Prostitution in the shadow of life-long sexual abuse: Arab women’s retrospective experiences

ABSTRACT

The present study uses the life-course and intersectionality perspectives to explore the meaning that aging Arab women attribute to their lived experiences of life-long sexual abuse in the shadow of engaging in prostitution. Interpretive phenomenological analysis was used to analyze the narratives of 10 older Arab women in Israel who were engaged in prostitution. Four themes emerged: experiencing childhood in the shadow of sexual abuse, becoming a prostitute, being entrapped in prostitution, and settling accounts with the native culture. Women aging in prostitution experience a harsh reality of abuse and loss. The present study points to multiple channels of abuse throughout the life course, from childhood until old age.

KEYWORDS:

• Arab society
• intersectionality perspective
• life-course perspective
• older women
• prostitution
• sexual abuse

Child sexual abuse can be one of the most traumatic events in a person’s life, shattering the sense of safety, trust, and resilience to harm (Hughes et al., 2017; Labadie et al., 2018; Lassri et al., 2018). Sexual abuse in childhood is considered a central factor in women’s entry into the prostitution cycle (Begun & Hammond, 2012; Chohaney, 2016; Hickle & Roe-Sepowitz, 2017; O’Brien et al., 2017; J. A. Reid et al., 2017). Sexual and physical abuse among women in prostitution have received research attention in recent years among women in the general population in the various cultures of the world (Benoit et al., 2018; Moran & Farley, 2019; Weitzer, 2018). Moreover, approximately 35% of women, globally, experience sexual and physical abuse during their lives, and half of them are abused by family members (World Health Organization, 2013). However, knowledge about sexual abuse among women in life-long prostitution, including those in old age, is limited, particularly among Arab women in prostitution in Israel. In this study, therefore, the narratives of older Arab women in prostitution provide a retrospective and comprehensive view of their later lives in the shadow of sexual abuse. This may shed light on their personal and social worlds, as well as on their identity and how it was shaped by long-term sexual abuse. In addition, the present study serves as a platform for Arab women aging in prostitution to express their pain, giving a voice to a marginalized population. Sociocultural and political structural factors are important for deepening the understanding of the perception and consequences of long-term sexual abuse among Arab women in prostitution (Choi, 2015; Fedina et al., 2019). This is because cultural norms, social expectations, and conventions define and shape these women’s behaviors and perceptions.

The study of sexual abuse of women in various cultural contexts has critical implications for practice and policy making (Li et al., 2020). There is a need for greater recognition, social, economic, institutional, and professional support, as well as the creation of a unique rehabilitation package to address these women’s acute needs.

Therefore, to address this need in the present study, we used the life-course and intersectionality perspectives to explore the life experience of older women who had been sexually abused in the context of life-long prostitution. Specifically, our aim was to explore the long-term experience of sexual abuse in contexts of social and cultural constructs among Arab women engaged in prostitution and to understand the meaning they attributed to this experience throughout their lives and during the aging process.

Literature review

Sexual cultural norms and values in the Arab society

Arab society, in general, is based on conservative, patriarchal ideology in which masculine supremacy dominates and controls women’s sexual behavior. Central values of the society are family honor and the woman’s honor (Abu-Rabia-Queder, 2017; Ahmed, 2021; Haj-Yahia & Sadan, 2007). According to this ideology, sexual intercourse is legitimate only within marriage. Therefore, sexual relations outside of wedlock are considered a sin, and a woman who violates these codes is deviant (Abu-Baker, 2012; Abu-Rabia-Queder, 2017).

Older women in the Arab society

In the context of women aging in the Arab society, respect for and appreciation of women is measured according to their successful commitment to the society’s central values and norms, of which there are three main aspects: 1) Sexuality – single or married women, at all stages of life, are expected to protect their bodies, their sexuality, and honor. 2). Family values – preserving the family’s honor, reputation, and the woman’s dignity, and remaining committed to extended family unity. 3). Conformism – forgoing personal wishes and goals for the sake of the collective (Abu-Rabia-Queder, 2017; Jamal & Ilkkaracan, 2004; Mernissi, 2011).

Older Arab women are generally more valued and respected than younger women because of their age and because they have already proven their loyalty to society’s values and social norms. However, changes occurring in the Arab society may redefine the gender contract, which shapes society’s perception of women and affects their lives in the private and public spheres. In doing so, it changes their status and position in the family, and reshapes the range of possibilities available and opportunities for women (Abu-Rabia-Queder, 2017; Meler, 2016; Zoabi & Savaya, 2017).

Sexual abuse and older women

Sexual abuse is defined as any action or statement of a sexual nature performed or made without the consent of both sides. Sexual abuse may include incest, rape, attempted rape, sodomy, an indecent act, and sexual harassment (Vaillancourt-Morel et al., 2016). Most frequently studied in the prostitution literature is the link between childhood sexual abuse and subsequent entry into prostitution (Abramovich, 2005; Cimino et al., 2017; Pereda, 2015). Childhood sexual abuse is considered a major factor in prostitution entry (Chohaney, 2016; O’Brien et al., 2017; J. A. Reid et al., 2017).

Childhood sexual abuse alters the normal developmental trajectories that are necessary for healthy socioemotional function (Clayton et al., 2018; Langevin et al., 2016), increasing the likelihood of a child experiencing social-relational difficulties, cognitive dysfunction, depression, anxiety, internalization and externalization of problems, sexualized behaviors, and posttraumatic symptoms (Lo Iacono et al., 2021).

