HIGHLIGHTS FROM THE LITERATURE

Magnitude

Estimating the magnitude of sexual exploitation of boys is also difficult. Many barriers exist in attempting to quantify the scope of the problem, including underreporting, definitional ambiguities and inconsistencies, misconceptions about the abuse of boys, social stigma and, simply, a lack of research on the experiences of sexually exploited boys (Adjei & Saewyc, 2017; Edinburgh et al., 2015; Hebert, 2016; Hounmenou, 2017; Interagency Working Group on Sexual Exploitation of Children, 2016; Mitchell et al., 2017; Tadele, 2009). In 2018, Moynihan and others conducted a systematic review of the state of the English literature on the sexual exploitation of boys internationally. Specifically, they searched for studies that: used a definition of sexual exploitation consistent with the one they used in their review,1 involved male participants, included a majority of participants under the age of 18, drew upon empirical data, were peer reviewed, and were published in English after 1 January 1990. They found a substantial funnelling effect in which thousands of articles were identified for potential review, but only 42 representing 33 unique datasets met their criteria. With such limited information, it is difficult to understand the unique aspects of boys’ experiences and the ways in which their rights can be protected (Mitchell et al., 2017; Moynihan et al., 2018).

Global prevalence rates on the sexual exploitation of boys have yet to be determined (Cockbain et al., 2017). Much of the existing research on this topic has taken place in Europe, North America and Southeast Asia (Hounmenou, 2017). Evidence from Western countries indicates that boys constitute a significant portion of sexually exploited children (Edwards et al., 2006; Homma et al., 2012; Lavoie et al., 2010; Pedersen & Hegna, 2003; Svedin & Priebe, 2007). Among school-based probability samples in Canada, Sweden and the United States, the prevalence of sexual exploitation among boys ranges from 1.7 to 4.8 per cent (Edwards et al., 2006; Fredlund et al., 2013; Homma et al., 2012; Svensson et al., 2013). School-based probability samples are, however, likely to underestimate the magnitude of the problem given the exclusion of some of the most vulnerable populations, such as homeless and runaway youth. Questions relating to sexual exploitation were also included in the Baltic Sea Regional Study on Adolescents’ Sexuality, which was conducted between 2003 and 2004 (Goran-Svedin, 2007). The study was carried out on nationally representative samples of adolescents in secondary and vocational schools in Estonia, Lithuania and Poland and on representative samples from large cities in Northwest Russian Federation, Norway and Sweden. Participants were asked whether they ever offered sexual services for pay. The highest proportions of 18-year-old boys who reported that they exchanged sexual services for pay at least once were found in Poland (22 per cent) and the Northwest Russian Federation (10 per cent).

Estimates of the magnitude of sexual exploitation of boys in low- and middle-income countries are limited; data that may be relevant must be carefully interpreted given that sociocultural norms do not always recognize the sexual exploitation of boys as a concern (Hounmenou, 2017). Moreover, these estimates may cover only some forms of sexual exploitation, since they may use different questions to elicit children’s experiences or only address such questions to a subset of the male population of children and adolescents.

Adjei and Saewyc (2017) analysed data from the 2004 National Survey of Adolescents, which was conducted on nationally representative samples in Burkina Faso, Ghana, Malawi and Uganda. The surveys included a question on whether adolescents aged 12 to 19 who had sexual intercourse within the previous 12 months received gifts or money from their last sex partner in exchange for sex. Those who answered in the affirmative were coded as having traded sex. The question was only asked of boys (and girls) who were not married at the time of the survey and who reported having sex more than once in the year preceding the survey. The proportion of children who met these criteria and reported trading sex for something in return was 3 per cent among boys aged 12 to 17 compared to 8 percent of girls of the same age.

Many of the Violence against Children Surveys (VACS) included questions on respondents’ involvement in ‘transactional sex’, commonly defined as sex in exchange for money, gifts, food or favours. In the 2010 VACS conducted in Kenya, 6 per cent of males aged 18 to 24 who experienced sexual violence before age 18 reported receiving money for sex; 4 per cent reported receiving gifts, food or favours in exchange for sex. In the VACS conducted on mainland United Republic of Tanzania in 2009 and in Rwanda in 2015, only a few cases of boys aged 13 to 17 said they received money or goods in exchange for sex at least once in their lifetime, and stable prevalence estimates could not be produced. In the 2011 VACS in Zimbabwe, among males aged 18 to 24 who reported physical, sexual or emotional violence prior to age 18, 3 per cent said they received gifts, food, favours or money in exchange for sex. In the 2017 VACS in that country, however, there were no reported cases of transactional sex in childhood among males aged 18 to 24 who had ever had sex. These proportions were 4 per cent in Uganda (2015) and 1 per cent in Botswana (2019). In the VACS conducted in Malawi in 2013, 1 per cent of males aged 18 to 24 who had experienced childhood violence said they received money, goods or favours in exchange for sex. Among all males aged 18 to 24 years, 7 per cent in Haiti (2012) reported having transactional sex prior to age 18; the proportions were 1 per cent in Nigeria (2014) and Zambia (2014), 0.2 per cent in Lao People’s Democratic Republic (2014) and 0.1 per cent in Cambodia (2013).

