Interpersonal Violence, Behavioral Health, and the Need for Improved Healthcare Delivery for Sex Trafficking Victims

By | December 13, 2017
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Each year, millions of people around the world are victims of human trafficking. In the US, the National Human Trafficking Hotline, which maintains one of the most extensive data sets, received 13,897 calls in 2017, with 4,460 human trafficking cases reported. Of the 4,460 cases reported, 3,186 cases were of sex trafficking and 689 cases were of labor trafficking. Of the reported cases, 3,698 of the victims were women, 607 were men, and 53 were gender minorities.

The Trafficking Victims Protection Act of 2000 defines human trafficking as:

  1. 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; and
  2. 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.

A recent article by Ravi, Pfeiffer, Rosner, and Shea published in this month’s issue of Medical Care reports qualitative research based on in-depth interviews with 21 sex trafficking victims who were incarcerated in the New York City jail system, specifically the women’s jail on Rikers Island. Ravi and colleagues provide information on the violence experienced by victims and their health needs, as well as advice to the healthcare system on helping victims.

Sex trafficking survivors in the study reported emotional, physical, and sexual violence from traffickers and the buyers who paid for sex. Some examples of violence included “being beaten to unconsciousness, gang raped, choked, burned, imprisoned, threatened with weapons, threatened to harm loved ones, deprived of sleep, food, and clothing, and witnessed violence perpetrated against other trafficked women and girls.” Many victims also reported financial quotas for money they were required to generate daily, and violent repercussions were reported if those quotas were not met. Results demonstrated that substance use was the most common method of coping with trafficking-related trauma.

Additionally, 25% of victims reported using substances to address other trafficking-related stressors — cocaine to help victims fight the sleep deprivation required to meet certain financial quotas, and heroin to numb the physical pain of sex. One victim noted:

It was much more difficult to work sober because I was dealing with the emotions or the pain that I was feeling during intercourse, because when you have sex with people 8, 9, 10 times a day, even more than that, it starts to hurt a lot. And being high made it easier to deal with that and also it made it easier for me to get away from my body while it was happening, place my brain somewhere else.

Survivors also provided healthcare delivery advice, including improving rapport with front desk staff, training providers to communicate with compassion and without judgment, normalizing the conversation around sex trafficking and sexuality, and providing wrap-around services in healthcare settings. Wrap-around services often constitute in-house therapists and social workers for “warm hand-offs” for patients who need immediate mental health support. Wrap-around services might also include access to food or shelter support, which would benefit human trafficking survivors in addition to various other vulnerable populations.

Human trafficking is something that continues to plague our local, national, and international communities. In the midst of these tragic circumstances, the healthcare system has the opportunity to provide positive interactions and assistance for survivors of human trafficking.

[Editor’s note: The paper discussed in this post was originally presented at the American Public Health Association’s 2016 annual meeting as part of the Student Awards session sponsored by the Medical Care Section. In a special arrangement with Medical Care, the researchers were invited to submit their work to the journal for full publication. For more, check out the accompanying editorial by the Student Award organizers Julie Zito and Linda Green.] 

Rebekah Rollston

Rebekah Rollston

Rebekah L. Rollston, MD, MPH, is a Family Medicine Physician at Cambridge Health Alliance, Instructor in Medicine at Harvard Medical School, Faculty of the Massachusetts General Hospital Rural Health Leadership Fellowship (in partnership with the Indian Health Service Rosebud Hospital), Editor-in-Chief of the Harvard Medical School Primary Care Review, and Head of Research at Bicycle Health, a digital health startup that provides biopsychosocial treatment of opioid use disorder via telehealth. She earned her Medical Degree from East Tennessee State University Quillen College of Medicine (in the Rural Primary Care Track) and her Master of Public Health (MPH) from The George Washington University Milken Institute School of Public Health. Dr. Rollston’s professional interests focus on social determinants of health & health equity, gender-based violence, sexual & reproductive health, addiction medicine, rural health, homelessness & supportive housing, and immigrant health.
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About Rebekah Rollston

Rebekah L. Rollston, MD, MPH, is a Family Medicine Physician at Cambridge Health Alliance, Instructor in Medicine at Harvard Medical School, Faculty of the Massachusetts General Hospital Rural Health Leadership Fellowship (in partnership with the Indian Health Service Rosebud Hospital), Editor-in-Chief of the Harvard Medical School Primary Care Review, and Head of Research at Bicycle Health, a digital health startup that provides biopsychosocial treatment of opioid use disorder via telehealth. She earned her Medical Degree from East Tennessee State University Quillen College of Medicine (in the Rural Primary Care Track) and her Master of Public Health (MPH) from The George Washington University Milken Institute School of Public Health. Dr. Rollston’s professional interests focus on social determinants of health & health equity, gender-based violence, sexual & reproductive health, addiction medicine, rural health, homelessness & supportive housing, and immigrant health.