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“I’m Doing Everything Right All Over Again”: How Women Manage Exiting Street Prostitution Over Time

Published onAug 30, 2021
“I’m Doing Everything Right All Over Again”: How Women Manage Exiting Street Prostitution Over Time
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Abstract

Exiting the criminalized sale of sex, which we refer to as prostitution, is a complex, recursive process which has been rarely studied longitudinally. Using typical case sampling, we selected two respondents from a two-year ethnographic study of a court-affiliated diversion program in Philadelphia who participated in a total of eight interviews. Saldaña’s (2009) seldom-used longitudinal coding method was applied to conduct a fine-grained analysis of participants’ perceptions of exiting prostitution over time, focusing on participants’ motivations and actions. Respondents managed expectations of others and themselves and their sense of self-worth within a context of changing relationships, structural opportunities, accomplishments and setbacks. Viewed in a longitudinal context, the same relationships and structural hurdles often had a different impact on women’s motivation to exit at different time points. We argue that a longitudinal perspective of the exiting process is critical to avoid erroneous binary classifications of women as either exiters or non-exiters from prostitution, as the exiting process is more complex than what cross-sectional studies have previously revealed. Findings have implications for researchers of prostitution and programs for women exiting prostitution that should structure supports and (dis)incentives in a nonjudgmental fashion in line with this nuanced understanding of exiting over time. This is particularly important in criminal justice settings, where punitive responses have serious short- and long-term consequences.

Introduction

Researchers and service providers almost unanimously agree that exiting street prostitution, or the criminalized sale of sex, is a cyclical process of exit and return (Baker et al., 2010; Dalla, 2006; Månsson & Hedin, 1999). Returns to prostitution, particularly when accompanied by addiction relapse, are part of exiting (Baker et al., 2010; Roe-Sepowitz et al., 2011). Regardless of legal status, the stigmatized sale of sex influences the availability and uptake of resources, as well as understandings of self, that are part of the exiting process (Armstrong, 2019; Blakey & Gunn, 2018). This study is the first explicitly designed to examine perspectives of women exiting street prostitution over time, in this case per court mandate. It contributes to the street prostitution exit literature by using respondent-centered longitudinal case study analysis that closely examines how people understand their own exiting trajectories over time (Saldaña, 2009; Wahab, 2006). Our findings further contribute to the literature by revealing that the binary cross-sectional classifications of “exiters” and “non-exiters” (Dalla, 2006) is inaccurate, as most people could be both at different times. Our approach reveals the crucial role of small steps within a complex interplay of factors that support and undermine the respondents’ efforts to stay out of prostitution. These insights have implications for future research, service provision, and policy.

Literature review

The process of exiting has been of interest in countries with different legal regimes governing sex work, including Norway (Høigård & Finstad, 1992), Sweden (Månsson & Hedin, 1999), England (Matthews et al., 2014; Sanders, 2007), Scotland (Cusick et al., 2011), Canada (Benoit & Millar, 2001) and the US (Baker et al., 2010; Cimino, 2019; Oselin, 2014). Scholars find similar patterns of exiting despite legal differences and regardless of whether the impetus for exit is overt state control or personal motivation (Armstrong, 2019). Researchers and service providers almost unanimously agree that exiting prostitution is not a single event but usually a lengthy process involving multiple cycles of exit and return (Baker et al., 2010; Cusick et al., 2011; Dalla, 2006; Månsson & Hedin, 1999). Many studies find that returns to prostitution, particularly when accompanied by drug addiction and relapse, are part of exiting (Baker et al., 2010; Cusick et al., 2011).

Similar to desistance (Giordano et al., 2002; Sampson & Laub, 1993) and different from a more temporary cessation (Hamilton-White et al., 2020), prostitution exit has no single definition (Preble et al., 2016) or agreed-upon time frame (Horning, 2019), although some theories of exit suggest the two-year mark as the period necessary for behavioral change and identity transformation (Benoit & Millar, 2001; Hickle, 2017). In their study of addiction, which may apply to women in prostitution with substance use disorders, Prochaska, DiClemente, and Norcross (1992) found that behavioral change advances toward a goal through cyclical movements . The majority of their respondents rarely returned to their starting point, but applied what they learned from one exiting experience to the next, with increased exiting successes over time.

The stigma of deviance across legal regimes may make exiting prostitution especially difficult (Fuchs Ebaugh 1988; Oselin 2010; Sabella 2011). Some contend that exiting prostitution requires a “role exit” or a complete identity transformation (Benoit & Millar, 2001; Preble et al., 2016). Sabella (2011) found that women involved in prostitution had “before, during, and after involvement in prostitution” identities (p. 190-191). Women who had a positive identity and self-esteem prior to their involvement in prostitution were able to construct a new “after” identity more easily than those who did not. In a diverse sample, Benoit and colleagues (2018) noted that the relationship between self-esteem and sex work is complex, with both positive and negative impact. Some women in Månsson and Hedin’s (1999) study felt insecure about their post-prostitution identity, as if they were “suspended between two worlds” (p. 72). Women’s difficulties in reconciling themselves to new identities have been corroborated in other studies (Fuchs Ebaugh, 1988; Gorry et al., 2010).

Longitudinal perspectives and prostitution exit

Longitudinal research on exiting prostitution is limited and focuses on outcomes more than on the process of exiting and changes in women’s lives. Some studies (e.g. Oselin, 2014) use an ethnographic approach, observing respondents for several months, but do not report later follow-up. Høigård and Finstad (1992) conducted multiple interviews with some participants over months and sometimes years; however, they did not set out to conduct a long-term systematic follow-up, and these later interviews were the result of special rapport established with some of their participants. Bachman et al.’s (2019) mixed-methods study with criminal justice-involved women used event history calendars to contextualize respondent experiences and enhance recollection. Although their interviews elicited information on prostitution, their focus was criminal desistance. While their respondents retrospectively reflected on the past twenty years of their life, Bachman et al.’s cross-sectional study demonstrate a one-time perspective on the past, rather than respondents’ perspectives as they evolved over time.

