Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
J Urban Health. 2020 Jun;97(3):406-417. doi: 10.1007/s11524-019-00410-z.
Female sex workers are a structurally vulnerable population, including critical insecurity such as having access to food and shelter. This risk may be heightened among individuals who enter sex work as minors. However, the reasons for entering sex work as a minor and the long-term structural risk implications are poorly understood. Here, we investigated the reasons for and long-term impact of trading sex before the age of eighteen on women's structural vulnerability among a cohort of 250 cisgender women involved in street-based sex work in Baltimore City, Maryland, USA. We used logistic regression to explore the role of age of entry on two structural vulnerability outcomes of interest (homelessness and recent food insecurity in the past 3 months). Overall, 73% of women entered the sex trade to get drugs, 36% of women entered to get basic necessities such as food or housing, and 17% of women entered to support their children or family. Of significance, 21% of those aged < 18 years at entry reported being either coerced, threatened, pressured, misled, tricked, or physically forced into trading sex compared to 5% in those who entered at an older age group (p value < 0.001). In adjusted analysis, women who first trade sex before the age of 18 had 4.54 increased odds of experiencing recent homelessness (95% CI 1.92-10.70) and had 3.14 times increased odds of experiencing recent food insecurity (95% CI 1.42-6.94). Those who entered as minors were also more likely to be HIV positive (11.3% vs 3.6%, p value = 0.02). This study highlights that those who trade sex at a younger age experience an ongoing cumulative vulnerability in comparison to those entering over the age of 18. These findings call for additional research into a more detailed understanding of young women's entry into the sex trade and trajectory. A focus on the importance of policy changes and structural interventions that directly alleviate young people's socio-economic disadvantage is needed.
性工作者是一个结构上脆弱的群体，包括获得食物和住所等关键不安全因素。这种风险可能在未成年时进入性工作的个体中更高。然而，进入性工作的未成年人的原因以及长期的结构性风险影响还了解甚少。在这里，我们调查了马里兰州巴尔的摩市 250 名参与街头性工作的顺性别女性中，在 18 岁之前从事性交易的原因以及对女性结构性脆弱性的长期影响。我们使用逻辑回归探讨了进入性交易的年龄对两个感兴趣的结构性脆弱性结果（无家可归和最近 3 个月内的食物不安全）的作用。总体而言，73%的女性从事性交易是为了获取毒品，36%的女性从事性交易是为了获取食物或住房等基本必需品，17%的女性从事性交易是为了支持孩子或家人。值得注意的是，与年龄较大组（进入年龄组）的 5%相比，年龄<18 岁时进入性交易的女性中，有 21%的人报告说受到强迫、威胁、压力、误导、欺骗或身体强迫从事性交易（p 值<0.001）。在调整分析中，18 岁之前首次从事性交易的女性最近无家可归的几率增加了 4.54 倍（95%CI 1.92-10.70），最近食物不安全的几率增加了 3.14 倍（95%CI 1.42-6.94）。那些未成年人进入性交易的女性也更有可能感染艾滋病毒（11.3%比 3.6%，p 值=0.02）。这项研究强调，与 18 岁以上进入性交易的女性相比，那些较早从事性交易的女性会持续经历累积性脆弱性。这些发现呼吁进一步研究，以更详细地了解年轻女性进入性交易的情况和轨迹。需要关注政策变化和结构性干预措施的重要性，以直接减轻年轻人的社会经济劣势。
