughts and/or attempts to
exit the sex industry. Future interview protocols should be designed to reduce the logistical and
conceptual challenges described above by only including questions pertaining to participants’
exiting attempts, as this can be a complex process for survivors to discuss.
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Sixth, presenting qualitative findings through timeline visualizations was a pragmatic
analytic choice, however, may not describe the full depth and nuance of participants’ experiences
in the sex industry. Given the relatively large sample size and variability in when participants
were first introduced to the sex industry, analysis heavily relied on visualizations to synthesize
findings for each research question. This approach was able to highlight complex and dynamic
findings over a large span of time. Although participant quotes were included to supplement the
visualizations, I recognize that this approach does not lend itself to the detailed narrative
approach that is characteristic of qualitative data analysis. Future studies can address this
limitation by adapting the recruitment and sampling strategy to limit the number of participants
included in the study and/or have inclusion criteria that bounds the of the amount of time
participants spent in the sex industry. This will provide a manageable amount of data that can be
analyzed and presented through data visualizations and a more detailed narrative qualitative
approach.
Seventh, emergent and unexpected findings are not uncommon in qualitative research,
and it can be difficult to pivot in the midst of a study to capture additional information and
context that might help explain a study’s results. For some participants in this study, childhood
sexual abuse preceded their entry into sex work, and the interview did not have enough questions
about the influence of adverse childhood experiences, grooming tactics, and/or other risk factors
on participants’ experiences in the sex industry. For these participants, childhood sexual abuse
and/or adverse events were conceptualized as separate from their involvement in the sex industry
and may have occurred up to decades before they were first introduced into the sex industry.
Therefore, these years and formal system contact that occurred during those years were not
discussed in the interview or included on the timeline visualizations. However, some survivors
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conceptualized childhood sexual abuse and adverse events as the beginning of their involvement
in the sex industry, and therefore were included on their timeline visualizations. Given these
variations, information about adverse childhood events and/or sexual abuse was not collected
systematically from all participants in the sample. Researchers wishing to conduct future studies
on the connections between survivors’ childhood events and subsequent experiences in the sex
industry can avoid this limitation by explicitly and systematically asking childhood-related
questions of participants regardless of their age of entry into the sex industry.
Finally, as previously mentioned, this study was only able to capture participants’
experiences with their most recent exit from the sex industry. However, this recent exit – shown
at the end of participants’ LHC visualizations – was not the end of their exiting process, but
rather the beginning of the process of sustaining their exit by initiating the process of recovery
and healing. Many participants in this study exited the sex industry several years ago and since
then had contact with many formal systems to support their recovery. As it was designed, the
interview protocol did not incorporate questions about long-term supports or formal services
beyond participants’ most recent exit from the sex industry into the scope of this study. Survivors
made multiple attempts to exit sex trafficking and the sex industry, and future research should
also focus on the iterative process of healing that survivors begin after they physically exit the
sex industry and begin the road from surviving to thriving.
Implications for Policy & Practice
Despite these limitations, the findings of this study offer useful guidance for practitioners
and policy makers. First, given the variation in how participants in this study defined their
experiences in the sex industry, formal systems and organizations providing services to survivors
should expand their understanding and definitions of who they serve. Some participants clearly
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and distinctly defined their experiences as “sex trafficking,†and the identification with and use
of that specific term opens specific doors and services; however, others were experiencing sex
trafficking but did not know or use that term to describe their experiences, and thus, certain
service sectors were functionally unavailable to them. There is simply too much responsibility
placed on survivors to know and use the exact terms that will identify and make available the
various services that are designed to support those being trafficked. To lessen this burden on
survivors, formal systems and organizations should broaden their eligibility requirements for
service provision to focus on the behaviors associated with a person’s experience and not on a
label or definition. As seen in this study, some providers at sex trafficking organizations adopted
a practice of proactively recognizing the indicators of sex trafficking in an individual’s
experience during their outreach efforts. Once they identified elements of sex trafficking in a
person’s situation, the outreach provider offered resources and support, often over multiple time
points, even if a person had not identified their situation as sex trafficking yet. Practitioners at
formal systems must be trained on the experiences that define sex trafficking and incorporate
behaviorally-specific screening questions in their intake procedures and throughout their
subsequent service provision and outreach. Given the findings from this this study, implementing
these trainings and procedures is especially critical at organizations serving survivors of child
sexual abuse and domestic violence since there are likely survivors of sex trafficking among
those already receiving services.