Non-probability samples of vulnerable populations show higher rates of sexual exploitation. For example, a study of a centralized case management system in the United Kingdom found that one third of users of services related to child sexual exploitation (which included sexually exploited children, as well as those at risk for exploitation and those exploiting peers) were boys (Cockbain et al., 2017). Furthermore, studies estimated that 40 per cent of boys in Lahore, Pakistan live or work on the streets (Towe et al., 2009) and 45 per cent of homeless boys in Ghana have experienced sexual exploitation (Oppong Asante, 2015). While these studies are based on non-probability samples and cannot be used to estimate prevalence, they speak to the vulnerability of specific subpopulations.

Causes and risk factors

The causes of sexual exploitation are multiple and complex. Whether or not an individual child is exploited is influenced by an interplay of individual, family, community and societal factors (Radford et al., 2016). At a societal level, risks include social norms condoning violence, values surrounding the status of children in society, cultural beliefs around masculinity and sexuality, homophobia, sexual entitlement among perpetrators, insufficient child protection systems, weak legal sanctions, poverty and economic inequality, discrimination, armed conflict, and humanitarian crises, among others (Berelowitz et al. 2012; Radford et al., 2016). Additionally, reluctance of community stakeholders to acknowledge the sexual exploitation of boys places them further at risk (Tadele, 2009). Furthermore, law enforcement and service providers are less likely to identify boys than girls as victims of sexual exploitation (Berelowitz et al., 2012; Hounmenou, 2017). Boys who experience sexual exploitation may be viewed as criminals in the community, which can diminish the support they receive (Miller, 2011). And when boys who have experienced sexual exploitation report discrimination and violence by the police, it makes them more vulnerable (Dank et al., 2015; Hounmenou, 2017).

Research has consistently demonstrated that primary risk factors for sexual exploitation include a history of experiencing prior physical, emotional, and sexual abuse and neglect (Adjei & Saewyc, 2017; Hounmenou, 2017; Lavoie et al., 2010; Moynihan et al., 2018; Reid & Piquero, 2014a; Svedin & Priebe, 2007; Svensson et al., 2013; Wilson & Widom, 2010). At the family level, a history of parental substance abuse heightens the risk for sexual exploitation among boys (Hilton, 2008; Reid & Piquero, 2014a). A lack of familial support, poor parent-child relationships, and feeling unwanted or unloved by family members all increase the risk for exploitation (Edinburgh et al., 2015; Fredlund et al., 2013; Hallett, 2016; Kebede, 2015; Moynihan et al., 2018; Reid & Piquero, 2014a).

Poverty in the family also places boys at risk for exploitation. Research has found a relationship between boys’ experiences of sexual exploitation and lower parental employment, limited employment opportunities, family financial needs, including family financial dependents, and pressure to meet basic needs in the family (Adjei & Saewyc, 2017; Fredlund et al., 2013; Hilton, 2008; Hounmenou, 2017; Miller, 2011; Moynihan et al., 2018; Svedin & Priebe, 2007). Boys’ parents may, in fact, encourage them to enter sexually exploitative relationships, not necessarily seeing these relationships as harmful (Davis & Miles, 2014; Frederick, 2010; Hilton, 2008; Interagency Working Group on Sexual Exploitation of Children, 2016; Ricardo & Barker, 2008). Research in Southeast and South Asia has shown that boys who migrate from rural, impoverished communities in search of employment in urban centres are vulnerable to sexual exploitation (Davis & Miles, 2014; Frederick, 2010; Hilton, 2008). Boys may exchange sex for shelter, food, clothing and other basic needs (Chynoweth et al., 2017; Embleton et al., 2015; Frederick, 2010; Kudrati et al., 2008; Moynihan et al., 2018; Tadele, 2009). Lower educational attainment has also been identified as a risk factor for exploitation (Adjei & Saewyc, 2017; Reid & Piquero, 2014a).

Boys who are engaged in other high-risk behaviours also have heightened vulnerability to sexual exploitation. For example, boys involved in using and/or selling drugs are more likely to be sexually exploited (Edwards et al., 2006; Reid & Piquero, 2014b; 2014a), and boys may sell sex in exchange for drugs (Embleton et al., 2015; Kudrati et al., 2008). Research in the United States has found that involvement in the juvenile justice system is a significant risk factor for youth sex trafficking (Fedina et al., 2019). Sexually exploited boys are more likely to have a criminal record, be engaged in delinquent behaviour, and be arrested prior to being exploited (Reid & Piquero, 2014b; Towe et al., 2009). Sexual exploitation and juvenile criminal activity may be the result of shared environmental risk factors, or boys may meet perpetrators through involvement in criminal activity (Chynoweth et al., 2017). Peer networks also influence the risk for exploitation, with research in the United States showing that youth are at times recruited by peers who have also been exploited (Edinburgh et al., 2015). Research in multiple contexts has shown that early sexual initiation, prior sexual experiences with peers, and seeing peers engaged in transactional sex all increase the risk for exploitation (Miller, 2011; Wilson & Widom, 2010).

