Personally I came to this book having missed (being in the UK) all the hype and subsequent backlash. So I treated the book as a work of fiction. I thought it was very very good. To me it was in the traditional of many southern writers (I know Albert is not genuinely southern but who cares) with a dark gothic but also comedic surrealness that made it more than a story of a child prostitute. The use of religious imagary, weird strange characters, backwood setting, good vs evil only add to this feel. Similar themes to what you would find in books by writers I love like Harry Crews, Larry Brown or William Gay.
The book, although dealing with a very disturbing subject, avoids being too graphic early on and the humour helps to dilute the nastiness of the situation Cherry/Sarah/Sam is in. The story is fairly simplistic - a naive child frustrated by being held back by those trying to look out for her (relatively speaking) inadvertantly wanders into a much more dangerous situation. There then follows a battle of sorts between good (again relatively speaking) and evil. The story then takes on elements of religeous fanaticism and charlatanisem before it becomes nastier in feel as Charry/Sarah/Sam's situation really worsens.
I feel the author has shot herself in the foot by not just admitting it was a work of fiction. Had she admitted it was fiction it is possible that this book would have become a cult classic over time. I think the problem with her claims that JT Leroy was real and the subsequent charade that ensued left people feeling cheated and foolish and no one likes to feel like that (look at the tags in on the US Amazon site - scam, faker, lame, dishonest). I also think the publicity brought many people to this book who would not have normally read a book like this with such a subject matter. Many people cannot read books about uncomfortable subject matters unless they feel it is true and the victim has managed to survive and rebuild their life. As soon as it was discovered JT was not real a lot of sympathy for the character disappeared. It was seen as exploitative and the matter of fact way acts most of us would consider unthinkable are described or mentioned only worsens this. However, I consider this a fairly realistic portrayal of how an abused child may think (the story itself is not that realistic but neither do I think it is meant to be). Many child victims of abuse become conditioned to it so it is not unusual to them and they would not think to complain about their lot in life as it is all they and the people around them know. Although not as good a book and certainly a more graphic book The Heart is Deceitful Above All Things describes the sort of lifestyle and experiences that shape an abused child's development and thinking and it is sort of a prequel to this book.
This is not a book for everyone and no matter what would probably have been controversial (how many other books deal with child prostitution without them being over the top "real life" exposes with a life affirming ending where the victim finds god and all is well such as A Piece of Cake by Cupcake Brown). Be aware everybody in this book who is not a child but including some children are either abusing, exploiting or assisting in the exploitation of children. That said while the book does not openly condemn what is going on (the "good" guy is a pimp of children) it does not attempt to glorify child exploitation. It is merely written from the point of view of an adult remembering a part of their life as a child. Dark, funny, bizarre, unsettling and very sad but a very good book all the same.