If the ways in which providers identify survivors of sex trafficking are expanded, policies
and funding allocation should also follow suit to have less rigidity and restrictions on who can
receive services. Given that people in the sex industry have experienced or are co-experiencing
childhood sexual abuse, intimate partner violence, and/or sexual assault, funding streams should
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not be as siloed in the way they award or prescribe funding for services. For example, providers
at domestic violence or sexual assault organizations may not be able to use certain funding
streams to provide services to a sex trafficking survivor if they do not fall within the
specifications the funding was intended for or if the survivor does not identify having any
experiences of violence inflicted by an intimate partner and/or sexual assault. As an additional
challenge, findings from this study show that the ways survivors define their experiences in the
sex industry are not necessarily aligned with legal or conceptual definitions and also change over
time. Therefore, to account for the dynamic interpretation of experiences in the sex industry,
policies, funding streams, and organizations should not be structured to artificially silo these
experiences. Doing so runs the risk of denying adequate service provision and care to survivors
of sex trafficking and other forms of sexual violence. Furthermore, funding must also prioritize
increasing the capacity of organizations to offer survivors long-term care because their physical
exit from the sex industry is only the beginning of the ongoing process of recovery and healing.
Thus, policies and funding that do not include long-term support to survivors who are not
actively being trafficked will ultimately fail survivors beyond their physical exit from the sex
industry and may lead them to re-engage with the sex industry to make ends meet and provide
basic needs for themselves.
Given the presence and effectiveness of formal system collaboration immediately before
participants’ most recent exit from the sex industry, efforts should be focused on creating new
and sustaining existing task forces, coalitions, and multidisciplinary teams. Based on the findings
from this study, these collaborative groups should be established and/or operate with the
following considerations in mind: (1) decentralize law-enforcement intervention/response, (2)
expand the membership roster of included organizations/sectors, and (3) prioritize survivor
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involvement and leadership. First and foremost, considering the historically violent and
oppressive context of the of the criminal-legal system, particularly for communities of color, task
forces should seek to de-centralize law enforcement intervention as much as possible. Although
this study showed that arrest and law enforcement intervention coupled with other services was
an effective and useful method for some survivors, it was conducted with a non-representative
sample of mostly cisgender, white women. This same pattern of formal system collaboration
could be perceived as a negative, harmful, disempowering method of exiting the sex industry for
survivors with diverse social identities. Therefore, given the justified distrust communities of
color have of the criminal-legal system, interagency taskforces and coalitions should aim to
increase the capacity of other sectors to identify, intervene, and support survivors of sex
trafficking, thus de-centralizing the role of law-enforcement intervention.
To date, police and law enforcement have been at the center of society’s response to sex
trafficking and prostitution given that both circumstances are illegal. However, given the
victimization inherent in experiences of sex trafficking, and potentially cases of prostitution,
criminalizing individuals who have experienced sex trafficking causes further harm, particularly
as they attempt to exit and rebuild their lives. Continuing to center law enforcement in the
community response to sex trafficking limits opportunities to build up other resources and
supports that survivors are more likely to engage with and benefit from because they do not fear
criminal prosecution. Therefore, this “de-centralization†process should prioritize funding and
resource allocation to community organizations and non-profits that provide health services and
basic life essentials to individuals in the sex industry, survivors of domestic violence, sexual
assault, and sex trafficking. Providing resources to these organizations should be done in
conjunction with building their capacity to operate both independently and in collaboration with
98
each other to provide support to survivors in the communities the task force or coalition serves.
Further, resources should be allocated for lived-experience experts (i.e., survivors) to conduct
outreach in communities to identify individuals in the sex industry in need of resources and
support. Doing so should allow these organizations to build trust, identify, and serve survivors in
more trauma-informed ways that do not rely on law enforcement referrals from arrests and/or
sting or raid operations or require individuals to self-identify their experiences. Building capacity
and establishing these networks of formal systems in communities will lessen the burden on a
single system or defaulting to the most resourced sector, often the criminal-legal system, when
supporting individuals exiting the sex industry.
