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

2. 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

3. 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

4. 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

5. 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

6. 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

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

8. 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

9. 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

10. 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

11. 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: years of age
Avg age = (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

12. 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 = (SD = 8.27)
Years Prostituting
Ranged from 1 to 41 years
Avg years = (SD = 11.72)

13. 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

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

15. 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, % of the women reported being raped or sexually abused as a child
Range of 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

16. 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)

17. Right Program at the Right Time
National Human Trafficking Resource Center 1 (888) SMS: (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 What to look for in a healthcare setting

18. Polaris: National Human Trafficking Resource Center, 30-min trainings for healthcare providers, including mental health providers, l-type/online-trainings PATH: Physicians Against Trafficking of Humans,
HEALtrafficking.org