Are women involved in sex trades more likely to have symptoms of sexual abuse trauma?

Background: Studies finding that women involved in sex trades have high levels of sexual abuse trauma often lack appropriate comparison groups. We assessed sexual abuse trauma among a sample of urban women who use methamphetamine. We hypothesized that after controlling for other factors, women who did and did not trade sex would have similar odds of sexual abuse trauma.

Methods: Using respondent-driven sampling, 322 participants were interviewed in San Francisco. Sex trade involvement was defined as the exchange of vaginal, anal, or oral sex for some type of payment within the past 6 months. The Sexual Abuse Trauma Index sub-scale of the Trauma Symptom Checklist-40 assessed current levels of symptomatology of trauma from sexual abuse, with scores > 4 indicative of trauma.

Results: Over half the sample (61%) traded sex in the past 6 months. The majority (80%) had scores indicative of trauma from sexual abuse (85% among those who traded sex and 73% among those who didn't; p=0.01). In multivariate logistical analysis, sex trade involvement was not associated with sexual abuse trauma (adjusted odds ratio=1.86; 95% C.I.=0.94, 3.68) once race, homelessness, receiving outpatient mental health care, dependence upon methamphetamine, and adult and childhood experiences with physical or sexual abuse variables were included in the model.

Conclusion: The association between sex trade involvement and sexual trauma was not significant once covariates were considered. This finding highlights the importance of comparison groups in research on marginalized populations to promote accurate theorizing and to guide service providers and policy makers.