How do families respond to a crisis? The experience of sexual trafficking victim families

Sex trafficking is a form of human trafficking in which a trafficker compels a victim to engage in commercial sex acts. Traffickers often control victims using physical violence, sexual abuse, psychological abuse, isolation, and by introducing victims to illegal drugs. Throughout the course of their victimization, many victims of sex trafficking experience such distress that they turn to drugs to cope or steal to meet their basic needs. Unfortunately, the trauma of trafficking is prolonged and exacerbated when victims are prosecuted for and convicted of crimes they committed as a direct result of trafficking. In addition to prostitution convictions, many victims of trafficking accrue criminal records for “collateral” offenses such as drug possession, theft, disorderly conduct, or weapons offenses. When victims of trafficking have criminal records, they encounter barriers to housing and employment, subjecting victims to lives of poverty, which increases their risk of being re-trafficked. Wisconsin provides victims of sex trafficking with two forms of decriminalization: (1) an affirmative defense to avoid conviction of any crime committed as a direct result of being a victim of trafficking and (2) a pathway for victims of sex trafficking to expunge or vacate prostitution convictions that were a result of being trafficked. Both pathways are insufficient remedies for victims because victim identification is poor and, more importantly, only prostitution convictions are eligible for vacatur or expungement, which leaves victims with criminal records for the collateral crimes they committed as a direct result of being a victim of sex trafficking. Wisconsin should expand its vacatur statute for victims of trafficking to allow victims to vacate or expunge any nonviolent conviction committed as a direct result of being a victim of trafficking. Moreover, an expansion of the vacatur statute for victims of trafficking would better protect victims and help them to reintegrate into life outside of trafficking.

Background Despite recognition that social determinants are critical to health outcomes, many groups, including those with lower incomes, racial/ethnic minorities, and other historically marginalized populations, continue to experience significant social and structural barriers to care. There is need for research that incorporates patient and stakeholder engagement in developing, testing, and disseminating interventions to improve outcomes for patient populations that have been marginalized in the health system. Patients who use a language(s) other than English (LOE) for healthcare communication are at increased risk for experiencing adverse events and worse health outcomes in healthcare settings, including in paediatric hospitals. Canadian census data indicates 12.7% of Canadians predominantly speak a language other than French or English. This work aims to generate knowledge to improve health outcomes for children and families who speak LOE. Objectives (1) To understand the lived experience of families who speak LOE around the hospitalization of their child and (2) To understand the perspectives of patients and families who speak LOE on how the healthcare system can improve care during hospitalization. Design/Methods The premise of this study is participatory research. We designed a qualitative study involving children hospitalized in the General Paediatric Inpatient Unit at the Hospital for Sick Children. The study includes family caregivers of children age 0 to 18 years who identify as speaking LOE. Children and families could speak any language that we were able to obtain interpreter support for. We excluded patients that spoke a traditional Indigenous language as we noted this work required a separate study in partnership with the Indigenous community. We conducted semi-structured virtual individual interviews with children and families post-discharge with a medical interpreter. An interview guide was developed and transcripts were analyzed using thematic analysis. We took several steps to ensure an effective study design given our goals of participatory research including ensuring patient and family engagement throughout the design process. Results 19 families participated in the interviews and 16 different languages were represented amongst our participant groups. Our study is unique in especially unique in it's ability to recruit and interview individuals with so many different primary languages. Our study provides rich insight into opportunities within the paediatric inpatient setting for quality improvement to address the health disparities experienced by patients and families who use LOE for healthcare communication. Our analysis of the interviews identify several themes that provide insight into the lived experience of patients and families who use LOE for healthcare communication. 1) Inconsistent interpreter use affects communication “in the moment” and the ability to develop an “overall understanding” of the current clinical situation and broader healthcare context. Our participants note a "snowball effect" when interpreters are not consistently utilized. 2) In addition to language, multiple additional social factors contribute to an increased sense of vulnerability and modulates how families “trust” the healthcare system. 3) Despite families expressing positive experiences, they noted that they did not, nor expect to feel like they “belonged” within the healthcare system. It is critical to recognize the complex interplay between many factors surrounding our participants’ identities. Though they use a LOE for healthcare, the intersectional marginalization they experience was thoroughly represented during our conversations Conclusion Our research aimed to take a participatory approach to consider the lived experience of patients and families who use LOE for healthcare communication. This work builds on the current literature on patient and family centered care, experiences of families who speak LOE and participatory community-based research in the paediatric hospital settings. Our study's findings support the development of a research and intervention agenda in Canada to improve health outcomes for patients and families with LOE.