Childhood sexual abuse and its link to prostitution

Most frequently studied in the prostitution literature is the link between childhood sexual abuse and subsequent entry into prostitution (Abramovich, 2005; Cimino et al., 2017; Pereda, 2015). Childhood sexual abuse is considered a major factor in prostitution entry (Chohaney, 2016; O’Brien et al., 2017; J. A. Reid et al., 2017). Various studies show that 70%–90% of women engaged in prostitution have experienced childhood sexual abuse, mainly incest (Begun & Hammond, 2012; Hickle & Roe-Sepowitz, 2017; Kotrla, 2010). Dalla (2003) reported that 74% of prostitutes had experienced childhood sexual abuse. Prostitutes also report high rates of childhood physical and emotional abuse (Roe-Sepowitz et al., 2011). Farley et al. (2004) reported that 70%–95% of prostitutes from nine countries had been subjected to physical violence and 60%–75% had been raped. In addition, women engaged in prostitution are exposed to violent behavior such as rape, gang rape, attempted murder, choking, and battering (Fedina et al., 2019; Ruff, 2015). Research shows that more than 80% of women engaged in prostitution have been sexually assaulted (Tyler et al., 2013; Wiechelt & Shdaimah, 2011) and experience a wide array of victimization including physical, emotional, and sexual violence perpetrated by procurers and clients (Cimino, 2013; Dalla et al., 2003; Hickle & Roe-Sepowitz, 2017; M. A. Kennedy et al., 2007; Muftic & Finn, 2013).

Updegrove and Muftic (2019) found that women engaged in prostitution who had experienced multiple types of childhood abuse had increased risk of victimization later in the life course and reported greater trauma symptomatology. Other studies found that more than three out of four women who experienced childhood sexual assault experienced polyvictimization later in life (Hopper, 2017; Wilson & Butler, 2014). Finkelhor et al. (2005, 2007) introduced polyvictimization as a concept to describe the cumulative effect of an individual’s repeated exposure to traumatic events. Polyvictimization (PV), as a term, has been used to describe exposure to multiple types of victimization experienced by an individual, which may include child maltreatment, witnessing family violence, and sexual violence (Finkelhor et al., 2005, Finkelhor et al., 2007; Updegrove & Muftic, 2019). Female survivors of childhood sexual abuse are more likely to be polyvictimized later in life than women who have not experienced childhood sexual abuse (Aakvaag et al., 2017).

In sum, sexual abuse has been associated with negative mental and physical health effects that further aggravate the trauma resulting from sexual abuse (Ahrens et al., 2012; Walls & Bell, 2011). Women in prostitution may be at increased risk of experiencing polyvictimization, which can reduce resiliency and increase vulnerability to victimization in the long-term (Adjei & Saewyc, 2017; M. W. Baker et al., 2009; Bows, 2018, 2019; Naramore et al., 2017; Ulloa et al., 2016).

Prostitution in the Arab society

The traditional Arab society perceives women prostitutes as inherently inferior, mentally ill, negatively tainted, deviant, sinful, and dishonorable. As a result, they are judged as unworthy of attention, protection, and respect and as deserving of exclusion, ostracism, and humiliation (Mernissi, 2011). As prostitution contradicts the society’s central values and is damaging to the family’s honor, it is considered legitimate for male members of the family to inflict a variety of punishments on these women, including home imprisonment, humiliation, ostracism, and severe physical violence, even murder. Prostitutes are stigmatized as “abnormal” and deprived of their social rights; thus, these women believe that they deserve the negative attitudes directed toward them and the discrimination against them (Weitzer, 2009). Internalization of stigma may lead to low self-esteem, feelings of powerlessness, and justification of the disrespect shown toward them.

Prostitution and older women

Prostitution is defined as engaging in sexual conduct with another person in return for payment (Benoit et al., 2018; Weitzer, 2018). Payment can take the form either of money or of its material value, such as food, drugs, clothing, or housing (Sanders et al., 2017). The literature views prostitution as one of the extreme traumas of contemporary Western society. It is also described as “white slavery” while being compared with extremely cruel, harsh, and oppressive institutions (L. A. McCarthy, 2014; Moran & Farley, 2019). In this context, prostitution as a social phenomenon is seen as a female practice (Belser, 2005; Farley, 2018), a social taboo, harmful to the values of society and to public health, undermining the social order, and destructive for women who engage in the practice. It is important to note that sex trafficking of older women in patriarchal societies and, in fact, in any society, has been understudied.

The risk factors and reasons for entering prostitution can be divided into two main categories. First, the micro level, related to economic motives (Footer et al., 2020; Vanwesenbeeck, 2013) and experience of childhood sexual abuse and physical violence (De Vries & Goggin, 2020; J. A. Reid & Piquero, 2014; Updegrove & Muftic, 2019), drug addiction (Clarke et al., 2012; Tavakoli et al., 2021), homelessness (Heerde et al., 2015; Miller et al., 2011; Warf et al., 2013), and mental health issues (Roe-Sepowitz, 2012). Second, the mezzo level, in which the family system balance is related to problematic family dynamics (Farley et al., 2016; J. A. Reid et al., 2017), dysfunctional parenting and neglect (Ehrensaft et al., 2015; FitzGerald & McGarry, 2016), domestic violence, intimate partner violence (Cimino et al., 2017; Cobbina & Oselin, 2011; A. C. Kennedy et al., 2012), and dysfunctional child welfare and childcare (Fong & Cardoso, 2010; Rafferty, 2013).

