9. Which Comes First: Sexual Exploitation or Other Risk Exposures Among Street-involved Youth?

Elizabeth M. Saewyc, Christopher Drozda, Robert Rivers, Laura MacKay, Maya Peled

Introduction

Street-involved and homeless youth are a diverse group, who end up in their precarious living conditions for a variety of reasons. Nearly all of these youth face serious threats to their health and well-being as they attempt to navigate a variety of harmful risks, such as alcohol and drug use, inadequate shelter, limited sources of food, discrimination, stigma, and high rates of violence (Roy et al., 2004).

One serious risk street youth face is sexual exploitation. Sexual exploitation is defined by Canadian law and the UN Convention on the Rights of the Child as the exchange of any sexual activities by someone 18 years or younger for money, drugs, food, shelter, or other goods, or even for services, such as transportation (Office of the United Nations High Commissioner for Human Rights, 1990). Canada signed the original UN Convention in 1990, and also signed an optional protocol in 2000, which included governments’ commitment to address the sale of children, child pornography and child prostitution (United Nations Treaty Collection, 2000). By this definition, giving money or other things to a young person in exchange for sex is a form of sexual abuse, a violation of their right to be free from coercion (including the pressure of economic survival) in deciding when and with whom to have sex.

Among street-involved and homeless youth in North America, an estimated 1 in 3 report sexual exploitation, whether in Vancouver (Chettiar et al., 2010), Los Angeles (Milburn et al., 2006) or New York City (Gwadz et al., 2007). Even outside major urban centres, in communities such as Prince Rupert, Abbotsford or Kelowna, BC, around 1 in 3 homeless and street-involved young people report ever trading sex for money, drugs, or other things (Saewyc et al., 2008b).

Much of what we know about sexually exploited street-involved youth is from studies of older adolescents and youth, usually between 16 and 24 years of age, typically with an average age of 19 to 20 years (see for example, Haley et al., 2004; Marshall et al., 2008). Very few studies have focused on those under 19 (Cauce et al., 2000; Smith et al., 2007). However, most studies have found that risk exposures and health challenges for street-involved youth begin in early adolescence, or even younger. For example, most of these studies reported that street-involved youth may run away or get kicked out at as young as age 12, and exposure to family violence, alcohol or other drugs may occur even earlier. Sexually exploited older youth in these surveys also report first trading sex at very young ages, often by age 14.

There are common misconceptions about who is more likely to be sexually exploited. This is because much of the research about exploitation has recruited participants from among those who access services and programs, which misses others who are not reached by these services. For example, the recent report on commercial sexual exploitation of children and youth by the Canadian Standing Senate Committee on Human Rights states, “It is clear that the overwhelming majority of sexually exploited children are girls and the perpetrators are adult men” (Senate Standing Committee on Human Rights, 2011), yet large-scale studies of students in school, or multi-city surveys of street-involved and marginalized youth, disagree. Most of them have found that equal numbers of boys and girls have traded sex, or slightly more boys than girls. For example, a national survey of adolescents in grades 7 to 12 in the U.S. found nearly 5% of boys but only 2% of girls had traded sex (Edwards et al., 2006). In BC, a school survey of students in grades 7 to 12 in the rural East Kootenay area found just over 2% of both boys and girls had ever traded sex for drugs (Homma et al., 2012), while 6% of both boys and girls in alternative education programs in seven communities across BC have traded sex for money or other goods (Smith et al., 2008). On the other hand, a study of high school students in Quebec City reported that only 2% of boys, but 6% of girls had traded sex for money or other things (Lavoie et al., 2010). Among multi-city surveys of street youth, several have found nearly equal rates of boys and girls reporting sexual exploitation (see for example, Smith et al., 2007; and Greene et al., 1999).