The Tragedy and Horror of Human Trafficking of Children and Youth

This chapter recognizes human trafficking as a transnational criminal enterprise as it reaches far beyond geographic boundaries and flourishes from the victimization of individuals for profit. It focuses on the trafficking of individuals for sex or, as commonly referred to, sex trafficking. Victims of sex trafficking are forced into a variety of forms of sexual exploitation to include prostitution, pornography, bride trafficking, and sex tourism. The phrase "white slavery" is used today to describe the Eastern European women first perceived to be involved in sex trafficking in the United States. The general demographic characteristics of the victims of sex trafficking are, of course, young and female. Since sexual exploitation is the goal of the trafficking, the more "attractive" the product, the higher the sale price. Investigative effort is one aspect of the problem of sex trafficking that remains a challenge in reducing sex trafficking and in many ways fuels the problem.

This chapter recognizes human trafficking as a transnational criminal enterprise as it reaches far beyond geographic boundaries and flourishes from the victimization of individuals for profit. It focuses on the trafficking of individuals for sex or, as commonly referred to, sex trafficking. Victims of sex trafficking are forced into a variety of forms of sexual exploitation to include prostitution, pornography, bride trafficking, and sex tourism. The phrase "white slavery" is used today to describe the Eastern European women first perceived to be involved in sex trafficking in the United States. The general demographic characteristics of the victims of sex trafficking are, of course, young and female. Since sexual exploitation is the goal of the trafficking, the more "attractive" the product, the higher the sale price. Investigative effort is one aspect of the problem of sex trafficking that remains a challenge in reducing sex trafficking and in many ways fuels the problem.

Sex trafficking is a pervasive problem in many parts of the world. This study investigates the relationship between different types of prostitution laws and the prevalence of sex and human trafficking across European countries using data that covers 2008-2010. The Article attempts to make three contributions to the literature.First, it builds on existing theories of the link between the demand for purchased sex and the supply of sex trafficking to create a simple ordinal measure of prostitution laws that better reflects the actual cross-country variation in prostitution laws compared with a binary variable that merely indicates whether prostitution is legal or illegal. The measure is called the Prostitution Law Index and is based on a very rudimentary framework that analyzes forms of scale, substitution, and replacement effects in the market for prostitution. Scale refers to increases in the prevalence of trafficking that are caused by growth in the overall size of the market for prostitution. Substitution refers to when current consumers begin to purchase sex with individuals who voluntarily sell sex rather than with trafficking victims. Replacement refers to when new voluntary sellers of sex enter the market and crowd out trafficking victims. The index ranks prostitution laws across countries on a four-point scale (from 1 to 4) based on expected effectiveness (from least to most effective) in terms of reducing the prevalence of sex trafficking.Second, the study uses a new dataset provided by the European Union to study the relationship between Prostitution Law Index scores and prevalence of sex trafficking. Cross-country analyses suggest that there generally appears to be a negative relationship between a country’s Prostitution Law Index score and the prevalence of trafficking. Greater legislative efforts to reduce scale and to increase substitution and replacement — as captured by a higher score in the index — appear to, on average, be associated with lower levels of sex trafficking.Third, the Article presents a basic Difference-in-Differences analysis — with very limited data and thus with many caveats — that seeks to study the causal impact of Norway’s implementation in 2009 of a set of prostitution laws that made it legal to sell sex, but illegal to buy sex (the category of laws that receives the highest index score). Tentative results suggest that this legal reform may potentially have caused some reduction in the prevalence of trafficking.

