Identifying Health Experiences of Domestically Sex-Trafficked Women in the USA: A Qualitative Study in Rikers Island Jail

Abstract

While sex trafficking in the USA is a significant medical and public health issue, there is sparse data on the healthcare needs of and access for this population. This study was designed to identify experiences of domestically sex-trafficked women regarding healthcare access, reproductive health, and infectious diseases while trafficked. Trafficking survivors incarcerated in New York City's Rikers Island women's jail participated in audio-recorded interviews between July and September 2015. Recordings were transcribed, and a content analysis was completed to identify health-related themes. Twenty-one women ranging from 19 to 60 years old were included in this study. Reasons for accessing care included sexually transmitted infections (STIs) and HIV testing, unintended pregnancies, traumas, and chronic diseases. Emergency departments, Planned Parenthoods, and jails were common care sites. Traffickers and substance use impeded care and access to follow-up. Unintended pregnancy and STIs resulted in trafficker-perpetrated violence. Condoms, the most common form of contraception and HIV prevention, were inconsistently negotiated due to financial and violent consequences. These findings demonstrate that domestic sex trafficking survivors experienced chronic and acute health issues while trafficked and multiple barriers to care. Substance use and financial vulnerabilities furthered unintended pregnancy and infection risk. These findings can inform future research regarding healthcare access and practices for domestically trafficked women.

Understanding Commercially Sexually Exploited Youths' Facilitators and Barriers toward Contraceptive Use: I Didn't Really Have a Choice

“…19 Additionally, the available research suggests the value of adopting a standardized, evidence-based, trauma-informed approach that incorporates gender, cultural competencies, and survivor input. 6,20 Yet the question remains how best to implement such an approach. Greenbaum et al (2018) applied the Center for Disease Control's Social-Ecological model as a framework for implementing human trafficking prevention strategies for health care professionals.…”

“…Available literature on the medical needs of CSEY, although sparse, has focused on reproductive health and contraception use among adult survivors of commercial sexual exploitation. 5,6,7 A study involving female survivors of commercial sexual exploitation (n=21, age range 18-60 years) detained in a New York City jail described survivors' contraception use while trafficked. Condoms were identified as the most common form of contraception.…”

“…Condoms were identified as the most common form of contraception. 6 Additionally, one of the largest studies involving female survivors of commercial sexual exploitation (n=107, age range found that while trafficked, 71% reported at least one pregnancy, 21% reported five or more pregnancies, 55% reported at least one abortion, 30% reported multiple abortions, and 55% had at least one miscarriage. 5 Several participants with histories of pregnancy reported at least one forced abortion by their trafficker.…”

Fierce Autonomy: How Girls and Young Women Impacted by Commercial Sexual Exploitation Perceive Health and Exercise Agency in Health Care Decision-Making

“…The continuum of harmful experiences endured in childhood and throughout the course of exploitation often results in complex trauma that leads to multifarious health care needs. Prior studies have confirmed survivors' significant health-related risks and needs, and documented frequency of using and barriers to accessing health care services (Barnert, Kelly, Ports, et al, 2019;Ijadi-Maghsoodi et al, 2018;Lederer & Wetzel, 2014;Ravi et al, 2017a;Varma et al, 2015). Though health care treatment may be available to youth and young adults affected by CSE, a multitude of structural, environmental, and internal barriers to utilization and engagement (i.e., "buy-in") into treatment remain .…”

“…Though health care treatment may be available to youth and young adults affected by CSE, a multitude of structural, environmental, and internal barriers to utilization and engagement (i.e., "buy-in") into treatment remain . As such, the lack of timely care may lead to sequelae such as suicidality, worsening mental and physical health issues, and destructive substance use Greenbaum & Crawford-Jakubiak, 2015;Ijadi-Maghsoodi et al, 2018;Powell et al, 2018;Ravi et al, 2017aRavi et al, , 2017b.…”