There are a variety of paths by which young people may first become sexually exploited, and certain life circumstances appear to increase their risks. Stigma and marginalization due to poverty, racism, or homophobia all contribute to vulnerability; studies have found that Indigenous youth, refugee and immigrant teens, and gay, lesbian and bisexual youth are at greater risk of being sexually exploited (Saewyc et al., 2008b; Edinburgh et al., 2006; Seshia, 2005). Gangs recruit or coerce some young people into sexual exploitation (Auerswald et al., 2004; Saewyc & Edinburgh, 2010). Sometimes young people are recruited into trading sex by other youth, or emotionally manipulated by a “boyfriend” or romantic partner into trading sex to earn money for them to live on (Holger-Ambrose et al., in press). Some young people are exploited while living at home, and may be prostituted or pimped out by a parent or older sibling (Holger-Ambrose et al., in press). Others may trade sex to support their alcohol or drug use, which may have begun when they were drugged in order to be exploited (Edinburgh et al., 2006). A history of sexual abuse, whether in the family or by someone outside the family, can lead to sexual exploitation (Wilson & Widom, 2010), in part because such youth may run away to escape the abuse and end up trading sex to survive. Much of the research exploring pathways into sexual exploitation has involved qualitative studies with limited numbers of exploited youth (for example, Seshia, 2005; Holger-Ambrose et al., in press). While these studies show the variety of situations that can occur, they are limited in their ability to identify some of the broader risk factors, occurring at potentially earlier ages, that might place youth in vulnerable situations that lead to exploitation.

Understanding potential risk factors that may be linked to sexual exploitation for both boys and girls is an important first step toward prevention. Though we find young people reporting both sexual exploitation and possible risk factors, like substance use, at the same time, how do we know whether these risk factors cause sexual exploitation? In other words, which comes first, the various risk factors (e.g. substance use, homelessness) that have been found to be higher among sexually exploited youth, or the sexual exploitation itself? Are they potential causes of exploitation, or perhaps the result of it? To help answer these questions, this chapter draws on the findings from the 2006 British Columbia Street Youth Survey (BCSYS), conducted among street-involved and marginalized teens aged 12 to 18 in nine communities across the province. First, we will consider what other studies and the BCSYS suggest about the pathways into street-involvement or homelessness for adolescents, then what is known about pathways into sexual exploitation, and the timing of both, to tease out potential means for prevention. These findings have implications for policy and practice, particularly concerning the unintended consequences of existing policies and programs. We will compare two approaches to steering youth away from pathways into sexual exploitation, and offer some thoughts on where we might have a window of opportunity to prevent sexual exploitation or to reduce the trauma experienced by street youth who have been exploited. But first, a word about our data source.

About the BC Street Youth Survey

In the fall of 2006, the McCreary Centre Society conducted a Street Youth Survey in 9 communities across BC: Victoria and Nanaimo on Vancouver Island, Prince Rupert and Prince George in the North, Kamloops and Kelowna in the Interior, Abbotsford/Mission and Surrey in the Fraser Valley, and Vancouver (Smith et al., 2007; Saewyc et al., 2009). Unlike most street youth surveys, which focus on large urban centres, these communities include relatively rural and remote areas, and range in size from very small (around 8,000 people in Port Rupert) to regional hubs of 80,000-100,000 people, as well as Vancouver, the third largest metropolitan region in Canada. This makes it a relatively unique survey of street-involved youth. We used a participatory approach in conducting the survey, adopting a variety of strategies to actively bring communities into the research process. For example, we worked with one or two leaders from street youth-serving agencies in each city as community champions, who encouraged their colleagues and partner services to be involved in the research. They also served as an advisory group for the overall project. Through their recommendations, we hired street-involved youth and outreach workers from local agencies as community co-researchers for every step of the research process, from recruiting participants to sharing the results with communities (Martin et al., 2009).

We administered the pencil and paper survey in small groups or individually to young people aged 12 to 18 years who identified as street youth. For this survey, street youth were defined as “being involved in a street lifestyle, which may include being homeless, panhandling, involvement in the sex trade, selling and using drugs, or engaging in criminal activities” (front cover of BC SYS, 2006). To help with literacy issues but ensure privacy, the co-researchers read the questions aloud but the youth filled in the surveys themselves. The survey included more than 150 questions relevant to the life experiences and health issues of street-involved youth, such as reasons for leaving home and different kinds of housing and risk exposures. The survey included several questions about sexual exploitation, although that specific term was not used, as young people do not necessarily recognize their circumstances as exploitative even if the law does. All of the questions were phrased to be clearly understandable and non-judgmental; the survey included a number of positive questions as well, recognizing that youth in even the most toxic situations have personal strengths and supportive relationships that help them survive. We also included several questions about the age at which certain things first occurred, such as the age of first running away, of first being kicked out, being street-involved, first using alcohol, marijuana, and the age of first trading sex. Thus, we could examine the timing of these factors in relation to street involvement and sexual exploitation for both boys and girls. One area in which we did not have a question about first experiences was age of first sexual abuse, as it is difficult to distinguish between sexual exploitation and other forms of sexual abuse, and some youth may have been reporting the age of first exploitation in both questions.