Human trafficking, or modern-day slavery, is a global problem with broad reach that is often underrecognized in the United States. Victims of trafficking have been found in a wide range of legal and illegal business settings, and this frequently hidden population is most often exploited in the commercial sex industry, agriculture, factories, hotels, restaurants, as domestic workers, and by marriage brokers and some adoption firms. Human trafficking disproportionately affects underserved women and children, with more than 70% of trafficking cases involving women and girls and more than 90% of victims trafficked into the sex industry. Obstetrician-gynecologists and other women's health care providers are well-situated to identify and assist victims of human trafficking. Many trafficked individuals present to outpatient obstetrics and gynecology clinics, community health centers, family planning clinics, urgent care centers, and adolescent medicine clinics, and one half of all female victims of sex trafficking have visited the emergency department while involved in sex trafficking. Obstetrician-gynecologists and other women's health care providers should be aware of human trafficking, recognize signs of human trafficking, and be prepared to assist patients who are victims or who have been victims of human trafficking. This Committee Opinion has been updated to include screening questions and indicators to identify victims of human trafficking, additional information regarding reporting obligations for suspected human trafficking, and additional resources for survivors of human trafficking.

Human trafficking, or modern-day slavery, is a global problem with broad reach that is often underrecognized in the United States. Victims of trafficking have been found in a wide range of legal and illegal business settings, and this frequently hidden population is most often exploited in the commercial sex industry, agriculture, factories, hotels, restaurants, as domestic workers, and by marriage brokers and some adoption firms. Human trafficking disproportionately affects underserved women and children, with more than 70% of trafficking cases involving women and girls and more than 90% of victims trafficked into the sex industry. Obstetrician-gynecologists and other women's health care providers are well-situated to identify and assist victims of human trafficking. Many trafficked individuals present to outpatient obstetrics and gynecology clinics, community health centers, family planning clinics, urgent care centers, and adolescent medicine clinics, and one half of all female victims of sex trafficking have visited the emergency department while involved in sex trafficking. Obstetrician-gynecologists and other women's health care providers should be aware of human trafficking, recognize signs of human trafficking, and be prepared to assist patients who are victims or who have been victims of human trafficking. This Committee Opinion has been updated to include screening questions and indicators to identify victims of human trafficking, additional information regarding reporting obligations for suspected human trafficking, and additional resources for survivors of human trafficking.

To explore the experiences and perceptions of midwives in the treatment of sex trafficking victims. The study was qualitative with a hermeneutic-phenomenological approach, using semi-structured interviews and focus groups. Two focus groups and six interviews were carried out on 14 midwives in primary care, delivery and emergency rooms. Data were collected in three hospitals in Spain in June 2021. ATLAS.ti 9 software was used to conduct a content analysis of the focus group and interview data. The results revealed two primary themes and six subthemes. The two primary themes were (i) sex trafficking: a camouflaged reality on the invisible spectrum, and (ii) a thirst for attention in the aftermath of violence. Representative quotations were used to illustrate both the main themes and the subthemes. This study provides new insight into midwives' experiences treating sex trafficking victims. Professionals view this type of violence as a silent issue that negatively impacts victims' health and livelihood. However, a number of different factors stand in the way of correctly identifying and treating victims. Therefore, healthcare workers must be provided with practical tools and continuous professional development on this topic. This study indicates the importance of the midwives' key role in identifying and assisting victims of sex. Not only do measures in the healthcare setting, such as on-going specific-related content training or up-to-date protocols, need to be implemented to ensure proper care for those affected by sexual exploitation, but also focusing on suspicious characteristics and reducing obstacles to patient communication will help bring the true situation to light and better respond to patients' priority needs.

While female victims of sex trafficking continue to face criminal indictments in sex trafficking prosecutions, the extent of the problem and an understanding of the victims it disproportionately impacts is unclear. This study investigates the extent to which victims of trafficking are prosecuted in sex trafficking cases, and what defendant-, victim-, and trafficking-related patterns predict who is likely to be a victim. We begin by presenting the T.R.A.P. Typology of female defendants in sex trafficking prosecutions which places female defendants in types based on whether they have a trafficker, recruit victims, perform administrative functions, and engage in prostitution. The T.R.A.P. Typology yields five groups: manager, bottom, associate, partner, or CEO. Using federal prosecutions data, we categorized 399 female defendants using this typology to systematically determine their victim versus offender status and its predictors. Significant patterns emerge. Victims (the combined manager and bottom ideal types) constitute 53% of defendants and are younger, more likely to be white or black, and are involved with sex trafficking organizations that are most likely to traffick adult, American women via online and outdoor solicitation. The results have implications for victim-centered criminal justice responses and offer empirical support for various policy reforms.

