“I can't carry on like this”: barriers to exiting the street-based sex trade in South Africa

Abstract

In South Africa, gender-based violence and sexual assault is widespread. Poverty, particularly amongst black women, is also rife. Women selling sex on the street are at greatest risk for adverse health outcomes, violence and poverty. This study sought to explore the challenges faced by women attempting to exit the street-based sex trade. Two focus groups, a total of 21 black women, were conducted. These groups were recorded, transcribed and analysed using thematic analysis. The emerging themes exemplified a general sense of disempowerment and highlighted needs for exit. Context-specific requirements need to be elucidated for the development of successful exit interventions and policy reform. Further research should focus on the issue of decriminalization, empowerment and consciousness-raising in order to truly understand the relative harms to health in diverse contexts.

Keywords:

• sex trade
• exiting
• health
• gender oppression
• violence
• human rights

Introduction

Despite South Africa's comprehensive human rights constitution, human rights violations continue to occur daily: poor access to basic resources, such as education, housing, healthcare and income still afflict a large proportion of the South African population. Women, particularly black women, are the most vulnerable to these violations. Poverty and this pervasive context of generally oppressive circumstances (Cornish, 2006; Gould & Fick, 2008; Manopaiboon et al., 2003; Sanders, 2005, 2007; Williamson & Folaron, 2003) often renders selling sex as one of the few viable alternatives for employment. As such, while selling sex¹ may appear voluntary (a chosen source of income), in the South African context, it is more likely to be a constrained choice made due to limited viable alternatives (Gould & Fick, 2008). Approximately, 130–180 thousand individuals trade sex in South Africa; 90% of them are females (SWEAT, 2013).

South Africa has some of the highest globally reported incidence statistics of sexual and physical violence against women (George & Finberg, 2001; Hutson, 2007; Wechsberg, Luseno, & Lam, 2005). Women selling sex on the street are at the greatest risk; clients frequently subject soliciting women to varying forms of physical and sexual assault (Bucardo, 2004; Dalla, 2000, 2002, 2006; Elmore-Meegan, Conroy, & Agala, 2004; Farley et al., 2004; Miller, 2002; Monto, 2004; Okal et al., 2011; Raphael & Shapiro, 2004; Ribeiro & Sacramento, 2005; Sanders, 2004; Stadler & Delany, 2006; Wechsberg et al., 2005). Furthermore, women in the sex trade in South Africa are at increased risk for STIs, such as HIV, and are frequently stigmatized and ostracized from their communities (Beran, 2012). Women selling sex are also up to one hundred times more likely to be murdered (Salfati, James, & Ferguson, 2008), and their Posttraumatic stress disorder (PTSD) rates are on par with war veterans and torture victims (Roxburgh, Degenhardt, & Copeland, 2006). In fact, despite frequent contravention of basic human rights on multiple levels (e.g. safety, health, housing, employment), protection under the law is rare. As selling sex is illegal in South Africa (and thus those selling sex are regarded as common criminals), engaging in this activity increases the risk of brutality at the hands of the police (Boyce & Isaacs, 2011; Gould & Fick, 2008).

The often dehumanizing nature of the sex trade (Stadler & Delany, 2006; Wechsberg et al., 2005; Wepener, Learmonth, McLeod, & Chikte, 2013; Wojcicki & Malala, 2001), combined with the associated violence, disempowerment, physical health risks and marginalization, strongly suggests that selling sex is inherently harmful. Subsequently, according to premises laid out in systems theory, this harm would not be limited to just those selling sex, but extends to their children, the men who buy sex from them, the women these men in turn have sex with, those women's children and thereby, the broader community.

In South Africa, where selling sex is an illegal activity and where the harm is both obvious and insidious, encouraging exit from selling sex seems a logical step. In a study done by Farley et al. (2004), 89% of the South African participants expressed a desire to exit the sex trade. However, women wishing to exit the sex trade face many complex barriers. While much research has been done on specific barriers to exit (Cimino, 2012, 2013; Dalla, 2006; Farley et al., 2004; Hedin & Månsson, 2004; Manopaiboon et al., 2003; Månsson & Hedin, 1999; Mayhew & Mossman, 2007; Sanders, 2007; Saphira & Herbert, 2004; Swendeman, Basu, Das, Smarajit Jana, & Rotheram-Borusa, 2009), little attempt has been made to elucidate the broad range of barriers on multiple private and collective levels that challenge a woman's exit success. As exiting the sex trade is not a singular spontaneous event, but rather a process (Dalla, 2006), the importance of structural and societal factors that may influence the exiting process needs to be taken into account.

