How Do I Fit? Understanding Barriers and Facilitators to Social Services among Women Involved in Commercial Sexual Exploitation through Identities, Traumas, and Substance Use

Sex trafficking and commercial sexual exploitation can lead to devastating health and mental health consequences for women, such as elevated rates of substance use, trauma, posttraumatic stress disorder, and depression, as well as sexually transmitted infections, including HIV. Consequently, access to and engagement with services that address addiction, mental health, housing, and provide general advocacy are critically important to women's increased safety, stabilization, and quality of life. The purpose of this grounded theory study is to 1) understand self-identities (with regard to sex trading) and the role of substance use among women involved in CSE and 2) identify perceived barriers and facilitators to service access and engagement with addiction treatment and related services among women involved in CSE. Using a constructivist approach, in-depth, semi-structured interviews were conducted with 30 women (ages 18 and older) with experiences of trading sex as adults and 20 service providers who come into contact with this population. Findings suggest women held varied identities, as they had diverse experiences with sex trading, trauma, and substance use. Women experienced judgment when disclosing sex trading in social service intakes, and in individual and group sessions from providers and other women in the groups. Racial tensions among women engaging in services and experiences of racism for African American women were also identified. A grounded theory model is presented depicting how women navigate social services. Implications for practice, policy, and research are discussed.