The consequences of prostitution can be divided into four main categories. First, psychological implications can be expressed in complex, ongoing posttraumatic stress disorder (Hossain et al., 2010; Newton et al., 2014), such as flashbacks, nightmares, depression, anxiety, shame, fear, anger, and guilt (Muftic & Finn, 2013; Pierce, 2012). Second, they have health implications, such as sexually transmitted diseases, malnutrition, dehydration, exhaustion, headaches, and migraine (De Chesnay, 2013; Newton et al., 2014; Williamson et al., 2012). Third, family-societal implications include loss of child custody (Dodsworth, 2014), social stigmatization (Godbout et al., 2014; Huschke et al., 2014; Sallmann, 2010; Weitzer, 2018), and estrangement from immediate and extended family that leads to social isolation (Dalla, 2004; Hankel et al., 2016). Fourth, addiction to drugs as a coping mechanism with prostitution-related suffering (Bachman et al., 2021; Clarke et al., 2012; Roe-Sepowitz et al., 2012; Sanders, 2017; Tavakoli et al., 2021).

Older women, in general, and those engaged in prostitution, in particular, experience different types of changes. Physical changes related to aging include wrinkled skin, white hair, and sagging breasts (Bachi et al., 2017). Physiological changes attributed to prostitution in old age include infectious diseases, bruising, frailty, exhaustion, and internal and chronic infections (Bachman et al., 2021; Roe-Sepowitz et al., 2012; Wiechelt & Shdaimah, 2011). Social changes are associated with decreased support network, role changes in the family, and reduced income (Boeri, 2018).

Women’s engagement in prostitution increases their exposure to physical and psychological risks because of their unhealthy lifestyle including harmful choices such as smoking, drug use, and bad nutrition, as well as sexually transmitted diseases and ongoing physical and sexual abuse (Staton et al., 2018; Turner et al., 2017). Their lack of healthcare consumption negatively affects their aging process (Farley, 2018). These events and changes may speed decline of physical and mental functioning due to constant and untreated physical, mental, and environmental stressors (Capoor & Stein, 2005; Heuser, 2002)

In sum, as Arab women’s engagement in prostitution continues, the consequences and influence intensify, creating accumulation of social, emotional, and physical burdens and stresses leading to a difficult and complex life reality (L. M. Baker et al., 2010; Hammond & McGlone, 2014).

Life-course perspective

The life-course perspective emphasizes interaction between biological, physical, behavioral, social, and familial factors, personality, life history, and significant life events in the context of transitions and changes over time and the way in which they shape humans’ development from birth to death (Elder, 1998; Elder et al., 2003). Researchers have used the life-course perspective to study the phenomenon of prostitution, especially in studies seeking explanations for pathways of entry and transition into and out of prostitution (Cox et al., 2013; Farley et al., 2016; B. McCarthy et al., 2014). The life-course perspective, as a broad framework for this study, considers aging of older women in prostitution in the context of “time, period, and cohort” (Hooyman et al., 2002; Mayer, 2009). According to this approach, past and ongoing socioeconomic, political, and other factors shape and influence the experiences of old women in prostitution. In addition, events, trajectories, or circumstances experienced in one life stage may influence events in another (Bengtson et al., 2005; Carpenter, 2015; Dannefer et al., 2016; Elder et al., 2003).

Therefore, according to the life-course perspective, aging is not seen as a vulnerability related to a person’s chronological age, but as one stage in the entire course of life, and as a continuous process. Life events from the past and the experience of changes and transitions affect current and future life paths (Bowes & Daniel, 2010; Brady & Gilligan, 2018; Braveman, 2014). For example, childhood sexual abuse, as a turning point, can affect the trajectory of women entering prostitution at an early age, as well as later life outcomes (Henriksen, 2021).

In addition, this approach emphasizes that the lives of women in prostitution are connected to the family unit. Women depend on the family as a primary environment for growth and development. Dysfunction of the family, regarding issues such as violence, drugs, and prostitution, affects their experiences at different stages of their lives (Elder & Giele, 2009; Jones et al., 2018; Shanahan et al., 2016).

Therefore, this study focused on the life histories of women engaged in prostitution and on significant life events that shaped their development from their early years to old age.

Intersectionality perspective

The intersectionality approach relates to the categories of race, status, gender, sexuality, nationality, physical and mental competence, ethnic origin, and age, which integrate, intertwine, and shape each other (Crenshaw, 1991). In this context, emphasis is placed on power relations between and within diverse societies, as well as on individual experiences in daily life (Collins & Bilge, 2020). Over the years, this perspective has become a central topic in describing the individual and social situation of people who are shunted to the margins in multiple ways (Calasanti & King, 2015).

In the context of the present study, the intersectionality perspective explains and gives meaning to the many difficulties affected by the multiple channels of discrimination and exclusion regarding aging Arab women who are engaged in prostitution. In addition to being female, they are old, they are Arab and belong to an ethnic minority, and are victims of life-long sexual abuse (Bowleg, 2012).

An intersectional perspective also refers to the subjection of women to several patriarchal regimes and control that establish multiple identities (gender, nationality, religion, class, and age). Arab women engaged in prostitution are subjected to situations of inequality and social and gender oppression, a consequence of a patriarchal and collective order, which characterizes the traditional conservative society and stigma resulting from society’s perception of women’s involvement in prostitution (Haj-Yahia, 2013; Jabareen, 2015). The intersection of these identities creates multiple experiences of loss that, each time, lead to different forms of oppression and exclusion (Abu-Rabia-Queder & Weiner-Levi, 2013; Meler, 2016; Sa’ar, 2007).

