Understanding and Responding to Human Trafficking: A Medical Perspective
The article discusses the medical response to human trafficking, including defining human trafficking, identifying potential victims, reporting requirements, barriers to rescue, available resources, and prevention strategies. It explores confusing nomenclature, misconceptions, commercial sexual exploitation of children, and clarifies that consent does not justify trafficking. The content emphasizes the importance of recognizing and addressing human trafficking irrespective of victims' past actions or manipulations by traffickers.
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The Medical Response to Human Trafficking SHALON M. NIENOW, MD, FAAP CHILD ABUSE PEDIATRICIAN ASSISTANT PROFESSOR OF PEDIATRICS UNIVERSITY OF NEW MEXICO CART MEDICAL DIRECTOR, PARA LOS NINOS Nienow 2017
Objectives Define Human Trafficking Discuss issues with the nomenclature Provide alternate, more appropriate name Learn how to identify potential victims Understand the requirement to report Identify barriers to rescue Identify resources Discuss prevention Nienow 2017
Whoever knowinglyrecruits, entices, harbors, transports, provides, obtains, or maintains by any means a person or benefits, financially or by receiving anything of value, from participation in a venture which has engaged in an act described in violation of paragraph (1) or that the person has not attained the age of 18 years and will be caused to engage in a commercial sex act Human Trafficking 18 U.S.C. 1590 Nienow 2017
Confusing Nomenclature Nienow 2017
Contrary to some misconceptions, human trafficking crimes do not require any smuggling or movement of the victim For minor victims there does not need to be: force, threats of force, fraud or coercion Nienow 2017
CSEC Commercial Sexual Exploitation of Children Nienow 2017
What does that mean? Sexual activity involving a child in exchange for something of value Nienow 2017
From the State Department It does not matter if a victim once consented to work for their trafficker It does not matter if the victim returned to their trafficker after he or she was freed Nienow 2017
It does not matter if the victims enslavement was through chains of mental dependency or psychological manipulation as opposed to being physically locked up It does not matter if their trafficker was at times nice to them or gave them presents or if they veered between feelings of love and fear for their trafficker Nienow 2017
This or That Prostitute Sexually Exploited Child A young person who has been sexually used, coerced, manipulated, and violently controlled for another person s profit Brings up connotations of being a bad kid, juvenile offender or criminal Seen as a professional who is doing a job Deserving of consequences: sexual violence, social isolation, incarceration Defines what has happened to the child not who the child is Appropriately names them as a victim Nienow 2017
We Need A New Vocabulary Pimps Trafficker Prostitutes Victims Tricks/Johns Buyers/Exploiters Nienow 2017
Statistics HOW BIG IS THE PROBLEM? Nienow 2017
2 Million Children /Yr, Worldwide1 300,000 Children/Yr , Nationwide1 83% of sex trafficking victims identified between 2008 and 2010 were US citizens2 25% of sex tourists abusing children outside of the US are American & Canadian1 1ECPAT-USA 2DOJ Bureau of Justice Statistics Nienow 2017
Average age of entry is 12 14 80-90% were sexually abused before being commercially sexually exploited Human trafficking is the second largest international crime industry (behind illegal drugs). It has surpassed arms trafficking and reportedly generates a profit of $32 billion every year. Of that number, $15.5 billion is made in industrialized countries US Department of Justice Nienow 2017
Risk Factors Nienow 2017
Children at Risk for Recruitment Nienow 2017
INDIVIDUAL FACTORS Nienow 2017
Individual Factors Abuse and Neglect Mental Health Issues/Learning Disabilities Runaway 1.6 million children/yr 1 in 3 recruited within 48 hrs Throwaways homelessness Survival sex (esp. LGBTQ) Hammer, H., Finkelhor, D., Sedlak, A., 2002 Nienow 2017
ENVIRONMENTAL FACTORS Nienow 2017
Environmental Factors Transient Male Population Poverty/Homelessness Violence/Street Culture Drug Abuse Nienow 2017
Societal Factors Nienow 2017
Societal Factors Sexism and Misogyny Homophobia Sexualization of girls and young women Glorification of Pimp/Prostitution Culture Access to Technology Nienow 2017
PATHWAYS TO ENTRY Nienow 2017
Parents selling children Seduction and coercion False advertising for modeling, acting, or dancing Peer recruitment Internet Violence & force/kidnapping Nienow 2017
