WHAT YOU NEED TO KNOW SEX TRAFFICKING AND SEXUAL EXPLOITATION A TRAINING TOOL FOR HEALTH CARE PROVIDERS Human Trafficking and terms like “modern ers use tech- interact with victims are trained day slavery” usually conjure images of young nology to In 2013, to recognize the signs. girls being sold to sex tourists in faraway reach a wide multiple cases of Sex Trafficking is now being countries. Movies and documentaries feature client base for human trafficking treated as a public health scenes of tourists being kidnapped and forced prostitution ser- crisis, and has become a into sexual servitude. vices. The per- were reported in topic of research and de- Human trafficking is a real and growing ceived anonymity all 50 states and bate across all sectors. of online transac- problem all over the world, including here in Washington, D.C. Common public health con- the United States. It defies stereotypes and tions has embold- ened traffickers to (Polaris Project, 2013). cerns often co-occurring experts continue to build new knowledge with sex trafficking victimiza- about the issue. openly recruit, buy and sell their victims tion include domestic violence, The sex trafficking market is driven by the via the internet (Boyd, child abuse and neglect, HIV and laws of supply and demand. As long as there 2012). other Sexually Transmitted Infec- remains a demand for a commercial sex indus- tions, unwanted pregnancies, unmet try, there will remain a supply of individuals Consequently, those looking preventative healthcare needs, drug and al- willing to profit from its sale. to profit will continue to recruit, cohol abuse and addiction (Williamson et Sex Trafficking is a highly profitable criminal abduct, and exploit young people al., 2009). enterprise generating for the pur- Unfortunately, the majority of health care pose of supply- several billion dollars an- Front-line health care settings providers have a limited understanding of nually, second only to il- ing the demand. the issue of sex trafficking and how it may where a victim may present (Harris, 2012) legal arms trafficking and for services include the present with their patients. the drug trade. (FAS, Although there is limited The reality is that trafficked victims often en- 2000) Sex trafficking is a emergency room, urgent data to quantify the exact care, primary care clinics, dure physical violence and neglect, and are high profit, low risk busi- number of human traffick- likely to present for medical care at some point obstetrics/gynecology ness where the commod- ing incidences, we know during their abuse. ity, a human body, can be clinics, school nurse’s office, that the sex trafficking sold repeatedly, unlike community health centers, of minors happens and In fact, health care providers are one of the few groups of professionals who in- drugs or weapons, where mobile clinics, Planned has devastating physical and mental health con- teract with victims while they are still the product can only be Parenthood and dental clinics. sold once. sequences on victimized under the control of their abuser or youth. It can be difficult to the person profiting from their abuse Along with a means to (Issac, Solak & Giardino, 2011). recruit victims, traffick- detect unless people who IF YOU SUSPECT HUMAN TRAFFICKING, CALL THE NATIONAL HUMAN TRAFFICKING HOTLINE AT 1-888-3737-888 AS MANDATED REPORTERS IN ALL MANY HEALTH CARE PROVIDERS 50 STATES, HEALTH FEEL UNCOMFORTABLE WITH THEIR CARE PROVIDERS PLAY A CRUCIAL ROLE IN KNOWLEDGE LEVEL AND ABILITY KEEPING CHILDREN TO RECOGNIZE THE PHYSICAL AND SAFE. IF YOU SUSPECT MENTAL SIGNS OF TRAFFICKING. OR HAVE REASON TO BELIEVE THAT A CHILD IN YOUR CARE HAS BEEN WHO ARE THE VICTIMS? SEXUALLY ABUSED OR While there is no commonly accepted profile MISSED OPPORTUNITIES EXPLOITED IN ANY WAY, for victims of minor sex trafficking, certain Despite chances for intervention, health care populations are more vulnerable than others. providers can easily fail to identify victimized YOU MUST TRIAGE THE SITUATION AND ALERT youth. With increased knowledge about HOMELESS, RUNAWAY, the topic, and new screening tools and THE APPROPRIATE THROWAWAY, AND FOSTER intervention strategies, you can begin to ask AUTHORITIES CHILDREN ARE THE MOST the right questions and help your clients IMMEDIATELY. VULNERABLE POPULATION avoid further exploitation and abuse. OF YOUTH AT RISK FOR SEX Vulnerable youth can be lured into TRAFFICKING prostitution and other forms of sexual (ECPAT USA, 2013). exploitation using promises, psychological In a recent study of Emergency manipulations, provision of drugs and Pimps/traffickers target runaway or medicine residents, alcohol, and violence. The trafficker’s main “throwaway” teens or those who are having purpose is financial gain and will make every ED attendings, ED nurses, and trouble at home. Runaway and homeless effort to establish trust and allegiance by hospital social workers, only 4.8% youth are at increased risk for predators wooing the victim in what feels like a loving as they have few resources, may not be old felt some degree