Health-care reform has dominated policy debates. While human trafficking has not been at the front of these debates, human trafficking something. Though there are serious health consequences from trafficking itself - including STDs and STIs, broken bones, burns, malnourishment, and psychological trauma -, victims often do not have access to proper medical care until their situation becomes serious. At the same time, medical professionals may be the only person a victim does come in contact with. Service providers also need to be aware of their own mental health needs when working with victims and survivors; secondary trauma is an issue often ignored. The relationship between health issues, health-care, and human trafficking is complex and multifaceted.
Meg: Sexually transmitted diseases are drastically high among women who have been prostituted. For example, in one study done in 1994 with 68 females who had been prostituted in Minnesota for at least six months, only 15% had never contacted one of the study's focus STDs (chlamydia, syphilis, gonorrhea, and herpes). However, women in the sex trade can be less likely to seek out treatment for a number of reasons, including inability or suspicion of outsiders and authorities. How can governments increase treatment/decrease STDs among these populations? Should a policy of decriminalizing prostitution for the prostitute, while criminalizing it for the purchaser (similar to Sweden's policy), be adopted in order to encourage more women caught in the sex trade to seek treatment? In 2009, the sheriff of Cook County, Illinois, initiated a similar policy to Sweden's by shifting resources away from arresting prostituted females (instead referring them to social services), to arresting sex purchasers. It will be interesting to see if this is a model that will be useful for the rest of the country.
Shreya: In 2003, Global AIDS Act, i.e. United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 is signed into law. This ACT requires organizations to sign a "Prostitution Pledge" to receive U.S. funding. This pledge prohibits funding to organizations that do not have a policy explicitly opposing prostitution and sex trafficking.
The Act seems to merge the terms "prostitution" and "sex trafficking". As a PLoS Medicine article points out this is not acceptable: "One of our key findings was that the merging of the terms “prostitution” and “sex trafficking” in the Global AIDS Act is not accepted as standard language or practice by the scientific literature on HIV/AIDS or by international agencies with HIV prevention programs. Trafficking in persons for any purpose is consistently seen as a criminal and human rights offense, and the subset of human trafficking related specifically to the sex industry is universally seen as among the most grievous of trafficking-related crimes. While the law calls for opposing sex trafficking, we could find no entity that did not already oppose it. The same holds true for any form of prostitution involving children or minors—this was universally acknowledged as a crime and a human rights violation before the policy. However, many organizations disagree with the Act's equation of all forms of prostitution with sex trafficking. The term prostitution itself is controversial—most groups working with persons who sell or trade sex for money use the terms “sex work” and “sex worker,” rather than “prostitute,” which is widely held to be stigmatizing and pejorative".
The goal of the pledge was to control HIV transmission by decreasing or ending prostitution, but according to most studies the pledge has had no measurable impact. Most people believe this pledge only hurts the already vulnerable population of sex workers.
Youngbee: When one thinks about health and human trafficking, the first thing that comes to his or her mind is HIV/AIDS infection. Though HIV/AIDS is a commonly known byproduct of human trafficking, especially, sex trafficking, the victims often suffer more than sexually transmitted disease. Along with sexually transmitted disease, they suffer mentally or psychologically as a result of forced prostitution or even labor exploitation. According to a research, child victims suffer depression, guilty&shame, cultural shock, Post Traumatic Stress Disorder(PTSD), and traumatic bonding with the traffickers. In a case of forced prostitution or prostitution alone, both child as well as adult victims suffer from PTSD, guilt and shame, difficulty in establishing a healthy relationship, and low self-esteem. Many times, victims are re-victimized in the brothels or sex industry after the rescue, if they fail to receive proper counseling treatment to recover from the trauma.
Jenn: Medical professionals and health-care workers may be the first or only people to come in contact with a trafficking victim. Doctors, nurses, emergency medical responders, and other medical professionals need to receive training on recognizing potential trafficking indicators and should be part of coordinating anti-trafficking efforts. The London School of Hygiene and Tropical Medicine provides a report on the causes of health issues in trafficking victims and the consequences of these issues, including physical, psychological, and sexual/reproductive health issues.
Polaris Project points out that health-care workers have unique opportunities to recognize the signs of trafficking, and advises that human trafficking assessment protocols should be "adapted to fit existing organizational protocols for interacting with potential victims of child abuse, violence, sexual assault and other related crimes. Health practitioners should familiarize themselves with social service providers in their area working on the issue of human trafficking and work with these agencies to create a protocol for responding to victims of trafficking." Polaris Project also provides several lists of health indicators that should be trafficking red flags and information about short and long-term effects of trafficking on health.
Elise: Over the last year, as I have worked for a service provider for survivors of human trafficking, I have come to better understand the important role of health care workers in the fight against human trafficking, both as sources for identification of victims and support for survivors. Low-income clinic workers and emergency personnel are particularly important because traffickers often withhold medical care from the victims until it becomes absolutely necessary. DHHS created an identification card as well as other training materials for health care workers.
In addition, I would submit that survivors would be better served if hospitals and medical personnel were trained not only on identification, but also on an understanding of the support system set up to assist survivors through the TVPA. I mention this specifically because even when survivors are linked with NGOs, he/she may still be considered undocumented until the service provider or law enforcement agency has been able to adjust their status as their case proceeds. Outside of emergency assistance, this time of limbo complicates the survivor's ability to receive health care services because this individual may have limited identification documents, no insurance and a limited cap on medical expenses depending on the funding or grant source of the organization. Even with the existence of MOUs or SOPs that a service provider may set up with a medical provider, staff turnover and gaps between cases may lead to unnecessary complications. Perhaps the solution lies in training mandates or curriculum in medical schools or stronger cooperation between service providers and health care facilities, but this is an extremely important service to survivors of any type of trafficking.