Next, task forces and coalitions should expand the bounds of their membership rosters to
include practitioners and advocates working with individuals affected by every area of gender-
based violence and the sex industry. As previously discussed, many survivors do not identify
their situation as sex trafficking yet are still having contact with service providers in multiple
sectors. Therefore, task forces and coalitions should identify as many community stakeholders
working with individuals who are experiencing or have experienced elements/indicators of sex
trafficking as possible. This may include but is not limited to domestic violence organizations
and shelters, sexual assault response centers, organizations serving individuals who sell or trade
sex, SUD treatment centers, child protective services and foster care, community mental health
centers, local hospitals, and other community groups. Doing so will help reach survivors of sex
trafficking who may otherwise go unidentified and unserved and build capacity of other sectors
to address the needs of survivors in their communities.
Finally, survivors should be seen as lived-experience experts and be included in the
membership and leadership roles of task forces and coalitions. This will add valuable expertise
99
and further address the institutional distrust many survivors of sex trafficking feel toward formal
systems when establishing interagency taskforces and coalitions. Ideally, survivor members will
be from the communities the task forces serve and, in addition to contributing to leadership
duties of the task for or coalition, contribute to training practitioners and community members on
sex trafficking. These survivors might also be responsible for contributing to outreach and
engagement efforts, particularly with diverse and/or hard to reach groups, to identify and build
trust with other survivors who may be apprehensive about the role of the task force in ways
practitioners cannot. Therefore, it is critical to include survivors as lived-experience experts in
every area of creating and sustaining interagency networks to build trust among other survivors
and establish a standard of survivor-centered, trauma-informed outreach, care, and referral
methods among all member organizations.
Conclusion
Exiting from sex trafficking and the sex industry is a complex and iterative process
involving numerous individual, interpersonal, and systemic factors. How survivors define their
experiences within the sex industry and the formal systems they have contact with play a critical
role in their decision and ability to physically leave their situation and eventually rebuild their
lives. Formal systems and community service providers can be instrumental in helping survivors
exit, particularly when they focus less on pursuing criminal charges against victims and instead
focus more on collaborating and connecting survivors to specialized anti-trafficking
organizations.
100
APPENDICES
101
Appendix A. Researcher Characteristics and Reflexivity Statement
As the author of this dissertation, it is important to situate myself in the context of the
research process. During this study, I held a master’s degree and was pursuing a doctorate degree
in Community Psychology at Michigan State University and also worked as a research
consultant affiliated with local and national anti-sex trafficking organizations. Throughout my
training as a community psychologist, I gained experience developing and conducting
community-based research in partnership with organizations, survivors, and community
members working to address sex trafficking. These experiences led me to develop the current
study based on conversations with sex trafficking survivors and service providers.
As part of my training as a community psychologist and my own personal perspective, I
approached this project with a set of interests, beliefs, and assumptions. First, my interest in
completing this project was to fulfill doctoral requirements to obtain my degree, which was
clearly communicated to participants during the consent process. Next, I designed this study with
the assumption that survivors of sex trafficking are experts in their own lives and experiences.
Relatedly, I believe it is important to speak to survivors directly to have them share their
expertise through qualitative interview methods and felt the LHC was an appropriate,
participatory way to facilitate the interviews conducted in this study. My final assumption is that,
although I am still refining my positionality and understanding of the implications of sex
trafficking policies in the lives of survivors, I approached this research with the belief that
carceral approaches and criminalization of victims of sexual exploitation are not appropriate
responses to address sex trafficking.
I continuously considered and reflected upon these beliefs and assumptions through the
lens of my social identity as an educated, middle-class, cisgender, White woman, throughout
102
each stage of the research process. I did this by periodically engaging in critical conversations
with fellow scholars in the field about how my assumptions and identity shaped the design of this
study and my interpretation of the findings. I was mindful of the power dynamic my identity and
role in this research created during interviews and spent a great deal of time at the beginning of
the interview emphasizing to participants that, in fact, they were the experts on this subject and
their experiences, and my role in the interview was to facilitate the conversation and record the
information they chose to share. In addition, after each interview, I debriefed with participants
and encouraged them, as the experts, to provide critical feedback on the content and my
administration of the interview protocol. Finally, at the conclusion of this study, I considered my
role in disseminating the findings of this study. I reflected on how holding participants’ stories
and experiences, once again, put me in a position of power. I grappled with this privilege
because (1) I did not want to co-opt participants’ stories and claim their knowledge as my own,
and (2) I recognized the professional benefit that could result from publishing and presenting on
these findings. Although I felt a sense of responsibility to widely communicate findings from this
study to academic, practitioner, and policy-maker audiences, I did not want to do so without
input from participants or by providing them the opportunity to present the findings themselves
particularly because these findings would not exist without their participation and expertise. I
also did not want to overpromise my capabilities in sharing these findings widely nor did I want
to be the only person benefitting from presenting or sharing this information. As a result of this
reflection, I developed a participatory dissemination strategy wherein I offered participants the
opportunity to be co-authors and/or co-presenters of subsequent publications and presentations
that could be included on their resumes and used to further their professional and/or educational
careers.
