Over the last two decades, the use of empowerment approaches to help reduce health-related vulnerabilities and violence among female sex workers has increasingly informed global health efforts directed at HIV/STD prevention. The empowerment approach to sex worker health rejects both abolitionist and narrowly conceived clinical approaches in favor of strategies that promote commercial sex as valid work, strengthen sex workers’ agency, reinforce female sexual autonomy, and support rights-based framing. A significant outcome of the empowerment approach to integrating health, social, and legal strategies has been the creation of numerous sex worker associations and NGOs, which advocate for collective mobilization and community-based HIV/STD prevention programs among sex workers. Despite numerous studies examining the efficacy of community empowerment approaches to sex worker health and the creation of civil society organizations to implement such approaches, there has been little theorization about how participation in sex worker NGO-based programming and activism shapes the personal, embodied experiences and subjectivities of sex workers. Similarly, questions of how sex worker associations and NGOs are shaped by the experiences, realities, feelings, and personal opinions of sex workers have received limited attention. Given the morally charged and highly stigmatized environments in which sex workers typically operate, studying how and which sex workers come into contact with these NGOs helps to illuminate how community and kinship relations, and individual and collective aspirations, shape sex work activism and contribute to the making (and unmaking) of related associations and NGOs. Drawing on long-term ethnographic research with female sex workers and sex work activists, this work combines medical anthropological and feminist perspectives to interpret sex worker associations and NGOs as “local moral worlds” that highlight how subjectivities, body, moral experience, kinship, care, and women’s agency relate. From the subjective experiences of older female sex worker/activist informants, I argue that sex worker associations and NGOs are best comprehended not simply as the outcomes of global health efforts to curb the spread of HIV and other STDs, but also as complex social arenas that need to be reconsidered in light of existing relationships between and among sex workers and their families and the state. This argument is informed by my yearlong engagement with Women’s Solidarity House (WSH), a pseudonym for an organized association of active and retired female sex workers in the red-light district of San José, which recently received NGO status from the Costa Rican state. One important dimension of WSH that requires careful consideration is the fact that most of the women who participate in its development and programming are over the age of 40, with an average age of about 52. This fact makes WSH an interesting and important case study, since it caters most especially to female sex workers who are generally outside of the purview of most sex worker empowerment and health-related prevention programs, which are designed and implemented by public health researchers and development specialists. While theories of gender, stigma, and social inequality have increasingly informed medical anthropological efforts to understand how structural factors shape the personal, embodied experiences of sex workers and the distribution of HIV/STDs, there has been very little effort to understand how aging and ageism factor into the making and unmaking of sex worker embodiment and subjectivity and older women sex workers’ risk of contracting sexually transmitted diseases and infections. Given that sex work is a profession or income-generating strategy that adult women in various stages of their lives perform, the lack of research and theorization about these aspects of female sex workers’ lives, I suggest, has prevented a broader research and programmatic response both to common risks such as HIV/STDs and violence, and to work-related health problems and occupational conditions that older sex workers may consider more important in their day-to-day lives. My research shows that a “structural approach” to sex work, which highlights the underlying social, historical, political, and economic forces that encourage and foster the economic exploitation, stigmatization, and negative health outcomes of women (and men) who sell sex, would benefit from adding a feminist anthropological perspective on aging. In this view, aging is a critical social structural inequality that society uses to devalue women’s status and which women often experience as stigmatizing and/or shameful. In Costa Rica, where recent reporting has suggested an increase in the number of older women in the local sex industry, studying women’s experiences of and responses to growing old in the sex trade reveals not only the long-term impacts of neoliberal reform polices, but also how gendered discourses about aging, increasing familial caregiving responsibilities, and growing inequality and economic pressure, together, conspire to limit older women sex workers’ employment opportunities and put them at greater risk of violence, discrimination, psychological distress, sexual assault, substance abuse, poverty, and HIV/STDs.