Arab women, in general, are expected to conform to patriarchal norms and values as well as to fulfill expectations and roles that define their status, sexuality, and family. Arab women who infringe the boundaries of the collective in issues that are considered unacceptable, such as drug use, criminality, immodest clothing, and having sex outside of marriage including prostitution, reshape the space of possibilities facing women. The intersectional perspective used in this study can help deepen the understanding of how society perceives these violations and how the participants’ experiences, status, and identity are shaped by their social status. Focusing on marginalization, oppression, and multiple exclusion of women in prostitution, from an intersectional perspective, provides depth to understanding the essence of complex patterns and offers deeper insight into the complex experiences of Arab women in prostitution.

In sum, the literature review shows that the phenomenon of prostitution has been studied from many different aspects, starting with the experiences of women in prostitution, through the pathway of entry and entrapment in prostitution, consequences for women involved in prostitution, to perceptions and attitudes toward the phenomenon. Although extensive knowledge exists on the prostitution phenomenon, the study of older women’s life-long sexual abuse is scarce (Chen et al., 2014; Hao et al., 2015). Furthermore, the research is even more limited regarding conservative and Arab societies (Rizvi, 2015; Rostamzadeh et al., 2016). Moreover, several recent literature reviews have indicated the dearth of studies that give voice to firsthand experiences of older women victims of sexual violence (Bows, 2018; Fileborn, 2017). Thus, the research question in the present study was as follows: How do older Arab women retrospectively describe their experiences of sexual abuse in the shadow of life-long prostitution?

Method

In this study, we chose interpretive phenomenological analysis (IPA) to present the narratives of older Arab women in prostitution. This qualitative methodology is dedicated to the exploration of participants’ experiences, understandings, perceptions, and views (K. Reid et al., 2005). IPA examines personal lived experiences and how individuals construct their meanings (Larkin & Thompson, 2011; Smith et al., 2011). The phenomenological tradition is conducive to highlighting areas of knowledge that have not yet been studied or that have limited knowledge, which can be enriched and explored in greater depth, as in the present study (Sanjari et al., 2014; Smith et al., 2009).

Participant recruitment procedure

The research team included three researchers, all certified social workers: two experts in the gerontology field and one criminologist. All are experienced in treating and researching sensitive populations (Band-Winterstein & Avieli, 2022). After approval from the university ethics committee (IRB), we contacted women’s advocacy centers that treat women in prostitution. Professionals at the women’s advocacy centers referred 10 women to us. We talked on the phone with all 10 participants and introduced ourselves as academic researchers who were interested in listening to them and in learning about their experiences relating to prostitution. During these conversations, we were able to address participants’ suspicions and fears about our identity and motives, to ensure the women’s sense of safety, and to obtain their initial consent. The participants’ safety was ensured in several ways: the researcher who interviewed the women was a professional social worker with experience treating adolescents and women in distress and thus acted professionally toward participants, was alert to participants’ needs, and treated participants with respect and sensitivity while putting their mental and physical well-being before the needs of the research. The researcher offered the participants mental support from various therapists, in cases where difficulties arose resulting from the interview. She made sure to avoid leaving the participant with a painful experience with no appropriate therapeutic response or immediate assistance. In addition, we adhered to ethics committee rules, which included maintaining confidentiality, assigning participants pseudonyms, and obtaining informed consent. The interviews were conducted in a safe environment without the presence of potentially dangerous individuals. Regarding the researcher’s physical safety, another researcher was present nearby and could be called if necessary. In addition, the researchers debriefed with the research team or another expert to release negative and difficult emotions that had accumulated during the interviews.

Interviews

The interviews were conducted at the participants’ locations of choice: six interviews were conducted in cafés, two in the researcher’s car, and two interviews in the private office of one of the researchers at the university. One researcher conducted the interviews because of her fluency in Arabic. The duration of each interview depended on the women’s individual needs and abilities and usually lasted from 1–2 hours. The interviewer paid special attention to the participants’ emotions expressed during the interview, particularly any erratic or uneasy reactions. The interviews were audio-recorded and transcribed verbatim. The data collected during the study were kept confidential, stored in a locked computer, and protected with a password known only to the researchers.

Data collection

We performed data collection via in-depth, semi-structured phenomenological interviews using an interview guide (Kvale & Brinkman, 2009; Pietkiewicz & Smith, 2014). The interview guide addressed the following categories: the experience of family life before entering prostitution (e.g., Describe significant events in your life before entering prostitution; Describe the relationship in your family of origin.); the everyday experience of prostitution (e.g., Describe the circumstances of your entering prostitution; Describe how you learned to deal with clients and procurers; What are the consequences of your engagement in prostitution?); the perception of prostitution in a traditional Arab society (e.g., How does society view your engagement in prostitution today? How does it feel to be an older Arab prostitute?), and life in retrospect and future prospects (e.g., Looking back at your life from the present reality, what message would you like to pass on to other Arab women in prostitution?).

Participants and sample

The research sample included 10 participants, all women between the ages of 42 and 56 (M = 48.8). The participants were purposefully selected by criterion sampling (Patton, 2015) to obtain the widest possible variation of respondents among older Arab women in prostitution. The inclusion criteria were: 1) Women older than 39—in accordance with research that revealed accelerated aging of participants due to their living conditions (L. M. Baker et al., 2010; Chen et al., 2014; Hao et al., 2014, 2015); 2) Arab women, and 3) Engagement in prostitution. There is no agreed upon definition of aging women in prostitution. However, published studies have used several age cutoffs ranging between 35 to 45 to describe the starting point of aging in prostitution (Hao et al., 2014; Pomales, 2015). This age may be considered young for other populations, but since women in prostitution face accelerated aging due to precarious lives and cumulative disadvantage, they may experience premature physical and mental aging (Footer et al., 2020; Guida et al., 2019; Kakchapati et al., 2017; Su et al., 2014). Cumulative disadvantage theory emphasizes how early advantage or disadvantage is critical to how cohorts become differentiated over time. Early risk factors, such as sexual and physical abuse, shape trajectories in both short-term and long-term outcomes (Ferraro, & Shippee, 2009: Ferraro, 1996). The research sample in the present study comprised 10 women older than 42.

