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VICTORY: City of Portland funds “housing first” pilot program for women leaving prostitution

Date: July 31, 2010

While I was attending the Desiree Alliance conference in Las Vegas, there was a big news in Portland: YWCA of Greater Portland received a $900K federal grant to create a shelter for girls and women under the age of 18 who have been “trafficked” (and I put the word in quotation marks because the legal definition of “trafficking” makes no distinction between youth engaging in prostitution under force, coercion or deception, and those who do so without these factors–I think it’s a bad idea to conflate these very different cases).

But the more interesting news, reported by Portland Tribune, is that the City of Portland is now planning to fund a pilot program in which several women (of any age, it appears) leaving prostitution will receive financial and other support that will enable them to live independently in the community, rather than in a centralized transitional facility. Tribune reports:

The third effort under way is led by City Commissioner Dan Saltzman, who is working on a pilot program that would begin this fall. The program would place women seeking to escape their life on the street into private-market units around the city, rather than in one central “safe house.”

The nonprofit Join, which already works with the city’s housing efforts, uses a “housing-first” model that places people in housing and then gives them the social, financial and other support they need to maintain that housing. Join will provide the up-front rent and moving costs, work with the landlord and supply other help as needed.


If the woman relapses and returns to the street for a short time, she will not lose their housing, since that’s one of the philosophies of the housing-first model, says Amy Trieu, a policy coordinator for Saltzman: “The purpose is to build that trust.”

This is exactly the approach I along with others affiliated with Sex Workers Outreach Coalition (SWOC), a network of activists, sex workers, and social service providers, advocated for back in December 2009, when the 82nd Avenue Prostitution Advisory Committee (PAC) made its report to the City Council. The PAC had been set up by the Council a year earlier, and it largely represented the perspectives of the law enforcement, anti-prostitution activists, and area business owners, rather than the women and social service providers who outreach to them. Among other things, PAC recommended:

Allocate funds for in-patient rehabilitative services and addition of supportive housing directed to prostituted persons, both adult and minor ; PAC asks that City Council commits to help fund a housing program (includes external evaluation) in fiscal year 2011

The PAC wanted to create a “10 bed in-patient rehabilitative housing” with the FY2011 budget of $657-913K. In contrast, SWOC recommended “housing first” approach precisely as described by Tribune–and the City apparently agreed with us. Here’s that section from SWOC’s December 2009 recommendations:

Housing is often considered a primary need for women working in prostitution, and it is essential if we are to assist women who wish to leave the sex industry (or abusive pimp, partner, etc.). We support the use of housing first approach in collaboration with existing housing advocacy organizations.

Housing first, also known as rapid re-housing, is an innovation within homeless advocacy that seeks to quickly place recently or chronically homeless persons and families in their own permanent housing in the community instead of keeping them in centralized “transitional” housing that they must vacate after the program period. This eliminates the stigma of living in a shelter or transitional housing, provides the stability necessary to address personal issues, and builds sense of autonomy and independence.

Many homeless people experience multiple problems, such as mental illness, addiction, psychological trauma from abuse, and HIV/AIDS. Traditional service providers try to address these issues while they are in shelters or transitional housing, but their effectiveness is limited by the hardship of their living circumstances. Housing first model seeks to establish stability to people’s lives through housing, so that other issues can receive adequate attention once individuals are secure in their own place. Women in the process of leaving prostitution can also be supported by a combination of a housing first program and a series of other services arranged with the help of the caseworker.

Some people may find the idea of residential treatment centers, in which women can access support groups, case management, addiction treatment, etc. at the place they live, appealing. One advantage of such plan is that it offers built-in opportunities where women who have a history of prostitution can meet and support each other. But forcing them to live together and share living quarters at some centralized location in order to receive that support is likely to be a mistake. Without a private housing to go home to, participants would not feel inclined to take the risk and disclose personal stories and feelings among their peers.

In addition, women who drop out from the program for any number of reasons at a residential treatment facility would also lose their housing. Housing first approach gives women greater protection from this problem. If we believe that housing is a basic human right, we should not be threatening to withdraw it in order to coerce compliance with the treatment program. Nor should we need to, if the programs actually offer something that women benefit from.

Locally, homeless advocacy organizations such as Transition Projects Inc. as well as Volunteers of America’s domestic violence program (Home Free) incorporate some forms of housing first model as part of their respective programs. We should make use of their experiences and expertise in providing assistance with housing, as we develop specific services and resources for women who are in the process of leaving prostitution.

