Sex Trafficking of Women and Girls in Three Major Cities in the United States: Implications for Local Health Systems

Background: Human trafficking for commercial sexual exploitation leads to devastating physical and psychological outcomes and poses serious public health risks including transmission of sexually transmitted infections such as HIV. Of the estimated 14,500-17,500 individuals trafficked annually into the United States, 80% are female and 70% enter the commercial sex industry. Domestic minor sex trafficking through forced prostitution is also being increasingly recognized as a problem among American youth.

Objectives: We examine sex trafficking of women and girls in three major U.S. cities in order to identify potential future anti-trafficking roles of local health systems.

Methods: Using comparative case study methodology, we conducted semi-structured interviews of 67 key health and non-health informants in Los Angeles, New York and Boston. Main constructs include prevalence, composition, mechanisms, and determinants of sex trafficking; health consequences and needs of victims; current local health system response; and barriers to greater health system participation. Data analysis was carried out using qualitative software.

Results: Sex trafficking of women and girls involves highly complex, yet systematic mechanisms of recruitment and control. Multiple factors facilitate trafficking including childhood sexual abuse, lack of income, and demand for commercial sex. Currently, health services for victims are patchy and poorly coordinated. Low levels of awareness of sex trafficking among health professionals and victims' health-seeking behaviors are among several factors operating as barriers to a greater health response.

Conclusions: Modeled after the child abuse and domestic violence movements, a more comprehensive and coordinated health system response to sex trafficking may help alleviate its devastating effects on vulnerable women and girls. Education and training programs for health professionals are needed. As frontline providers, emergency and other community-based physicians are uniquely positioned to engage not only in routine treatment of trafficking victims, but also in prevention, victim identification, and referral activities. This may represent a distinct opportunity for the medical and public health communities to introduce trafficking as a public health policy issue and lead the medical community's efforts in addressing this form of interpersonal violence.