Dalla’s (2006) research is the only longitudinal study of prostitution exit. Eighteen of Dalla’s (2006) sample of 43 women were located for a three-year follow-up; of those, all but five returned to prostitution, some within a few months of exiting. For those who had not returned to prostitution, meaningful employment was key. Other factors distinguishing what Dalla (2006) described as “exited and non-exited women” (p. 183) were spirituality, fewer mental health problems, and relationships. Non-exited women’s loss of relationships with significant others created a crisis that precipitated relapse and a return to prostitution; on the other hand, exited women found a source of support in reconnecting with children and other significant people in their lives. Exiters also distanced themselves from “old playmates” and focused on maintaining supportive relationships (Dalla, 2006, p. 172). While nearly all of Dalla’s respondents remained in contact with service providers, services alone were insufficient to sustain exit. Respondents’ commitment to exiting was significant to maintaining behavioral changes. Our study addresses the dearth of longitudinal research on prostitution exit by looking at micro-level changes over women’s first two years of exit.

Method

Qualitative longitudinal research (QLR) has become an established methodology in the past two decades (Neale, 2019; Thomson & McLeod, 2015). Thomson et al. (2003) characterize QLR by “the deliberate way in which temporality is designed into the research process making change a central focus of analytic attention” (p. 185). While quantitative longitudinal research is “variable oriented” and can reveal trends, patterns, and significant variables predicting change over time, “person-oriented” QLR can illuminate complex processes and explain dynamics of individual change (Laub & Sampson, 1998, p. 221). The focus on time through repeat interviews allows participants to reflect on the past and the future at each encounter, offering a broader perspective on individual perceptions than single interviews or retrospective accounts. The collection of multiple accounts over time produces nuanced and multi-faceted perspectives of human agency (McLeod, 2003), making QLR ideal to study dynamic processes as they unfold (Neale, 2019), allowing researchers to capture relationships between time, timing, and resources in women's changing lives (Henderson et al., 2012).

This case study was designed to elicit perspectives of women participating in a court-based prostitution diversion program through longitudinal interviews and observations. Our secondary data analysis is grounded in respondents’ understanding of their exit in the larger context of their lives.

Research site

Longitudinal data on the two study participants was collected as part of a larger study that explored defendants’ experiences in a prostitution problem-solving court, Philadelphia’s Project Dawn Court (PDC) (for greater detail, see Leon & Shdaimah, 2012). All participants in PDC, including the two respondents for the current study, had at least three prostitution convictions or charges as a criterion of eligibility. Grounded in the principles of problem-solving justice, PDC mandates defendants to utilize community resources designed to address their underlying causes of offending and uses incentives and sanctions to encourage behavioral change (Blakey et al., 2017; Leon & Shdaimah, 2019; Wolf, 2007). Study respondents were required to interact weekly with a designated probation officer and monthly with the court for a minimum of one year (and longer if they were sanctioned for non-compliance). They attended a variety of mandated and voluntary programs for drug treatment, sexual trauma treatment, and therapy. At various points most lived in inpatient treatment facilities, supported housing, or with family, romantic partners and/or children. PDC supervision and support were prominent features of study respondents’ experiences while in the program, which may limit our findings as we discuss more fully below.

Recruitment and data collection

Eighteen respondents in the original study were interviewed multiple times as long as the second author was able to contact them; because some became unreachable, the number of interviews per respondent varied from one to seven. Interview guides focused on respondent perceptions, including their motivation to enter PDC and perspectives on exiting prostitution, which was a PDC requirement. Data also include participants’ reflections on their prior exiting attempts within and outside of the criminal justice system. At each interview, participants were asked similar questions. Rapport that was built over time allowed the second author to delve deeply into previously discussed topics and events that occurred between interviews.

Interviews, lasting between 45-90 minutes, were recorded and transcribed verbatim. The second author also conducted monthly court observations and observations at the prison where the public defender offered entrance into PDC. The second author took handwritten notes during observations, supplemented with reflective memos immediately following the observations. Participants were recruited by the second author and through snowball sampling. No one, including program staff, was informed whether particular PDC participants took part in the study. Participants received $25 per interview as compensation for their time and effort. Interviews and observations were confidential; we refer to respondents by their chosen pseudonyms. The study was approved by the University of Maryland, Baltimore Institutional Review Board.

Data were collected during 2012-2014. Although arrests for prostitution have decreased in Philadelphia for a variety of reasons including new prosecutorial policies and the COVID-19 pandemic, we know of no more recent longitudinal studies of PDC or with women involved in street-based prostitution. Data collected in an ongoing follow-up study by the second author with current and former PDC providers and program participants indicate little change in the experiences and trajectories of women engaged in street-based prostitution.

Sample

The original study included 18 PDC respondents ranging in age from 28 to 53, who self-identified with various ethnic and racial categories, and had different levels of education. All engaged in street-based prostitution exclusively or combined with other forms of sex work for periods ranging from 4 to 17 years. All had long histories of addiction and, regardless of sequencing, saw prostitution and drug use as intertwined and mutually reinforcing. Fourteen had between one and 6 children ranging from infancy to adulthood. Our sample reported prevalence of traumatic events that is higher than among the general population, as is common among participants in prostitution diversion programs (e.g. Schultz et al., 2020). Almost all were incarcerated when they were invited to participate in PDC. Nearly all opted into PDC because it allowed them to leave jail faster and promised better treatment and services than traditional criminal justice processes. Table 1 provides detailed demographic information for all PDC respondents.