Thesis advisor: Janet E. Helms / Historically, psychological theory and mental health researchers have viewed sex work as inherently harmful to sex workers and capable of producing negative mental and physical health effects (Sprankle et al., 2018). Moreover, research focused on clinicians’ expectations for sex workers in therapy has not specifically examined clinicians’ attitudes toward sex workers or sex work as separate concepts (Benoit et al., 2015; Koken, 2011; Ma et al., 2017). In addition, mental health professionals may not view sex work as legitimate work because of the virtual lack of evidence-based theoretical frameworks for guiding therapy for sex workers, and, therefore, may use prostitution stigma as a substitute for theory (Krumrei-Mancuso, 2017; Williamson & Cluse-Tolar, 2002). The present study investigated the extent to which mental health professionals’ expectations of sex work and sex workers were related to prostitution stigma and their perceptions of sex workers’ overall mental health and evaluations of sex work as decent work. In particular, the study investigated the extent to which mental health professionals stigmatized the work of sex workers. Mental health professionals (N = 201) read a clinical vignette and completed an online survey containing a demographic information sheet, the Attitudes Toward Prostitutes and Prostitution Scale (Levin & Peled, 2011); (c) the Decent Work Scale (Duffy et al., 2017), (d) the Hospital Anxiety and Depression Scale (Zigmond & Snaith, 1986), and (e) the PTSD-8 (Hansen et al., 2010). Results from multivariate multiple regression analyses supported that when mental health professionals held higher levels of stigma towards sex work and sex workers, they may diagnose the client with higher levels of PTSD symptoms. Further, the results supported that endorsement of a feminist orientation moderated the relationship between sex work stigma and diagnosis clients’ PTSD avoidance symptoms. The discussion included methodological limitations and implications for research and practice. / Thesis (PhD) — Boston College, 2020. / Submitted to: Boston College. Lynch School of Education. / Discipline: Counseling, Developmental and Educational Psychology.

This study aims to look at the challenges faced by women of low socio-economic status in exiting sex work, in a South African context where gender-based violence is normalized and widespread. In doing so, this research applies principles of feminist theory to create a contextualized understanding of the process of exit. Two focus groups, with a total of 18 non-transgendered women were conducted in an informal setting, resulting in an open-ended discussion around these challenges. These interviews were recorded, transcribed and analyzed using thematic analysis. The categories and themes emerging from this analysis were past trauma, motherhood, partnerships, social support, economic necessity, employment and gossip. These themes are permeated by a pattern of escapism. This pattern exemplifies their disempowerment and lack of agency, which is symptomatic of the gender oppression pervading their lives. The results of this research will be used to draw up a policy in collaboration with the NGO Embrace Dignity, for parliament, to initiate legal reform relating to sex work.

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Women’s social and economic freedom is violated on both in the private and public life, and this needs to be resolved in order to achieve a society which realizes human dignity. This thesis aims to position the sex work on OnlyFans within the realization of women’s social and economic freedom. Using argumentation analysis through the theoretical frameworks of liberal feminism and radical feminism, this thesis investigate whether the sex work on OnlyFans is compatible with the social and economic freedom of women. The analysis was further divided into the factors of safety, economy, and agency. Based on both academic studies with interviewed sex worker as well as statistic sources on the question, this thesis engages with the question of online sex work with the added elements of the gig-economy and celebrity-influence to fully grasp the scope of the issue and its consequences for women. The findings show that both liberal feminism and radical feminism recognize that OnlyFans have major safety deficiencies which poses a threat on women’s social freedom. Furthermore liberal feminism recognize that the possibilities of economic gain for sex worker women exist, but radical feminism finds that these possibilities are slim and require skills in marketing and technology, and lastly the findings showed that in line with liberal feminism, the free will of sex workers is to be fully realized and respected, but at the same time radical feminism shows that there are elements of coercion and financial pressure present when agreeing to provide certain sexual content and services which does not comply with the realization of women social and economic freedom.

Although human trafficking was not a new concept, it gained increased attention across the United States and Canada in the first two decades of the 21st century. To better understand the Canadian anti-trafficking movement, this thesis analyzed the discourse on the topic in six local and national daily newspapers between 2008 and 2018. The goal of this thesis was to investigate the emergence of human trafficking as a social problem. Using social constructionism as a point of departure, a critical discourse analysis was conducted in NVivo of the quotes made by human trafficking experts in Canadian media. The results of this analysis suggest that an Unofficial Christian Coalition emerged in Canada, which – assisted by the media – led a moral crusade against human trafficking and pushed for the adoption of restrictive sex work legislation in Canada.

