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.

Compassionate Care—Going the Extra Mile: Sex Trafficking Survivors’ Recommendations for Healthcare Best Practices

“…Additionally, withholding judgment about the ST-patient, demonstrating respect when taking a medical history and/or asking probing questions, and being aware of one's personal biases must be reflected in the institutions' culture, as well as in the healthcare providers' daily practices. Moreover, these practices always warrant being subsumed within both trauma-informed and victim-centered approaches to care, as well as being part of the healthcare providers' medical ethos [25,27,37,50,51]. Nonetheless, this study introduces the concept of Compassionate Care in the context of caring for ST-patients.…”

“…The literature speaks of collaborative models that work best in addressing ST-patients in the context of healthcare settings. Both coordination of services and needed resources to move beyond victimization are essential [6,10,24,25]. In the context of healthcare settings, frontline staff, clinicians, and social workers can take first steps to achieve the following: (a) identify HT victims and perpetrators; (b) stabilize and control the HT situation; (c) prepare victims and pass information on to trained investigators; and (d) refer victims to specialized service providers [26].…”

“…The intersection of healthcare with trafficked victims is a significant opportunity for identification and support. If clinicians, frontline responders, law enforcement agents and other needed professionals such as public health practitioners seek to adequately assist HT-patients in transitioning from victimization to survivorship, and reintegration to society, strategic approaches must be in place [7,15,[24][25][26]. This is not to say that these processes are simple.…”

Modern-day Slavery in our Health Care System: An Advocacy Journey

“…Despite this, studies show health care providers lack accurate knowledge about human trafficking, 5 and few hospitals in the country have a formal protocol for identifying and referring victims. 6,7 As this case highlights, a high index of suspicion is crucial in identifying human trafficking. Untrained doctors can miss the most vulnerable children in our communities, who are exploited and subjected to repeated abuse that often leads to complex trauma.…”

The Impact of Human Trafficking Training on Healthcare Professionals’ Knowledge and Attitudes

“…A trafficked person’s interface with a healthcare professional provides a unique opportunity for identification, intervention, and assistance. 3 - 6 Studies report that 68% to 88% of trafficked persons encounter a healthcare professional during their period of exploitation. 4 , 7 Many physicians, however, continue to miss signs of trafficking primarily because of lack of training, 8 - 10 and most report lack of confidence in their ability to identify and treat victims.…”