By Hilary Friedlander
Editors' Note: Since publication of this piece, a reader drew our attention to several articles from The Washington Post, which call into question the numbers of domestic sex traffic victims cited in this blog and the methods used to estimate them.
In the United States, some 100,000 to 300,000 children and adolescents are victims of domestic sex trafficking--and that's a conservative estimate. When I first heard this I felt shock and disbelief. How can this be such a pervasive problem in our own country, and why are we so unaware of it?
That was in April 2015, at the centennial meeting of the American Medical Women's Association (AMWA) in Chicago, which I'd attended with Albert Einstein College of Medicine AMWA board members Rachel Cohen, Yuliana Noah, Sarah Marx and Rachel Zolno.
Following the event, we resolved to dedicate our efforts to raising awareness at Einstein about domestic sex trafficking. We knew our colleagues might be just as uninformed as we had been. Later that year, we developed research on how to best teach sex-trafficking issues to medical school students.
We tested three educational modalities (lecture, small-group workshop, individual video watching) to learn which of these would best increase awareness and knowledge of sex trafficking among first- and second-year medical students. All three proved effective. In July our board traveled to Vienna, Austria, and presented our research at the International Congress of the Medical Women's International Association.
Defining the sex-trafficking problem
Most sex-trafficking victims in this country are U.S. citizens. According to the Trafficking Victims Protection Act of 2000, sex trafficking is defined as "the recruitment, harboring, transportation, provision, or obtaining a person for the purpose of a commercial sex act, in which the 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." These acts include pornography, prostitution, sex tourism, strip clubs, escort services, brothels, massage-parlor work, truck-stop "companions" and Web and social-media sex. The average recruitment age of victims is 12 to 14, though there have been cases reported involving children as young as 7.
Significantly for physicians, one study found that 28 percent of all victims present to healthcare providers while being trafficked. In a survey of trafficked youth in New York City, 75 percent of the victims were found to have visited physicians in the previous six months.
This puts doctors in a unique position to identify victims--who may have risk factors suggested by their gender, age, economic status or history of abuse--and provide important care and resources.
Spotting signs of sex trafficking
There are some red flags in a patient's presentation and healthcare history that warrant further questions: poor eye contact; anxiety; a scripted or mechanically recited history; being a runaway or in the foster-care system; sexual promiscuity; recurrent STIs; multiple pregnancies; malnourishment; substance addiction; weather-inappropriate clothing; bruising, scars, or burns in hidden places; a tattoo of a pimp's name or a strange symbol; the inability to provide an address; and a companion who refuses to leave the examination room.
- Where do you live?
- Do you eat, sleep and work all in the same place?
- Can you leave your work or job if you want to?
- Have you been threatened or hurt? Has anyone threatened your family?
- Have you ever exchanged sex for food, shelter, drugs or money?
- Would you know how to seek help if you needed it?
- Establish trust and confidentiality.
- Make it a policy to see the patient alone.
- Make it a policy to schedule follow-up visits.
- Know the laws for mandatory reporting in your state.
- Call the national sex trafficking hotline at 888-373-7888.
- Know your local resources; visit polarisproject.org to search for resources by zip code.
- Avoid the "rescue fantasy. Our role is not to save anyone but to assist - and the patient needs to be an active member in the decision making.
What more can be done? Join organizations such as Physicians Against the Trafficking of Humans (PATH), a subcommittee of AMWA that seeks to raise awareness about human trafficking and offers resources to healthcare providers.
Healthcare providers can also support legislative action. On November 4, Governor Andrew Cuomo of New York signed legislation to help physicians and healthcare workers better identify human-trafficking victims. This critical legislation--a joint effort of AMWA's PATH team and New York State assembly member Amy Paulin--requires every "general hospital, public health center, diagnostic center, treatment center or outpatient department to establish written policies and procedures for the identification, assessment, and appropriate treatment or referral of persons suspected of being human trafficking victims as well as training for physicians, nurses and other clinical care personnel in service units in those facilities regarding those policies and procedures."
Einstein's AMWA student group has hosted several workshops and lectures where medical students learn about this problem. We believe that the most effective and sustainable way to expose students to this issue is to make it a part of the permanent curriculum in the preclinical years. It's crucial not only that we, as part of the next generation of physicians, are aware of the scope of sex trafficking in the United States, but that we also have the tools and resources to identify victims so that when we intervene, we are prepared.
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- HEAL Trafficking, a public health organization devoted to ending human trafficking and supporting its survivors;
- Polaris, which fights slavery. In 2007, Polaris launched the National Human Trafficking Hotline (888-373-7888), which serves victims and survivors of human trafficking and the antitrafficking community in the United States;
- SOAR, a training program for healthcare and social-service providers designed to educate people how to identify, treat and respond appropriately to potential victims of human trafficking.
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Ms. Friedlander is a third-year medical student at Albert Einstein College of Medicine. She is the current region 2 (NY/NJ) director of the American Medical Women's Association (AMWA)'s national student division and past president of Einstein's AMWA chapter. Her work with AMWA and sex trafficking has led to research exploring different educational modalities for introducing the issue of sex trafficking into medical school curricula. She also serves as education co-chair of the Physicians Against the Trafficking of Humans (PATH)'s national student division. She plans to pursue a career committed to women's health.