Consequences

When reviewing research regarding the consequences of sexual exploitation, limitations in the available evidence should be noted from the outset. While substantial research exists regarding the consequences of child sexual abuse, less research has been conducted on the consequences of sexual exploitation specifically (Selvius et al., 2018). Risk factors for exploitation often overlap with the consequences of exploitation. Due to the cross-sectional nature of available data, determining what places boys at risk for exploitation and/or the consequence of exploitation can be complicated. Researchers have called for better temporally ordered data in light of this concern (Cockbain et al., 2017; Selvius et al., 2018).

Sexual exploitation can have severe immediate and long-term psychological, physical, social and economic consequences for victims (Mitchell et al., 2017; Moynihan et al., 2018). Boys who have experienced sexual exploitation report poorer overall mental health (Moynihan et al., 2018; Svensson et al., 2013). And that experience can lead to depression, anxiety, hopelessness and post-traumatic stress disorder (PTSD) (Edinburgh et al., 2015; Freccero et al., 2017; Homma et al., 2012; Moynihan et al., 2018; Nodzenski et al., 2019; Selvius et al., 2018). For example, a recent study with youth participating in post-trafficking assistance services in Cambodia, Thailand and Viet Nam found that over one third of boys were symptomatic of anxiety and depression, and over one quarter were symptomatic of PTSD (Nodzenski et al., 2019). Children who have been sexually exploited report low self-esteem and self- harm (Berelowitz et al., 2012), with boys reporting higher rates of self-harm, suicidal ideation and attempted suicide (Edinburgh et al., 2015; Freccero et al., 2017; Moynihan et al., 2018; Svensson et al., 2013; Towe et al., 2009). A study in Pakistan found that 52 percent of male children who lived and/or worked on the street and who exchanged sex for money, drugs or goods reported having cut themselves, in comparison to 22 per cent of male street-involved children who did not report incidents of sexual exploitation (Towe et al., 2009).

The experience of sexual exploitation is also associated with complex trauma (Cole et al., 2016). Complex trauma refers to chronic exposure to traumatic events, often interpersonal in nature, that begins early in a child’s life (Wamser-Nanney & Vandenberg, 2013). In fact, a significant proportion of trafficked youth have already experienced complex trauma prior to trafficking (Fedina et al., 2019); Hopper & Gonzales, 2018). Research in the United States has found that pre-existing complex trauma is intensified through the experience of sexual exploitation. Complex trauma has a wide range of effects. It can disrupt emotional regulation and lead to a range of behavioural and mood impacts, such as withdrawal, aggression, compulsiveness, hostility, mood swings, inability to self-soothe and attention problems (Barnert et al., 2017; Hopper & Gonzales, 2018; Palines et al., 2019). Complex trauma can lead to slow language development, somatic complaints, attachment problems, disorganized memories and an altered sense of meaning (such as feelings of hopelessness or loss of faith) (Cole et al., 2016; Hopper & Gonzales, 2018). The symptoms of complex trauma often overlap with those of many mental health disorders, including depression and anxiety, complicating diagnoses for this population (Palines et al., 2019).

Research with boys who have experienced sexual exploitation across a variety of contexts has consistently found high rates of substance use, particularly drug use (Adjei & Saewyc, 2017; Edinburgh et al., 2015; Freccero et al., 2017; Moynihan et al., 2018; Pedersen & Hegna, 2003; Selvius et al., 2018; Towe et al., 2009). Additionally, boys who have experienced exploitation report elevated risk for HIV and higher rates of sexually transmitted infections. They are more likely to have multiple sex partners and report low condom use (Adjei & Saewyc, 2017; Edwards et al., 2006; Freccero et al., 2017; Moynihan et al., 2018; Selvius et al., 2018; Towe et al., 2009). In addition, boys commonly experience physical violence during the exploitation process, leading to physical injuries (Berelowitz et al., 2012).

Sexual exploitation can be associated with conduct problems and criminal activity such as aggression, theft and destruction of property, among others (Pedersen & Hegna, 2003; Selvius et al., 2018). Perpetrators may instruct children to engage in criminal behaviour, or the child may engage in the offending behaviour as a result of his or her abuse (such as self-medicating with drugs or destroying property due to anger) (Berelowitz et al., 2012). Experiencing exploitation can lead to disruptions in boys’ education, with increased absences from school (Berelowitz et al., 2012). Boys facing family financial pressures and vulnerability may drop out of school and find themselves in sexually exploitative situations due to a need to provide financially for the family (Adjei & Saewyc, 2017; Hounmenou, 2017; Selvius et al., 2018). Children who are exploited often become socially isolated from family and friends, and increasingly dependent upon those who are abusing them (Berelowitz et al., 2012). Boys who have experienced sexual exploitation report an absence of trusting relationships, feeling unseen/invisible or lonely, lacking someone to talk to and diminished social connectedness (Fredlund et al., 2013; Hallett, 2016; Pedersen & Hegna, 2003).