All the participants had grown up in dysfunctional families (e.g., criminal environment, parent using drugs, death of the mother, parental divorce) and had suffered from life-long financial distress and poverty. (See Table 1 for additional data.) All the participants were victims of domestic abuse, such as sexual, physical, and emotional abuse. Six participants had experienced sexual abuse in childhood in and outside the family. All the women had experienced sexual abuse while in prostitution. The average age of entry into prostitution was 17.4 years and the average length of time in a prostitution circle was 24.9 years.

Table 1. Characteristics of Arab women in prostitution.

	Najlah	Salma	Krema	Ola	Reem	Dina	Hawla	Samera	Nadin	Rola
Age	42	52	45	52	50	44	54	45	54	50
Education	No schooling	High school	Elementary school	Elementary school	Elementary school	No schooling	Elementary school	Elementary school	No schooling	Elementary school
Marital status	Divorced	Single	Divorced	Widowed	Married	Single	Widowed	Single	Single	Divorced
Children	1	1	1	5	4	2	4	-	1	3
Age entry	16	18	20	17	17	16	20	17	16	19
Length of time in prostitution	28	27	25	25	26	24	26	23	30	15
Domestic violence/sexual abuse	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
Drug use Before	Yes	Yes	No	Yes	No	Yes	Yes	No	Yes	No
Drug use After	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
Crime	Yes	Yes	No	No	Yes	Yes	Yes	Yes	No	No
Contact with family	No	No	No	No	No	Yes	No	No	Yes	No
Child Custody	Foster care	Mother’s Custody	Foster care	Foster care	Foster care	Foster care	Foster care	-	Mother’s Custody	Foster care

Data analysis and trustworthiness

Data analysis was performed using interpretive phenomenological analysis (IPA), as suggested by Smith et al. (2009). All researchers were involved in the data analysis. In the first step, we all read the transcripts several times to get to know the text as well as possible. We performed initial coding inductively by coding meaningful statements made by participants. For example, we identified a wide variety of participants’ memories in the context of childhood sexual abuse, physical violence, and a dangerous family environment. The next step involved grouping the sayings into meaningful units, including quotes that capture the essential quality of the participants’ experiences and perceptions, e.g., concerning the perception and consequences of sexual abuse in old age. We then identified, collected, and conceptualized emergent relationships.

At this stage, we used a deductive analysis, driven by the life-course and intersectionality perspectives, to gain a broader understanding of the findings and to enhance our understanding of the complexity of Arab women’s experiences in prostitution as a result of the many forms of exclusion and oppression (Smith et al., 2009). During the analysis, the researchers discussed and identified similarities and differences in the participants’ accounts. For example, most of the older women saw themselves as life-long victims of sexual abuse and a variety of losses. Many of them expressed the fierce desire to restore their lost dignity and demand social justice.

Trustworthiness was achieved as follows: First, audio-recorded interviews and their verbatim transcriptions enabled verification with the original, ensuring referential adequacy (Lincoln & Guba, 2013; Rodham et al., 2015). Second, we compared and negotiated the identified themes until agreement was reached. As researchers, we bracketed our experiences to reduce preconceptions as much as possible, to prevent them from influencing the study or our interpretations of the phenomenon (Chan et al., 2013). We followed Moustakas’s (1994) description, performing repeated rounds of reflection on any of our preconceptions or prejudgments. For example, when difficult feelings were evoked in the interviewer during the interviews and became a setback to continuing with subsequent interviews, she wrote down her feelings and discussed them with the team, until she reached “an internal sense of closure” (Moustakas, 1994, p. 89).

Findings

The findings revealed four major themes: (a) “The rape was the worst thing that ever happened to me. I cannot forget:” Experiencing childhood in the shadow of sexual abuse; (b) “They treated me like candy, passing me around to each other:” Becoming a prostitute; (c) “You need to be thick-skinned to survive all that disgusting trash that seeps down into the prostitutes’ street:” Being entrapped in prostitution; (d) “I am socially ostracized, judged as deviant and promiscuous:” Settling accounts with the native culture.

“The rape was the worst thing that ever happened to me. I cannot forget:” experiencing childhood in the shadow of sexual abuse

The first theme reveals that all the women experienced incest at the hands of a father, brother-in-law, or another family member as well as sexual abuse by other adult men, in addition to physical and emotional violence by parents and brothers during childhood. They also described dysfunctional families, criminality, drug use, divorce, and the loss of a parent. Most participants linked their complex family situation to their entry into the world of prostitution. The following quote describes an experience of childhood incest:

When I was 11 years old, my father raped me. He would put a knife to my throat and rape me. He would bring other men to have sex with me. After that, we all used drugs. They would give Dad money. This story went on for a long time. I didn’t tell anyone … I didn’t understand what was happening, and what could I do? I was a weak and helpless girl. (Nagla, 42)

Another participant described child sexual abuse by a stranger:

My parents abused me badly for years. They didn’t let me go to school. When I was 12, I was raped by a neighbor. I lost my virginity. It lasted a long time. My mother blamed me and said I had agreed to it. The rape was the worst thing that ever happened to me. The experience devastated me, stressed me out, and put me in shock and confusion. Running away from home and wandering the streets was my way of coping. (Rola, 50)

Another participant recounted child sexual abuse by a relative:

