Is Paying for Sex a Disease?

Many U.S, jurisdictions send men to “John Schools” for treatment.

Posted Jul 03, 2018

Pixabay
Source: Pixabay

Like many folks, I will admit that I have been to traffic school. That’s where you get a speeding or traffic ticket, and are offered an option to attend a course of driving safety, as a means to get the ticket dismissed. This makes sense, right? It gives more information and safety awareness to people on the street, including people like me, who sometimes have a lead foot. When I attend driving school for speeding, coursework never suggests that my tendency to drive too fast is a disease–but in “john schools” around the country, men are being taught exactly that, that their desire to purchase sex is evidence of a sex addiction and a disease needing treatment.

In recent years, there has been a shift from prosecuting the (mostly female) people charged with prostitution, solicitation, and selling sexual encounters, to charging the (mostly men) people who attempt to purchase sex. In 2010, data from the U.S. DOJ shows that 43,000 women were arrested for prostitution-related charges, compared to only 19,000 men, leading to legitimate criticisms that this reflects sexist and misogynistic social and legal attitudes towards females. 

In New York, “Operation Flush the Johns” in 2013 led to the publication of 104 men’s pictures, after they were arrested for “patronizing a prostitute.” The arrests included two physicians, as well as numerous lawyers, including one 79 year-old attorney. Their names and pictures were then published in a local newspaper, sending shockwaves through families, businesses and clinics. This effort was part of an attempt to publicly shame these men (not all public interventions use shame, though this is an often criticized element), a strategy used across the country in an effort to suppress the demand for sex for sale. 

John school curricula typically includes information about the laws against sex work, as well as information about the exploitation experienced by many involved in sexwork. "It is about changing attitudes," Jacquie Aitken, a director of a John school in Canada said: "We have to look at the attitudes of the people who are purchasing and their understanding of what purchasing sex means." 

Most John schools are based on a model developed in 2008, called the “First Offender Prostitution Program” or FOPP, implemented in 2008 in San Francisco, and included these elements: 

  • Prostitution Law and Street Facts, focusing on the legal consequences of subsequent offenses and addressing johns’ vulnerability to being robbed or assaulted while involved in prostitution.
  • Health Education, describing the elevated risk of HIV and STD infection associated with prostitution, and stressing that many STDs are asymptomatic and/or difficult to detect and have long term negative impacts on health.
  • Effect of Prostitution on Prostitutes, focusing on numerous negative consequences for women serving as prostitutes, such as vulnerability to rape and assault, health problems, drug addiction, and various forms of exploitation.
  • Dynamics of Pimping, Recruiting, and Trafficking, featuring discussions of how pimps and traffickers recruit, control, and exploit women and girls for profit, and the links between local street prostitution and larger systems of human trafficking.
  • Effect of Prostitution on the Community, describing the drug use, violence, health hazards, and other adverse consequences that co-occur with street prostitution.
  • Sexual Addiction, focusing on how involvement in commercial sex may be driven by sexual addiction, and where help for this condition can be sought.

The FOPP curriculum included a presentation from members of Sex Addicts Anonymous (SAA), who administered a 12 item assessment of sex addiction with the remarkably broad question: “Do your sexual activities include the risk, threat, or reality of disease, pregnancy, coercion, or violence?” Written evaluation of the FOPP program suggested that the reliance on a sex addiction model was actually a limitation to the program, potentially alienating men who didn’t view themselves as sex addicts, and failing to provide more information on healthy relationships.  

According to John School directors, men who seek sex for money are often viewed as having “ignorance about how to have the healthy relationships that could replace their reliance upon commercial sex.” In Texas, a John School run by a nonprofit called “Jesus Said Love” includes a sex addiction therapist, in an effort to educate men that their desire to pay for sex may be evidence of a sexual disorder. Jesus Said Love describes their mission as: “We share the revolutionary love of Christ with people in the commercial sex industry by awakening hope and empowering change.” 