Cape Town has been classified as the sex capital of South Africa, with roughly 3% of its population being involved in the sex trade (Gould, 2008). A plethora of research has been published in recent decades on the experiences of individuals involved in selling sex. This research has mapped not only the precipitating factors, including childhood abuse, substance abuse and economic adversity (Dalla, 2002, 2006; Earls, 1990; Hardman, 1997; Potterat, Rothenberg, Muth, Darrow, & Phillips-Plummer, 1998), but also the many and varied experiences of men and women in the sex trade (Dalla, 2006; Gould, 2008; Mattu, 2007). However, to date, research into exiting the sex trade has mainly been conducted in developed countries, such as USA and Canada. No research has yet been done on the process of exiting in developing countries, such as South Africa. South Africa's history of racial segregation, repression and enforced racial discrimination, as well as the status quo of deprivation and high exposure to violence, makes South Africa a rather unique exit context.

Embrace Dignity is an organization that advocates for legal reform to end prostitution and sex trafficking in South Africa. This organization also supports women navigating the process of exit from the street-based sex trade. The presented research was carried out at Embrace Dignity's behest in order to inform further development of psychosocial exit interventions, sex trade law reform and policy development around government-supported interventions and services to facilitate the process of exit in South Africa.

Method

Recruitment procedure and participants

In co-operation with members of Embrace Dignity's sex trade support groups, purposive, convenient sampling was used to recruit participants. The participants composed of a pre-existing group of women, who share not only a desire to exit the sex trade, but who are in many ways similar to one another in terms of background and current life circumstances. The women in two of the groups agreed to attend a meeting explaining the study. After this meeting, women who wished to participate in this study attended one of the two focus groups. The women who participated in the study all lived in peri-urban settlements located in the greater Cape Town area. Only women attempting to exit the sex trade were included in the study. In total, 21 black isiXhosa women between the ages of 20 and 41 years of age participated in the study. All of the participants claimed to sell sex independently on the streets.

Data collection and analysis procedure

Two researchers conducted two focus groups, approximately 90 minutes in length, composed of 9 and 12 women, respectively. One of the focus groups was held in a participant's home in Khayelitsha¹ and another was held in a hostel residence in Langa.² Participants who struggled to express themselves in English were encouraged to communicate in their own language, isiXhosa; however, the researchers communicated predominantly in English. An interpreter was present at both of the focus groups. Consent was sought, both through signature and verbally (for those who could not read or write), and the description of the study with the consent forms was presented in both English and isiXhosa by the researchers and the interpreter.

Focus groups were used to collect the data. The focus group method allows for greater interaction between participants and more in-depth data are generated as participants’ opinions are challenged, qualified and developed by other members of the group (Willig, 2001).

The focus groups were semi-structured with the leading questions focusing mainly on experiences and barriers to exiting the sex trade. Broad open-ended and non-directive questions focusing on sex trade entry, experience and exit were posed for collecting data and aiding the flow of group discussion, if required. The aim was to facilitate an environment of sharing, not to check participants' experiences against pre-formulated ideas (Wilkinson, 1999).

Although the interviews addressed sensitive subject matter and posed intimate questions about participants’ experiences, the homogenous and pre-existing nature of the groups neutralized some of the potential effects of this sensitive subject matter. Additionally, the focus group method empowered participants through the validation of one another's experiences (Willig, 2001).

The process of analysis began with transcription of the focus group data and subsequent immersion in the data (Rabiee, 2004; Terre Blanche, Durrheim, & Painter, 2006). The data was then analysed using thematic analysis. Thematic analysis is theoretically flexible, allowing for a rich overall description of the data set and true malleability in the identification, organization, analysis, and reporting of themes (Braun & Clarke, 2006). Emergent overarching theme categories were identified in the transcripts. Emergent sub-themes were then highlighted, cross-referenced and placed into these broader categories. Three researchers were involved in analysing the data in order to increase the rigour of individual analyses. Each researcher analysed the data independently before emergent themes and sub-themes were compared, discussed and defined. This process enhanced confirmability of the results.

Power relations and reflexivity

As the research is embedded within power relations, it was important for the researchers to be able to reflect on their connectedness with the participants, and explore how building the research and participant relationship may have led to the specific data at hand (Parker, 2005; Rabiee, 2004). Reflection on the similarities and differences between the self and participants is vital (Andrews, Corrine, & Tamboukou, 2008). The sale of sex is a highly sensitive issue, and therefore such an issue is likely to provoke thoughts and attitudes informed by the “social imaginary” in which researchers find themselves (Brinkman, 2008). Acknowledging the importance of the researcher in interpreting the experience of participants leaves space for exploration of issues around reflexivity and meaning-making on part of the researcher, which is of great importance in researching sensitive issues such as selling sex (Terre Blanche et al., 2006).

As researchers, we were also mindful of the fact that the participants may have been reluctant to share their accounts with us in detail and that concealment may have been an issue. With face-to-face reporting and discussions, social desirability can also be an issue. However, focus groups tend to reduce power inequalities between the researcher and the participants enhancing disclosure and authenticity (Karnieli-Miller, Strier, & Pessach, 2009); the homogenous and pre-existing nature of the groups may have neutralized some of the effects of the sensitive nature of the subject matter (Willig, 2001). Two personnel from Embrace Dignity were also present to provide support and build rapport.

Ethical considerations

This research adhered to the University of Cape Town's guidelines for research with human subjects (UCT, 2012). Additionally, the research met the ethical requirements specified by the Research Ethics Department of the Department of Psychology (UCT, 2013).