At a young age, I witnessed severe violence between my parents. In the end, they divorced. My stepmother treated me badly. I dropped out of school. We were removed from home to a foster family by the welfare authorities. After several months, I ran away and moved in with my sister in the city. My sister’s husband used to beat me and rape me at night. I told my sister, but she didn’t believe me. Home was my prison, and I was not allowed to leave. Eventually, I got tired of that life and decided to run away. (Salma, 52)

This theme deals with different forms of sexual abuse and violence during childhood, such as rape, incest, and sexual relations without the women’s consent. The abuse was perpetrated by men within the family (fathers, brothers-in-law, uncles) and family acquaintances (friends, neighbors). The women described the abuse as a traumatic event and a turning point in their lives, leading to dropout from school, involvement with the welfare services, placement in foster care or residential institutions, drug use, and even running away from home from their village to an unfamiliar city. At this stage, the abuse served as a central factor in their entry into prostitution, as well as a mediating factor increasing the risk for sexual behavior and other forms of criminality, which were a shortcut to prostitution.

“They treated me like candy, passing me around to each other:” becoming a prostitute

The second theme deals with the stage of becoming a prostitute after ongoing sexual abuse drove the participants to flee the family home in the village for the city. Once in the city, they had no means of livelihood, accommodation, or occupation, and no source of protection and support. While attempting to make a living, these women were exposed to danger and exploitation by men who offered them help and support. The following quote reveals sexual abuse at the stage of becoming a prostitute:

I ran away from the village to the city when I was a young girl of 17. On the first day in the city, I met a man who had sex with me and dumped me on another guy … I decided to live with him, so I could sleep with a roof over my head and not on the street; and survive. He used to beat me and force me down to the street, for prostitution … all with violence and force. Whenever any man wanted sex, he would come to our house, exploit me, and sexually abuse me. (Ola, 52)

Another participant told her story:

I finally ran away to Tel Aviv. My life is one long rape. Rape started with my father and then my boyfriend and men my boyfriend brought me … they all raped me, exploited me, abused me, and humiliated me. I started using drugs to help me not feel what I was doing. The landlady of the brothel took pictures of me naked and with men and threatened to share the photos if I refused to have sex with men or move to another brothel. (Nagla, 42)

A third participant described her experience:

At a young age, I ran away from home to the big city and had no choice. I had to live and survive. I started selling my body to get money for drugs and food so I wouldn’t die of starvation. I met a guy who said I could sleep at his place. I was taught how to behave and what to do. Very quickly I became his obedient servant and his doormat. All the people he brought me exploited me and abused me. They treated me like candy, passing me around to each other. I had sex with them without wanting to. (Rola, 50)

In this theme, the women recounted escaping from the village to the city as a central stage of entering the prostitution cycle. On reaching the city, they encountered a cruel, threatening environment while lacking the skills, tools, or competencies to survive the transition. Therefore, they sought protection, a roof over their heads, food, drugs, and more. These needs were provided largely by their new abusers – young men whom the women described as friends who offered to help them and relieve their distress. Later, they sexually extorted them and coerced them into having sexual relations in return for their help. They also forced them to have sex with men who came to the house, as well as in the street, and sent them to work in brothels. At this stage, the women, who had chosen to escape from the abuse at home, became more vulnerable to continued sexual abuse. In addition, prostitution was a means of survival. They tended to perceive their bodies as an object that could be traded for support and protection and to finance basic needs and drugs.

“You need to be thick-skinned to survive all that disgusting trash that seeps down into the prostitutes’ street:” being entrapped in prostitution

The third theme deals with the women’s entrapment in a reality of different types of violence after living in prostitution for a lengthy period. This reality is characterized by the women’s acknowledgment of the difficult conditions in the street, the dangers, and risks; and they had developed survival strategies. At this stage, the women’s identity in prostitution is perceived as eternally stained, with no option of either change or erasure. This is apparent in the following quote:

To be in prostitution means experiencing exploitation, rape, assault, harassment, humiliation, beatings … street prostitution is very brutal, violence by clients … there is no prostitute who has never been raped. They asked to do disgusting, horrible, inhumane things, as if I had been bought. My drug addiction increased. If I wasn’t drugged, I would have gone crazy with disgust and with the dirt. You go into prostitution clean and come out of it dirty. Even if I forget, my body will not forget. (Deena, 44)

The next two participants shared more details about the street:

The street is very dangerous, deathly frightening, you see horrible people. I needed someone to protect me. The pimp made out as if he was protecting me, but he raped me, body and soul, forced clients on me, took all my money. My only option was to steal, sell drugs, and cheat clients to have enough money to buy the drugs … You need to be thick-skinned to survive all that disgusting trash that seeps down into the prostitutes’ street. You don’t know what each day will bring. (Kareema, 45)

Life on the street is very hard. I experienced all types of violence. It became part of my prostitution business. The harsh reality on the street is also reflected in my lifestyle—hunger, drugs, fatigue … I would stand on the sidewalk completely naked in the freezing cold, and in the heat on summer days, to draw clients. Fighting with other women in the street, eating garbage to live, sleeping on the road, on people’s piss. No showers for days or months, until it rained and then I would wash my body. So, it stayed dirty in any case. They’ll rape you either way. (Salma, 52)

In this theme, the women described the stage at which they were so immersed and entrapped in prostitution that it had turned into a way of life. At that stage, sexual abuse and the different types of violent behavior were unavoidable. They encountered a threatening reality every day, of violent, abusive clients, even to the extent of a threat to their lives. New abusive figures – such as procurers – forced sex on them, raped them, violated their rights, and deepened their addiction to drugs. The entrapment was characterized by increased use of hard drugs, to survive and suffer the harsh sexual abuse, criminal involvement, and physical abuse. In addition, they described the transition from an authentic, clean, pure identity to a stained identity expressed by dirt, disgust, impurity, which could never be erased in the eyes of the Arab culture. The more time that passed, the more this identity appeared to stabilize and consolidate, making change impossible. This identity accompanied the women’s memories that surfaced in old age.