Common Recruiting Sites Junior high and high schools Courtrooms Hallways of court buildings Foster homes Bus stations Group homes Homeless shelters Halfway houses Restaurants and bars Parks and playgrounds Polaris Project Nienow 2017
Seasoning/Grooming The process of breaking-down a girl from healthy adolescent sexual boundaries to commercial sex with strangers Beating/Slapping/Whipping Sexual Assault Confinement Other torture techniques Emotional abuse Removal from familiarity and support structures Document confiscation Nienow 2017
Very Young Girls http://www.gems-girls.org/get-involved/very-young- girls http://www.youtube.com/watch?feature=player_emb edded&v=7fX6EaHuRCg#at=74 Nienow 2017
Some Local websites Fling.com - Fling Official Site - Join Fling. Have sex tonight - http://albuquerque.bac kpage.com/MenSeekW omen/ Nienow 2017
Why Dont They Seek Help? Captivity/Confinement Frequent accompaniment/guarded Use and threat of violence Shame /Self-blame Dependency Debt bondage Loyalty to the pimp Stockholm syndrome Distrust of law enforcement Nienow 2017
How You May Encounter Victims Nienow 2017
Medical Treatment of acute injuries STIs Drug intoxication/withdrawl Reproductive issues Acute sexual assaults Suicide attempt Nienow 2017
Law Enforcement Failure to ID Truancy Runaway Possession of drugs/weapons Gang activity Prostitution stings Pornography rings Nienow 2017
Social Services Foster home placement CYFD investigations for lack of supervision, parental drug abuse, neglect, physical abuse or sexual abuse Runaways Nienow 2017
Why You NEED To Be Concerned Most children are recruited & trafficked online Children will not self-identify and do not view themselves as victims Children who are already victims of abuse/neglect are at high risk of being trafficked
Have It On Your Radar Nienow 2017
How To Identify Victims Child is accompanied by a dominating, older, nonrelated adult (male or female) Adult insists on speaking for child and will not be separated from them Child acts fearful or submissive toward adult Child won t make eye contact Child is hostile or distrustful of authority figures Possession of a great deal of cash or expensive items Nienow 2017
How to Identify Victims Changing information on name, age, living situation Possession of hotel keys History of 1+ of following: Physical or sexual abuse CYFD involvement with family Running away (especially >3 times in past year) Truancy and school problems Pregnancies/Abortions/Miscarriages Older friends and/or boyfriend Nienow 2017
How to Identify Victims Gang signs/affiliation Physical signs Unexplained bruises, scars Cigarette burns Branding Tattoos Back of neck Underarm Ankle Nienow 2017
How to Identify Victims Has signs of substance use/abuse History of multiple sexual partners in short period Refugee fleeing conflict Adult prostitution in the home Nienow 2017
What Questions to Ask Nienow 2017
Social History Where do you live and with whom? Where do your parents live? Have you ever run away? Why? How many times? Can you come and go as you please? Nienow 2017
Social History Do you have to ask permission to eat, sleep or use the bathroom? Do you have to pay back or do anything in exchange for your living arrangements? Do you go to school? Ever skip school? Do you have a boyfriend/girlfriend? How old are they? How did you meet? Nienow 2017
Traumatic Experiences Is anyone forcing you to do anything you don t want to do? Has anyone ever threatened you or your family? Nienow 2017
Sexual History Have you ever had sex before? How many partners in the last 6 months? Have you ever had an STD? Have you ever been pregnant? Nienow 2017
Sexual History Has anyone ever asked you to have sex in exchange for something you wanted or needed (money, food, shelter, or other items)? Has anyone ever asked you to have sex with another person? Nienow 2017
Other History How often do you or your friends drink alcohol or use drugs? Are there pictures of you on the internet? What sites are they on? Are they in a classified ad? Do you have any tattoos? Where did you get them? What do they mean? Nienow 2017
Tips for First Encounters Building TRUST is a number one priority One-on-one interactions are imperative Use street language when possible Be aware of and expect lies and rehearsed stories Take your time Nienow 2017
What to Do if you Identify a Victim Maintain safety Report to law enforcement Secure safe discharge plan Obtain a sexual abuse/assault examination Refer for additional mental health/medical services Nienow 2017
Sexual Assault Exams Nienow 2017
Why a Sexual Assault Examination is Important Help the child to understand that her/his body is NORMAL To ensure the health/wellbeing of the child Reduce public health risk posed by STI s Assess for suicidal ideation or other trauma related psychological effects Coordination of services Nienow 2017
