Introduction
Sex trafficking is a form of modern-day slavery that occurs when someone uses force, fraud or coercion to produce a commercial sex act, which includes prostitution, pornography or sexual performance done in exchange for any item of value, such as money, drugs, shelter, food, or clothes. If the victim is a minor under the age of 18, it is considered trafficking even without the presence of force, fraud, or coercion (“Sex Trafficking”, 2018). It thrives because the demand is constantly high, fueled by the buyer who has money, traffickers who exploit their victims for this money, and the victims, who are bought and sold for the profit. Traffickers find their victims through social media, walking around their city, clubs and bars, and even schools.
These victims are often young teens who appear vulnerable, and are lured with promises of protection, love, shelter, advancement of career, money, anything they value and need. This commonly escalates to violence, fear tactics, threats and intimidation to force compliance. These victims are often lost due to their silence through manipulation and fear or misidentified, so they are punished or judged instead of helped. These victims are seen by healthcare professionals for drug and alcohol abuse, domestic violence, delinquency, teenage pregnancy, abortion, and STDs, but rarely recognized as victims (“The Problem”, 2019). This is where the nursing role comes in.
Background and Review of Literature
The United States Department of State puts out an annual report titled “Trafficking in Persons Report” that details the current data by country, as well as offers essays on relevant issues surrounding trafficking. Their 2018 annual report explained that the most vulnerable populations in the United States are
“children in the child welfare and juvenile justice systems; runaway and homeless youth; unaccompanied children; American Indians and Alaska Natives; migrant laborers, including undocumented workers and participants in visa programs for temporary workers; foreign national domestic workers in diplomatic households; persons with limited English proficiency; persons with low literacy; persons with disabilities; LGBTI individuals; and participants in court-ordered substance use diversion programs” (Trafficking in persons report: June 2018, 2018, p. 449).
Multnomah County reported that the Oregon U.S. Attorney’s Office commissioned a 2013 study conducted by Dr. Chris Carey of Portland State University to understand the scope of Portland’s problem with sex trafficking. The study found 469 minor victims in the metropolitan area alone. They found that the average age of entry into the sex industry was 13 years old (Weaver, 2018), while Shared Hope International found the national average to fall between 14 and 16 years of age (“The Problem”, 2019).
Many victims turn to traffickers due to “sustained unemployment, unpaid debt, and desperation to provide for themselves and their children” (“The Facts”, 2018). The Institute for Women’s Policy Research explains the cost to these victims as significant and life-long, resulting in wage theft, high cost of care for physical, sexual and psychological abuse, and diminished economic opportunity due to a lack of legal work history (Gonzales Bocinski, 2017). This abuse results in $99 billion in illegal profits each year for traffickers (International Labor Office 2014), and is the third largest source of income for organized crime, enslaving twice as many people today as during the African slave trade (Dovydaitis, 2010).
Nurses have a unique opportunity to intercept this pattern of abuse, as over 85% of sex traffic victims have contact with a health care provider for care in any year (Baker & McDade, 2019). Nurses are in the front line of identifying these victims and navigating their safety and health needs, as well as implementing research of best practices and championing public policy initiatives at a local, state, and national level (Speck, Mitchell, Ekroos, Sanchez, & Messias, 2018). An example of a national legislative initiative would be the Trafficking Victims Protection Reauthorization Act, which was passed as an amendment to the Violence Against Women Act, establishing and strengthening programs to ensure U.S. citizens do not purchase products made by victims of human trafficking, and to prevent child marriage (“Survivor Support”, 2019).
State policymakers should dedicate resources to specialized training for providers, which on a local, clinic-based systems level would be implemented by ensuring staff who have direct patient contact receive regular training on how to identify coercion tactics to reduce misconceptions about victims and are educated in immigration rights of victims (Gonzales Bocinski, 2017). “Economic security is safety. Sex trafficking victims, like other survivors of violence against women, need a supportive justice system and robust services that provide practical, meaningful, and realistic pathways to safety and independence,” Gonzalez Bocinski said.