Back to table of contents Previous article Next article Professional NewsFull AccessShift Sex-Trade Focus Away From Victims, Advocates UrgeRich DalyRich DalyPublished Online:4 Jun 2010https://doi.org/10.1176/pn.45.11.psychnews_45_11_015AbstractSex trafficking and prostitution have much more in common than just pervasive mental illness among the women and girls who are involved in the two activities. Now advocates of controlling the two practices view them as intricately linked and urge using a new approach to addressing them."Demand for prostitution fuels sex trafficking," actress Demi Moore said in May at the U.S. Capitol at a forum on sex trafficking. "We need to focus on how we can make the johns more accountable."Moore—who launched a foundation with her husband, Ashton Kutcher, in January to fight sex trafficking—is one of a growing number of advocates who see a strong link between adult prostitution and the domestic and international trafficking of unwilling women and girls for sex.At a briefing for staffers of members of Congress, actress Demi Moore joins three victims of domestic sex trafficking to call for increased efforts to reduce the use of prostitutes and prosecution of sex-trade organizers.Credit: Rich DalyShe and other opponents of both trafficking and prostitution are urging federal, state, and local governments to focus on both the prosecution of sex buyers and preventive education directed at men and boys.The concerns about both trafficking and prostitution stem in part from research that consistently finds high rates of posttraumatic stress disorder (PTSD) and other mental illnesses among commercial sex workers. For example, a 1998 study by researchers at Kaiser-Permanente Medical Center in San Francisco interviewed almost 500 prostitutes from around the world and discovered that two-thirds suffered from PTSD. Similar high rates of serious mental illness affect many women and girls who are victims of sex trafficking, said psychiatrist Donna Stewart, M.D., chair of women's health at the University of Toronto, who has studied the mental health impact of sex trafficking on its victims.The few trafficking victims who make their way to the offices of psychiatrists and mental health professionals are "often terrified" of their pimps and captors, Stewart told Psychiatric News.High rates of drug abuse also are common among both trafficking victims and prostitutes. For instance, a 1998 survey-based study of 475 prostitutes in five countries published in Feminism & Psychology found that 45 percent were regular users of illegal drugs. Researchers have found that many women and girls are lured into and kept in the sex trade through drug addiction.A growing number of researchers have become convinced of a connection between adult prostitution and sex trafficking, beyond their similar mental health sequelae—a position that is disputed by legalization advocates. A 2003 study by London Metropolitan University researchers of different governments' approaches to discouraging prostitution found evidence of such a connection."[I]nternational trafficking in women and children cannot flourish without the local prostitution markets. If a local prostitution market decreases substantially, organized crime networks are likely to relocate to a more profitable location," concluded the authors on the basis of data from law-enforcement and social-welfare agencies.The link has led many advocates to urge a common approach to both problems—one that replaces prosecution of the woman with prosecution of the buyers and organizers. Additionally, educational outreach can teach men and boys who have never bought the services of prostitutes or engaged in sex trafficking about the damage these practices inflicts on those involved. This approach is popularly known as the Swedish model, because that country was among the first to implement it nationwide.In 1999, Sweden decriminalized the sale of sex but made it a crime to buy sex, while launching a nationwide education campaign about the damage women suffer when they are caught up in the commercial sex trade. The resulting arrests of sex buyers led to a decline in both demand and sex trafficking in Sweden.Similar but more limited efforts have begun in the United States, where several states have toughened laws against so-called johns, pimps, and traffickers. These efforts are intended to reverse the longstanding practices of arresting prostitutes and rarely prosecuting male customers.At a press conference on Capitol Hill in May, Rep. Chris Smith (R-N.J.; right) calls for increased federal prosecution of pimps, traffickers, and commercial sex buyers. Rep. Joe Pitts (D-Pa.) joined him in raising concerns that a new Obama administration overseas funding regulation could thwart efforts to reduce trafficking.Credit: Rich DalyRep. Chris Smith (R-N.J.) is the author of a 2000 law that deemed all girls caught in federal prostitution arrests as trafficked victims. However, Smith told Psychiatric News that he has been disappointed in the years since with the low priority that federal prosecutors have given to pursuing cases against men buying and pimping such girls.Meanwhile, educational efforts include End Demand Illinois (EDI), a Chicago-based coalition of nonprofits, which began a statewide education initiative to change attitudes of potential buyers toward commercial sex. The efforts of EDI include a high-school program that organizers hope will become a national model, which teaches boys about the damage women in commercial sex suffer and encourages them to spread the message to friends and relatives. The approach is based in part on research by EDI that found the average age of men when they first buy sex is between 18 and 25.The ability of men to abandon the notion of paying for sex, according to sex-trade opponents, is the most effective way to reduce the demand that drives sex trafficking and prostitution.This approach differs sharply from those of countries and localities that have legalized prostitution to regulate and tax it. The highest-profile such approach is in the Netherlands. Prostitution has flourished there since its legalization in 1988, and police now estimate that four illegal brothels exist for each one of the 142 licensed brothels. Additionally, British police say the Netherlands has become a leading pedophile destination in Europe, with police suspecting that child-prostitute abusers choose the Netherlands because of its prostitution-tolerant environment. The Netherlands has seen the rise of an open pedophile lobby since prostitution legalization that advocates for the "right of children to sexual self-determination." The nation now limits prosecution of sexual abuse of children older than 12 years to cases where a parent or child reports the crime, according to a report by the Child Rights Information Network.Like many trafficking opponents, Stewart favors the Swedish approach and applauded attempts to redirect the prosecutorial focus away from the victims of the sex trade, citing the potential benefits for the women and girls caught up in it, but doubted that a nationwide realignment in local, state, and federal governments' approaches to the commercial sex trade was really possible in the United States.In the meantime, she urged psychiatrists to watch for signs of trafficked women and girls among the trauma patients they see in hospital emergency rooms.A Department of Health and Human Services guide for physicians on recognizing victims of sex trafficking is posted at <http://aspe.hhs.gov/hsp/07/humantrafficking/CaseMgmt/ib.pdf>. ISSUES NewArchived

