Greater awareness of sex trafficking needed

By Kelsey Lessard | 08/25/2016

Healthcare providers are among few able to identify and help victims.

Image of traffic lightAs a public health nurse, I worked with pregnant teens and teenage parents who faced a multitude of health and social wellness barriers. These clients, many of whom were well below the federal government’s 100-percent poverty guideline, were not only busy navigating pregnancies and raising families, they were often simultaneously dealing with intimate-partner and family violence, homelessness, food security issues, drug and alcohol abuse, and mental health issues.
Lessard_Kelsey_ID_embed_SFWAs a nurse, it was my job to guide them through pregnancy and their child’s first few years of life by supplying nursing support, education, and resources. I knew these clients were at risk for all kinds of healthcare and social disparities that needed to be addressed. What I did not realize was that the daily challenges they faced often placed them at great risk for sex trafficking. Like many nurses and other healthcare providers, I was unaware that sex trafficking was probably affecting my clients, and I was not equipped to offer appropriate support or resources.
It wasn’t until I started volunteering for a local organization that offers support for sexually exploited women, including survivors of sex trafficking and those trying to leave “the life,” as it is often called, that I realized the true nature of sex trafficking. Hearing their stories, I began to understand how deeply my own community was affected.
Definition and scope
Human trafficking, one of the fasting growing public health concerns affecting communities throughout the United States, is often described as a form of modern-day slavery. People are sold or exploited­ for a variety of reasons, including sex, labor, and forced engagement in criminal activities. Traffickers use many means to get victims to do what they want. I’m focusing here, however, solely on sex trafficking, where victims are forced, tricked, manipulated, threatened, or otherwise coerced to perform commercial sexual acts. Any activity involving a person under age 18 where a sexual act is traded for money or something else of value is considered to be trafficking, and it is illegal. Youth and adults alike are victims.
Although many think the majority of sex traffic victims in the United States are from outside the country, 83 percent of those in confirmed cases between January 2008 and June 2010 were U.S. citizens. International human trafficking is certainly an issue that needs to be addressed, but we must not overlook the reality that trafficking happens to people who live, work, and grow up in our communities.
The reality is, the true incidence and prevalence of sex trafficking in the United States is not known. Because sex trafficking is illegal, often hidden, dangerous, and highly stigmatized, it is difficult to obtain reliable statistics. Available data are often estimates and likely underestimates. What we know is, sex trafficking is happening, and it affects the lives of many.
Health concern
Although sex trafficking has serious legal and social ramifications, it is also a major public health concern. Victims suffer from poor health caused by sexual traumas, physical injuries, child abuse, substance use and abuse, and mental health disorders. Adults and children involved in sex trafficking often endure trauma, including rape and incest. Not having control over their own reproductive health causes them to be at greater risk for gynecological concerns, such as sexually transmitted infections and unplanned pregnancies.
Sex trafficking victims may suffer from physical injuries such as blunt force trauma, burns, firearm and knife wounds, and head injuries. Living each day in a high-stress environment of manipulation, fear, and physical and emotional abuse leaves many with mental health disorders. To cope with life, they often become dependent on alcohol and drugs.  
These significant health consequences bring victims into contact with people working in healthcare. In fact, healthcare providers are among the relatively small group of people they are able to interact with outside the world of trafficking, and they are coming to our clinics and hospitals.
A 2014 study by Lederer & Wetzel of more than 100 trafficked women throughout the United States found that nearly 88 percent of victims visited a healthcare provider while under the control of a trafficker. This close contact places providers in a unique position to screen for, identify, and provide care and resources to these patients. Even when victims benefit from outside support and advocacy, they often lack access to needed healthcare resources.
This lack may be due, in part, to the fact that the high-risk circumstances of sex-trafficked patients often make them invisible to healthcare providers who are not trained on what signs and symptoms to look for. Because evidence-based education programs and clinical practice guidelines on screening and care of these patients are largely absent from healthcare provider education, sex-trafficking victims remain unrecognized and fail to receive needed care and resources.
Greater awareness needed
Healthcare professionals must know about sex trafficking and what to do when they encounter someone who is being trafficked for sex. We have a duty to ask possible victims appropriate questions, identify specific needs, and provide the best care and resources possible. To screen for trafficking, we need to watch for behavioral red flags, draw upon pertinent histories when interviewing patients, and look for physical and emotional signs and symptoms that may indicate trafficking. Because these signals are not always evident, we must also be alert to other factors that may keep us from “seeing” traffic victims and understand why a patient is not disclosing what is really happening in his or her life.
This need for increased awareness prompted me to focus my Doctor of Nursing Practice project on implementing a program that would help educate nurses and other healthcare professionals on sex trafficking. It is essential that sex-trafficked people have a voice in that education. Working with a community partner organization, we asked women who had been trafficked or were in the process of leaving “the life” what healthcare professionals should know and do when interacting with sex-trafficked people.
They gave us all kinds of wonderful advice. They described feelings of fear—of their situations but also of visiting clinics and hospitals. They recommended that healthcare professionals be honest, ask questions that need to be asked, be open to difficult stories, and remain professional and nonjudgmental. Their pearls of wisdom were incorporated into the lesson plan we developed for healthcare providers. In addition to information, the program also provided healthcare practitioners with tools to identify, assess, care for, and support sex-trafficked patients. In evaluating the program, I found that even brief educational intervention increased awareness of sex trafficking.
Looking ahead
In my new role as a women’s health nurse practitioner, I still have the privilege of working with high-risk youth and adults. Now that I know what to look for, sex trafficking is constantly on my radar. I make sure to watch for red flags, ask more in-depth questions when I detect suspicious physical signs of trafficking, and pay special attention to the sexual, mental, and chemical health of patients who visit the clinic where I work.
My hope is that greater awareness of sex trafficking by nurses and other healthcare professionals will lead to increased identification and screening of victims, provision of better healthcare resources, and, eventually, improved healthcare management for people affected by sex trafficking.
Part 2 in this series: Prison and sex-traffic victims: A place for help but not a safe zone
Part 3 in this series: Integrating sex-trafficking awareness into women’s health curricula
Kelsey Lessard, DNP, APRN, CNP, a women’s health nurse practitioner, is employed at Nucleus Clinic in Coon Rapids, Minnesota, USA.
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