Table 1. PDC study participant demographics 

          Name

# of interviews

Age

Race

Education

Childhood abusea

Reason
 for entry

Age of
entry

Years in prostitutionb

Childrena

Addiction

Jerri

1

30

White

Some college

Yes

Drugs

23

6

1

yes

Keisha

5

37

AA

GED classes

Yes

Drugs

14

13

6

yes

Maria

4

28

Hispanic

8th grade

No report

Drugs

24

4

4

yes

Nicole

2

40

White

Graduated HS

Yes

Drugs

29

10

No report

yes

Angela

1

53

White

12th grade

No report

Drugs

40

13

4

yes

Ariella

4

37

AA

GED

No report

Survival

~27

10

2

yes

Ava

5

42

White

BA

Yes

Drugs

25

17

2

yes

Sara

5

44

White

7th grade + GED classes

Yes

Drugs

33

12

4

yes

Silver

1

45

AA

10th grade

No report

Drugs

25

15

No report

yes

Toni

1

44

White

Some college

Yes

Drugs

28

16

5

yes

Lorraine

2

46

White

8th grade +GED

No report

Multiple

18

16

2

yes

Sharon

2

39

Multiracial

Some college

Yes

Drugs

33

6

1

yes

Casey

1

40

White

Some college

No report

Drugs

28


No report

yes

Sheila

4

51

AA

Some college

Yes

Drugs

25


3

yes

Christina

4

48

White

11th grade

No report

Money

19


No report

yes

Toodles

5

44

AA

Some college

Yes

-

12


1

yes

Amy

7

31

White

9th grade

Yes

Drugs

18

12

1

yes

Gina

4

44

AA

10th+GED

No

Money

22


2

yes

Note: ‘a’ denotes that women were not directly asked about childhood abuse or their number of children, therefore “No report” implies no information with respect to these issues was volunteered by the women during the interview. ‘b’ denotes this is an approximation based on respondents’ narratives. For some of the interviewees this information was difficult to determine, hence the cells were left empty. ‘-’ denotes no direct information was received from the participant, despite being asked. In the race column, ‘AA’ denotes African American.


Case study selection

For the current secondary analysis, we read all 65 interviews with 18 PDC participants from the original study. Based on this initial reading, we used typical case sampling (Yin, 2017) to select two PDC participants, Keisha and Lorraine, who reflected different characteristics of the full PDC sample in regard to race/ethnicity, past history, and program trajectory. We purposively selected case studies that were not participants who were considered to be on the extreme ends of program standards for success or failure, but rather case studies in the middle of the spectrum that were more reflective of the sample as a whole. In their bounded focus, case studies “comprise more detail, richness, completeness, and variance—[and] stress ‘developmental factors,’ … and focus on ‘relation to the environment’” (Flyvbjerg, 2011, p. 301). We focused on these two participants in order to prioritize depth of analysis and nuance in their lived experiences.

Keisha and Lorraine, our selected participants, share some similarities, such as relationships with significant others, children and a history of addiction. They also have important differences, such as their experiences of incarceration, different geographic proximity to family, and their race/ethnicity. Taken together, their accounts are reflective of the full sample. Like nearly all PDC study respondents, Keisha and Lorraine did not complete the program within the minimum time frame of one year because they experienced at least one relapse. Table 2 provides a timeline with the date of interviews, program phases, relapses, and events they deemed significant, followed by a brief summary that provides narrative context for Keisha and Lorraine’s overall trajectories.


Table 2. Interview dates and life events for two case studies

 

Prison observation

Interview 1

 

Interview 2

 

Interview 3

Interview 4

 

Interview 5

Keisha

Date

6/2012

12/2012

 

4/2013

 

9/2013

10/2013

 

7/2014

Program phase

Prior to entrance

Phase 2

 

Phase 3

 

At program completion

A month after completion

 

10 months after completion

Life event

Arrest

 

 

Began a romantic relationship

 

Graduation

 

Breakup with boyfriend; short relapse

 

Lorraine

Date

--

5/30/2012

 

10/11/2012

 

3/20/2014

--

 

--

Program phase

 

Phase 1

 

Beginning Phase 3

 

1.5 months after completion

 

 

 

Life event

Short relapse

 

Short relapse; moves in with boyfriend

 

Long relapse; 60 days in jail; breakup with boyfriend

Graduation; got a job

Lost to follow-up

 

 


Keisha, an African American woman in her late 30s, has four children living nearby; another died in his teens. Like all PDC participants, she has a long history of drug addiction and prostitution, which began at 16 (a young age relative to the sample). Keisha attended school through eighth grade, starting her GED while in PDC. During PDC she reconnected with family and helped care for her ailing mother. She also met and moved in with her boyfriend for several months, but the relationship ended badly. She worked briefly at a fast-food restaurant far from her residence, but quit at her boyfriend’s insistence. Keisha relapsed after graduating PDC but quickly re-engaged with her drug treatment provider.

Lorraine, a white woman in her late 40s, moved to Philadelphia after her release from state prison. She has two adult children who were raised by her parents in another state. “Seeking approval from a boyfriend,” Lorraine began engaging in prostitution at 18 and soon thereafter began using drugs. Lorraine also attended school through 8th grade, completing her GED while incarcerated. While in PDC, Lorraine’s relationship with her family improved and she pursued employment at a fast-food chain. She developed an intimate relationship with her boyfriend, also in recovery, eventually breaking up with him at the insistence of court personnel, treatment providers, and her transitional housing staff. She had two short and one long relapses during PDC, and graduated. Shortly after graduation, she relapsed and our attempts to contact her were unsuccessful.

Data analysis

Qualitative longitudinal studies require creative methods of analysis to manage cumulative data (Henderson et al., 2012). We used Saldaña’s (2009) longitudinal coding method to conduct a fine-grained analysis of the exiting process in Keisha’s five interview transcripts and prison observation (from June 2012-July 2014) and Lorraine’s three interview transcripts (from May 2012-March 2014). Despite being recognized as a useful QLR technique (Grossoeheme & Lipstein, 2016), we found only one other published study using Saldaña’s method (2012). Saldaña’s matrix is a tool for organizing and synthesizing qualitative longitudinal data. It also serves as a data analysis probe that helps researchers uncover patterns and trajectories that can only be gleaned from data collected over time, such as turning points, continuity, and the valence and intensity of changes (Grossoehome & Lipstein, 2016).

Both authors independently reread all interviews, entering notes and quotations from each interview into a structured coding matrix based on Saldaña’s (2009) rubric that organizes “change and development in individuals, groups, and organizations through extended periods of time,” including “surges, epiphanies, or turning points” (pp. 175-176). Matrix rubrics functioned as a series of probing questions that summarize the cumulative data for each respondent. Table 3 provides an abbreviated sample matrix for one of the respondents.


