Major sporting events like the Olympics and the Super Bowl are often surrounded with excitement and drama. This year’s Olympics in Brazil was buzzing with talk of the Zika virus. The Super Bowl was fraught with drama surrounding Beyoncé’s halftime performance. It seems like everyone has something to say about these topics. But, one thing spectators don’t talk about is an unseen drama that often surrounds major sporting events: sex trafficking.
It is suggested that major events such as these are associated with an increased influx of sex workers and sex trafficking. Although there is a tendency to characterize sex trafficking as an exotic enterprise, there is a significant problem with sex trafficking in the United States. It is projected that between 100,000 to 150,000 persons, mostly women and children, are enslaved in the sex labor industries in the United States alone. Being from the Upper Midwest, it is of particular interest to me that sex trafficking is prevalent in this area, with Minneapolis among the top thirteen cities in the United States with the highest concentrations of human trafficking. Even closer to home for me is Minot, North Dakota, which has seen a steady and dramatic increase in sex trafficking and prostitution since 2011 with the rise of the oil boom in the Bakken. Even the Republican Convention saw a supposed rise in sex trafficking! As health care workers, we are in a unique position to identify victims and not only provide medical care, but also to provide other resources for victims who wish to escape. How can we identify, protect and treat victims of sex trafficking?
The first step to identifying victims of sex trafficking is to recognize presenting signs and symptoms. The sequelae to physical and mental health associated with sex trafficking may be the presenting complaints of patients who are victims of trafficking. Physical health manifestations include addiction to drugs or alcohol, physical injuries from constraints or abuse, bruises and scars in uncommon places, sexually transmitted diseases, pelvic pain, rectal trauma, pregnancy, sterility, miscarriages and forced abortions. Mental health effects include dissociated states, shame, grief, fear, distrust, self-hatred, phobias, panic attacks, suicidal thoughts, suicide, extreme anxiety and depression. Often victims of sex trafficking do not have adequate access to health care, and those that do seek care may do so after the problem has been uncontrolled for a long time. A study done by the Family Violence Prevention Fund interviewed 21 victims of trafficking, and found that 28 percent of those victims had some kind of contact with the health care system while they were captive, yet were not identified as victims. Victims may go unrecognized because of a general lack of awareness to sex trafficking as a health issue among providers, or because health care providers may not be trained in managing victims appropriately.
Another potential barrier to recognizing victims of trafficking is communication. Communication barriers can and should be overcome. If a patient who does not speak English comes in with another person as their ‘translator,’ it is always important to use a professional translator instead and to interview the patient alone, as traffickers inevitably control the patient’s responses. Although ideally, health care professionals would be able to help victims once identified, it is important that these professionals are educated and trained to do so, as intervention can be a dangerous undertaking for all involved parties. Thus, the United States Department of Health and Human Services Office on Trafficking in Persons has published the “Rescue and Restore Campaign Tool Kits” for health care providers. It consists of documents that describe tips for identifying and helping victims, useful screening questions, common health problems in victims and other helpful resources.
Should you find yourself suspecting that your patient is a victim of human trafficking, appropriate screening questions may include: Can you leave your job or situation if you want? Have you been threatened if you try to leave? Have you been physically harmed in any way? Is anyone forcing you to do anything that you do not want to do? More screening questions can be found in the “Rescue and Restore Campaign Tool Kits.” Witnesses should call the National Human Trafficking Resource Center at 1-888-3737-888 to report victims and find local resources and social service organizations to help victims of sex trafficking. As health care professionals, we have a unique opportunity to know the most vulnerable and secret aspects of patients’ lives. The unfortunate truth is that for some people, that secret is that they are victims of sex trafficking.