A few years ago when I was working at a charter school in upstate New York, one of my students was caught “prostituting herself” to men she was messaging online. When asked, she said she was doing so for a 30-year-old man she claimed was her boyfriend. Word about this traveled quickly at school. Students talked about her behind her back and called her a “hoe.” Staff members rolled their eyes at the news, not surprised or concerned this had happened. She was labeled as a teen prostitute who needed to be reprimanded. All of the blame and responsibility fell on her. Nobody was able to see through their societal bias and view the situation for what it really was.
This girl was 14 years old. She had experienced sexual and physical abuse growing up. She was raped by a stranger at age eight and again at 10. Her mother was in jail, and her father had been incarcerated her whole life. She had bounced around several foster homes and had run away from those homes many times in the past few years. The man who she claimed to be her “boyfriend” was a known pimp in the community, and had a reputation of being dangerous. By all legal standards she was a victim of sex trafficking. Unfortunately, stories like this are far too common in the United States. My student was among the many who slip through the cracks and fall into a cycle of abuse to which our society, until recently, has turned a blind eye.
The term “trafficking” has become a buzz word, popularized by politicians, humanitarian efforts and movies like “Taken.” While this is a step towards increasing awareness, many still believe that trafficking occurs mostly in the third world, or that all victims found in the United States have been smuggled into the country. The reality is that while many victims are trafficked into the United States every year (the Department of Justice estimates 17,500), the number of US citizens who are trafficked for sex is on the order of hundreds of thousands.
According to US law, sex trafficking is defined as “a commercial sex act that is induced by force, fraud or coercion, or where the person performing the act is under 18 years of age,” which would make any prostituted youth under 18 a trafficking victim. Shockingly, in the United States, the average age of entry into prostitution is 12 to 14 years old. Though the focus has largely been on girls, boys are also trafficked — in some cities in equal numbers to girls. Domestic sex trafficking occurs in all 50 states, and surprisingly even in small towns. Children are sold on the streets, on the internet through websites like backpage.com, in strip clubs, through “massage” businesses, and can be moved around states and across the country. The trafficker may be a single pimp, a family member, a gang or the youth can be exploited through a social network.
The value of the sex industry is estimated at $9.8 billion, and for traffickers it is a high demand, low investment business. A trafficker can make upwards of a quarter million dollars per victim per year — purchasers of sex are willing to pay a premium for services, and trafficked youth often have quotas for how much money they need to make each night. A recent study on the underground sex economy found that the sex industry was more lucrative for traffickers compared to selling drugs or weapons. And contrary to popular belief, most youth are expected to turn over all of their earnings to their trafficker at the end of each night, often facing violence if they fail to do so.
Who are the victims of domestic sex trafficking?
While any youth can be sexually exploited, over 70 percent of children who are trafficked for sex in America have experienced prior physical or sexual abuse, time in foster care, or have run away from home. The lack of family support and compassion in their lives makes these youth especially vulnerable. A predominating view of the public is that these “teen prostitutes” have chosen to sell their bodies. However, if you look into their histories and the options available to these children, the word “choice” becomes irrelevant. In a study that interviewed a few hundred sexually exploited youth in New York City, a majority of youth stated they constantly felt shame, stigma, and were unhappy with their situation, and over 85 percent stated they would leave if given an opportunity.
From a medical standpoint, we know that child abuse inhibits proper development of certain brain structures, including decreased volume of the prefrontal cortex which controls advanced reasoning, social and moral judgment. This speaks to the decision making capacity of a sexually exploited youth who has experienced prior abuse. As a society we do not trust the average 15-year-old to vote, drive or drink alcohol. Yet we are quick to point a finger at a 14-year-old prostitute, who has been repeatedly exploited and likely experienced more past hardships than most ever will.
Why should we care as future physicians?
Victims of sex trafficking seek health care, both while trafficked and as survivors. It is important that physicians are aware of the issue, can properly screen for victims in the clinic, and know where to refer trafficked youth. In a survey of trafficked youth in New York City, over 75 percent had visited a doctor in the last six months, and most reported that they saw doctors regularly. Victims come in to the clinic for a variety of reasons, including sexually transmitted infections, pregnancy, trauma, neurologic problems or, most commonly, for a general check-up.
Physicians are in a unique position to build rapport and trust with this population in a safe setting. If trained on the signs of a trafficking victim, doctors can be a part of the crucial first step of removing a child from exploitation. It is also important for physicians to provide non-judgmental and trauma informed care for survivors of trafficking. This is common practice for the more obvious long-term issues of sex trafficking, such as mental health care and PTSD. However, survivors frequently need services from specialists such as orthopedists and neurologists. It is important that any doctor providing care to a survivor is familiar with the issue and is careful not to re-victimize the patient during the visit.
As medical students, we can educate ourselves through trainings and tools available online that will prepare us to work with victims or survivors of trafficking during clinical years, in residency and throughout our future careers. The Polaris Project, Shared Hope International and Walk Free are great sources to learn more about human trafficking. Physicians Against the Trafficking of Humans and the National Trafficking Resource Center (NHRTC) have free online trainings that walk you through identifying and caring for this population. Finally, the NHRTC has a list of state by state resources so you can educate yourself on where to refer potential victims of trafficking locally. With these tools in hand we will be able to assist the next victim or survivor who walks into our care.