Over the last several years, we (at SWOC) have made numerous attempts to communicate with City Council members and explain why we must be included in the discussion about the City’s response to the issue of prostitution on our streets and in our neighborhoods, but we have been mostly ignored. But it appears that now the City is choosing the recommendation we made at the City Council over that of the City’s officially sanctioned (albeit misinformed) “advisory committee,” and it says a lot about the power of democratic deliberation even when things appear hopeless.

New Zine Release – Surviving the Witch-Hunt: Battle Notes from Portland’s 82nd Avenue, 2007-2010

Date: July 25, 2010

Just in time for the Desiree Alliance conference this week, “Working Sex: Power, Practice, and Politics,” which I am already starting to feel depressed about already by the way, I have published a new zine, “Surviving the Witch-Hunt: Battle Notes from Portland’s 82nd Avenue, 2007-2010.”

Surviving the Witch-Hunt chronicles the resistance against the massive anti-prostitution panic in east Portland neighbourhoods between 2007 and 2010 in which women trying to survive working on 82nd Avenue were targeted by baseball bat-wielding, camera phone-snapping, vigilante “community foot patrol” and other angry neighbours worried about their property value.

The zine is available for download (PDF) for free, or it can be purchased online in hard copy. I will have some copies at the conference this week as well.

Zine Cover

City and County commissioners continue to broadcast smooth lies that comfort citizens

Date: July 23, 2010

This past Wednesday, I attended the afternoon session of Portland City Council to hear its report on human trafficking—or rather, domestic minor trafficking (only one speaker, someone from Catholic Charities, spoke about a different form of human trafficking, that is the exploitation of migrant workers in labour trafficking).

I knew what I was getting myself into, but it was still painful to sit through such entourage of willful ignorance disguised as genuine concern for children being forced to engage in prostitution.

As I had expected, Portland City Commissioner Dan Saltzman, Multnomah County Commissioners Diane McKeel, and others invoked the nonsensical and debunked claim that “the average age of entry into prostitution is 13,” as if they are utterly ignorant about what “average” means.

Commissioner Saltzman stressed several times throughout the session that these very young girls eventually become adult women, implying that prostitution in our society is all about child abuse and its prolonged consequences, because most adults engaging in prostitution started out at very young age when they should have been in elementary and middle schools.

Somehow, they seem to think it is much easier to believe in this nonsense rather than facing the reality that, for the most part, it is a product of poverty, homelessness, welfare reform, unjust immigration law, sexism, homophobia, transphobia, and other economic and social injustices. Once they define all prostitutes as child abuse victims who must be “rescued”—from prostitution, but not necessarily from poverty and other injustices—by arresting and jailing them.

By intentionally conflating prostitution and child abuse, they frame the issue of prostitution as a simple law enforcement problem. While it is unsettling to think that so many young children are being trafficked (nevermind the fact most child sexual abuse happens in homes, churches, and schools), it is somehow easier to digest than a more nuanced and politicised view that calls for across-the-board social and economic justice agenda.

This willful ignorance of reality closely mirrors many Americans’ support for the War on Terror in the immediate aftermath of the 9/11 attacks. Instead of untangling resentment and frustration the West has built up all over the world through centuries of violence and exploitation, many people rushed to accept the clearly nonsensical explanation that “they hate us because they hate freedom” because it was much more palatable.

It is not entirely accurate to say that Bush administration lied to the people about the weapons of mass destruction, links between Iraq and Al-Qaeda, domestic wiretapping, torture in Guantanamo and Abu Ghraib. If anyone actually cared to exercise common sense and reason, the truth was always apparent. But too many Americans were invested in believing the obvious lies. In other words, people were not fooled or deceived by the Bush administration; rather, people actively sought out smooth lies that comfort them, and the Bush administration bottle-fed them to us. I feel that Commissioners’ and their supporters’ response to trafficking/prostitution is similar to that.

Commissioner McKeel also stated that “basic economic theory” holds that reducing demand (for sexual services, some of which may involve trafficking) lead to lower supply. But she is neglecting the fact that a sudden reduction of demand diminishes bargaining power of the seller, forcing many women to work under even worse conditions for less money.

County is planning to start “john school,” which “educates” johns arrested in prostitution sweeps about the harms of prostitution on women and girls in order to get their cooperation to reduce the demand. But this, too, will put women and girls at more danger than they currently are.