In all, 762 young people completed the surveys in the nine communities. The average age of the youth was just under 16. Unlike most surveys of older street-involved youth in large cities, which typically reach more boys and young men, half of those in our survey were girls, and 1% identified as transgender. More than half identified as Aboriginal (54%), although the survey also included youth from almost every ethno-cultural background found in Canada, and 14% of boys and 4% of girls said they were born outside Canada. Similar to other surveys of street-involved youth, sexual minority youth were more highly represented among youth in our survey than in the general population: only 76% of boys and 42% of girls identified as exclusively heterosexual and another 9% overall as not sure. More than 40% had been in government care at some point in the past; 65% of boys and 74% of girls had run away, while more than half had also been kicked out; many youth had both run away and been kicked out at different times. One in four young people had lived in the most precarious types of housing in the past year (hotels, tents, cars, shelters, squats, abandoned buildings, on the street, couch-surfing) and 21% were currently doing so; 70% had lived in 2 or more types of housing during the past year, and 19% had lived in 5 or more different types during that time period (Smith et al., 2007).

The picture is not overwhelmingly bleak, however. Street-involved and marginalized young people in BC also identified a number of positive assets in their lives, such as remaining connected to school, and having at least one positive relationship in their family or with other supportive adults. For example, nearly two out of three youth in our survey reported attending school (62%), including more than one-third of those living in the most precarious housing situations. Nine out of ten street-involved youth also felt their mother cared about them. More than half had a pet 1, which has been linked to an increased likelihood of attending school (Smith et al., 2007).

Drawing on the data from these young people, along with the evidence from other studies of street-involved and homeless youth in Canada, let us consider their reasons for street involvement and pathways into sexual exploitation.

Pathways to Street Involvement

Research in major Canadian and U.S. cities has repeatedly identified the same types of events that influence young people to run away or become street-involved. Most studies have identified family conflict, physical or sexual abuse, family substance use and poverty as some of the major factors. For example, an international study in Toronto, Montreal and Guatemala by Karabanow (2008) found that most of the homeless young women surveyed reported sexual abuse by family members, while young men reported physical abuse, and being kicked out as a sort of ‘tough love’ approach to parenting youth with problem behaviours. A study from Seattle identified family as the main site of physical abuse and non-family members more often as the perpetrators of sexual abuse, noting that the majority of problems these young people face happen before they run away or are kicked out (Tyler & Cauce, 2002). Even among much younger adolescents who have not been homeless for long, family violence is one of the main experiences that lead to leaving home. In St. Paul, Minnesota, police routinely ask a series of 10 questions to all runaways they encounter, one of which is why the youth left; a recent review of responses found the majority of boys and girls indicated some form of family conflict or violence as the reason for leaving (Edinburgh et al., 2012).

Part of the cycle of family problems that leads to street-involvement appears to be family substance use, and early exposure to alcohol and other drugs among street-involved youth is common. A variety of research shows a link between early use of alcohol and other drugs and later substance abuse (Anthony & Petronis, 1995; Chen et al., 2009), while other research shows high levels of substance use among street-involved youth (Smith et al., 2007). Very little of the research, however, has teased out whether early alcohol use leads to running away and exposure to other drugs, or whether early running away leads to exposure to alcohol and drugs on the street.

Street involvement, however, is not always an escape from family violence or neglect. Although 1 in 4 participants in our BC Street Youth Survey said they were on the street because of conflict with parents, and another 15% said they were on the street because of violence and abuse at home, these were not the most common reasons given. One-third of youth said they were street-involved because they had friends on the street, and nearly as many said it was because they feel accepted on the street.

