Sex Trafficking: Identification and Treatment Rene Love PhD, DNP, PMHNP-BC, FNAP, FAANP

Right Person at The Right Time I wasn’t showing up for my appointments. I would always call and be like, hey, I need to reschedule my appointments. I meant, I was going but I wasn’t going like I should have been going. And when they called me in, I went in and told them everything. I said, look, like I need help

Sex Trafficking (A) Sex Trafficking in which a commercial sex 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 (B) The recruitment, harboring, transportation, provision, or obtaining of a person for labor or services, through the use of force, fraud, or coercion for the purpose of subjection to involuntary servitude, peonage, debt bondage, or slavery (Victims of Trafficking and Violence Prevention Act of 2000 can be found at www.ojp.usdoj.gov/vawo/laws/vawo2000/)

Going Unnoticed Nearly 88% of sex trafficking survivors reported some kind of contact with health care while being exploited Lederer & Wetzel, (2014) Over half of labor and sex trafficking survivors surveyed had accessed health care at least once while being trafficked Coalition to Abolish Slavery & Trafficking,( 2017) Nearly 97% indicated they had never been provided with information or resources about human trafficking while visiting the health care provider Coalition to abolish Slavery & Trafficking, 2017

Role of health Professionals in Responding to Human Trafficking Identification of victims/survivors Tend to Treatment Needs----Immediate, short, and long-term Medical, mental health, sexual & reproductive health, dental, integrative Linkage to Services Forensic evaluations Sexual Assault Response

Common Health Problems Typically only have health care when their condition becomes serious Sexually Transmitted Diseases Vaginal and Rectal Trauma Unintended Pregnancies Infertility Urinary Tract Infections Diseases often go undiagnosed and untreated Infectious diseases such as TB Bald patches/lacerations/bruises, scars, burns HIV/AIDS Back problems from hours walking the street in high heels

Mental Health Problems Depression Anxiety Suicidal ideation Post traumatic stress disorder Addiction

Violence Branding Physical and Sexual Violence Partial or dentures because teeth are knocked out Jaw and neck problems from repeatedly being forced to perform oral sex

Red Flags Someone else is constantly in the room The person in the room speaks for the patient whether or not they speak English The person doesn’t have identification or travel documents or someone else holds them Patient has no spending money Patient appears to be under control and supervision of the person who never leaves them alone Signs of malnutrition, dehydration, drug use, or addiction, poor general health or personal hygiene Signs of physical abuse or neglect (scars, bruises, burns) Patient appears frightened, anxious, or distressed Patient’s story about what they do in this country or on the job doesn’t make sense The patient lives with someone else but can’t give you an address

Sample Questions to Assess Do you feel safe at home? Is anyone hurting you, threatening you, pressuring you to do anything you don’t want to do? Is anyone forcing you to have sex with others or to perform sex acts for money? Or for food, clothes, drugs, a place to sleep? Has this ever happened to you? Has your boyfriend (or anyone else) ever forced or pressured you into working in prostitution, escort services, strip clubs? Has anyone ever tricked you into meeting them, or into a relationship and then asked you to perform a sex act for money? Has anyone ever taken a photo of you that made you feel uncomfortable Dignity Health, 2017

Demographics PhD Dissertation 50 Participants: Cross sectional design Women still prostituting Women early in exiting lifestyle(less than 6 months) Women later in exiting lifestyle (more than 18 months) Age: 18-60 years of age Avg age = 36.89 (SD = 11.28) Race Caucasian- 54% African American -40% Other/ Not specified – 6% The typical women who exited prostitution > 18 months, were older had prostituted for more years and had started prostituting at an earlier age as compared to the other two groups. They were African American

Demographics (cont) Education Age First Prostituted Years Prostituting High school education or higher – 62% Less than high school education -26% Did not answer -12% Age First Prostituted Ranged from 8 to 49 years Avg age = 20.98 (SD = 8.27) Years Prostituting Ranged from 1 to 41 years Avg years = 15.82 (SD = 11.72)

Aim 1 Results: Describe No Significance Difference between the three groups for total scores for the following: Childhood Trauma (ACES) Adult Trauma Score Quantity of healthcare Visits Ways of Coping

Aim 1 Resilience Women exiting prostitution > 18 months had higher resilience scores as compared to those who exited less than 6 months ago.

Significant risk for mental/physical health problems Key Findings Mean scores for Childhood Trauma ranged from 4.47 to 5.18 out of 10 questions Significant risk for mental/physical health problems Across the three groups, 61-73.3% of the women reported being raped or sexually abused as a child Range of 2.44-2.57 for Adult Trauma Score for the three groups out of 4 questions Visits to healthcare providers ranged from 0-5 for those still prostituting to 0-20 for those who had exited

Resilience had higher scores for women >18 month or more Key Findings Substance abuse, crime/violence and externalizing disorders resolved within first six months but internalizing disorders resolved within the last month for women out for > 18 months Women prostituting reported more acute conditions as compared to chronic conditions reported by women who were out of prostitution greater 18 months Resilience had higher scores for women >18 month or more Resilience similar to people with severe physical/mental health issues (dysfunctional reintegration) “Normal People” (resilient reintegration)

Right Program at the Right Time National Human Trafficking Resource Center 1 (888) 373-7888 SMS: 233733 (Text "HELP" or "INFO") Hours: 24 hours, 7 days a week Languages: English, Spanish and 200 more languages Framework for a Human Trafficking Protocol in Healthcare Settings http://humantraffickinghotline.org/resources/framework-human-trafficking-protocol-healthcare-settings What to look for in a healthcare setting http://humantraffickinghotline.org/resources/what-look-healthcare-setting

Polaris: National Human Trafficking Resource Center, 30-min trainings for healthcare providers, including mental health providers, https://traffickingresourcecenter.org/materia l-type/online-trainings PATH: Physicians Against Trafficking of Humans, http://www.doc-path.org/ HEALtrafficking.org