Table 3. Sample longitudinal qualitative data summary matrix (shortened version)

Longitudinal Qualitative Data Summary Matrix

DATA TIME POOL FROM 9/26/2013  THROUGH 10/29/2013 (Keisha 4)

STUDY: Keisha Case Study

RESEARCHER: _____________________________

Increase/ Emerge

Cumulative

Surge/Turning Point

Decrease/Cease

Constant/Consistent

Idiosyncratic

Missing

* Higher self-esteem, not even thinking about prostitution: “I don’t even have the thought of, just the thought of another man touching me for money. I’m worth way more than that” (197-198)

* Seeing the consequences of messing up in court made her determined not to mess up herself: “I’m not testing the waters, ain’t no making no  mistakes” (166-69).

* Talks about the day she got arrested, before starting PDC, as “that was the greatest day, thing that ever could have happened to me.” Felt like the arrest saved her life (344-350)

* Decrease in self-depreciation, negative self-talk – you’re never going to have this and that, never going to be able to do this and that… (429-435)

* Has no job, still job searching (25)

* Fear of jail as a motivation all the way through the end of the program (190-192)

 

* Avoided 2 house checks by her PO because she was doing so well in the program (406-419)

 

* Fear about the future

Differences above from previous data summaries

* Talks about group therapy being helpful (not hating it), but she prefers not to share with a whole group plus other women’s stories as triggers (249-281)

* Talks about working on traumatic childhood experiences (father) with therapist (246-249)

* Describes the hearing when she lost custody over her 3 younger kids with more emotion; talks about losing her 2 older kids to the system and to her parents in law, respectively.

* Disliked being sent to Chances in the beginning of PDC (another IOP); now she is glad she went there (65-67)

* Talks in terms of weighing pros and cons of being in the life (667-670)

 

 

 

Contextual/intervening conditions influencing/affecting changes above

* Making her own decisions without supervision changed her thinking.

* Explains her entry to PDC – a friend had printed information about PDC from the internet (107-112)

 

* Keisha says love and care from others (not her family) made her motivated and capable (368-371).

* Accepts that she was really ready for the program (199-200) – “I was tired and I was looking for a way to change my life. And the program was the door opening up for me, and I used it to the best of my ability.” (203-205)

* Recognizes the hard work she put into getting her own apartment, says she’s always wanted a place to call her own (393-396)

* Keisha at the same time owns her independence, applies independent thinking, yet is scared of self-reliance (maybe afraid of relapse) (75-83)

 

 

Preliminary assertions as data analysis progresses

* Thinks of herself in terms of her legacy—what she’ll leave behind her

* Shares more about her life and feelings—parents not loving her, molestation by father, near-death experiences in prostitution, losing her children in court hearings [is this because she’s opening up to interviewer or because she’s allowing herself to remember and address some experiences with therapist?]

* More self-confident than before: Succeeds in things she never thought she would (got her permit, working on GED, talks about a career)

* Love and recognition from the program as a transformative power in changing her identity

* Maintains identity of a good wife and a loving mother, but aspires to have a career too

* Connects her prostitution to her childhood—parents on drugs and not caring for her

Note: This matrix was adapted from Saldaña’s longitudinal coding matrix (Saldaña, 2009). Content of the matrix was abridged due to space limitations.


We compared and contrasted our matrices, noting patterns across interviews over time and across respondents. This process resulted in a consensus set of a priori codes grounded in insights from the exiting literature and codes that emerged from the data (Elliott, 2018) such as self-worth and recognition. We grouped the codes into five major themes, presented below.

Findings

Keisha and Lorraine described a number of factors that influenced their exiting trajectories. We place special emphasis on how these factors evolved, and how respondents related to them. We also indicate where these factors applied to other PDC participants in the original study in order to situate Keisha and Lorraine’s experience within the broader sample. These factors include motivations, structural and personal hurdles, respondents’ relationships, and their assessments of successes and failures.

Motivation to exit prostitution

Like all respondents, Lorraine and Keisha’s external and internal motivation to exit prostitution evolved during and after PDC participation. Keisha’s incarceration forced an immediate exit:

[Getting] locked up [after I got raped] was the greatest thing that ever could have happened to me. The ... warrant people was like, “Why are you so happy?” I said, “cause you just saved my life. I need me a break. I am so tired. Take me to jail …” I had made my decision right there. Enough is enough. I’m sick and tired of being sick and tired. I wanna change (Interview 3).

Keisha, like several other respondents, described her arrest as a rescue from the dangers of street prostitution. Keisha’s relief at being arrested existed simultaneously with her fear of incarceration, which was shared by all respondents.

In her first interview, Keisha shared a common refrain that prostitution was an efficient way to meet her needs, given her limited opportunities, and continued to trade sex with two long-term clients. Keisha’s narrative around both prostitution and substance use changed significantly by her third interview, as she neared PDC completion. She became involved in a romantic relationship and moved in with her boyfriend, dropping her regular clients. Keisha was “happy [that] [she didn’t] have to go out there and have sex for money” (Interview 3). While Keisha’s determination to exit was initially influenced by external factors, when she graduated PDC, her motivation had become internal: “So what if you’re court stipulated? ... after a while ... you gonna stop thinking about ‘because of stipulations’; you gonna actually wanna do this because this is what you wanna do. That’s how it was for me” (Interview 3). Keisha tied her exit to her improved view of herself: “I don’t even have the thought of, just the thought of another man touching me for money. It’s not worth it. I’m worth way more than that” (Interview 4).

Internal and external motivations to stay away from prostitution coalesced after Keisha graduated. During her brief drug relapse, Keisha did not return to prostitution, fearing incarceration. “I haven’t been back out there on the street as far as prostitution ‘cause I’m scared to death to catch a new case or even going back to jail. So that’s far from me” (Interview 5).

Unlike Keisha, some respondents shared Lorraine’s ambivalence about exiting. Lorraine described prostitution as something that had made her feel powerful. Later, guilt and shame made it hard for her to exit:

[Prostitution] boosted my self-esteem—so I thought. At first I felt real dirty and slimy about it but then I was saying, “Wow, I can stop traffic,” and it built me up. And then it became a controlling tool that I could, you know, I had the money that the people that I wanted to be around, I could keep them around me and sort of manipulate the way things turned out with the money and the drugs. And the cycle of not being a mother to my children and the shame, the guilt, was in the background; and that was also something that I was covering up with the drug addiction (Interview 1).