But how does sexual exploitation fit into street youth’s experiences? Not all street-involved youth end up being exploited; in the 2006 BCSYS study, 27% of the girls and 34% of the boys had traded sex for money, drugs, shelter or other goods. So, how does sexual exploitation figure into the risk experiences among street-involved youth? Are some exploited before they run away or are kicked out? Do they begin using alcohol and other drugs before being exploited, during their exploitation (i.e., drugged and then exploited) or do they start using as a way of coping with their exploitation? To the extent that we can disentangle some of these patterns, we may be able to identify potential approaches in policy or practice to help prevent exploitation.

Which Comes First? Age of First Exploitation

With data from the 2006 BCSYS, we were able to identify the time at which youth identified being kicked out, running away, becoming street-involved, and/or trying marijuana or alcohol, in relation to when they were first sexually exploited. For these analyses, our sample was focused only on the 209 young people who had ever traded sex and answered how old they were when they had first done so. We present the average ages of first trading sex and the other risk behaviours for the entire group below, but this is not enough to identify the timing for each youth. For each risk factor, we compared how old youth were the first time they experienced that situation (running away, drug use, etc.) to how old they were the first time they traded sex. Exposure to each risk factor was categorized as happening before they were exploited, after being exploited, or within the same year. Those who said they had not done something (for example, they had never tried marijuana) were included in the group “exploited first.” Because there might be differences in the timing for boys and girls around other risk exposures, even if their average age of first exploitation is the same, we considered boys and girls separately. The results are shown below in a series of charts.

Among sexually exploited youth, the average ages of first trying alcohol or marijuana were quite young, both being between 11 and 12 years old. However, regardless of the age at which young people were first exposed to alcohol or marijuana, the overwhelming majority of them were exploited after they had first used these substances, with another 1 in 10 having it happen within the same year, making it impossible to determine which came first.

Similarly, youth first became street involved, ran away or were kicked out at fairly young ages. Youth can spend much of their time on the street with friends who are homeless and still go to a home at night, or can become involved in the street economy (i.e., panhandling, selling drugs, busking on street corners for income) while living with family, so running away or being kicked out could happen before or after street involvement. On average, exploited youth became street involved at about 12.4 years old, while they first ran away at about 12.7 years, and were first kicked out at about 13.3 years of age. The majority of boys and girls became street involved before trading sex; nearly 1 in 4 youth traded sex and became street-involved in the same year, and 1 in 10 were exploited before becoming street-involved.

Youth were also more likely to have run away before first being exploited, with even fewer reporting that running away and exploitation happened during the same year, or that they traded sex before running away.

The pattern is slightly different among those who were kicked out, especially for girls. Although the majority of youth were still kicked out before being exploited, more than 1 in 5 girls reported first trading sex at a younger age than first being kicked out, as did 7% of boys, while another 1 in 5 reported trading sex and being kicked out in the same year. For girls, this may be explained in part by their answers to another survey question, where they were living when they first traded sex: 27.4% of girls reported they were living at home when they first traded sex, a significantly higher rate than the 14.4% of boys. Although we cannot conclude from this that family members were actually involved in sexually exploiting these boys and girls, it is possible, even likely, that this was happening in some cases.

One of the issues we could not test was whether sexual abuse (other than exploitation) occurred before or after sexual exploitation, because we did not ask the age of first sexual abuse. Sexual exploitation itself is a form of sexual abuse, so all of them should have indicated experience of sexual abuse, but exploitation may not always be recognized as abuse by young people; 73% of exploited girls and only 30% of exploited boys reported they had been sexually abused. On the other hand, we did ask who had sexually abused them, and the majority of girls (55%) and 17% of boys said they had been sexually abused by family members, relatives, or caregivers such as foster parents.

These findings are clear: young people face significantly increased risk of sexual exploitation, regardless of gender, after leaving home, or being forced from home, and becoming street-involved. Young people who are leaving home due to abuse, family conflict, or substance use issues are already experiencing trauma, and are vulnerable to exploitation and further trauma. These findings suggest that interventions to prevent or address sexual exploitation may be more effective when they target early risks, focusing on younger adolescents who are just beginning to run away, or are starting alcohol or marijuana use at very young ages, and whose families are dealing with conflict and struggling with parenting young teens. Indeed, preventing youth from being kicked out and becoming street-involved or persistently homeless appears to be a key strategy for preventing a good deal of sexual exploitation of young people. While it is important to address the trauma and urgent needs of young people who are already homeless or street-involved and sexually exploited, it would be far more effective to prevent their vulnerability to sexual exploitation in the first place.