Let’s imagine that there are two types of johns. The first group consists of men who are generally respectful of women but don’t realise that prostitution is so harmful. “John school” will likely make them stop going to prostitutes. The second group consists of men who are selfish and thrill-seeking, and do not care about how their actions affect women. “John school” probably has no effect on them.

In other words, “john school,” if it is effective at all, will drastically change the composition of johns who frequent prostitutes, on top of reducing the amount of money women can make. How is this going to make women and girls safer?

Not that I am concerned about “john school,” though—studies have shown beyond reasonable doubt that it has no impact whatsoever. I just wish they don’t spend any money on it and put the money toward housing assistance for the women or something like that.

Recommendations on Medicaid funding of surgeries for intersex individuals

Date: July 23, 2010

Recommendations for Colorado Department of Health Care Policy and Financing
Re: Medicaid Funding for Remedial Surgeries for DSD

Emi Koyama
Director, Intersex Initiative

My name is Emi Koyama and I am the director of Intersex Initiative, a national advocacy organization for people born with intersex conditions, or disorders of sex development (DSD) as they are referred to within the medical community.

I have studied the draft Colorado Medicaid Policy titled “Disorders of Sexual Development (DSD or intersex) Surgical Remediation,” and wish to offer following recommendations.

1. First thing first: the correct medical term is Disorder of Sex (not “Sexual”) Development. (And when not referring by this established medical terminology, I prefer to use “anomalies” over “disorders.”)

2. Philosophical statement must make a clear distinction between “gender assignment” which is a social and legal determination of one’s sex of rearing, and surgical reinforcement of the assigned gender. The controversy is not whether or not children should be assigned gender: it is whether social and legal assignment of gender should be accompanied by cosmetic surgical alterations of the child’s genitalia before the child is old enough to be involved in the decision-making. I believe not.

3. The philosophical statement also seems to presume that the main risk of early cosmetic genital surgeries is the accidental assignment of the “wrong” gender. While this is a major concern, it is not the only one. Any surgeries on such sensitive areas risk damaging the child physically, psychologically, and sexually–which is why advocates argue that they should not be performed without the child’s participation, unless of course there is an urgent medical necessity. Perhaps Medicaid is not able to take either side of this controversy at this point, but critics’ concerns should be accurately reflected in the document.

4. I applaud the draft for acknowledging the need for multidisciplinary approach to treating children with DSD. That said, if Medicaid were to recommend multidisciplinary team to care for these children, it must also provide payment for counselors, psychologists and social workers who will assist patients and parents as part of the multidisciplinary team. Counseling for parents or other caregivers is a critical part of providing competent care for children with DSD.

5. Some surgeries performed on children with DSD result in sterilization. The policy statement should specifically require any parent or physician seeking these surgeries to be extremely cautious and abide by all existing State laws and Medicaid regulations on sterilization on minors or legally incompetent people in order to protect the rights of children with DSD.

6. Medicaid is mandated to cover out-of-state medical expenses as well as travel expenses for the patient and the accompanying parent if providers with adequate experiences or specialization in the specific procedure being prescribed cannot be found in the State Medicaid system. The policy statement should include this information instead of simply stating that “The provider must be enrolled with Colorado Medicaid.” Further, funding for in-state medical travel should be included as well if a qualified provider cannot be found in the immediate area where patient and his or her family live.

7. “Gender transformation surgery” does not encompass a wide range of surgical procedures performed for children with DSD with or without the assent of the patient (e.g. vaginoplasty for a female with DSD does not transform her gender in any way, but simply reinforces it). The statement should state that all medically recommended surgeries are covered, preferably with the assent of the patient himself or herself, in addition to the “gender transformation surgery.”

8. I support Colorado’s leadership in acknowledging that “gender transformation surgery” should not be rushed at the time of birth. However, the timing of the surgery should not be limited to just two options (at birth or at puberty). At minimum, Medicaid should cover such surgeries that take place anytime in the patient’s adolescence and even young adulthood, allowing full time for the individual to explore and develop a sense of who he or she is.

9. The sentence denying coverage for “trans-sexual surgery” is unnecessary and potentially harmful. The next revision of Diagnostic and Statistical Manual of Mental Disorders (DSM) is expected to change the definition for Gender Identity Disorder (which is associated with transsexuality), allowing children and adults with DSD to be diagnosed with Gender Incongruence (a new name for GID). In other words, a child may be diagnosed with both DSD and GI, which puts two sentences in this policy statement (coverage for “gender transformation surgery” for children with DSD and denial of coverage for “trans-sexual surgery”) in conflict with each other.