Lorraine initially described herself as a “volunteer, not a victim” (Interview 1). The majority of her convictions, resulting in a cumulative 12 years incarceration, were for prostitution. Most respondents provided unsolicited accounts of dehumanizing and difficult conditions while incarcerated, including terrible food, lack of appropriate medical care and treatment. Such negative treatment is counterproductive to the rehabilitation of women once they are released (Arditti et al., 2020) . Staying out of jail, which Lorraine described as being “caged like an animal” (Interview 1), was a strong motivator for many of them.

By her last interview, after disengaging from her program, being apprehended and incarcerated, and returning to PDC, Lorraine’s narrative became self-critical: “What do I look like still with the hustling mentality? I would like to get better with that.” Her acceptance back into her residential facility and the staff’s investment in her well-being made Lorraine reconsider her self-perception in her third interview:

[Program staff] want me to heal. I didn’t see the need for a healing. I didn’t know there was anything even wrong … I also learned through [sexual trauma counseling], [that] I have control issues. And that’s probably how I ended up in the prostitution—having the money, to control people, maybe wanting to get high, or to control myself, it’s the only thing I ever had control over. I tried to control the cat, and the leaves falling off the trees, so I wouldn’t have to rake. “Okay, maybe I do have an issue.”

As Lorraine connected her drug addiction to prostitution, her view of herself shifted from “volunteer” to a “victim.” With this shift came what she described “willingness” to address different problems in her life (such as her mental health), while she worked hard to stay away from drugs: “But it takes a willingness too, on the part of the participant, and I don’t know if I’m with all of this acceptance because now that I’m older, and I just want different things in life” (Interview 3).

Lorraine and Keisha’s motivations for staying out of prostitution and avoiding drugs fluctuated, but their overall trajectory headed away from both. Keisha was internally motivated to exit despite multiple challenges; Lorraine, who experienced similar hurdles, was less certain whether and how she would sustain her exit by her last interview. Our findings show that even motivated PDC respondents were often thwarted by ongoing or recurring structural and personal hurdles.

Decision-making always sits at the intersection of aspirations and possibilities. Even though structural factors were relatively static, their influence on PDC respondents’ trajectories varied as they moved through the program. Respondents’ identification an used of various strategies to navigate systemic hurdles such as strict program regulations, poor transportation, and limited housing and employment evolved over time. Sometimes this was a result of enhanced self-efficacy. In other instances respondents drew on their expanding professional and personal support systems. Respondents’ efforts were met with successes and failures.

Resources and program limitations constrained study respondents’ perceived options, and these drove the strategies they employed to meet their needs. In her third interview, Lorraine described a string of experiences that illustrate how structural factors shaped her trajectory. When she had a 12-hour relapse using cocaine, she immediately sought detoxification but was turned away. “I called [the court coordinator] and told her I was trying to get into detox ... [but] I couldn’t get in without [a doctor’s] note. Plus you had to have heroin in your system.” Lorraine “went to [the Avenue] and got dirty. [I took s]ome heroin … in order to get in. [T]here’s no detox for cocaine ... you have to be dirty for Benzos. Heroin. Something along them lines” (Interview 3). Eligibility criteria for detoxification programs led Lorraine to seek the ‘right’ drugs in an area known for its high prevalence of drug sales and prostitution. What started as a relapse that may have voluntarily ended after 12 hours turned into a longer disengagement that ended in the court issuing a bench warrant, Lorraine’s arrest on the street, and a 60-day incarceration. Such a result was likely a setback for her exiting.

Economic necessity was another structural influence. Like many respondents, Keisha and Lorraine perceived few legal options to meet their needs, including gaining or maintaining employment. This was particularly true early in PDC participation, when initial phases required frequent and intensive engagement with court-mandated activities such as treatment, therapy, and weekly probation meetings. Lorraine cited financial constraints as the reason she sold suboxone illegally to pay rent until she was confronted by the PDC coordinator and decided to stop “compromising [her] principles” (Interview 3). Similarly, in her first interview, Keisha explained that she still engaged in prostitution with regular clients “[b]ecause I need cigarettes, my clothes washed. I’m not getting high today, but I still need things done, and it takes money to do it.” In a later interview, however, Keisha said that she stopped seeing these clients as well.

When Keisha and Lorraine found legal employment, they held low-wage, unskilled positions, which was the case for all respondents who were employed. In many cases, jobs are hard to get to and may involve shift work during non-traditional hours. Keisha had difficulty sustaining her low-wage job at a fast food restaurant due to limited late-night transportation. These difficulties led her to quit when her boyfriend no longer agreed to pick her up at the end of late shifts. Keisha’s housing situation followed a trajectory similar to her employment. She submitted a public housing application and was excited by the possibility of having her own place to live. During her second interview, she proudly described appealing a decision to disqualify her from public housing because of a drug case. By her final interview, Keisha was discouraged: “I’m still on the waiting list; it’s almost been two years. I almost wanna give up on that, but I’m not. But I really do wanna give up on that.” In the meantime, after breaking up with the boyfriend, she moved back in with her mother.

Keisha’s and Lorraine’s experiences demonstrate how structural barriers can lead to return to prostitution and impede sustainable exit. PDC participants’ navigation of structural hurdles evolved constantly against a backdrop of changing relationships and motivation to stay out of prostitution.

Evolving relationships with others

Study participants often tied their exiting trajectories to how they thought of themselves. One facet of this was how they defined their relationships with others, including loved ones and program staff. Respondents’ identities were constantly evolving: as a person who engaged in prostitution, a mother, wife, daughter, or friend. PDC respondents’ sense of self changed over time, often in a non-linear fashion, as they tried on different identities and as their relationships shifted. These changes were also related to their openness to receive assistance from others.

Keisha was initially eager to improve her relationship with her mother and her children. Early in the program, she described how these relationships had changed: “I’m happy. I got my family trusting me again. My mom, she did a whole 360 degree turn on me from the way she used to feel…She’s proud of me and she’s showing it” (Interview 2). In her third interview, Keisha shared how her family supported her recovery:

[T]hrough my whole process my family has been supportive. I have some that still smoke weed and they drink beer, but they respect my recovery; they all for me. My family’s seen me out there for so long, this is the day they finally get to see that I did it. And my mom and my dad, everybody like, “We so proud of you. Keep it up.”