Since the adoption of the UN Convention on the Rights of the Child’s optional protocol on sexual exploitation in 2000 by both Canada and the U.S. (United Nations Treaty Collection, 2000), perspectives in law enforcement and child welfare in North America have started to shift from considering child and adolescent prostitution as criminal or delinquent behaviour on the part of the adolescent, to a recognition that it is a form of sexual abuse. The right to safety and protection from violence is an important element of the Convention, but child welfare policies and community programs seldom engage with young people and their families at the point where teens are first running away, only intervening after they have become street-involved and persistently homeless (street-entrenched). Programs to help young people exit sex work reach out primarily to youth and young adults who have already been exploited for years. Must we wait? What policies or programs might make a difference earlier in the pathway? Let us critically consider some recent approaches and their potential to act upstream in preventing some of the health challenges faced by sexually exploited youth.

Policies or Programs to Address Sexual Exploitation Upstream

Implementing policy and programs to protect street-involved youth is no easy task. The right to safety and protection needs to be balanced against other rights in the UN convention that support youth’s growing autonomy, such as their right to have a say in decisions that affect them. Of the various approaches to early intervention in street involvement and sexual exploitation that have been put into action around the world, most have elements in common with two particular approaches, one used in Alberta, and the other in both Scotland and Minnesota. Both involve recognizing youth who trade sex as victims of sexual exploitation, and runaways as youth at high risk for exploitation, but the two strategies take different directions to address their needs.

Protection of Sexually Exploited Children/Protection of Children Involved in Prostitution Laws in Alberta

The Protection of Children Involved in Prostitution (PChIP) legislation, now called the Protection of Sexually Exploited Children (PSECA), was first introduced in 1999 as an attempt to protect children from sexual exploitation. It developed from an Alberta task force that was formed to respond to the issue of sexual exploitation (Alberta Children’s Services, 2004), stimulated in part by the 1997 review of Canada’s commitments to the UN Convention that outlined each province’s commitment to ensure children were protected. The task force recommended increased powers for police, child welfare workers and families to ensure sexually exploited youth were protected (Government of Canada, 2001).

Although there were a number of voluntary supports for youth included in the PChIP programming, a key element of the approach was the development of Protective Safe Houses. Once a youth is suspected by authorities of being sexually exploited, police or social workers are legally permitted to apprehend the young person and detain them for up to 42 days in a safe house. The goal appears to be to remove them from dangerous street environments and give them access to victim protection services and support (Government of Alberta, 2010). Although the purpose of the legislation is clearly aimed at supporting exploited youth as victims, it may not always work in the best interest of the exploited child or youth.

One of the potential concerns is that the legislation places protection above other human rights of exploited youth, and has the potential to cause further stigmatization. In one evaluation, youth focus groups and other stakeholders critiqued the involuntary detention approach as punishing youth who trade sex, saying that law enforcement singled out girls who are exploited rather than considering both boys and girls, and that the law did not address the underlying reasons that youth trade sex, often for survival (Alberta Children’s Services, 2004). Stakeholders raised questions about whether the approach, where young people can be forced against their will into shelters merely on suspicion of involvement in prostitution, is a form of detention without actually being charged with or convicted of a crime. They also suggested it forces exploited youth to continue trading sex “underground,” in more hidden areas, and avoid using services, making them less accessible to social workers or other essential service providers. At the same time, both staff and some former youth detained in the protective safe houses felt it gave them an opportunity for reflection in a safe place, and sometimes connected them with other services.

Grover (2002) cited this approach as an example of potential Charter rights violations for Canadian street-involved youth. Grover argued that PSECA does not align with the UN Convention on the Rights of the Child, as the term, the ‘best interest of the child,’ an important clause in the Convention, is not actually included in the wording of the law (PSECA). Grover also argued that when the provincial government neglects to follow up or provide essential services to all street-involved youth, they are in violation of section 7 of the Canadian Charter of Rights and Freedoms, and of their responsibility to act as the parens patriae, the guardian of those in the country who cannot care for themselves, particularly children and youth.