This thesis uses the four principles of biomedical ethics as put forth by Beauchamp and Childress to address the issue of the criminalization of sex work in contemporary national and international settings. Though a controversial subject, the existence of sex work has been a constant for centuries worldwide. However, the criminalization of sex work in contemporary society has been largely predicated on the conflation of sex work and a number of social ills, particularly human trafficking and sexual exploitation. This uncritical and inappropriate conflation of terms has enabled discourse, legislation, and even health care policy that is unethical, ineffective, and explicitly harmful to both sex workers and victims of human trafficking alike.Medical professionals have a unique set of moral obligations to which they must hold themselves in their practice of medicine, both with their individual patients as well as with the society in which they live. This thesis argues that the criminalization of sex work is fundamentally incompatible with contemporary health care ethics, reviewing each of the four fundamental pillars of biomedical ethics as it applies to policies that criminalize sex work. Each chapter will outline the many ways in which criminalization violates each of these fundamental principles, causing immense and largely preventable harm in the form of human rights violations and poor public health outcomes. At the same time, this thesis will introduce the alternative policy of decriminalization, discussing its features and implications for public health, and highlighting the ways in which the decriminalization of sex work results in improved health, safety, and human rights outcomes for both sex workers and victims of sex trafficking, exemplifying a viable, ethical, and evidenced-based alternative to criminalization. Given the gross bioethical and humans rights violations associated with the criminalization of sex work, this thesis concludes that there exists evidence of a substantial ethical imperative on the part of the medical community and its constituent professional societies to formally condemn policies that criminalize any and all aspects of sex work and issue formal recommendations for its urgent decriminalization, as both a public health issue and an issue of human and patients’ rights. / Urban Bioethics

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Access to health care services is critical to both personal health outcomes and health equity within a community. While non-monogamous behavior is widespread, stigma surrounding consensual non-monogamy can create barriers to health care access. This research outlines the experiences of non-monogamous women during sexual health care visits, how class acts to modify those experiences, the barriers to health care access that they encounter, and the adaptive strategies they employ. The sample for this research was 23 consensually non-monogamous women. Participants were contacted through online support groups, message boards, and snowball sampling. In-depth interviews about their sexual health care experiences were conducted. Interviews were recorded, transcribed, and analyzed for themes related to the intersection of non-monogamy and health care experiences. The interactions between health care professionals and non-monogamous women, whether or not those women disclose their non-monogamous status, were often perceived as stigmatizing. Increased class status, both of participant and of provider, was described as increasing experiences of stigma and barriers to care. The information provided by this research may be used to better understand, and thus improve, the barriers health care access experienced by non-monogamous women. Suggestions given by the participants for improving their health care access and decreasing experiences of stigma are included.

This study investigates how two museums in Europe embody and portray prostitution and sex work. This paper is based on a comparison between the Red Light Secrets Museum in Amsterdam and the walk out tour We have always been everywhere in Berlin. The purpose of this essay is to discuss and analyse how, within various museum activities and dimensions, prostitution can be described and portrayed based on different contexts. The method used to conduct the investigation is based on observations and a thick description of the audio guides found in the museums. This will be examined through theories based on the view of prostitution and visitor behaviours. This paper will also include an analyse of spaces and places.    This study concludes that the two museums are similar in how to display the different dimensions of their exhibitions. Both museums discussed how prostitution is described, portrayed the sex buyer, the visitor’s integration with the museum, how to handle control and the shape of the environment. But they had different approaches to the material. The walk out tour approaches prostitution from an Empowerment paradigm. The Red Light Secrets Museum is more ambiguous in its material and can to some extent be connected to an Empowerment paradigm. However, since it also includes other views than the conventional ones, the material should be considered more from the perspective of the Polymorphous paradigm. To inform the visitor of their information the audio guide and the environment in its in-situ settings came to be an important tool for both museums approaches to portray prostitution. The previous research that has been done on prostitution, from this papers view, is very lean. It´s therefore problematic to draw conclusions about the material based on earlier research and theoretical approaches.