and caring relationship. of confidence enough to legally get a job, and are often running away from difficult situations. in their TARGETED Pimps “shop” for their ability to The Office of Juvenile Justice and victims online, in shopping malls, bus stops, Delinquency Prevention estimates that identify and schools, after school programs, foster homes 7.7% to treat 1.6 million youth run away in a year in the United States. and other places where teens gather. a trafficked patient It is common for these adolescents to trade TRICKED Pimps invest a lot of time and sex to meet their basic survival needs of food, (Chisolm- effort in forming a bond with their victim. Straker, 2012). clothing or shelter. According to a recent survey of homeless youth in New York, of They often buy gifts, provide a place to stay, those engaged in commercial sex, they said and give affection before revealing their true they did it for shelter because they needed intent to sexually exploit them. Traffickers use someplace to stay (Bigelsen, 2013). a powerful technique pioneered by religious cults knows as “love bombing” in which a How do individuals become victims girl is showered with affection as a means of trafficking? of manipulating her (Dorais & Corriveau, •Recruitment by “Romeo/ 2009). boyfriend” pimps who convince them that they love and care for them TRAUMATIZED The pimp’s use of • Kidnapping by “gorilla pimp” psychological manipulation, physical violence and forced into the life and rape can make the victim feel trapped • Gang related prostitution and powerless. The “trauma bond” is very • A parent or family member difficult to break and may require intensive long pimps their child for drugs term treatment and counseling (National or money Center for Missing and Exploited Youth, 2014). • Running away and living on the streets and are forced to exchange sex for survival If you suspect Human Trafficking, call the National Human Trafficking Hotline at 1-888-3737-888 THERE IS NO SUCH THING AS A WILLING CHILD PROSTITUTE The Federal Trafficking Victims Protection Act (TVPA) defines the crime of trafficking as the recruitment, harboring, transportation, provision, or obtaining of a person for the purpose of a commercial sex act where such an act is induced by force, fraud, or coercion, or in which the person induced to perform such act has not attained 18 years of age. The most important thing to understand from the federal definition is that anyone under the age of 18 who is induced to perform a commercial sex act is automatically a trafficking victim. Victims are often reluctant to come forward It is helpful to understand that there are many Health care providers can apply their knowledge because they have been taught by their “ about domestic violence, trauma and sexual similarities in victimization between intimate victimizer that abuse to better understand a trafficking victim’s partner violence and if they attempt fear and reluctance to leave the relationship. sex trafficking. Victims to seek help, no “A lot of victims of trafficking do of sex trafficking and In addition, common myths and stereotypes one will believe not identify themselves as being a domestic violence tend to about sex trafficking can affect judgment and them, and they hide their situations and response. Common myths include “that only will be treated victim. Some may feel that they got both victim groups are happens abroad” or “it was consensual.” The like a criminal themselves in this situation and it’s hesitant to disclose their more health care providers know about this and a prostitute their responsibility to get out.” victimization in medical population, including the mindset of a victim, (Bigelsen, 2013). – Jane, a survivor or clinical settings. the better equipped they will be to identify (Roe-Sepowitz et al, 2013) victims and focus on prevention strategies. UNDERSTANDING the Mindset of a Victim VICTIMS OFTEN DO NOT SEE THEMSELVES AS VICTIMS SEX TRAFFICKING OF VICTIMS MAY FEEL SHAME, SELF –BLAME MINORS IS A FORM OF AND FEELINGS OF UNWORTHINESS OF A CHILD ABUSE. BETTER LIFE According to the National VICTIMS MAY BE COACHED TO LIE TO Coalition to Prevent Child Abuse MENTAL HEALTH PROFESSIONALS AND and Exploitation, sex trafficking OFTEN GIVE FABRICATED HISTORIES of minors is a severe form of WITH SCRIPTED STORIES child abuse with lasting effects on the health and wellbeing of VICTIMS ARE OFTEN FEARFUL AND individuals, family and society DISTRUST LAW ENFORCEMENT AND (National Plan 2012). GOVERNMENT SERVICES DUE TO FEAR OF Young people can be com- ARREST mercially sexually exploited VICTIMS MAY HAVE FORMED A TRAUMA through prostitution, pornog- BOND WITH THEIR EXPLOITER AND MAY raphy, stripping, erotic enter- HAVE DEEP LOYALTIES AND POSITIVE tainment or other sex acts. The FEELINGS FOR THEIR ABUSER commercial aspect of the sex- ual exploitation is critical to VICTIMS OFTEN FEAR FOR THEIR OWN separating the crime of traffick- SAFETY AND THE SAFETY OF THEIR ing from sexual assault, moles- LOVED ONES DUE TO THREATS OF tation or rape (Shared Hope, VIOLENCE 2014).