“I Am socially ostracized, judged as deviant and Promiscuous:” settling accounts with the native culture

The fourth theme deals with the women settling accounts with the Arab society. The women pointed an accusing finger at the hypocrisy of Arab society that, on one hand, condemns and stigmatizes them in the most negative way while, on the other hand, takes pleasure in their services.

Nadine described the society’s attitude as a source of torture and suffering in old age, demonstrating the negative attitude toward women who are aging in prostitution:

People say I am the devil, guilty and must be buried … I am a sinful woman, socially outcast, isolated, judged as perverted and promiscuous … They tell me: “You sold your body for money, went after your sexuality so you are not worthy of respect, worthless.” They enjoy hitting me, walking on me, spitting on me. This is what happens in our society. There is no justice in this world. (Nadine, 54)

Another participant illustrated the society’s hypocrisy:

They will not admit they are guilty. You were my customers. If you don’t accept me as a prostitute, why did you use my body for your pleasure? They made all the mistakes and came out pure. They are allowed to do this because they are men. Maniacs. And I am a weak woman. I’m not a prostitute anymore, but they still see me as a whore. I have lost my dignity. My family is not in touch with me, I have lost my children. I feel lonely and have lost everything dear to me. (Hawla, 54)

Another participant demonstrated the self-perception of women aging in prostitution:

Over the years, when you reach old age, you begin to reconstruct what you have done in your life and the events you experienced throughout life. A woman who was a prostitute ends her life with feelings of despair, shame, guilt, grief, loss, shame, and great regret, and there is no way to fix it, there is no way to get back what was lost … My dignity, purity, and innocence have been taken from me, and they cannot be taken back. I can’t change how people see me and perceive me. (Rola, 50)

These women, who experienced ongoing sexual abuse while working as prostitutes, described the society’s attitude toward them. They reported abusive, pitiless behavior. People in the Arab society call them negative names and perceive them as infidels and sinners. The society allows itself to behave cruelly and unjustly toward them and they remain “worthless,” “transparent,” “invisible,” “erased,” and “not a human being at all.”

The women described how the Arab society continues to estrange them and disregard them in their old age. They find themselves excluded, without status and on the margins of society. They have lost their honor, as well as their family and social support. They spoke about the hardships imposed by the patriarchal Arab society and society’s hypocritical talk. From the religious and social perspectives, sexual relations outside of a normative framework are forbidden, for both women and men. They harshly criticize the men and their male clients who have forgotten that, for many years, they were sexual abusers. They were the men who abused these women, who say that now, they have no right to judge them and stigmatize them as inferior deviants, whores, immoral, dishonorable, repulsive wrongdoers. In fact, it was the men who sinned by exploiting the women’s bodies, went astray and committed an offense, and yet the society does not punish them and does not settle moral accounts with them.

The women also conduct a monologue with themselves about responsibility for their own reality. On one hand, they admit to having sinned and to being guilty and, therefore, perceive themselves as disgusting, dirty, dishonorable deviants. On the other hand, they perceive themselves as victims of the society (mainly of its men) who sexually and physically abused them, caused their decline, exploited them, solicited them, and forced themselves upon them. They rebelliously ask to restore the honor they have lost and demand social justice from the society; that society should judge the men, as well, because they also sinned and continue to do so. They request justice for themselves, their families, and their children.

Discussion

Women aging in prostitution experience a harsh reality of abuse and loss. The findings of the present study point to multiple channels of abuse throughout the life course, from childhood through old age. In the discussion, we will relate to two main aspects: long-term sexual abuse from the life-course perspective and shaping a unique identity from the intersectionality perspective.

Long-term sexual abuse from the life-course perspective

The study participants’ experiences and identities have been shaped by ongoing abuse and engaging in prostitution. Childhood sexual and physical abuse are considered key factors in explaining women’s entry into the prostitution cycle, and many studies have indicated the relationship between the two (e.g., Cobbina & Oselin, 2011). The literature on sexual abuse and incest notes that child sexual abuse can lead to prostitution in two ways: 1) Girls who choose to escape from the abuse at home become more vulnerable and choose prostitution to survive. 2) Girls who objectify their bodies and perceive them as commodities (Matthews, 2015).

From the life-course perspective and retrospectively, the women described their early sexual abuse as a traumatic turning point in their lives (Bachman et al., 2021; Park et al., 2021; Teruya & Hser, 2010). As a result, they experienced inevitable life transitions, such as running away from home, using drugs, living with foster families, marrying older men at a young age, moving from the native village to the city, entering and becoming entrapped in the world of prostitution. In other words, abuse at such an early stage irrevocably shaped their lives (Henriksen, 2021).

Arab women involved in prostitution report having experienced childhood abuse and facing a high level of adversity from early on in life (Farley et al., 2004; Hickle & Roe-Sepowitz, 2017; Vanwesenbeeck, 2017). In addition, many sexually exploited women, including those who engage in survival sex (Cobbina & Oselin, 2011), are routinely exposed to various forms of abuse while involved in prostitution (Tyler et al., 2013; Wiechelt & Shdaimah, 2011). They experience a wide array of victimization including physical and sexual abuse perpetrated by buyers, pimps, and intimate partners (Cimino, 2013; Hickle & Roe-Sepowitz, 2017). Recent research demonstrates that long-term sexual abuse, both in childhood and at a later age, has a multiple, multidimensional, lifelong influence on women’s lives. Cruz et al. (2021) found lifelong psychological, physical, sexual, and social impacts. Connected to the experiences of the participants in this study, several psychological and physical health consequences were found. These included low self-esteem, depression, posttraumatic stress disorder, borderline personality disorder, suicidal behavior, compulsive eating and sexual behavior, headaches, migraines, and metabolic disorders, as well as predisposition to cardiovascular diseases, chronic inflammation, unwanted pregnancy, and sexually transmitted infectious diseases.