BackgroundSex trafficking and sexual exploitation has been widely reported, especially in conflict-affected settings, which appear to increase women’s and children’s vulnerabilities to these extreme abuses.MethodsWe conducted a systematic search of ten databases and extensive grey literature to gather evidence of sex trafficking and sexual exploitation in conflict-affected settings. International definitions of “sexual exploitation” and “sex trafficking” set the indicator parameters. We focused on sexual exploitation in forms of early or forced marriage, forced combatant sexual exploitation and sexual slavery. We extracted prevalence measures, health outcomes and sexual exploitation terminology definitions. The review adhered to PRISMA guidelines and includes quality appraisal.ResultsThe search identified 29 eligible papers with evidence of sex trafficking and sexual exploitation in armed conflict settings in twelve countries in Africa, Asia, and the Middle East. The evidence was limited and not generalizable, due to few prevalence estimates and inconsistent definitions of “sexual exploitation”. The prevalence estimates available indicate that females were more likely than males to be victims of sexual exploitation in conflict settings. In some settings, as many as one in four forced marriages took place before the girls reached 18 years old. Findings suggest that the vast majority of former female combatants were sexually exploited during the conflict. These studies provided various indicators of sexual exploitation compatible to the United Nation’s definition of sex trafficking, but only 2 studies identified the exploitation as trafficking. None of the studies solely aimed to measure the prevalence of sex trafficking or sexual exploitation. Similar descriptions of types of sexual exploitation and trafficking were found, but the inconsistent terminology or measurements inhibited a meta-analysis.ConclusionsFindings indicate there are various forms of human trafficking and sexual exploitation in conflict-affected settings, primarily occurring as early or forced marriage, forced combatant sexual exploitation, and sexual slavery. The studies highlight the extraordinary vulnerability of women and girls to these extreme abuses. Simultaneously, this review suggests the need to clarify terminology around sex trafficking in conflict to foster a more cohesive future evidence-base, and in particular, robust prevalence figures from conflict-affected and displaced populations.