Informed consent was obtained from all participants before conducting the focus group. Participants were provided with a detailed information sheet outlining the purpose of the study, confidentiality, their right to decline to answer certain questions and their right to withdraw at any point from the study. The participants were informed that should any concerns regarding abuse, assault or potential homicide arise during the focus groups, their right to confidentiality may be waived.

As the group of participants consisted of a vulnerable population, debriefing after the focus groups was imperative. In the event of negative or traumatic reactions during the focus group, a registered counsellor was present during the focus groups to provide support. None of the participants made use of the counsellor for post focus group support. Participants were also debriefed at a later meeting during which the findings of the research were presented and discussed.

Potential risks and benefits

This research did not pose any great risk to the participants. However, there was a chance that the participants may have become distressed by the discussion's content. Consequently, the researchers provided the participants with the contact information of a counsellor available for supported debriefing.

This research could benefit the participants through potentially increasing the provision of tailored interventions to assist with their exit from the sex trade. Additionally, some of the women found the process of speaking about their challenges cathartic.

Results and discussion

Due to similarities identified in the study's emergent main theme categories, Baker, Dalla, and Williamson's (2010) four tier framework for organizing identified barriers to exit was used to define the main themes. This framework is an expansion of Månsson and Hedin's (1999) three-tier framework of barriers: individual factors (factors that relate directly to a woman's personal aspects), relational factors (factors involving a woman's close relationships and informal social networks) and structural factors (related to a woman's social circumstances). Månsson and Hedin's (1999) research was motivated by a long-term Swedish state project to systematically stop expansion of the sex trade. This life-history study of 23, mainly street-based, women selling sex is considered a very important piece of exit research. It offers some useful insight into various approaches and challenges around exiting the sex trade (Sanders, 2007). Baker et al. (2010) included a fourth tier for societal factors to incorporate the social perceptions of women selling sex.

Individual factors

Trauma

Narratives of trauma were told by all participants. Nine of the participants spoke about childhood trauma, with abuse perpetrated by abusive fathers and stepfathers as being integral to their entry into the sex trade.

Thembi:

I grew up in the Eastern Cape, living under an abusive stepfather.

Nozipho:

 … her father which she thought was her real father was not her biological father, he was abusive and every now and then tell her you are not my child, and then she ran away to Cape Town … . then on the way she was raped?

Intimate partners also often abused the women.

Nomsa:

I was engaged to get married … but then unfortunately he was a drunk and abused me … 

Tumi:

He started forcing me. I stay with him maybe five or six years, not sure, but he would force, and we had two children together, but he was very abusive, verbally and physically … 

This violence evidenced the pervasive gender discrimination and oppression which currently exists in South Africa. Early abuse and trauma was compounded once the participants started to work in the sex trade as clients and the police frequently assaulted the women physically and sexually.

Thandi:

We are raped, we are robbed, even our clothes get taken off us and we have to come home naked … some of our friends got killed … 

Cynthia:

 … even those people that you think can support you, like the police are the ones who are raping.

Cillia:

 … because just now in January, I was abused by them, the police themselves. They took my money, the money that I have worked for. They demand that I give it to them. They beat me up and they spray (pepper spray). I went to their police station and I find that they are still there, and they make fun of me.

Nokuthula:

Someone will come and point us with a gun or something, the same person you are with and turn around and point you with something, maybe a knife or something … some of them will take the condom, and when you reach there, it is only you and him and he will point you with a knife and fuck you without a condom.

This context of persistent gender violence, and repeated trauma in South Africa, intensifies the risk of re-entry into the sex trade. Research indicates that identified psychological trauma (and resulting mental health issues) is a potential barrier to exiting the sex trade (Dalla, 2006; Dalla, Xia, & Kennedy, 2003; Farley et al., 2004; Rabinovitch, 2004). Women selling sex are at severe risk for PTSD (Choi, Klein, Shin, & Lee, 2009; Farley et al., 2004; Saphira & Herbert, 2004). PTSD diminishes psychological and social functioning. This reduction in functioning hampers women's ability to rebuild and restructure their lives: an absolute necessity for effective and sustained exit (Baker et al., 2010; Månsson & Hedin, 1999; Mayhew & Mossman, 2007; Sanders, 2007). Research into successful exit interventions has confirmed that the opportunity to begin healing from these often recurrent traumas is critical in facilitating positive exit (Choi et al., 2009; Hedin & Månsson, 2004; McClanahan, McClelland, Abram, & Teplin, 1999; Saphira & Herbert, 2004). Identifying and coping with distressing emotions and cognitions is specifically mentioned as being essential for providing an “earlier and more definite exit process” (Hedin & Månsson, 2004, p. 76).

Physical Health

Poor physical health was another factor which was mentioned as an impediment to exit from the sex trade. The participants spoke of tuberculosis (TB) and HIV infections.

Florence:

That time you go to the road you don't have HIV, and now you have HIV, because other clients they don't want to use a condom. So we take that money because we need that money.