To date, there has been limited evaluation of PSECA outcomes among youth who have been detained in safe houses, beyond tracking whether they have shelter 90 days after they are released from detention. As an intervention, PSECA is still closer to a harm reduction strategy, trying to reduce the harms from something that is already happening, than to a prevention strategy, since many of the youth they assist are already on the street and have already experienced sexual exploitation. It is unclear whether it is at all effective as early prevention for youth who are not yet persistently street-involved or being exploited.

Focusing on Young Runaways in Minnesota and Scotland

A different approach to early intervention and prevention has evolved in two different places: Grampian, Scotland, and St. Paul, Minnesota. In both settings, youth who run away or are kicked out are contacted and screened by either social workers or police as part of a referral service for addressing issues before youth become persistently homeless or street-involved. In Grampian, the Return Home Welfare program contacts youth within 5 days of their return home after running away, to interview them, assess their current circumstances, and refer them to supportive services when needed (Burgess et al., 2011). The youth generally were away from home for relatively short periods, as opposed to being persistently street-involved or homeless. In Minnesota, the Runaway Intervention Program (RIP) works in partnership with the police and other agencies to provide assessment and services for young runaways who have been sexually assaulted or exploited, or who are at risk of exploitation (Edinburgh & Saewyc, 2009). The program helped the local police department to then develop and implement a 10 Questions tool to use whenever they encountered runaways or youth who have been kicked out, to assess safety at home, reasons for leaving, potential injuries and harm that had occurred while the teen had been away from home, and referrals to the Runaway Intervention Program for more in-depth evaluation and access to home visits from nurses, health education, counselling, and other supportive services (Edinburgh et al., 2012). The police screening appears to be an effective route for identifying youth at risk who are new to the cycle of street-involvement, who may not yet be sexually exploited, and connecting them with needed support services.

RIP offers health care and case management services designed to reconnect young runaways with family, school, and other caring adults, offering positive youth development opportunities such as summer camp and volunteer activities, while also supporting parents in improving their relationships with their teens. Although the program was originally designed primarily for girls, it has been expanded recently to include boys, as well. An extensive evaluation of the first two years of the program showed that youth involved in RIP for 6 to 12 months showed significant improvements in family relationships, school attendance, and self-esteem, as well as reduced risk behaviours, trauma symptoms, and runaway episodes (Saewyc & Edinburgh, 2010). The evaluation showed so much improvement, in fact, that after 6 to 12 months of involvement in RIP, they were indistinguishable, with regard to the characteristics mentioned above, from a comparison group of girls in the general population who had never been abused. Even more promising, girls who had the highest levels of trauma, the lowest self-esteem, and the fewest social supports when entering the program actually improved the most with the intervention.

This completely voluntary approach, which reconnects youth to the social environments and caring relationships that are important to the healthy development of all young people, is focused earlier in the course of street involvement and homelessness and thus, may have a greater potential for prevention of sexual exploitation, possibly even preventing street involvement or homelessness itself. It may also work as harm reduction for those who are already exploited, or for the 1 in 4 young people identified in the BC Street Youth Survey as living at home when they were first sexually exploited; while the majority of young runaways in the RIP evaluation had not yet been sexually exploited, 14% had been prostituted, yet they too reported improvements as part of the program.

Conclusion

In working to offer safety and support for street-involved and sexually exploited youth, our policy and programs should aim to strike a balance between reducing the risks they face and fostering their connections to those they care about and who can care for them. Untangling the sequence of events that leads to homelessness – and among street-involved youth, the sequence that leads to increased risk of sexually exploitation – gives us clues as to when and how we might better intervene. As this research suggests, there are some key points in the pathway where prevention services might work best, when young people are just beginning to show the symptoms of family problems, such as early alcohol use, or family conflict, and the first runaway episodes. Although the interventions described in this chapter are still not at these earliest points along the pathway, as they focus on first runaway episodes rather than family problems, they do suggest that providing early support to youth and their families who are facing challenges is one potential area where policy may be effective. These may be important first line approaches, before young people become chronically street-involved and need harm reduction strategies instead.

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Endnotes

1. This included rats, lizards, dogs, and cats. Also, some of these young people were in and out of foster care or family housing, where pets may reside, but while they were on the street, they still felt they “owned” or were connected to that pet. We also found a number of situations where a group of street youth shared a dog and cared for it together, as a street family, and if most members of one group participated in the survey, they all reported they had a pet.