Besides, whether or not Medicaid covers sex reassignment surgeries for transsexual people should be specified in a separate policy statement, and is irrelevant to the issues addressed in this statement. I believe that it is quite sufficient to state that “Gender transformation is not covered under this policy when the diagnostic criteria for DSD are not met.”

(Also, I fully support Medicaid funding for sex reassignment surgeries for adult transsexual people who seek them. I understand that this discussion is not the time or place to advocate for such policy change, but we cannot in good conscience be completely silent about the struggle of our transsexual friends and allies, many of whom have advocated for intersex rights.)

Thank you very much for giving me an opportunity to make these recommendations. I am also sending you a copy of the draft statement with suggested edits. Please feel free to contact me if you have further questions, as I would be delighted to provide more information.

Anne Tamar-Mattis, a California attorney and the executive director of Advocates for Informed Choice, said that she is also available to answer any questions. Her phone number is XXX-XXX-XXXX and email address is XXX@XXX.XXX. In addition, Nancy Ehrenreich is a Professor of Law at University of Denver’s Sturm College of Law, and is knowledgeable about legal issues surrounding surgical treatment of children with DSD. Her phone number is XXX-XXX-XXXX and email address is XXX@XXX.XXX. They may be able to offer further insights that I am missing.

I am going to attend Desiree Alliance conference after all.

Date: July 14, 2010

This is an update to an earlier post about being awarded “merit based” “diversity” scholarship to attend Desiree Alliance conference, which actually wasn’t a scholarship at all.

Recently while I was talking to some people in the sex worker advocacy field about my recommendations about sex trafficking on Craigslist, I was asked if I was planning to attend Desiree Alliance conference. I told them that I wasn’t going to attend because I was disgusted with how the conference organizers treated me over the scholarship application I had submitted. Soon later, the word got back to the scholarship committee at the conference, and this is the email I received from them:

Dear Emi,

We had previously sent a letter offering a merit scholarship, which is a fee reduction for registration. We have offered these in previous years, but the circumstances are different this year, and we see that we made a mistake by offering people a “reduced” fee of $150, when that fee is actually the same as the ‘early bird’ registration fee.

Our approach to getting funds for scholarships is very grassroots (we’ve held fundraisers, we’ve approached the most radical foundations for some funds, we’ve donated money/resources ourselves to make up shortfalls). Yet despite these efforts not too many people have been able to give money to support sex worker rights and we had limited funds. Sometimes under all this pressure to share scarce resources we have made mistakes and the content of that merit scholarship letter was one of them.

We are sorry for the mistake and hope you excuse this misunderstanding. We really do want you to attend the conference. We want to serve as a resource for you, so please do let us know if you still plan to attend, if you have registered for the conference, and what resources you are looking for to attend the conference.

We hope you understand that we greatly value your contributions and look forward to you participation at the conference and we will make further efforts to assist you.

We then started emailing back and forth, and voila! they found some new money to help me attend the conference. So anyway, I will go :-) If anyone reading this is attending, please say hi.

Oh by the way–I just found out that former U.S. Surgeon General Joycelyn Elders is among the keynote speakers at this conference. Those of you who’s been reading this blog for a long time know that she is a pediatric endocrinologist who has advocated for intersex (cosmetic) genital surgeries (read about my encounter with Dr. Elders at Let’s Talk About Sex! conference)…

I totally think that her position on intersex contradicts everything she is famous for, which says a lot about the peer pressure and conformity within a medical field. I wonder what she thinks about the Cornell post-clitoral surgery sensitivity study or prenatal dexamethasone treatment for the purpose of preventing (gender)queerness.

The average age of entry into prostitution is NOT 13

Date: July 13, 2010

Over the last several years, I have been trying to correct the inaccurate notion that the “average age of entry into prostitution is 13” wherever I see it, but it is becoming increasingly overwhelming. This figure is in newspapers, official reports from City of Portland, and many websites and pamphlets claiming to confront sex trafficking (but often conflate prostitution with trafficking, and take anti-prostitution stances that are actually harmful to women). When I contact them to correct the errors, they either don’t understand what I am explaining or just plain don’t care. I’ve also been accused of being a pimp, pervert, pedophile, and other unpopular beings, simply because I challenge the falsehoods.

Here is the latest example, found on The Oregonian on July 3, 2010. Columnist Eliabeth Hovde writes:

Boys and girls are being lured or forced into what they call “the life” at younger and younger ages. […] The U.S. Justice Department believes that the average age of entry into prostitution is 13 and that 100,000 children are used for commercial sex each year in this land of the free.