Arab women who had experienced childhood abuse reported having experienced polyvictimization (Hamby et al., 2017; Le et al., 2018) later in life and greater trauma symptomatology (Finkelhor et al., 2007, Fox et al., 2015; Updegrove & Muftic, 2019). As they had coped with negative experiences and a greater typology of trauma, they were exposed to greater risk and poorer outcomes later in life (Aakvaag et al., 2017; Turner et al., 2017).

Shaping a unique identity from the intersectionality perspective

Arab women involved in prostitution are perceived by society as having blatantly violated the social codes and norms; they are judged and given negatives labels, such as deviant, sinful, promiscuous, dirty, disgusting, immoral, and unworthy of appreciation and respect. These women internalize society’s perceptions, admit their sinfulness and guilt, thus perceiving themselves as deviant, dirty, and disrespectful. However, they also perceive themselves as victims of society who have experienced continuous and repeated abuse, exploitation, and oppression.

The challenges facing Arab women survivors of sexual violence and prostitution in old age, as a minority group, stem not only from each of these dimensions but also from their intersectionality. Therefore, the intersection of prostitution as a social deviation, sexual abuse, gender identity, being part of an ethnic minority, and older age lead, each time, to a new reality in which the women experience abuse that in turn leads to exclusion, repression, discrimination, marginalization, and lack.

Women engaged in prostitution and living with sexual abuse contend with sexual-abuse-related stigma and sex-work-related stigma, which are co-constitutive and mutually exacerbating (Logie et al., 2011). These women have themselves identified stigma as a pervasive and powerful threat to their health and well-being. Its negative effects lead to myriad health and social outcomes (e.g., Shannon et al., 2018). Society’s perception of the women in prostitution and their self-perception have led to limited opportunities and reduced personal coping resources and resilience (Benoit et al., 2018; Grittner & Walsh, 2020), to endless loss of honor and authentic identity, to extreme loneliness and suffering, to being stuck in a rut, to early onset aging and vulnerability which, in turn, has led to double social exclusion on the family, economic, and health levels, and to a unique identity of ultra-marginalization.

Sadly, no change can occur in these women’s self-perception and in the way the society perceives them, even in old age. The participants in the present study found themselves at a dead end, in a harsh, complex reality. Being older Arab women as well as survivors of sexual abuse and prostitution considerably limits their power in this equation. We call for their voices to be heard and for representation to demand reparative justice for this marginalized population.

Limitations and recommendations for further research

This study examined the meaning of aging for Arab women in the shadow of engaging in life-long prostitution. The study had several limitations. The first is language related: Interviews were conducted in Arabic and were then transcribed and translated into Hebrew. Arabic is a rich language, and some nuances and meanings of the women’s words, phrases, and expressions may have been lost in the translation process, potentially creating bias. The second limitation is related to the purpose of the study, which was to describe and analyze the experiences of long-term sexual abuse throughout the participants’ lives and while they were aging. Researching a specific factor – sexual abuse – allows a broad and deep focus on all aspects and dimensions of a life in prostitution. To encompass broader aspects of the subject, we recommend supplementing the current retrospective study with longitudinal studies dealing with various events throughout the life course. To deepen understanding, we recommend conducting a study that will allow differentiation, isolation, and comparison between research groups at different points in time. For example, a comparison could be made between older women who have experienced long-term sexual abuse and young women, the differences in their experiences, and the meaning they attribute to their lives.

Finally, the participants in this study suffered from different degrees and types of abuse: All had been sexually and physically abused, and some had experienced verbal and emotional abuse, as well. Polyvictimization may have an impact on the experience of prostitution. Therefore, future studies are recommended to focus on different forms and patterns of life-long abuse.

Practical implications

A major contribution of this study is its exploration and analysis of prostitution in the context of sexual abuse throughout life, and of how older Arab prostitutes attribute meaning to their lives. According to the research findings, older women in prostitution are victims of long-term childhood abuse and of abuse while in prostitution. This study adds to the existing knowledge about older Arab women and may shed light on ways to help them process prostitution experiences and better understand their lives. Thus, this research has implications for professionals such as psychologists, social workers, physicians, psychiatrists, counselors, and nurses working with aging, sexual abuse, and prostitution.

By emphasizing the issue of long-term physical and sexual abuse, a comprehensive intervention and rehabilitation package can be developed to meet the acute needs of women at this stage of their lives. Therefore, women who have experienced abuse and prostitution will have the opportunity to accomplish agency, to gain abilities and to learn survival strategies to combat their frustration, shame, guilt, and despair. Intervention may help these women to cope with their pain, to achieve closure at this stage in their lives, to detach from their victim identities and build an alternative survivor identity, thus breaking the cycle of exploitation and marginalization. Furthermore, the “life review” process can be used as a therapeutic tool to help women deal with trauma, improve life satisfaction, and make life more meaningful, as well as to deal with past and future life experiences (Lan et al., 2018). Finally, intervention may empower these women to make their voices heard about their loss of dignity and the social injustice.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The participants of this study did not give written consent for their data to be shared publicly, so due to the sensitive nature of the research, supporting data is not available.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.