Polaris Project is a nonprofit organization based in Washington DC that is working to eradicate human trafficking, helping survivors restore their freedom and preventing more victims through use of data and technology to stop traffickers. They have multiple initiatives for the cause, including survivor support. This is where the nursing role can impact change in the lives of trafficking victims. As nurses, we need to focus on non-judgmental, trauma informed care by meeting our patients where they are to empower them to make their own decisions for their future. Nurses need to be trained in recognizing trafficking victims that won’t speak up for themselves (“Survivor Support”, 2019). The National Human Trafficking Resources Center has identified common warning signs for nurses to pay attention to, including presence of debris or trauma in vagina and/or rectum, problems with jaw or neck, inability to keep appointments, lack of identification, tattoos or branding, and being accompanied by a person who does not allow them to speak or be alone during care (“Human Trafficking”, 2016).
Your Analysis of the Issue and Its Significance
The result of sex trafficking is incredibly expensive on a societal level with the health care and justice systems taking most of the weight of the problem, as victims of trafficking experience poor immediate and long-term health (Speck, Mitchell, Ekroos, Sanchez, & Messias, 2018). In 2016, the American Nurses Association deemed human trafficking a public health and human rights crisis, which pushed a goal of ensuring all nurses have the skills to identify and refer victims of trafficking to the proper resources (ANA Center for Ethics and Human Rights, 2016).
These victims are particularly difficult to recognize as they are trained by their captors to keep their secret by all means. They and sometimes their families are threatened with violence if they don’t comply, and many are “tested” by their traffickers by having a client offer them a way out, and then punishing them severely for accepting the false offer (Sabella, 2011). For this reason, I see the impact of this issue on the healthcare delivery system in general as victims going unseen and the systems we have in place failing them much too often. They then come back sicker, with worse injuries, deeper trauma, and lower chances of survival. The impact on nurses is one of heavy obligation to be educated and aware of the weight of this problem in our society and of our role in recognizing and stopping the cycle for victims.
Responding
Inconsistency in policy, procedure, and practice among different facilities, as well as state and federal regulations has resulted in 87% of trafficked person having contact with health care providers without being recognized as a victim (Speck, Mitchell, Ekroos, Sanchez, & Messias, 2018). Because of this, the most important action I see for myself as a student nurse as well as future nurse is being aware of these warning signs and using my training to ask appropriate questions in appropriate settings to improve the chance of victims being seen by me. One of the most common issues I came across in my research was how invisible these victims can be. There is always something else you can blame for any one of those warning signs, or there may not even be any warning signs. One of the tactics I learned and appreciated was asking women in their screenings at appointments about their sexual history including both consensual and non-consensual sex. Any opportunity that can be given to a person to open up about abuse they’re experiencing while building trust is crucial.
A University of California Davis pilot program found that identifying adult victims of sex trafficking the emergency department was possible and simply with a screening survey that provided much better results than physician recognition alone. They found that answering “yes” to a single one of their 14 survey questions was sufficient to identify all adult victims of trafficking (Mumma, Scofield, Mendoza, Toofan, Youngyunpipatkul, & Hernandez, 2017). For this reason, my larger goal as a nurse would be ensuring a screening like this is being implemented in the hospital or clinic I work in, by researching the issue and lobbying as needed within my facility for improvement. I will also confirm that the National Human Trafficking Resource Center phone number is visible in bathrooms, exam rooms, and anywhere else victims may find themselves able to see the resource.
Reflection
I selected this topic because I have heard for so long how prevalent it is in Portland and was offered the opportunity this term to learn more about the issue through Gresham Police Department. I knew that I would encounter victims of trafficking in my role as a nurse, but I had no idea how common it would likely be or how difficult it would be to recognize. It’s shocking and upsetting to think how likely it is that I’ve already met someone who was or still is a victim. I see this as an incredibly important leadership because the number of people affected is astounding, the cost and damage to their lives is devastating, and the signs can be far too innocuous to notice without being intentional in your analysis. Learning about these clinical signs, and about how to recognize a trafficker or victim has impacted my nursing practice as well as my personal life enormously in the way I view people around me.
I am much more aware of what I’m looking for and how to see it. I will practice ways to speak with people I encounter who display even one sign of trafficking or abuse and make discussing resources and safe sex a regular part of my practice. This issue is particularly frightening due to its commonly silent and invisible nature. It is our obligation as nurses to fight on behalf of these victims by giving voice to the voiceless and hope to the hopeless.
