Document Type


Date of Degree

Spring 2015

Degree Name

PhD (Doctor of Philosophy)

Degree In


First Advisor

Prussing, Erica

First Committee Member

Lewin, Ellen

Second Committee Member

Graham, Laura R

Third Committee Member

Khandelwal, Meena

Fourth Committee Member

Wentzell, Emily


Over the last two decades, the use of empowerment approaches to help reduce health-related vulnerabilities and violence among female sex workers has increasingly informed global health efforts directed at HIV/STD prevention. The empowerment approach to sex worker health rejects both abolitionist and narrowly conceived clinical approaches in favor of strategies that promote commercial sex as valid work, strengthen sex workers’ agency, reinforce female sexual autonomy, and support rights-based framing. A significant outcome of the empowerment approach to integrating health, social, and legal strategies has been the creation of numerous sex worker associations and NGOs, which advocate for collective mobilization and community-based HIV/STD prevention programs among sex workers. Despite numerous studies examining the efficacy of community empowerment approaches to sex worker health and the creation of civil society organizations to implement such approaches, there has been little theorization about how participation in sex worker NGO-based programming and activism shapes the personal, embodied experiences and subjectivities of sex workers. Similarly, questions of how sex worker associations and NGOs are shaped by the experiences, realities, feelings, and personal opinions of sex workers have received limited attention. Given the morally charged and highly stigmatized environments in which sex workers typically operate, studying how and which sex workers come into contact with these NGOs helps to illuminate how community and kinship relations, and individual and collective aspirations, shape sex work activism and contribute to the making (and unmaking) of related associations and NGOs. Drawing on long-term ethnographic research with female sex workers and sex work activists, this work combines medical anthropological and feminist perspectives to interpret sex worker associations and NGOs as “local moral worlds” that highlight how subjectivities, body, moral experience, kinship, care, and women’s agency relate. From the subjective experiences of older female sex worker/activist informants, I argue that sex worker associations and NGOs are best comprehended not simply as the outcomes of global health efforts to curb the spread of HIV and other STDs, but also as complex social arenas that need to be reconsidered in light of existing relationships between and among sex workers and their families and the state. This argument is informed by my yearlong engagement with Women’s Solidarity House (WSH), a pseudonym for an organized association of active and retired female sex workers in the red-light district of San José, which recently received NGO status from the Costa Rican state. One important dimension of WSH that requires careful consideration is the fact that most of the women who participate in its development and programming are over the age of 40, with an average age of about 52. This fact makes WSH an interesting and important case study, since it caters most especially to female sex workers who are generally outside of the purview of most sex worker empowerment and health-related prevention programs, which are designed and implemented by public health researchers and development specialists. While theories of gender, stigma, and social inequality have increasingly informed medical anthropological efforts to understand how structural factors shape the personal, embodied experiences of sex workers and the distribution of HIV/STDs, there has been very little effort to understand how aging and ageism factor into the making and unmaking of sex worker embodiment and subjectivity and older women sex workers’ risk of contracting sexually transmitted diseases and infections. Given that sex work is a profession or income-generating strategy that adult women in various stages of their lives perform, the lack of research and theorization about these aspects of female sex workers’ lives, I suggest, has prevented a broader research and programmatic response both to common risks such as HIV/STDs and violence, and to work-related health problems and occupational conditions that older sex workers may consider more important in their day-to-day lives. My research shows that a “structural approach” to sex work, which highlights the underlying social, historical, political, and economic forces that encourage and foster the economic exploitation, stigmatization, and negative health outcomes of women (and men) who sell sex, would benefit from adding a feminist anthropological perspective on aging. In this view, aging is a critical social structural inequality that society uses to devalue women’s status and which women often experience as stigmatizing and/or shameful. In Costa Rica, where recent reporting has suggested an increase in the number of older women in the local sex industry, studying women’s experiences of and responses to growing old in the sex trade reveals not only the long-term impacts of neoliberal reform polices, but also how gendered discourses about aging, increasing familial caregiving responsibilities, and growing inequality and economic pressure, together, conspire to limit older women sex workers’ employment opportunities and put them at greater risk of violence, discrimination, psychological distress, sexual assault, substance abuse, poverty, and HIV/STDs.

Public Abstract

This dissertation explores women’s experiences and responses to growing old in the Costa Rican sex industry. I focus on how economic disparities and stigma shape the struggles of older women sex workers (ages 40 to 75). Based on my informants’ experiences, I argue for a view of sex work as an advanced form of capitalist wage labor that is highly developed in Costa Rica, yet highly unequal and uncertain due to pressures that call for an ever-more flexible and youthful sexual labor force. In this emergent global capitalist and neoliberal context, I demonstrate that the stakes surrounding aging and sickness are especially high for women sex workers, since they become removed from the more profitable locales of sex work as they grow older and have little recourse to good health care services. Combining analytic approaches from feminist theory and medical anthropology, my work shows that there is an important irony to be found here. Despite the fact that my informants act in ways socially prescribed, government officials, health care workers, and others subject their lives as women and caregivers to greater scrutiny. Moreover, as they age, they are treated more and more as disposable people for whom the state has little obligation. Now, despite the fact that they receive very little government support, it is at their feet which the ever-weakening Costa Rican social welfare state lays the important responsibilities of reproducing and caring for citizen and non-citizen subjects, compounding their risk for living in poverty in their later years.


publicabstract, activism, aging, Costa Rica, empowerment, inequality, sex work


x, 264 pages


Includes bibliographical references (pages 254-264).


Copyright 2015 Tony Orlando Pomales

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Anthropology Commons