Thembi:

Some of us, they have TB and some of us have both, because it is cold, so very cold there, because we stand there for the whole day and the whole night.

As a result of the legacy of apartheid and rapid urbanization, cities are unable to respond adequately to the pressing demands of urban growth (Western Cape Department of Local Government & Housing, 2009), resulting in an increase in unplanned peri-urban settlements. These areas are typically spatially marginalized with overcrowding and poor living conditions (City of Cape Town, 2006), contributing to a heightened risk for infectious diseases such as TB (Barrar, 2010), and high levels of crime and violence, including sexual assault (De Lannoy, 2008). South Africa has amongst the highest rates of HIV infection in the world. Approximately, 10% of the population is known to be infected with HIV (Abdool Karim, Churchyard, Abdool Karim, & Lawn, 2010). Rates of infection as high as 59.6% have been reported amongst women in the sex trade (Baral et al., 2012). Although treatment is available, poor living conditions and chronic stress tend to lower immune functioning (Adler et al., 1994; Antoni, 2003; Pennebaker, Kiecolt-Glaser, & Glaser, 1988) and adversely affect treatment adherence (Coetzee, Kagee, & Vermeulen, 2011; Leserman, Ironson, O'Cleirigh, Fordiani, & Balbin, 2008), increasing susceptibility to other communicable and non-communicable diseases.

Psychological well-being is closely interlinked with physical well-being, and poor physical health reduces employment opportunities as well as the ability to psychologically, emotionally and structurally rebuild one's life. As such, suffering from a chronic ill health condition presents a significant barrier to exit from the sex trade.

Shame

The emergent theme of shame was defined as “a loss of respect or esteem; dishonor” (Soanes & Stevenson, 2003). Besides the obvious psychological stress of recurrent traumas, the participants spoke directly about other aspects of selling sex which they associated with shame. These features frequently led to the participants engaging in behaviour which they felt was “bad”, “painful” or degrading. Occasionally they were left with little or no remuneration from clients. This sense of violation further compounded feelings of shame.

Thembi:

Because of rape, sometimes you get the client and you go to the bush, and that client sometimes only give you R20 or R30, sometimes they want to sleep with you, with no condom, sometimes they pour sperms on your face. Sometimes we get HIV, sometimes you in the bush with the client for 3 hours and they only give you R30 and you can't do nothing.

Nandi:

 … to sleep with different men, we don't like it, we just do it. We are not doing it for fun, we just doing it because we need money. If they say open the leg like this, you have to open, because they say so. Sleeping with different men is very hurting to us … Some are old like your grandfather, but you do not have a choice. The other one is just 16 years, the age of your child, but you sleep with them because you want that money. It is painful for us.

Nomsa:

Another thing is it brings bad habits on us, because if you see this one is a nice client we rob them. When you see that this one is a softy, you take a chance.

Shame becomes a barrier to exit when it is integrated by individuals into their beliefs about who they are and what they are worth. Internalized shame can destroy self-esteem and self-worth, and leave individuals over-identifying with being “bad” and therefore not worthy or capable of mobility in terms of occupying a different social space (Gilbert & Andrews, 1998; Sallmann, 2010). This inherent belief can set an individual up for repeated exit failures, which then serve to reinforce the belief. Counselling programmes designed to address this belief and rebuild individuals’ identities are vital for combatting shame as a barrier to successful exit from the sex trade (Baker et al., 2010; Cimino, 2013; Mayhew & Mossman, 2007).

Chronic Psychological Stress

As an exit barrier, chronic psychological stress has been discussed in research by Brown, Higgitt, Miller, and Wingert (2006), Williamson (2000) and Young, Boyd, and Hubbell (2000). Women working in the sex trade in South Africa are continually exposed to multiple serious harms, including those of violence, disease, criminalization, incarceration, stigma and exploitation (Baker et al., 2010; Collins, 2010; Cornish, 2006; Dalla et al., 2003; Nixon, Tutty, Downe, Gorkoff, & Ursel, 2002; Pardasani, 2005; Rekart, 2005; Ribeiro & Sacramento, 2005; Sanders, 2005; Williamson & Baker, 2009; Willis & Levy, 2002). In light of the emergent themes, chronic psychological stress was identified as an overarching theme incorporating many of the other emergent themes discussed. The harms and difficulties discussed by the participants create daily an environment of chronic psychological stress. Chronic psychological stress increases the chances of poor mental health, substance abuse, reduced immune functioning and subsequent re-entry into the sex trade (Baker et al., 2010; Månsson & Hedin, 1999; Mayhew & Mossman, 2007; Sanders, 2007). As such, dealing with the multiple factors which lead to chronic psychological stress is vital for effective exit.

Relational factors

Relational factors were those factors associated with close relationships, familial (relational) responsibilities and informal social networks (Baker et al., 2010). One of the most important factors in facilitating a successful and sustained exit from the sex trade has been identified as positive informal support from family (Hedin & Månsson, 2004).