103
Appendix B. Recruitment Script
Program Director: “Hi _________. We are partnering with a researcher to assess our
programming and your experiences with other service providers. She asked me to share the
following info to see if you would be interested in participating in an interview.â€
You are being asked to participate in a research study conducted by researchers at Michigan
State University. If you choose to accept, you will be asked to participate in a voluntary, one-on-
one confidential interview via Zoom. This interview will ask about your interactions with Selah
Freedom staff, service providers, healthcare personnel, and law enforcement both during and
after your trafficking experience.
The interview will last approximately 2 hours, and you will be paid $50 via Venmo, Cash App,
Zelle, PayPal, or Western Union at the end of the interview in compensation for your time and
expertise. Your participation in this study will contribute to our understanding of how different
factors affect survivors of sex trafficking when accessing services. All information gathered in
the interview will be kept confidential and no identifying, individual responses will be shared
with Selah Freedom staff. We hope to use the knowledge you share with us to make service and
policy recommendations to benefit other survivors who seek care at Selah Freedom and
elsewhere.
If interested, Program Director share the following:
“Great, what is the best way for the researcher to contact you? With your permission, I’ll
share your contact info and she will get in touch with you soon.â€
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Appendix C. Interview Protocol
Process of Exiting Sex Trafficking
Start of Block: Consent
PID
________________________________________________________________
Thanks again for taking the time out of your day to speak with me. I really appreciate it.
The first thing we will do is go through the consent form I sent you. There are a few things I'd
like to highlight.
First, the purpose of this study is to understand how different factors affect survivors of sex
trafficking and exploitation as they exit the life and connect to services.
Overall results from this study will be shared however, these findings will not include any
individual or identifying responses.
Your participation in this research project is completely voluntary. You have the right to say no,
and you may change your mind at any time and withdraw from the study without any
105
consequences. You may choose not to answer specific questions or to stop participating at any
time.
There is the possibility that you will find the interview emotionally difficult given the sensitive
questions you’ll be asked. As a reminder, you can stop the interview at any time or skip any
questions are you are not comfortable answering.
Do you have any questions for me about any of this?
Do you voluntarily agree to participate in this study?
o Yes
o No
Do you voluntarily allow the audio recording of the interview?
o Yes
o No
End of Block: Consent
Start of Block: Demographics
Where are you located? [state]
________________________________________________________________
106
How long have you been out of the life (trafficking / exploitation)? [years]
________________________________________________________________
What is your age?
________________________________________________________________
What is your race? (check all that apply)
â–¢ American Indian/Alaska Native
â–¢ Black or African American
â–¢ White
â–¢ Asian
â–¢ Hispanic or Latinx
â–¢ Native Hawaiian or other Pacific Islander
â–¢ Prefer to self-describe ________________________________________________
107
What is your gender identity?
o Cisgender man (male/man)
o Cisgender woman (female/woman)
o Non-binary
o Agender, genderqueer, or gender fluid
o Trans man
o Trans woman
o Prefer not to say
o Identity not described above, please specify.
________________________________________________
108
What is your sexual orientation?
o Asexual
o Bisexual
o Gay
o Heterosexual (straight)
o Lesbian
o Pansexual
o Queer
o Questioning or unsure
o Prefer not to say
o Identity not described above, please specify.
________________________________________________
What is the highest level of education you've completed?
________________________________________________________________
Do you have any children?
o Yes
o No
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Page Break
Display This Question:
If Do you have any children? = Yes
How many children do you have?
