SURVIVAL SEX ON THE STREETS: RESULTS FROM THE HOMELESS WOMEN'S HEALTH AND VICTIMIZATION STUDY

In order to meet the needs of homeless women in our community, we must first understand their experience. The Homeless Women’s Health and Victimization Study provides valuable insight about the frequency, types, correlates, and consequences of violence and victimization among homeless women in our community. Some of the most compelling results from this study were related to transactional sex. These findings contribute to an understanding of the role that “survival sex” plays in the complex experience of female homelessness. Survival sex can be defined simply as transactional sex acts that are performed to meet a person’s most basic and immediate needs. This behavior is an adaptation to survive in the hostile and predatory environment that many homeless women find themselves in. Some homeless women perceive survival sex as the “last resort”. Although these behaviors are often grossly underreported due to stigma, our study participants were graciously honest about their experiences. From their responses, it is clear that not only is survival sex happening in our homeless communities, but that it is happening at much higher rates than previously estimated. This finding is even more alarming when considered alongside the mental and physical health implications of these practices. Additionally this study highlights the correlation between survival sex and history of prior victimization among these women, broadening the conceptualization of transactional sex. This study has given a voice to women in our community that are often overlooked and these results highlight the significance of a practice that most would prefer to ignore. A problem cannot be addressed if nobody knows it exists. Purpose (a): The Homeless Women’s Health and Victimization Study was conducted in order to explore the unique experience of violence and victimization among homeless women and the effects these experiences have on physical and mental health. This poster will focus on the results related to transactional sex. Methods (b): This study utilized non-random, purposive sampling of women utilizing emergency shelter services in the East Lancaster area of Fort Worth, Texas. A total of 150 face-to-face interviews were conducted with homeless women by trained volunteers from December 2012 to May 2013. The interview consisted of closed and open ended questions covering recent victimization, service utilization, mental and physical health, healthcare utilization, prior abuse, and transactional sex. Quantitative data analysis was performed using statistical software and a grounded theory approach was used for qualitative data analysis. Results (c): One in every 4 participants reported that they had engaged in survival sex, or transactional sex acts intended to meet subsistence needs or substance dependencies. Many of those who had traded sex did so to meet their most basic needs. One in every 6 women had exchanged sex for a safe place to stay and 13% had traded sex for something to eat. Women who had engaged in survival sex activities were significantly more likely to report victimization in the past 12 months (p=.001), prior intimate partner violence (p=.03), and childhood physical and sexual abuse (p=.007). Sexual or physical victimization during childhood appeared to have an influential role: 75% of those who engaged in sex trade reported childhood victimization compared to 38% of women who reported no engagement in sex trade. Those engaged in survival sex were also significantly more likely to show signs of psychiatric distress (p=.004) and other health indicators. Conclusions (d): These findings contribute to a comprehensive understanding of the complex experience of homelessness and give new insight into the prevalence, context, and correlates of survival sex among women who are homeless. The results indicate that victimization may play a role as both a precursor and product of engaging in survival sex. The increased risk for psychiatric distress and other health conditions emphasize the serious health implications of transactional sex among homeless women.