In her fifth interview, after a brief relapse, Keisha had a different perspective on her family relationships. These relationships were a double-edged sword when expectations and demands conflicted with her own needs. She was tired of her children calling her “to see if I got any money” and her mother’s demands. Keisha’s previously supportive boyfriend lost patience with her night shifts at work. They eventually broke up over these different expectations and the resulting relapse scaled down her own expectations:

Right now I’m taking baby steps. Coming out of this little relapse because of this relationship .... I’m not ready for another relationship any time soon, [because] I put too much in everything else and not enough in me. So now it’s gonna be all about me, and I mean all about me. I’m pushing everybody to the side. I’m sorry, mother, kids, everybody. Because I got to; that’s the only way I’m [going to] keep going, and be able to get exactly where I wanna be later on in life (Interview 5).

Keisha’s extended description of her relationships was tied to her self-conception as a partner, daughter, and child. She adopted a view of herself as a partner in a more traditional relationship, “being just with one man” (Interview 3). She assessed the give and take in these relationships, seeking a place where she was valued, supported, and not overly burdened. Such a balance was hard to reach.

Lorraine also held changing visions of herself. Initially, she took pride in her independence. Later, she saw herself as someone learning to accept help and work with others. Lorraine viewed these identities as a source of conflict, rather than situationally applicable or coexisting. In her first interview she was proud of how others assessed her, sharing how quickly her recovery house asked her to serve as a resident representative and that a prospective employer was so impressed by her self-confidence that she was hired on the spot. Lorraine also described herself as an “addict [who is] self-ed up,” explaining that her pride did not always serve her well: “[M]y pride and ego, ‘I can do it’—I can get myself back in jail. I might get high for a while, but I always ultimately end up back in jail” (Interview 1).

Lorraine’s self-perception evolved by her second interview, when she said she was more open to advice: “I keep relapsing and finding myself in predicaments. So I’m just trying to stay open-minded and willing.” In her third interview, Lorraine gave up resisting others’ guidance, including the directive to end her relationship with her boyfriend:

I think I just surrendered ... I let [my relationship] go ... I [learned that] everything doesn’t have to be perfect [which] was part of my surviving skills, or my resilience. … I [didn’t] want you to say nothing negative to me [but] that’s what adults do; they talk. They tell you the truth. … I never wanted constructive criticism. “How dare you?”

In addition to their assessment of constructive criticism, Lorraine and all other respondents talked about the continuing recognition that they received from PDC staff and treatment providers, often in contrast to their personal lives and prior criminal justice encounters. Recognition and acknowledgment from PDC came, for example, in the tangible form of certificates marking phase completion and a graduation ceremony as well as “everybody patting me on the back for all the good work that I’m doing” (Keisha, Interview 2). The importance of this recognition was emphasized by Keisha more than Lorraine, but Lorraine too appreciated the invitation to join PDC despite her extensive criminal record: “I was very flattered and honored that … people ... were trying to help me even though I had a huge mountain in the way … I felt loved” (Interview 1).

Lorraine struggled with program requirements, and seemed less enthusiastic than Keisha and most other study respondents about reaching PDC milestones. Like the overwhelming majority of respondents, Lorraine had been incarcerated or under probation supervision for the majority of her adult life. After graduation, she did not see her probation termination for the first time in 30 years as an achievement; instead it made her feel unmoored. She reported that in an email to her probation officer, she wrote “’Oh my god, I feel like I should be coming into your office and taking a urine.’ It felt weird” (Interview 3). For most PDC respondents, however, acknowledgement from staff contributed to their sense of accomplishment and increased their self-worth. They also appreciated staff’s recognition of their various achievements.

Achievements and failures

Keisha and Lorraine spoke of achievements and failures across a range of interconnected domains. Keisha charted evolving progress on a variety of life goals. These included education and employment, abstinence from drugs and alcohol, and limiting her engagement with prostitution. Her job and career aspirations narrowed and expanded over time. In her first interview, Keisha had no thought of working. By her second interview, four months later, Keisha shared her career goals:

I wanna accomplish my dreams that I always had since I was a little girl, either a cosmetologist or a nurse. And so I’m going for my GED. I’m doing everything that I wanted to do but couldn’t.

Upon graduation, during her third interview, Keisha repeated her dream of becoming a cosmetologist or a nurse, and planned to become a nurse’s assistant. At the same time, she expressed skepticism about getting any job at all and wanted to first focus on completing her GED. This more pessimistic view changed again a month later when Keisha talked about her plan “to be somebody” (Interview 4). Despite not having secured employment, Keisha experienced a major accomplishment that she had not previously believed herself capable of: getting her driver’s permit at age 38 with her boyfriend’s help. Her accomplishment was shored up by the messages of pride and support from PDC staff and her family. Keisha’s accomplishments were accompanied by her changing state of mind: “I’m gonna go ahead and go for everything else that I thought I never could do” (Interview 4).

Keisha’s growing sense of competence diminished in her last interview, after a brief relapse. Ten months after graduating PDC, Keisha no longer talked about career aspirations. She quit her fast-food chain job under pressure from her former boyfriend, and she wanted only to find any job that would allow her to rent her own room.

In describing her successes and failures in all three interviews, Lorraine was cautious in what she expected of herself and what she promised to her family. For example, she explained in her first interview that it would be unreasonable to expect her children to view her as a mother, given the disappointment of her prior efforts:

I don’t expect to be the mom; I’m more like the distant aunt ... And it’s an acceptance piece. I can tell ‘em how I got this awesome court and I know that they’re happy to see that I’m getting help ... “Mom’s trying it again. Let’s see how long it goes.”

Lorraine was similarly hesitant to make promises to her probation officer. She understood the probation supervisor’s skepticism given her prior failures. She shared her conclusions from previous recovery attempts:

[I]n the past I’ve done recovery and I’ve always had to convince people. And now I know that I don’t have to convince anybody, … if I just relax and regroup that my actions are what’s gonna speak, ‘cause words are no good (Interview 2).

In contrast with her concerns about keeping her promises of sobriety, Lorraine was proud of her ability to secure employment on her own: “I have a lot of applications [in] ... I’m even in a job training program that has job partners. And I’ve had [Casino] and [Supermarket], two interviews from them. But I got the job from [fast-food chain] on my own” (Interview 3).