Social support

A lack of social support is one of the most significant relational factors posing a barrier to exit. Positive social support from family and the community as a whole facilitates the exiting process (Hedin & Månsson, 2004). However, social support is often initially lost when the women are forced to escape abusive childhood homes (Kennedy, Klein, Bristowe, Cooper, & Yuille, 2007), while others lie about their source of income to friends and family to avoid stigma and isolation (Collins, 2010; Mayhew & Mossman, 2007), making it difficult to ask for help when attempting exit.

Thembi:

 … no one can help me, what is going to help me is to go back on the streets. Even sometimes I stay home for two weeks in Cape Town, and not go there, but when my money is finished I must go. No-one is going to buy onions for me. No one is going to buy sugar for me.

Thandi:

Nobody was loving or supporting her in any way … Those people she thought it was family, but it is not, and now she must rely on other people.

In the absence of a support system, the women were forced to rely on each other for support. Entry, and re-entry, into the sex trade was often precipitated by friends already involved in the sex trade; this factor has also been identified as crucial to re-exit (Benoit & Millar, 2001; Dalla, 2006).

Cillia:

 … because it was her friends that influenced her that time … They motivated her to go with them to go stand … she told herself she was there to guard them, but not to do business. She did not want to do that, but the influence was there from her friends.

Cynthia:

I was having friends in Langa who were still in this business. So when we sitting down and we talk about this business, in my mind I am now thinking back.

In the South African context, trauma often forced the women to flee their homes, relocating them from the rural areas to bigger cities in the hope of finding a better life. This need to escape abusive situations removed the women from their familial support systems and robbed them of other potential resources, such as possible financial support and educational opportunities. The lack of these resources significantly contributed towards their initial entry into the sex trade, as well as their subsequent attempts to exit.

The combination of a lack of positive support, and the immediate presence of negative social support, was particularly risky for the women. Due to social isolation, other women working in the sex trade were often the only source of social support and companionship available to them.

Intimate Partnerships

To avoid returning to the sex trade after an initial exit, intimate partnerships were tested as possible sources of emotional and financial support. Notably, women were most often able to exit for longer periods of time with the help of a husband or boyfriend who could financially provide for them. Situations with husbands and boyfriends were commonly characterized by a form of exchange whereby the women and their dependents were provided for in return for expected benefits, such as professional labour, sexual intercourse and domestic work.

Thembi:

 … there was this guy who was a client of mine he used to support me every day, and he wanted me to quit and he wanted to marry me. So I said ok fine let me give myself to this guy. So I gave myself to this guy … He opened a shop for me … here is a spaza ³ shop … , just take care of the shop.

Makhosi:

Me, when I start this business (selling sex), I find a guy … he took me to Joburg (Johnnesburg). He marry me after that we have a daughter. I do not have a mother. I do not have a father. I tell him you promise to support my brother, because my younger brother is 15 years.

So even in their private lives the women's bodies were treated as a commodity that could be exchanged for favours, normally food, shelter or money (Petersen, Bhana, & McKayc, 2005). This often served to reinforce their position as “sellers” of sex rather than assisting them to relinquish it. The Role Exit Model (Fuchs-Ebaugh, 1988) discusses how important the final stage, creating the “ex-role” (adopted by Baker et al., 2010), is in exiting highly stigmatized roles. Achieving some distance from the stigmatizing role appears to be pivotal to exit success.

The normalization of the mercenary exchange of sex for money or material goods was even more pronounced in relationships with so-called “sugardaddies”⁴ (Cooper, 1989; Overall, 1992; Zembe, Townsend, Thorson, & Ekström, 2013).

Nandi:

 … because my sugar daddy, he have the wife and five kids, so I have to love him because of money … 

The women often became dependent on their “sugardaddy” and this power inequality precipitated the ability of the “buyer” to control and abuse the “seller”, and “trade her in” if she did not adequately fulfil her role through the provision of sex. Moreover, both husbands and “sugardaddies” often reinforced the women's dependence on them by attempting to prevent the women from seeking employment to support themselves. In instances where women had exited and were in relationships, they often wanted to find alternative employment. However, opposition on the part of their intimate partners often resulted in abuse and a breakdown of the relationship.

Susi:

 … so when I told him that I want to go look for a new job he was saying then no, I do not have a wife who can work while I am still alive … So I tell myself I am getting something in the house, there is nothing I do not get … but I am tired of a man now, I have to report where I am going what so ever.

Makhosi:

 … there you go, I find the job. That Monday he tell me no, you want to go out and fuck around now, I say no, I just want the money to support my brother … he lock all the doors and he don't want me to take the interview in that shop. So I tell myself I am leaving this guy, because he is a shit. Then I pushed the window there in Bellville, then I run straight to the police station … because this guy never pay lobola,⁵ he just want me to stand at the stand and not pay me.

Relationships disintegrated most often as a direct result of the women leaving due to the male partner's forceful assertion of power and control. Despite the fact that these partnerships provided the women with a level of financial stability, the desire for agency and power in their own lives was stronger than the financial support they received. Once the partnership had disintegrated, the women were often forced to return to selling sex on the streets.