Sex trafficking is a prevalent and ever-increasing social problem. While public awareness efforts have intensified and proliferated, misperceptions around sex trafficking remain, largely reinforced by misinformation and myths associated with the issue. Continued research is necessary to dispel those myths and bring about trafficking awareness that serves to inform communities and safeguard potential victims. This study narrows the focus to a particular aspect of how misperceptions aid in the obtaining of victims of sex trafficking and strengthen the hold sex traffickers have on their victims. Specifically, this work explores the experiences of women in the adult film industry and how their perceptions of trafficking in the industry are sometimes incongruent with the definition of sex trafficking, legal tenets of sexual consent, and the reality of the situations and environments they inhabit; all of which benefit and empower the trafficker. Utilizing the narratives of women in various stages of the adult film industry, this qualitative study investigates the dynamics of how traffickers use fraud and manipulation as techniques to control their victims. The findings reveal that, while not everyone in the industry is trafficked, there are significant instances where sexual exploitation is present and perpetuated through enforced and calculated fraud and misinformation that is the trademark of sex trafficking. This research underscores the issues of sex trafficking that are evident in the adult film industry and calls for greater advocacy, awareness, and education to protect women from exploitation, ensuring that all participants in adult entertainment are working with free will and true consent.

IntroductionEstimates suggest that hundreds of thousands of sex trafficking victims live in the United States. Several screening tools for healthcare professionals to identify sex trafficking victims have been proposed, but the effectiveness of these tools in the emergency department (ED) remains unclear. Our primary objective in this study was to evaluate the feasibility of a screening survey to identify adult victims of sex trafficking in the ED. We also compared the sensitivity of emergency physician concern and a screening survey for identifying sex trafficking victims in the ED and determined the most effective question(s) for identifying adult victims of sex trafficking.MethodsWe enrolled a convenience sample of medically stable female ED patients, age 18–40 years. Patients completed a 14-question survey. Physician concern for sex trafficking was documented prior to informing the physician of the survey results. A “yes” answer to any question or physician concern was considered a positive screen, and the patient was offered social work consultation. We defined a “true positive” as a patient admission for or social work documentation of sex trafficking. Demographic and clinical information were collected from the electronic medical record.ResultsWe enrolled 143 patients, and of those 39 (27%, 95% confidence interval [CI] [20%–35%]) screened positive, including 10 (25%, 95% CI [13%–41%]) ultimately identified as victims of sex trafficking. Sensitivity of the screening survey (100%, 95% CI [74%–100%]) was better than physician concern (40%, 95% CI [12%–74%]) for identifying victims of sex trafficking, difference 60%, 95% CI [30%–90%]. Physician specificity (91%, 95% CI [85%–95%]), however, was slightly better than the screening survey (78%, 95% CI [70%–85%]), difference 13%, 95% CI [4%–21%]. All 10 (100%, 95%CI [74%–100%]) “true positive” cases answered “yes” to the screening question regarding abuse.ConclusionIdentifying adult victims of sex trafficking in the ED is feasible. A screening survey appears to have greater sensitivity than physician concern, and a single screening question may be sufficient to identify all adult victims of sex trafficking in the ED.

This study looked at child sex trafficking in 3 regions in Texas: Houston, Lubbock and along the Texas-Mexico border. Researchers with IDVSA and the Bureau of Business Research at the IC2 Institute investigated the pathways to childhood sex trafficking, risks of victimization, and interactions with social services, among many other factors. A total of 466 research participants were interviewed from among at-risk community segments. From that group, 71 participants indicated they were exploited for commercial sex before the age of 18 — with the average age of first victimization being 15 — and 46 of them agreed to be interviewed in-depth about their experiences entering, exiting and during their exploitation. A majority of the 46 children and youths had interacted at some point with social service providers and systems tasked with keeping them safe but had not been identified at the time as victims of trafficking and exploitation. The report below provides guidance to policymakers, service providers and law enforcement officials as they seek to strengthen the safety net for at-risk youths and prevent trafficking with recommendations for specific prevention and intervention models. The study empirically supports the experiences of those who have been working directly with minor and youth victims.