Department of Justice does state this figure in its website:

Although comprehensive research to document the number of children engaged in prostitution in the United States is lacking, it is estimated that about 293,000 American youth are currently at risk of becoming victims of commercial sexual exploitation. Richard J. Estes and Neil Alan Weiner, Commercial Sexual Exploitation of Children in the U.S, Canada and Mexico, University of Pennsylvania, Executive Summary at 11-12 (2001)

This led me to find the University of Pennsylvania study titled “The Commercial Sexual Exploitation of Children In the U. S., Canada and Mexico,” which in fact states:

The age range of entry into prostitution for the boys, including gay and transgender boys, was somewhat younger than that of the girls, i.e., 11-13 years vs. 12-14 years, respectively.

But as the title suggests, this study only surveys minors (“children”), which means it does not include anyone who entered into prostitution at age 18 or over, or those who entered as a minor but has since aged out. Imagine conducting a research on those who died as minors: the average age of death would be somewhere near 10-12, but it would be ridiculous to claim that the average life expectancy for the general population is 10-12. Similarly, the “average age of entry” among youth who were studied does not tell us anything about the actual average age of entry for everyone who is in or has been in prostitution.

That’s not all. For the sake of discussion, let’s pretend that in a small town, six minors enter into prostitution each year, one individual each for ages 12-17. That means that there is one 12 year old, one 13 year old, one 14 year old, and so on. The average age of entry in this hypothetical town is the average of these six individuals, which is (12+13+14+15+16+17)/6 = 14.5.

But when researchers arrive in this town, they don’t just survey these six minors: they will also survey others who have started prostitution in the years past. So for any given year when the research is conducted, there are one 12 year old (who entered at 12), two 13 year olds (entered at 12 and 13), three 14 year olds (entered at 12, 13, and 14), and so on. The average among all of these youth will be: (12+(12+13)+(12+13+14)+(12+13+14+15)+(12+13+14+15+16)+(12+13+14+15+16+17))/21 = 13.7–which is almost one year younger than the actual average age of entry.

This discrepancy is caused by limiting the research subject to minors. Those who entered into prostitution at age 12 has six years in which he or she might be surveyed (at ages 12, 13, 14, 15, 16, or 17), while those who entered at 17 has only one year, which artificially inflates the proportion of research participants who entered early. In short, we cannot know the actual “average age of entry” by simply averaging the age of entry reported by research participants.

Case in point. Below is a chart and table found in “The National Report on Domestic Minor Sex Trafficking,” produced by Shared Hope International, an anti-trafficking group.

SHI Chart

This chart is based on Shared Hope International’s 10-city study on minor sex trafficking. In the same page where this chart appears, Shared Hope founder Linda Smith states “The average age that a pimp recruits a girl into prostitution is 12 to 14 years old.” But interestingly, the chart does not support this statement: the average of all responses represented in the chart/table is 14.97, which is much higher than Smith’s “12 to 14” figure. Plus, simply averaging all the responses is not enough, for the reason I pointed out above. So when we adjust the numbers to compensate for the over-representation of those who entered early, the re-calculated “average of entry” turns out to be almost 16 (15.91).

This calculation is rudimentary and at best an approximation, since we don’t have access to the complete data or truly representative sample. But I suspect that it is much closer to reality than 13, which is what journalists, politicians, and many anti-trafficking activists claim.

There is also an element of common sense here. Assuming normal distribution (bell curve), the average of 13 implies that for every 20 year olds entering prostitution, there are equal number of 6 year olds doing the same. That, common sense should say, cannot possibly be true. The alternative is that the distribution isn’t normally distributed, but heavily clustered around 10-12 year olds to balance everyone who enters into prostitution 16 or older. This again is implausible, as we simply do not find that many 10-12 year olds in prostitution, at least in the United States. The only logical conclusion is that the average age is not anywhere near 13, but is much closer to 18.

That doesn’t diminish the fact that some very young children are victimized, and we should do something about it. But it is not trivial if the average age of entry is 13 or 16 or even 18, because it drastically changes what social policies we must enact to combat forced prostitution and trafficking. I feel that many journalists, politicians, and anti-trafficking activists use the lower figure merely for the shock value, to arouse strong emotional reaction toward the issue, but they are acting irresponsibly when they distort reality. We need to understand reality as they are and craft rational and sensible responses to the problem, rather than indulging ourselves in panicked frenzy.

(note: changed the title to make it straightforward)