Motherhood

Motherhood was not only seen as a reason for entering the sex trade, it was also a significant reason for remaining in, and returning to, the trade. The women's families’ survival and hopes of education often depended on their ability to generate an income.

Andi:

 … she has five children … she wants to stop this work, but she needs work because she has those children whom she has to feed and educate.

Susi:

If my kids get everything they need and want then I am free, I am doing this job because of my kids. I do not want to be rich I want to afford for my kids.

Phumi:

So I go to my neighbour, please lend me R20, my son don't have transport to go to school, they say they don't have money, and that is the time I go back to the streets.

In the absence of a male wage-earner and with the disintegration of other forms of social support the burden of childcare and domestic duties became the women's sole responsibility. This severely limited their potential mobility and agency, often tying them down to hazardous income-generating activities (Mosoetsa, 2011), such as selling sex on the streets. As such, the majority of women ultimately require support from readily available formal support structures (Månsson & Hedin, 1999) to permanently exit the sex trade. It is also very important to repair relationships with family and partners (where possible), as well as to shift social networks, to ensure success in exiting (Hedin & Månsson, 2004).

Interestingly, the participants also spoke about motherhood being a significant factor in their desire to exit the sex trade. This factor has been illustrated in previous research, which has shown that a women's relationship to her children can often be a crucial incentive for change (Månsson & Hedin, 1999; Swendeman et al., 2009).

Structural factors

Structural factors are defined as those factors that are related to the women's societal circumstances (Månsson & Hedin, 1999), with economic necessity being one of the most widely cited structural barriers faced by women attempting to exit the sex trade (Brown et al., 2006; Cimino, 2012; Dalla, 2006; Gould & Fick, 2008; Manopaiboon et al., 2003; Mayhew & Mossman, 2007; Saphira & Herbert, 2004; Williamson & Folaron, 2003).

Economic necessity

Themes, such as economic necessity, and the lack of alternative employment are widely accepted as being key factors driving entry into the sex trade, as well as posing significant barriers to exit (Benoit & Millar, 2001; Brown et al., 2006; Gould & Fick, 2008; Manopaiboon et al., 2003). In South Africa, unemployment rates are high, and the average monthly income in 2012 was approximately R2 800 [$ 311] (Statistics South Africa, 2012). Financial oppression for women, particularly black women, is closely linked to their racially gendered positions in a post-apartheid society. Gender and race inequality exists in both educational and job opportunities (Wechsberg et al., 2005), and many women do not possess the necessary education, skills or working experience required for even low-level formal sector jobs (Brown et al., 2006; Gould & Fick, 2008; Hester & Westmarland, 2004; Manopaiboon et al., 2003; Sanders, 2007; Wojcicki & Malala, 2001).

Boniswa:

We are there for the money. They think we are there because we love the sex every day, something puts us there, it's the money.

Sandiswa:

 … it is about survival. I can't just get out, with no job, yabo,⁶ even now I do not have a job, and now I do not know what we are going to eat.

Victoria:

I don't know how I can stop, if I can get the same salary, as before I can stop, but if I can't get job that will give me R3000 a month it is difficult, it won't be easy to stop because I know what money I can get in this business.

The theme of economic necessity illustrates the direct impact that a lack of finance can have on the provision of one's basic needs. This in turn impacts on other important and interconnected areas of one's life, including safety, welfare, agency, health and social status (Hester & Westmarland, 2004; Statistics South Africa, 2012).

Employment

Alternative employment opportunities, especially ones that could offer equivalent financial gain, can be very scarce, especially when compounded by a commonplace lack of education, training and skills. This often left the participants feeling vulnerable and with feelings of having no other choice, but to re-enter the sex trade.

Boniswa:

I was doing this job (selling sex), then I stopped and I went to find a job for three years, then my boss went back to Canada, then I look and look for a job, it force me to come back here (to the sex trade). Again, I find a job in a restaurant, then they toy toy,⁷ then I lost the job. I have to come back, because if that job is stopped I have to come back because of my kids.

Thumela:

It doesn't help, because that job they gave me R2000 a month and I was working seven to seven, R2000 is not enough. My rent was R2500.

Interwoven into this theme was the idea of dreams. Many jobs were experienced as virtual slave labour and the women expressed having other ideas of what their professional lives would amount to. Feelings of exploitation made working in certain places for long periods of time intolerable. Furthermore, the women spoke of professional aspirations to start their own businesses. Many felt that self-employment could help them to exit the sex trade permanently.

Sandiswa:

 … it is not my dreams to work at Kauai [fast food chain]. I want to open a creche. That is why I said my own business will make me quit for good … So I came back to the road again. I am not going back there.

Andi:

 … I get the job … because that year very dangerous on the road … some of our friends got killed … .So this woman I was working for was not working … Every time I clean, she says to me this place you didn't clean. How can you say you clean if the place is like this? I can see that I will end up fighting with this women so let me rather leave this.