________________________________________________________________
Display This Question:
If Do you have any children? = Yes
What are their ages?
________________________________________________________________
End of Block: Demographics
Start of Block: Icebreaker
Introduction: Before we jump into everything, I like to do a bit of an ice breaker to frame the
context of our conversation a bit.
What is something about yourself that you wish people asked you about more? Or that you got to
talk about more? Or, if you were talking with someone at a BBQ, what’s something you could
talk about for hours?
End of Block: Icebreaker
Start of Block: Life History Calendar
110
Introduction: Next, we’re going to record on this calendar some details about events that
happened while you were in and out of “the life.†We will create this calendar together and it
will serve as our “roadmap†for our interview and the questions I’ll ask about the services and
systems you sought support from during this time. We will go through this in two “rounds.â€
Round 1is for us to put information on the calendar and Round 2 is when I’ll ask some follow-up
questions about the items or events on the calendar. As a reminder, you are able to provide as
much or as little information as you’d like and are free to skip questions at any time.
Page Break
First, we’ll enter the year and/or age you first met the person who got you into the sex industry or
when you first had involvement with the sex trade/commercial sex. This is whenever YOU
identify that this started.
What year was that?
How old were you?
Page Break
Now we’ve got our calendar all ready to go. Again, the purpose of this interview is to hear about
your experiences and decisions around seeking support or services while you were being
trafficked and afterwards. You’ll be able to see everything on the screen in front of you to make
sure I am taking accurate notes and you can see the topics we will be talking about in the far left
column.
Page Break
Together, we’ll record some key life events. These are important things that happened, key
events that you remember, or ‘turning points’ in your life. These events may be positive, or
negative, or both. Examples include the death of a loved one, birth of a child, child starting
school, an injury or illness, graduations, or party for a loved one.
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Page Break
Housing History
Introduction: Now we’re going to record the places you’ve lived during this time.
Where were you living in ______ (year)
Type of housing situation
Probes: Renting a house or apartment, Buying/own a house, apt, etc., Living with family
or friends, House hopping, or moving from someone’s place to someone else’s place on temp
basis, contributing to rent?, Homeless
b. City, state
When did you move? Where did you go? (Repeat these questions to capture other moves)
Page Break
Substance use:
Were you using drugs at this time?
If so, what drugs? How often?
Would you say your drug use was related to your trafficking?
If so, In what way?
Page Break
Self-defining Sex trafficking / Sex trade / Prostitution
Introduction: Words have power. There are lots of words we hear women use to describe their
situation like, people who trade or sell sex, prostitutes, sex trafficking victims, sex workers. We
also understand that people trade sex for a variety of reasons (e.g., to get things they need,
because they want to, because they felt they had to, etc.) and that people’s situations can change
112
depending on other things going on in their lives (e.g., drug use, working independently, working
for someone willingly or being forced to work, leaving and going back to the life, etc.).
So, in this section we’re going to talk about the different ways you you’d describe the
period of time on the calendar. Think back to how you’d describe it to yourself or others at that
time.
Starting with the first year on the calendar:
How would you describe your situation best during that time? (i.e., term)
Why did you choose to describe this point in your life this way?
What did that term mean to you at that time?
How is this different than how you think about that point in your life now looking back at
it?
When transitions between terms are identified:
1) Looking back on it, what was going on in your life when you started calling it ___ instead
of ___?
a. Why did you feel it was different? / Why did it change?
b. What did that signify?
c. Why was it important?
Page Break
Now we are going to switch gears and used the things we just spoke about to help you remember
times when you sought out supports or services during this timeframe.
Page Break
113
Hospitalizations / Medical Care:
Did you go to the hospital or get any medical care during this time? (e.g., emergency care,
Sexual assault evidence kit collection, reproductive health care, substance use disorder treatment,
chronic illness care)
For each contact with medical care,
Could you tell me a little more about that?
How did you get there?
(MONTH)
How long were you there?
What was it for? (Was this to get treatment or as an attempt to leave?
What was the outcome / experience of this?
Forced Engagement Screening / Questions
Did you feel obligated or forced to access this service?
What made you feel that way?
(If applicable) Did anyone tell you to access this service?
Who?
What effect, if any, did having someone tell you / force / mandate you to seek
support / services have? What was this like?