In Los Angeles, they even now offer referrals to sex addiction treatment, without arrest or being sent to John School. Fake, online advertisements lead to men calling to arrange to pay for sex. Instead of scheduling a rendezvous, the men talk to a volunteer, and receive a referral to a local sex addiction treatment program. 

Sex addiction is a debunked treatment model, with mounds of modern evidence showing that it has more to do with moral and religious conflicts over sex, than the sex itself. After 40 years of sex addiction treatment, there remains no empirical evidence that it works. Instead, there’s a great deal of evidence that conditions mislabeled as sex addiction are symptomatic of underlying emotional and sexual disorders that go untreated, by a moralistic focus on the sexual behavior.

David Ley PhD
Flyer shared by a John School student.
Source: David Ley PhD

Not all John Schools teach that desire for commercial sex is an illness–some teach that it’s an unhealthy part of manhood itself. In Washington state, men arrested as recently as 2016 were sent to a 10 week, $900 course called “Stopping Sexual Exploitation: a Program for Men” provided by a group known as the Organization for Prostitution Survivors. The program, according to materials shared with me by a man who’d been ordered into the course, included two individual, one hour long sessions of Motivational Interviewing (MI). MI is a therapeutic technique developed to assist substance abusers in developing the motivation and incentive to change their lives and substance use. Use of Motivational Interviewing in preventing the purchasing of sex is a novel application, to say the least. Despite the use of an addiction treatment strategy, the program in Seattle, run by Peter Qualliotine, “Director of Men’s Accountability” didn’t present purchasing sex as a form of addiction. Instead, the OPS model taught that men buying sex was a form of “gender based violence,” driven by men’s feelings of sexual entitlement, along with the message that male sexual identity is based on unhealthy, self-destructive beliefs.

Pixabay
Source: Pixabay

So, according to varied John Schools, men purchase sex either because of unhealthy attitudes about being men, or because of sexual addiction, or because they simply don’t know how to have healthy relationships. Paying for sex, going to strip clubs, using sex chat-lines and viewing pornography have all been invoked as criteria for sex addiction, without any empirical data showing that men who do these things do, in fact, have disordered sexuality. Around 14 percent of American men may have paid for sex, but there are no simple easy reasons to explain these men: “there is no evidence of a peculiar quality that differentiates customers in general from men who have not paid for sex.” 

There are in fact a great many reasons why men seek out sex for money, ranging from a desire for sexual experiences (such as threesomes or kink) that aren’t easily available to the men; because the men feel they are unattractive and can’t find a woman to have a relationship with; because the men are seeking a space where their sexual desires or interests won’t be shamed; because the men don’t have time or emotional availability for a relationship; because they are disabled; or because they desire sex without emotional involvement. Many sex workers report that a large number of men come to them, for reasons having nothing to do with sex, such as simple loneliness, or the simple fact that the sex worker provides a listening ear without judgment of the man. “The girlfriend experience” has become a popular commodity in modern sex work, with sex workers providing a date or relationship, that feels more like traditional dating, to men who desire more than simple sex. 

Evaluation of the FOPP program claimed that it dramatically reduced recidivism amongst men arrested. However, criticism of the design and analysis of this claim is strong, suggesting that changes in demand for sex work had more to do with social and justice issues, and were not in fact changed through education and treatment of sex worker's customers. Though John Schools have now proliferated across the country (around 50 at last count), evidence for their impact remains inconclusive, even ignoring the wide variations in jurisdictional processes, or differences in the programming, either treating men as sex addicts, teaching them religious principles, or educating them about male sexual identity. While they may hold some value as a social or criminal intervention, the “treatment” component of these programs ultimately rests on a flawed (or at least decidedly unproven) core assumption, that there must be something “wrong” or diseased, in men who try to buy sex and that public treatment intervention will alter that man’s future sexual behaviors.