Both Keisha and Lorraine had what could be perceived as failures during the study in a number of areas including housing, relationships, and addiction. Both had relapses that tempered their successes. Their achievements and failures were part of the cumulative and dynamic trajectories of their overall aspiration to exit prostitution. Their responses to these supposed failures, however, were different. Keisha expressed an overall sense of pride:

I fell back at one point ... but I didn’t stay out there ... I ran back here to [Outpatient facility]; they opened their arms to me and I’m back … I picked myself up ... I’m bringing myself back. I’m back at my mom’s house, I’m back at [the Outpatient facility], I’m doing everything right all over again (Interview 5).

Lorraine’s multiple relapses did not make her proud but rather caused her to re-evaluate and appreciate the help she received from others, such as the staff in her residential facility. While Keisha was humbled by her relapse, she saw her response to it, which was a source of confidence and pride, as a success. Lorraine was also humbled by her relapse before her third and final interview. Unlike Keisha, at the time of her final interview, Lorraine expressed doubts about her ability to exit moving forward. This combination of confidence and self-doubt was reflective of both individual trajectories over time and the sample as a whole.

Discussion

While theories of exiting prostitution acknowledge non-linear trajectories and the interplay of individual, organizational, and structural factors (Baker et al., 2010; Oselin, 2014), most are based on cross-sectional studies and thus provide a limited picture of how these exiting trajectories unfold. In contrast, the current longitudinal case study provides thick description of prostitution exit over time (Sandelowski, 2000) and demonstrates the challenges that women face in their trajectories. Such nuances are sometimes lost in cross-sectional analyses.

Our longitudinal findings also allow for examination of how participants’ meaning-making oscillates, including subtle shifts in processes or attitudes. Although participants must navigate relatively fixed structural factors such as lack of housing and low-paying jobs, these factors exert a different influence on participants’ self-efficacy at different time points. Lorraine and Keisha’s abilities to navigate structural limitations ebb and flow through a combination of enlisting staff assistance and a sense of personal achievements such as getting a driver’s permit and ingenuity in adhering to program rules. While it may be difficult to achieve desired goals, recognition of their occasional successes helped respondents maintain their exiting trajectory. They were also buoyed by program staff’s recognition of their efforts. These experiences demonstrate the need for programs to redefine success in smaller measures (i.e. Keisha’s taking “baby steps” (Interview 5)).

Our two case studies demonstrate a tension between setting attainable goals and future aspirations. Keisha had long-term career and housing goals, yet struggled to find a sustainable low-wage job and housing of her own. Lorraine was told by program staff that she should aspire to higher goals but filled out many job applications before she found employment at a fast-food chain. Dalla (2006) reported that women in her sample who found a career fared better after three years than those who only had low-wage employment after graduating from the program. While career aspirations may be important, upon graduating PDC Keisha and Lorraine both said that they had to scale back their aspirations in order to feel successful. This is often a result of pragmatism due to low educational attainment, criminal records, little legal job experience, health problems, limited transportation, etc. The literature bears out this bleak reality: Structural constraints including collateral consequences limit women’s options (Global Health Justice Partnership, 2018; Pleggenkuhle et al., 2017). It is not clear whether having career aspirations is in fact a helpful facilitator in the exiting process and what mechanisms might be necessary to make it so. Further research on this is merited.

Our findings corroborate extant literature regarding romantic relationships and family networks as both facilitators and impediments to exit (i.e. Dalla, 2006; Giordano et al., 2002; Hedin & Månsson, 2004). Our longitudinal analysis shows that even when relationships are helpful, their nature and quality can change over time. For example, Keisha’s romantic relationship was initially an important facilitator of her exit; her boyfriend encouraged her to get her driver’s permit, an accomplishment that significantly boosted her self-esteem. That very same relationship also made her vulnerable later on as she viewed the breakdown of the relationship as a chief precipitator of her relapse. Had we terminated our data collection after a single interview, we may have drawn the erroneous conclusion that the relationship was either beneficial or harmful (depending on the point of data collection). In fact, the more accurate conclusion is that while relationships can provide incentives to exit, they can also make exiting difficult and must be negotiated with care and attention to changing dynamics. Criminal justice professionals and service providers, who often supervise or provide feedback on women’s relationships, would also benefit from a more nuanced assessment that includes a fuller understanding of such relationships within the context of women’s lives.

Our findings highlight participants’ relatively stable relationships with program staff, which were characterized by fewer expectations, more rigid structures and boundaries, and less volatility. In contrast, families and romantic relationships can be a double-edged sword. They may also be influenced by history, such as Lorraine’s previous unfulfilled promises to her children and Keisha’s childhood parental neglect, which some literature indicates is more common among women in street-based prostitution than among the general population (Dalla, 2006; Hedin & Månsson, 2004). Family difficulties and other stressful life events were common among PDC participants in this study and may have made family relationships particularly complicated. Our data indicate that the socioemotional aspects of staff/client relationships warrant further investigation than is found in extant literature, which looks primarily at staff decision-making (e.g., Anasti, 2019).

Limitations

This study has several limitations. Our sample included only cisgender, court-and drug-involved respondents who were in long-term treatment. All participants in the study were arrested for selling sex on the streets. This means that the motivation and institutional resources for this group may differ from those for women exiting prostitution independent of the criminal justice system, or for women who are exiting other types of prostitution or sex work. As we and others note elsewhere, respondents may adopt language and behaviors in conformity with program strictures and norms for a variety of reasons that may or may not reflect their self-understanding and commitment (Corrigan & Shdaimah, 2016; McCorkel, 2013; Shdaimah & Leon, 2015). Additional research is needed to ascertain transferability of our findings to other populations. It is difficult to disentangle our prostitution-related findings from respondents’ drug recovery efforts, a limitation found in other studies (Bachman et al., 2019; Gesser, 2021). Despite the coercive backdrop of our respondents’ trajectories, to the extent that they reflect experiences outside the criminal justice system, our findings may have broader relevance. We provided detailed descriptions so readers can assess their analytic generalizability.