How did it affect your treatment / experience?
Page Break
114
Did you have any law enforcement involvement during this time?
If yes, what was it for?
How did they treat you?
What did they do / say to make you feel this way?
What was the outcome / experience of this?
(Did they offer / mandate services in lieu of charges or jail time?)
**If drug use was identified during this time earlier in interview:
Did your drug use impact your interaction with law enforcement? (e.g., drug
charges, treatment, outcomes?)
Page Break
Introduction: In this section I’ll be asking you about times you sought services or support from
organizations or agencies. (i.e., anti-trafficking orgs, street outreach, shelters, residential
facilities, community organizations, social workers, therapists, banks or other financial
institutions to open accounts/credit card (?) etc.)
What services did you utilize or come into contact with, either to try and get out or to address a
need you had?
115
What made you decide to go to these services? How did you get there?
How long were you there?
**If drug use was identified during this time earlier in interview:
How did your drug use affect the services you sought out during this time? (e.g.,
Did it disqualify you from any?)
Did you ever feel uncomfortable or unsatisfied while at this service
provider/organization?
What made you feel that way?
What was a positive experience you had while at this service provider / organization?
What made you feel that way?
What strengths of this service provider / organization?
What made them effective?
Forced Engagement Screening / Questions:
Did you feel obligated or forced to access this service?
What made you feel that way?
(If applicable) Did anyone tell you to access this service? Who?
What effect, if any, did having someone tell you / force / mandate you to seek support /
services have?
What was this like?
How did it affect your treatment / experience?
116
Access / Availability Questions:
Were there any other services that you wanted to access but chose not to?
Why?
Were there any other services that you wanted to access but were not available in your
community? (In other words, what were gaps in services in your area? / Were there services you
wish you would have had?
What were they?
Page Break
Introduction: In this section I’ll be asking you about times you sought “informal†support from
your personal network (i.e., family, friends, romantic partners, sponsors, etc.)
What made you decide to talk to this person?
How did this person treat you? How did they make you feel?
Were there any people in your life you wished you could have talked to but didn’t? Why?
Page Break
First Attempt at Exiting / Anything else?
Looking back at your calendar, when did you first think about trying to escape or leave the sex
industry / trafficking?
Is there anything else we haven’t talked about that you’d like to add to this calendar?
End of Block: Life History Calendar
117
Start of Block: Social Location Analysis
Introduction: OK we just spoke about ONE portion of your identity and the experiences you’ve
had, but I recognize that it’s not the ONLY thing you have experienced in your life or the only
way you likely define yourself.
So now we are going to go back and review this calendar to talk about your experiences seeking
services or support from the lens of some of your other social identities.
Page Break
This calendar we created only talks about a portion of your life, but I recognize that there was
time before this that likely influenced the things we’ve already talked about
Thinking about the time before the years on this calendar, what would be important for someone
to know about your life to better understand what we’ve put on the calendar? (Probe: foster care,
neglect, abuse, etc.)
Page Break
How, if at all, do you think your Sex-trade identity affected your service access? (Experiences?
How you were treated?)
How, if at all, did you see your experiences differ from those around you during this
time?
Was it easier / harder to access services during these different points? (Probe: treated a
certain way because you were on your own / with a pimp or trafficker, etc.)
Page Break
118
How, if at all, do you think your race / ethnic identity affected your service access?
(Experiences? How you were treated?)
How, if at all, did you see your experiences differ from those around you during this
time?
Was it easier / harder to access services during these different points? (Probe:
whiteness, etc.)
Page Break
How, if at all, do you think your gender identity affected your service access? (Experiences?
How you were treated?)
How, if at all, did you see your experiences differ from those around you during this
time?
Was it easier / harder to access services during these different points? Probe: cisgender
/ female presenting, etc.
Page Break
How, if at all, do you think your sexual identity affected your service access? (Experiences?
How you were treated?)
How, if at all, did you see your experiences differ from those around you during this
time?
Was it easier / harder to access services during these different points?
Page Break
119
How, if at all, do you think your economic status affected your service access? (Experiences?
How you were treated?)
How, if at all, did you see your experiences differ from those around you during this
time?
Was it easier / harder to access services during these different points?
Page Break
How, if at all, do you think where you lived (geographic location) affected your service access?
(Experiences? How you were treated?)
