While victim services are important, prevention is critical in order to eradicate child sex trafficking. Families and communities need to be aware of trafficking red flags and know how to safely respond, but we must also prevent our youth from becoming future victims and buyers. Child sex trafficking is profitable because it is driven by tremendous demand. Estimates of the percentage of U.S. men who purchase sex range from 19% to as high as 80%2. The trend is clear: purchasing sex is relatively common in our society. The revenue from the underground commercial sex trade ranges between $39.9 million and $290 million per year, depending on the U.S. city1. It’s important to understand that within the commercial sex trade, not all buyers are intentionally seeking children. Victims of child trafficking are often advertised to be older sometimes even with a false photograph. Child trafficking is therefore embedded in the underground commercial sex trade. To curb the growth of this criminal industry, we need to understand who the buyers are and what contributes to their choice to purchase sex.
Who are the buyers?
Buyers average about age 30 with a wide range of ages from 18 to 84 years old2,3. Most buyers purchased sex for the first time before the age of 212. Sex is typically purchased from both indoor and outdoor locations, with many instances occurring when men are traveling with fellow employees, going to a sports event or in the military2. These buyers are not lonely—over half are married or with a partner2. While some buyers experienced positive emotions after purchasing sex, many also experienced negative feelings including shame and guilt2. When asked why they purchased sex, some interviewees spoke about intense pressure from other men to use prostitutes2. Men are exposed to social pressure both online and in person that can glamorize, normalize and minimize the negative aspects of purchasing sex4,8. Other reasons given for purchasing sex were the male bonding experience, the convenience, the thrill and power, a distaste for “normal” relationships with women, and the desire to carry out a sex act that their partner had refused2.
There are some commonalities amongst men who purchase sex. Men who had purchased sex were far more likely than men who had not purchased sex to use pornography on a regular basis5. Men who bought sex also had a high rate of belief in prostitution myths and rape myths2. About 1 in 8 buyers agreed that the rape of a call girl was not possible and that the concept of rape does not apply to call girls2. Most buyers believe that the money exchanged cancels out the harm of buying sex and entitles the man to do whatever he wants to the women he buys2. Many buyers insist that prostitution prevents the rape of non-prostituting women, even in the absence of evidence to support this claim2,4. In fact, evidence from FBI statistics shows a positive association between legal prostitution in Nevada and the state’s elevated rape rates4. Overall buyers believe that prostitution is unpleasant but not traumatic to the female6. Agreement with these and other rape and prostitution myths is pervasive amongst buyers and society. Knowing what the myths are and uncovering the truth can be critical in prevention efforts.
What deters men from purchasing sex?
According to men who purchased sex, the most effective deterrent to purchasing sex would be placement on a registry of sex offenders or some form of public exposure, such as having their names posted. Most agreed that greater criminal penalties such as large fines or jail time would deter them, but they were not convinced that the laws would be enforced by police or politicians2. Only about half of buyers believed an educational program for men would effectively deter them from purchasing sex2. In the absence of consistent, lasting legal consequences, educational programs alone are not enough of a deterrent. Legal consequences could be very effective in deterring buyers, but the buyers must believe that the likelihood of enforcement is high.
How can this research influence our prevention efforts?
One major takeaway is that nearly 75% of buyers had purchased sex by the time they were 252. Researchers found that if a man had not paid for sex by the age of 25, he was less likely to ever do so7. Working with young people to prevent them from becoming future buyers needs to be an essential component in prevention efforts. With the acceptance of rape and prostitution myths common amongst buyers, we must also work within our society to dismantle these myths and expose the reality of the situations. Child sex trafficking is not just one city’s problem or one school’s problem. It is pervasive and therefore something that we as a society must solve together. A focus on youth prevention that addresses the demand side offers tremendous hope in eradicating child sex trafficking in our communities.
1) Dank, M., et al. (2014). Estimating the Size and Structure of the Underground Commercial Sex Economy in Eight Major US Cities. The Urban Institute. Retrieved from http://www.urban.org/research/ publication/estimating-size-and-structure-underground-commercial-sex-economy-eight-major-us-cities.
2) Farley, M., Macleod, J., Anderson, L., & Golding, J. M. (2011, March 28). Attitudes and Social Characteristics of Men Who Buy Sex in Scotland. Psychological Trauma: Theory, Research, Practice, and Policy. Advance online publication. doi: 10.1037/a0022645
3) Busch, N. B., Bell, H., Hotaling, N., & Monto, M. A. (2002). Male customers of prostituted women: Exploring perceptions of entitlement to power and control and implications for violent behavior toward women. Violence Against Women, 8(9), 1093–1112.
4) Farley, M. (2007). Prostitution and trafficking in Nevada: Making the connections. San Francisco: Prostitution Research and Education.
5) Monto, M. A. (2000). Why men seek out prostitutes. In R. Weitzer (Ed.), Sex for sale: Prostitution, pornography, and the sex industry (pp. 67– 83). New York: Routledge.
6) Matthews, R. (2008). Prostitution, politics, and policy. Abingdon, UK: Routledge-Cavendish.