Phumi:

All I need mna⁸ is capital. I already have my business. If someone can borrow me some cash I will never go back (to the sex trade) anymore. And I don't need too much money. I only want R1000.

Månsson and Hedin (1999) spoke about how a person's ability to dream about future possibilities was one of the most significant strategies developed to overcome the tensions and challenges inherent in leaving the sex trade. This ability was integral to the process of change and the building of resilience. Increased resilience in turn decreased vulnerability and increased the ability to adapt and cope.

Official documentation

Related to the theme of employment was the frequent lack of necessary documentation and desirable work experience. The important documents mentioned were an official South African identity document, a high school certificate and a work résumé.

Cynthia:

 … but the time I wanna stop she is not [I did not] have an ID,⁹ I leave my job because the boss he wants the ID, I get the ID this year in February. That is why I come back to be a prostitute.

Thumela:

I wish I could get the ID, then I can find a job. There is a lot of times I use to work in those places and I don't have an ID, so I get small money. It is not enough money I go back (to the sex trade). If I have ID I can work in the right job.

Thandi:

my problem is I don't have the standard.¹⁰ I need this schooling.

Without the appropriate documentation the women's employment opportunities narrowed significantly (Brown et al., 2006; Manopaiboon et al., 2003). This difficulty in attaining basic personal documentation speaks to the institutionalized class oppression experienced by the women and highlights the extent to which they are marginalized in society. Issues with lack of work experience are two-fold. Not only do women not have the concrete experience that employers seek, but gaps in their work résumés can be problematic and difficult to explain.

Tumi:

And if there is a gap, from 2000 till now, what were you doing … 

Although, most of the participants possessed skills in craftwork, housework or a beauty profession, jobs in these areas are highly sought after, as these are common skill-sets for low socioeconomic status women in South Africa. As a result, the women struggled significantly to find alternative employment, although many of the participants said that “any job would do”. The contradiction between dream fulfilment on the one hand, and the women reporting that any job would do on the other, alludes to their awareness of the desperate nature of their situation. The hope created by the presence of dreams allows a sense of escapism for the women from their unbearable situation and oppression.

The legacy of apartheid continues to have far reaching repercussions. Those classified as “white” during apartheid had privileged access to well-funded schools, preference in the labour market and access to social services, whilst the black population were severely limited by their education and in their post school employment options (Barrar, 2010; Lam & Seekings, 2005). Many black women throughout South Africa continue to lack formal education and vocational skills, remaining excluded from the job market, whilst those who do manage to gain employment receive the lowest paying wages and are often vulnerable to the whims of their employers (Hutson, 2007). As a result, some of the participants viewed selling sex as one way in which they could regain some semblance of economic power and social independence. However, they also expressed that the abuse and disempowerment experienced eventually far outweighed the power gained.

Societal factors

Societal factors was used by Baker et al. (2010) to define social perceptions of women selling sex that are likely to effect, in meaningful ways, the other three factors. Stigma, and the resulting discrimination and ostracization, emerged as a theme in this study.

Stigma

Varying degrees of abuse contributed to an alienated and stigmatized existence for the women. They reported being subjected to blatant name-calling, abusive language, insulting remarks and gossip in their communities.

Susi:

So other people make us feel very hurt, when I walk in the street I think to myself that I am useless, why are people always swearing us, prostitutes, they must come and ask us why we are here, what we are doing here, what make us to stand here.

Nomfundo:

 … like today before I came here, I was talking to my sister … , then this person he drive past and he go like this on the window (demonstrates sexually derogative gesture), and it was a boyfriend of my sister.

Nandi:

 … sometimes you go to the shops and there are people gossiping … they make fun of us … some people say look there is marhosa.¹¹

The use of the “whore” stigma was used to condemn the participants and reinforce their oppression and ostracization. This stigmatization further resulted in the women's sense of isolation and a lack of social support, both influential factors in successful exit from the sex trade (Hedin & Månsson, 2004). Kira, Ashby, Lewandowski, Smith, and Odenat (2012) in their paper on gender inequality and its effects on female torture survivors discuss how Type III traumas (which represent ongoing social structural violence that does not have a foreseeable end) are considered to be potentially the most serious kind of trauma in terms of negative effects on the individual. This trauma is often internalized by individuals and this internalization can lead to an acceptance of discrimination and stereotypes which harm self-concept, efficacy and a sense of control, all vital to overall health and well-being. Type III trauma is a common experience for women selling sex (Baker, Wilson, & Winebarger, 2004; Brown et al., 2006). It can lead to exclusion from various spheres of life and entrap individuals psychologically and structurally (Overall, 1992) in specific contexts, making exit very difficult.