How, if at all, did you see your experiences differ from those around you during this
time?
Was it easier / harder to access services during these different points?
Page Break
How, if at all, do you think any other identity I haven’t mentioned affected your service access?
(e.g. parent?) (Experiences? How you were treated?)
How, if at all, did you see your experiences differ from those around you during this
time?
Was it easier / harder to access services during these different points?
Page Break
120
Program / Service Fit
Even the best services can feel like they don’t “fit†with us in some ways and other times
services we’re not fond of can sometimes “fit†us in some ways. In what ways were these
services or supports a good fit for you? Or a bad fit for you?
Probes / explanation: Were they appropriate or acceptable to address your needs or
help you? In other-words did they seem mis-matched or mis-aligned with your trafficking
experience or needs
[Strengths-based] What were some of your personal strengths when identifying and
navigating services?
End of Block: Social Location Analysis
Start of Block: Economic Abuse / Coerced Debt Screening
[Economic Abuse / Coerced Debt Screening]
Another thing some traffickers do is harm people financially so I’m curious about whether you
experienced some of the following and if you sought support to address any of the lingering
effects.
121
Did your trafficker/s ever put any of the following types of debt in your name without your
permission or knowledge?
â–¢ Memberships, payments, or transactions from online sites for sex (i.e., Backpage,
Craigslist, Rubmaps, etc.)
â–¢ Credit card
â–¢ Utility bills
â–¢ Rent
â–¢ Medical Bills
â–¢ Taxes
â–¢ Vehicle Loan / Lease
â–¢ Mortgage
â–¢ Pay day loan
â–¢ Loan for property
â–¢ Personal Loan
â–¢ Student Loan
â–¢ Did not put any of these in my name without my permission or knowledge
â–¢ Other / describe ________________________________________________
122
Did your trafficker/s ever ask, encourage, or pressure you to put any of the following types of
debt in your name?
â–¢ Memberships, payments, or transactions from online sites for sex (i.e., Backpage,
Craigslist, Rubmaps, etc.)
â–¢ Credit card
â–¢ Utility bills
â–¢ Rent
â–¢ Medical Bills
â–¢ Taxes
â–¢ Vehicle Loan / Lease
â–¢ Mortgage
â–¢ Pay day loan
â–¢ Loan for property
â–¢ Personal Loan
â–¢ Student Loan
â–¢ Did not ask, encourage, or pressure me to put any debt in my name
â–¢ Other / describe ________________________________________________
123
Display This Question:
If Did your trafficker/s ever ask, encourage, or pressure you to put any of the following types of d... != Did not
ask, encourage, or pressure me to put any debt in my name
Were you ever worried that they might hurt you in some way if you said “no†to putting that debt
in your name? By “hurt you,†I mean physically, emotionally, financially, or any other way.
o Yes
o No
Display This Question:
If Were you ever worried that they might hurt you in some way if you said “no†to putting that debt... = Yes
Can you tell me a little more about your answer, what do you think would have happened if you
didn't put debt in your name?
â–¢ Psychological Abuse _______________________________________________
â–¢ Physical Abuse ________________________________________________
â–¢ Economic Abuse ________________________________________________
â–¢ Other / describe ________________________________________________
Page Break
Display This Question:
If Did your trafficker/s ever put any of the following types of debt in your name without your permi... != Did
not put any of these in my name without my permission or knowledge
Or Did your trafficker/s ever ask, encourage, or pressure you to put any of the following types of d... != Did not
ask, encourage, or pressure me to put any debt in my name
124
Did you have to physically go to any banks or financial institutions to do this?
If so, when and where did you go? How did you get there? Has this (financially) affected you in
any way since leaving sex trafficking?
End of Block: Economic Abuse / Coerced Debt Screening
Start of Block: Meta-Evaluation / Wrap-up
Introduction: This is the final section of our interview. This part is mostly to debrief and ask you,
as a lived-experience expert, what you’d like for folks working on this issue to know.
What was it like talking with me today? How did it feel?
What should interviewers like me know about sex trafficking and how should they
interact with survivors?
If you could share anything about your experience with a wide audience what would you
like to share?
Page Break
End of Block: Meta-Evaluation / Wrap-up
125
Appendix D. LHC Protocol
Table 10. LHC Protocol
126
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127
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