Sex Trafficking Victims at Their Junction with the Healthcare Setting—A Mixed-Methods Inquiry

ABSTRACT

U.S.-born citizens are victims of human trafficking typically exploited through sex trafficking. At least some of them interact with healthcare providers during their trafficking experience; yet a majority goes unidentified. Although protocols and training guides exist, healthcare providers often do not have the necessary skills to identify and assist victims of sex trafficking. Understanding where victims seek care and barriers for disclosure are critical components for intervention. Thus, this study interviewed survivors of sex trafficking to ascertain: a) healthcare settings visited during trafficking, b) reasons for seeking care, and c) barriers to disclosing victimization. An exploratory concurrent mixed-methods approach was utilized. Data were collected between 2016–2017 in San Diego, CA and Philadelphia, PA (N = 21). Key findings: 1) Among healthcare settings, emergency departments (76.2%) and community clinics (71.4%) were the most frequently visited; 2) medical care was sought mainly for treatment of STIs (81%); and 3) main barriers inhibiting disclosure of victimization included feeling ashamed (84%) and a lack of inquiry into the trafficking status from healthcare providers (76.9%). Healthcare settings provide an opportunity to identify victims of sex trafficking, but interventions that are trauma-informed and victim-centered are essential. These may include training providers, ensuring privacy, and a compassionate-care approach.

KEYWORDS:

• Human trafficking
• sex trafficking
• medical needs
• healthcare settings
• disclosure of victimization
• mixed methods
• United States

Acknowledgments

The first author would like to thank all the survivors who participated and made this study possible—may their voices impact the daily practices of healthcare providers and systems of care. Also, much appreciation and recognition is due to the organizations and leaders that were vital in connecting study participants to this research and whose experiences and practice-based knowledge added essential insights to this study and its design. These organizations and leaders included: Survivors for Solutions, GenerateHope, Hidden Treasures Foundation, Soroptimist International Vista and North County Inland, California, Freedom from Exploitation, Valley Against Sex Trafficking (VAST), The Villanova Law Institute to Address Commercial Sexual Exploitation, Dawn’s Court Project, and Women Organized Against Rape (WOAR), Susan Munsey, Tiffany Epps, Lynn Burgard, Kimberly Williams, Heather Evans, Kaye V. Nevel, Dr. Joan Bloch, Nora Kramer, and Kathy Love. Last, but not least, she would like to thank Dr. Makini Chisolm-Straker for her encouragement and mentorship throughout this research process.

Notes

¹ Coercion defined by the Public Law 106–386 Section 103 (22 USC § 7102) includes the following:

1. Threats of serious harm to or physical restraint against any person;

2. Any scheme, plan, or pattern intended to cause a person to believe that failure to perform an act would result in serious harm to or physical restraint against any person;

Or the abuse or threatened abuse of the legal process.

² It is important to note that although sex trafficking happens through prostitution of both youth and adults, it does not refer to the typical notion of prostitution where women and men choose this type of activity in exchange for financial support. Sex-trafficking victims are defrauded and coerced; however, because they are prostituted, the public many times may continue to see them as prostitutes and not victims of trafficking (See Dovydaitis, 2010).

³ We are borrowing the definition developed by Beth Crisp (2012), a social work academic. This definition is not attached to a specific religious framework or association, but one that touches the human experience, including five specific aspects: meaning, identity, connectedness, transformation, and transcendence (Crisp, 2012, p. 136).

⁴ Sex Trafficking was defined as an experience where the SST lived “under the abuse of a pimp, sex trafficking or someone who forced them to sell or use their body in exchange for money or any other goods either through prostitution, pornography, stripping or any other forms of commercial sex exploitation.

⁵ The intension was to include both English and Spanish speakers in the sampling; yet, all participants were English speakers and some bilingual but preferred English.

⁶ In Amy’s case, her father knew to a certain extent about her first trafficking situation due to a legal court case, but he was not aware that her current partner was also her second trafficker.