Implications

The importance of relating to exit as a multi-layered process should inform program design and specifically, program sanctions. Although extant literature recognizes nonlinear trajectories, it is often implied that drug relapses and returns to prostitution demonstrate failure of individuals who are not motivated enough to desist from their old familiar ways. Such failures in diversion programs often result in jail sanctions (Mueller, 2021). We recommend that service providers meet such events with non-judgmental understanding of relapse and return and view it as part of a difficult process worthy of support, rather than as evidence of a superficial or false commitment to exit. Keisha and Lorraine assessed themselves against their professed desire for permanent exit. A longitudinal perspective is helpful in assessing Keisha’s determination to exit in light of the obstacles she faces. If we only looked at Keisha’s relapse, we would assume that she “failed.” However, her narrative only a few weeks after that relapse is of developing resilience and regaining her motivation—accomplishments that should be rewarded rather than punished. Programs designed for women exiting prostitution should therefore structure supports and (dis)incentives with this larger context in mind. This is particularly important in criminal justice settings, where punitive responses such as incarceration have serious short- and long-term consequences.

Our study demonstrates that Dalla’s (2006) distinction between “exited” and “non-exited women” (p. 183), similar to the broader distinction between desisters and persisters, is not always applicable from a longitudinal perspectives, as people can be both exiters and non-exiters at different time points along their trajectory. Prescriptive distinctions often imposed by service providers and researchers may be counter-productive to women’s exiting efforts. Our data indicate the need for approaches which better reflect the reality of the psychological, personal, and systemic factors that make exiting difficult even when internally and externally motivated. Lorraine’s loss of hope and self-recrimination might hinder future attempts and even precipitate relapse and return to prostitution. Service provision should respond to self-professed goals and motivations as worthy of respect and assistance (Wahab, 2006). Such programs should apply supportive, anti-oppressive, and non-judgmental practices (Gesser, 2021), such as the program described in Wiechelt and Shdaimah’s study (2015). Keisha’s framing of her relapse, shared by other respondents whose returns and relapses were met with support rather than judgment, is instructive. Her rapid re-engagement with her treatment facility set an example for others. Longer longitudinal studies to further evaluate such destigmatized, non-punitive responses to relapse and return to prostitution are necessary.

From a research perspective, our findings demonstrate the value of QLR in providing a nuanced and accurate perspective on people’s lives. Since perceptions of the past tend to be affected by present perspectives, QLR illuminates the evolution of respondents’ framing of both past and current events (Grotpeter, 2008). QLR also reveals the full emotional valence of participants that is missing when we interview people only once and request a retrospective view. Our longitudinal study was critical to understanding the complexity of various factors undercutting participants’ exiting efforts, despite self-declared commitment to stay out of prostitution. QLR also highlights the need for more attention to the dynamic impact of structural factors on the motivation and success of individuals in prostitution and the ability of social service providers and criminal justice personnel to assist them.

The criminology field has long been preoccupied with the notions of criminal career and desistance. Our findings with respect to desistance from prostitution demonstrate that these notions, when studied from a qualitative longitudinal perspective, are more nuanced and complicated than what quantitative studies have found. Such perspective suggests that following the life trajectories of women who have exited prostitution would yield useful insights and nuances into the desistance process. Quantitative researchers should be aware of these nuances and study them in mixed-methods longitudinal research to allow for broader definitions of desisters and persisters across diverse groups and conditions.

Methodologically, we advocate for more frequent use of Saldana’s longitudinal analysis matrix which has not been applied in other criminal justice studies. We believe it is a valuable tool for qualitative longitudinal researchers, in that it enables researchers to organize large amounts of data and detect qualitative patterns over time. Future QLR studies could take advantage of the methodology introduced in this study, and enrich the body of QLR research which does not abound in the criminal justice field.

Conclusion

Most models of exiting prostitution provide a bird’s eye view. Here we offer a fine-grained examination of exiting through two longitudinal case studies, adding a fourth dimension: time. Privileging time in the analysis broadens our perspective from a particular outcome at a set point—exited/returned— to the dynamic micro processes that influence women’s (dis)engagement in prostitution. Our findings show changes in women’s relationships with families and significant others, their aspirations, and their responses to structural hurdles, in contrast to their relationships with program staff which remain relatively stable. Analysis of these elements over time reveals how fluid and volatile women’s exiting journeys can be. Diversion programs, where returns to prostitution and relapse are punishable, are incompatible with the understanding that prostitution exiting is long-term and cyclical. Women exiting within the criminal justice system may have a strong impetus to exit yet struggle to maintain their exiting efforts, especially after program graduation. The stigma associated with prostitution, particularly where it is criminalized, makes it similarly difficult for women and for society to view a return to prostitution as anything but a failure. Assistance to women motivated to exit prostitution requires shifting away from dichotomous classifications of exiters/non-exiters and addressing structural and social challenges with individual and programmatic support. Our study shows the need for stable, non-judgmental professional assistance that should be available to women on an as-needed basis over the course of their exiting trajectory.

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Contributors

Nili Gesser is a postdoctoral fellow in the Anderson Sexual Violence Prevention Lab in the Department of Psychology at the University of North Dakota. She received her PhD in criminal justice from Temple University, her LLM from Bar Ilan University, and her LLB from the Hebrew University of Jerusalem . She is a former prosecutor and a victim advocate. Her major research interests center on prostitution, therapeutic jurisprudence, victimology, sexual violence, and agent-based modeling.

Corey S. Shdaimah is Daniel Thursz Distinguished Professor of Social Justice at the University of Maryland, School of Social Work. She received her LLB from Tel Aviv University, her LLM from the University of Pennsylvania, and her PhD from Bryn Mawr College. Her research focuses on how professionals and laypeople work around policies that they view as unjust or inefficient, primarily in the areas of prostitution policy, dependency court, and child care.

Acknowledgement

Portions of this research were supported by funding from the University of Maryland, School of Social Work. We are grateful to study respondents who generously shared their experiences and reflections, especially “Keisha” and “Loraine”. We also would like to thank the University of Maryland School of Social Work for providing funds for incentives and transcription as well as in-kind support of MSW and PhD graduate research assistance. We also wish to thank our reviewers, Amber Horning-Ruf and Ronald Weitzer, for their thoughtful review as well as Chrysanthi Leon and Jennifer Wood for their feedback and ongoing dialogue.

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