Child Sex Trafficking and Commercial Sexual Exploitation: Health Care Needs of Victims

Abstract

Child sex trafficking and commercial sexual exploitation of children (CSEC) are major public health problems in the United States and throughout the world. Despite large numbers of American and foreign youth affected and a plethora of serious physical and mental health problems associated with CSEC, there is limited information available to pediatricians regarding the nature and scope of human trafficking and how pediatricians and other health care providers may help protect children. Knowledge of risk factors, recruitment practices, possible indicators of CSEC, and common medical and behavioral health problems experienced by victims will help pediatricians recognize potential victims and respond appropriately. As health care providers, educators, and leaders in child advocacy, pediatricians play an essential role in addressing the public health issues faced by child victims of CSEC. Their roles can include working to increase recognition of CSEC, providing direct care and anticipatory guidance related to CSEC, engaging in collaborative efforts with medical and nonmedical colleagues to provide for the complex needs of youth, and educating child-serving professionals and the public.

Care of the Adolescent After an Acute Sexual Assault

“…It is advised that adolescents who disclose a previous assault be asked about the dynamics of their relationships (eg, exploitative, controlling, nonconsensual). 66 Exploring the perceptions and attitudes of adolescents regarding nonconsensual sexual encounters is important. Because there may have been voluntary participation before an assault occurred, adolescents might think that "consent" cannot be withdrawn.…”

“…Physicians should consider the possibility that the adolescent could be a victim of human trafficking and commercial sexual exploitation and ask appropriate questions, such as "Has anyone ever asked you to have sex in exchange for something you wanted?" 66 In addition, the physician should address the physical, psychological, and safety needs of the adolescent victim of sexual violence and be aware that responses to sexual assault can vary. It is advised that adolescents be asked directly whether they have safety concerns related to the perpetrator, the perpetrators' friends, or others.…”

Global Human Trafficking and Child Victimization

“…In 2015, the AAP published a clinical report on child sex trafficking, with a focus on domestic victims. 31 This report has been promoted at national and regional conferences. Additionally, there are emerging international efforts to educate health care and other professionals on human trafficking and professional organizations dedicated to training, advocacy, and policy.…”

“…46,47 However, it is important for health care professionals all over the world to be alert to possible indicators of sex trafficking, and these are described in detail elsewhere. 31 With respect to labor trafficking, potential indicators may include a recent history of immigration, unfamiliarity with the city or town where the clinic or hospital is located, or apparent control and intimidation by an accompanying adult. Additional potential indicators are listed in Table 3.…”

Groupthink: How Should Clinicians Respond to Human Trafficking?

“…Human trafficking victims are marginalized and may be subject to repeated physical assault or sexual violence and, therefore, merit our care and concern. In most US states, adolescents can be prosecuted for prostitution [11]; young people who are trafficked for sexual exploitation-which may be unknown to clinicians-may be viewed as criminals, although in fact they are victims coerced into servitude [11,12]. The very conditions of confinement and abusive treatment can produce psychological symptoms and behaviors that can be mistaken for personality disorders [13], which are stigmatic [14].…”