7) Groom, T. M., & Nandwani, R. (2006). Characteristics of men who pay for sex: A UK sexual health clinic survey. Sexually Transmitted Infections, 82, 364–367.
8) Blevins, K. R., & Holt, T. J. (2009). Examining the virtual subculture of johns. Journal of Contemporary Ethnography, 38(5), 619–648.
Alexandra Haas, MPH
Child sex trafficking and the commercial sexual exploitation of children (CSEC) are formidable public health issues in the United States and the world at large. The health issues that result from child sex trafficking are extensive. Victims are at high risk for injuries, assault, infectious diseases such as HIV and STIs, substance abuse, untreated chronic medical issues, dental disease, malnutrition, and homicide1. In addition, victims face a high risk of mental disorders such as PTSD, major depression and increased prevalence of suicide1. Healthcare providers are in a unique position to identify victims, but it is crucial to prevent children from becoming victims in the first place2.
Prevention is necessary to curb the growth of the child sex trafficking criminal enterprise. By outlining the contributing factors and risk factors for child sex trafficking, we can work towards creating a roadmap by which to systematically eradicate the issue3. An ecological approach outlining the individual, interpersonal, organizational, community and societal factors that influence the issue is essential3. These contributing factors and risk factors have been outlined in the diagrams below.
1) Greenbaum J, Crawford-Jakubiak JE, Committee on Child Abuse and Neglect, COMMITTEE ON CHILD ABUSE AND NEGLECT. Child sex trafficking and commercial sexual exploitation: health care needs of victims. Pediatrics. 2015;135:566-574.
2) L. Lederer, C. Wetzel. The health consequences of sex trafficking and their implications for identifying victims in healthcare facilities. Annals of Health Law, 23 (2014), pp. 61–91
3) Bartholemew, L. K.; Parcel, G. S.; Kok, G.; Gottlieb, N. H.; Fernandez, M. E. Planning Health Promotion Programs: An Intervention Mapping Approach. Jossey-Bass, 2011.
4) Estes RJ, Weiner NA. The commercial sexual exploitation of children in the U.S., Canada and Mexico. Philadelphia, PA; Center for the Study of Youth Policy, University of Pennsylvania; 2001
5) Institute of Medicine and National Research Council. Confronting commercial sexual exploitation and sex trafficking of minors in the United States. Washington, DC: The National Academies Press; 2013
6) Smith L, Vardaman S, Snow M. The national report on domestic minor sex trafficking: America’s prostituted children. Vancouver, WA: Shared Hope International (SHI); 2009. Available at: http://sharedhope.org/wp-content/uploads/2012/09/SHI_National_Report_on_DMST_2009.pdf. Accessed July 7, 2013
7) Shared Hope International. Intervene: Identifying and responding to America’s prostituted youth. Resource package. Vancouver, WA: Shared Hope International; 2013
8) United States Department of State. Trafficking in persons report 2013. Washington, DC: US Department of State; 2013. Available at: www.state.gov/j/tip/rls/tiprpt/2013/. Accessed July 1, 2013
9) American Professional Society on the Abuse of Children. The commercial sexual exploitation of children: The medical provider’s role in identification, assessment and treatment: APSAC practice guidelines. Chicago, IL: APSAC; 2013. Available at: www.kyaap.org/wp-content/uploads/APSAC_Guidelines.pdf. Accessed July 7, 2013
10) Curtis, R., Terry, K., Dank, M., Dombrowski, K., & Khan, B. (2008). The commercial sexual exploitation of children in New York City: Volume 1: The CSEC population in New York City: Size, characteristics and needs. National Institute of Justice, US Department of Justice
11) Zimmerman, C., Yun, K., Shvab, I., Watts, C., Trappolin, L., & Treppete, M. et al. (2003). The health risks and consequences of trafficking in women and adolescents: Findings from a European study. London: London School of Hygiene and Tropical Medicine (LSHTM).
12) Cunningham KC, Cromer LD. Attitudes About Human Trafficking: Individual Differences Related to Belief and Victim Blame. Journal of Interpersonal Violence. 2016;31:228-244.
13) Macias Konstantopoulos W, Ahn R, Alpert EJ, et al. An International Comparative Public Health Analysis of Sex Trafficking of Women and Girls in Eight Cities: Achieving a More Effective Health Sector Response. Journal of Urban Health. 2013;90:1194-1204.
14) Busch-Armendariz, N., Nale, N., Kammer-Kerwick, M., Kellison, B., Torres, M., Heffron, L., Nehme, J. Human Trafficking by the Numbers: The Initial Benchmark of Prevalence and Economic Impact for Texas. December 2016. University of Texas at Austin School of Social Work Institute on Domestic Violence & Sexual Assault. http://sites.utexas.edu/idvsa/files/2017/02/Human-Trafficking-by-the-Numbers-2016.pdf
15) Fedina, L., Williamson, C., & Perdue, T. (2016). Risk factors for domestic child sex trafficking in the United States. Journal of Interpersonal Violence. Advance online publication. doi: 10.1177/0886260516662306
16) Bouche, Vanessa. TCU Department of Political Science. Report on the Use of Technology to Recruit, Groom and Sell Domestic Minor Sex Trafficking Victims, Thorn, 2015.
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