“...And they all think that for money we should do everything": Exploring conflict in sex work settings with immigrant and trafficked female sex workers in Israel

Background: The sex industry in Israel has grown markedly since the collapse of the Former Soviet Union (FSU). Besides the legal immigration of >1 million Russian Jews to Israel, organized trafficking of women originating in the FSU increased, currently estimated at 3000-5000 annually.

Purpose: The purpose of this study was to explore how conflict during the work experience of Russian speaking female sex workers (FSWs) in Israel may impact health.

Methods: Qualitative interviews were conducted in Russian with nine FSWs in Israel originating from FSU states. Six met the United Nations definition of a trafficked person. Participants were recruited from a free STI clinic, a shelter for victims of sex trafficking, and a detention center for illegal female migrant workers. Each FSW participated in a sequence of up to three in-depth interviews discussing work conditions, bosses, clients, condom use, violence and conflict.

Results: FSWs reported servicing 1-25 clients daily in a variety of settings. Women working in locations without security experienced more conflict and violence than women working with security personnel nearby. Client preference not to use condoms and inability to achieve orgasm were the most frequently reported reasons for conflict. Proximity to security personnel did not affect unexpected condom removal by clients during sex.

Conclusions: Understanding the context and setting of sex work, including the dynamics between FSWs and clients and the role safety and security play in the health of sex workers, is vital to appropriately targeting interventions, health care, and social assistance.