By Constance Johnson
Friday, September 22, 2000
The world's oldest profession is one of its most dangerous. Prostitutes are raped, battered and at risk for HIV. Now, a new study says medical and social scientists ignore the reality of prostitute's lives, harming them further.
Thanks to Hollywood movies like "Pretty Woman," and most fiction dealing with the subject, prostitution is most often viewed as a harmless profession, its ranks filled with young women who might not look like Julia Roberts, but who are fundamentally unsullied, waiting for a break, a better life.
In the meantime, this view holds, prostitutes ply a temporary but reliable, "victimless" career alternative, on the street corners and in penthouse suites, anesthetized in general or misguided by the notion that it's not so bad, it's just for a while.
As if that misconception were not cruel enough, a new study suggests it is not only image makers and the general public that don't comprehend the dangerous, darker side of prostitution, but also the medical and social science professions ignore the reality of their lives as well.
"For the vast majority of the world's prostituted women, prostitution is the experience of being hunted, dominated, harassed, assaulted and battered," write Melissa Farley and Vanessa Kelly in "Prostitution: A Critical Review of the Medical and Social Sciences Literature," published in the most recent edition of Women and Criminal Justice, a journal of the American Political Science Association.
"Prostitution must be exposed for what it really is: a particularly lethal form of male violence against women. The focus of research, prevention, and law enforcement in the next decade must be on the demand-side of prostitution," they write.
In trying to be nonjudgmental and professional, medical and social science researchers run the risk of overlooking the sordid, traumatic and humiliating daily experiences of prostitutes. The authors note, for example, that in 1988, the U.N. World Health Organization described prostitution as "dynamic and adaptive sex work, involving a transaction between a seller and buyer of a social service."
A program in Singapore, designed to reduce the transmission of HIV, disregarded the real danger of violence to prostitutes and instead focused on role-playing and use of comic books to increase condom use.
An article in the Annual Review of Sex Research published in 1996 suggested that prostitutes in the commercial sex industry are "simply another category of workers with special problems and needs."
These attitudes ignore the real dangers that prostitutes encounter daily.
Eighty-five percent of prostitutes surveyed in Minnesota had been raped, according to a 1994 study of violence and prostitution. In another study, Farley and Kelly found that of 475 women interviewed in South Africa, Thailand, Turkey, the United States and Zambia, nearly 75 percent had been physically assaulted and 62 percent had been raped. A 1994 study by the Council for Prostitution Alternatives in Portland, Ore., found that prostitutes were raped an average of once a week.
Even in the face of this ugly reality, medical and social science literature have "normalized" it, according to Farley and Kelly. They say the reason is that doctors and social scientists, most of them men, identify more with the customers than with the women engaged in prostitution. In the international field of research, prostitutes are frequently categorized as "commercial sex workers," which de-stigmatizes their work while making it seem "normal."
Farley, a clinical psychologist with Prostitution Research & Education in San Francisco, and Vanessa Kelly, the coordinator of the Traumatic Stress Treatment Program at the University of California in San Francisco, spent two years reviewing the literature on prostitution in medical and social science journals.
The misconception about prostitution is important, the authors argue, because social science research is influential in many areas, including the criminal justice system. Because prostitution is viewed in a benign way, the authors say, the needs of the women arrested and incarcerated are not addressed.
Many prostitutes experience post-traumatic stress disorder because of rape and other assaults as well as the trauma of daily sexual contact with dominant strangers. But Farley and Kelley write that medical and psychology professionals who treat them for other problems, such as depression and drug abuse, often overlook the diagnosis of post-traumatic stress disorder.
More than 90 percent of women in various surveys want to stop being a prostitute, but lack viable options because safe housing, drug treatment and job training are not available, Farley and Kelly report. If professionals continue to treat prostitution as a reasonable career alternative--a victimless crime--then helping the women who want to get out will never become a priority, Farley and Kelly claim.
They add that researchers' focus on sexually transmitted diseases among prostitutes, particularly HIV, has often meant that the everyday violence and sexual exploitation are overlooked.
"In much the same way that slave owners discussed the inevitability of slavery and the improved care of slaves, there was an underlying assumption in much of the research that prostitution is inevitable," Farley and Kelly write.
The authors cite, for example, a 1995 study, which focused on women who worked at a truck stop in South Africa. Researchers found women were at a higher risk for physical violence when they tried to persuade customers to use condoms. In the same study, however, the researchers simply recommended that the women learn to communicate better with customers in an effort to change men's attitudes about condom use.
Prostitutes' primary risk factor for HIV is violence, because the virus can more easily pass through broken or abraded tissue, according to the World Health Organization. The number of prostitutes infected with HIV is staggering. For example, 58 percent of the prostitutes in Burkina Faso in West Africa and 74 percent of the prostitutes in Kenya are HIV-positive.
In the United States, the rate of HIV infection among prostitutes varies from state to state. In New Jersey, 57 percent of prostitutes are HIV-positive, and in Atlanta, 12 percent of prostitutes are HIV-positive, Kelly and Farley report.
Yet, most research treats HIV as if it were only a threat to the male customers who must protect themselves from irresponsible females, the authors say.
"In spite of extensive documentation that HIV is overwhelmingly transmitted via male-to-female vaginal and anal intercourse, not vice versa, one of the misogynist myths about prostitution is that the woman is a vector of disease," Farley and Kelly say, "that the prostitute is ultimately the source of contamination of the 'good wife' through the husband's weak moment."
In the end, the widespread view that women simply "choose" prostitution as a viable career option, much like waitressing or doing secretarial work, diminishes the possibility of helping women get out of prostitution and improving their lives.
"These women don't make choices--it's not a free choice," Kelly says. "If you look at what is perceived as a free choice, it is significantly impacted by one's financial situation or by poverty, racism or prior sexual abuse. When you consider all those factors, it is not a decision at all. It's the limited choices that people have."
Constance Johnson is a former Wall Street Journal reporter, now a free-lance writer based in New York.