Limitations

The theoretical framework of any piece of research inevitably constrains the findings of the research. Notably, the greatest potential weakness of the chosen methodology is its assumption of experience as the basis of knowledge. Such assumptions have been commonly criticized for their acceptance of experience as factual rather than as constructed through discourse and politics (Ramazanoğlu & Holland, 2002). One limitation of the methodology of this research was the use of the focus group method. Contradictory to held beliefs, the participants disclosed more personal information about their experiences during informal one-on-one conversations with researchers than in the focus group settings. Another limitation was the necessary use of an interpreter. The interpreter ensured the inclusion of participants who spoke limited or no English, but who also provided rich qualitative insights into the world of the participants. However, as an interpreter may add their own dimension to the participants’ responses, this data can only represent an interpretation of the first person accounts.

Qualitative research tends to be considered limited in that hypothesis testing is not possible, results are less generalizable and it can be difficult to establish reliability and validity (Braun & Clarke, 2006). An attempt at transferability, through describing the research context and the assumptions considered central to the research, was made. It is the responsibility of the individual who subsequently wishes to “transfer” the results to a different context to then make the judgment of how sensible such a transfer is.

Sample sizes are also often smaller in qualitative research. Although these factors were an issue in the current research, these findings are exploratory and hope to give direction to further investigations into the street-based sex trade in South Africa.

Conclusion

Poverty, multi-layered deprivation and trauma adversely affect psychological and physical well-being (Belle, 1990; Carey, Stein, Zungu-Dirwayi, & Seedat, 2003). As such, the South African context of multiple traumas compounded by abject poverty, marginalization and deprivation is likely to significantly influence women's attempts to exit the sex trade. Although many women currently working in the sex trade would like to exit, the process of exiting is complex. The main themes which emerged were similar to those found by Baker et al. (2010). However, the sub-themes presented a somewhat divergent montage. A pattern of gender oppression was evident in this study. This usually began with abuse perpetrated by male relatives, compounded by abuse by male partners, a lack of educational opportunities and financial resources and oppressive domestic gender roles. These findings concur with the argument made by Mohanty (2003) concerning the significance of gender as the most important form of oppression, particularly in the global south. Although women in South Africa and women in the traditional West (developed global north) face similar gendered barriers, the gender oppression experienced by the participants of this study appears to be qualitatively different to that experienced by women in the developed global north. Their gendered experience “intersects” with the oppressions of class and race to produce a uniquely disempowered position (De La Rey, 1997; Hill-Collins, 1990; Kempadoo, 2001). While frameworks developed in previous research can be useful in understanding the process of exit, they do not sufficiently account for the matrix of oppressions faced by black women of low socioeconomic status in South Africa. Too often there is an implicit assumption made about unmarred choice. Assuming that women in the sex trade are totally empowered to stop selling sex as, and when, they wish, disintegrates into victim blaming. This could, in fact, reinforce entrapment in the sex trade.

To avoid further disempowering women seeking to exit the sex trade in the South African context, a greater focus on consciousness-raising and education for vulnerable women, their male clients and society as a whole is vital. Such educational strategies have already seen success in facilitating the exit process in developing country contexts elsewhere (Norsworthy & Khuankaew, 2008). Tailored support services are also required: substance-abuse programmes, general healthcare provision, psychological counselling, vocational and life skills training, housing and employment assistance (Dalla, 2006; Farley et al., 2004; Hedin & Månsson, 2004; Månsson & Hedin, 1999; Mayhew & Mossman, 2007; Sanders, 2007).

This research contributes to the established literature on exiting the sex trade and highlights the necessity of an increased focus on the provision of local solutions for local problems in local contexts. Further research into the barriers to exit, decriminalization, empowerment and consciousness-raising for exit is vital in order to end continued gender, class and racial oppression through the (too often accepted) trade of the disadvantaged as commodities.

Acknowledgements

The authors would like to thank Floretta Boonzaier, Catherine Srubisky, Priscilla Mbaleni, Anica Jansen van Vuuren, Sarah Westwood and Joni Halland for their individual inputs.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

1. “Selling sex” in this paper refers particularly to sexual acts as defined in the Sexual Offences Amendment Act 23 of 2007. It is used interchangeably with the term “trade sex” or “sex trade” to indicate “selling sex”. The participants and other survivors of the sex trade, who were consulted on the use of representative terms, preferred the terms “selling sex” and “sex trade” to “sex work” or “prostitution” as they considered them to be more ideologically acceptable terms.

2. Khayelitsha and Langa are peri-urban settlements on the outskirts of Cape Town.

3. Colloquial term for corner shop or kiosk found particularly in South Africa's peri-urban settlements.

4. A term used for older men in South Africa who date younger women and gain sexual favours from them in return for material items or money.

5. The bride price is paid by the bridegroom's family in cattle or cash to the bride's family shortly before the marriage. Makhosi's parents were dead so she expected the bride price to be paid to her.

6. An interjection in isiXhosa.

7. A form of dance used in protest gatherings, such as amongst striking workers or in political rallies.

8. Mna means “me” in isiXhosa. It is used here to emphasise the use of the first person in the statement.

9. The official South African Identity document which verifies that a person has South African citizenship.

10. “Standard” refers to the Standard 10 or Grade 12 certificate, which indicates that you have successfully completed your secondary school education.

11. Derogatory colloquial term for a prostitute in isiXhosa.