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Victims鈥� agency and needs, independent of their desire to exit trafficking, should be the focus of healthcare services for individuals who have been sexually exploited, concludes a new study by researchers with 91社区鈥檚 Ingram School of Nursing (ISoN).

鈥淯nfortunately, we found a lack of awareness on the part of healthcare professionals and the inability to recognize the signs and symptoms of sex trafficking. This represents a lost opportunity to provide appropriate support, resources and services,鈥� says Johane Lorvinsky, RN, MSc(A), one of the study鈥檚 co-authors and a former graduate student at the ISoN.

The study was conducted in Montreal, Quebec, in conjunction with the directors of 鈥淟es Survivantes鈥�, a unit within the Service de police de la Ville de Montr茅al (SPVM) that raises awareness of trafficking while supporting and educating service providers who interact with sex-trafficked individuals. 鈥淭his is a very hard to reach population,鈥� explains Ms. Lorvinsky. With the assistance of Les Survivantes, the researchers contacted 12 sex trafficking survivors who had left their abusers. Of these, seven participated in in-depth interviews that explored their experiences with the Quebec healthcare system. The goal of the study was to inform future education programs for health care professionals tailored to the complex needs of this underserved population.

Sex traffickers use force to coerce their victims to perform commercial sex acts. 鈥淭he problem is largely hidden but experts believe that is far more prevalent than the 1700 police-reported human trafficking cases in Canada from 2009鈥�2018, of which sex trafficking is the largest subset,鈥� says Ms. Lorvinsky.

Signs of sex trafficking not recognized by healthcare professionals

Sexually exploited individuals often experience acute injuries, sexually transmitted infections, untreated anxiety and depression and post-traumatic stress symptoms. Fear of their trafficker, low self-esteem and feelings of shame often prevent victims from disclosing the abuse to healthcare professionals.

鈥淎t the same time, healthcare professionals often do not suspect these patients may be trapped in situations of sexual exploitation,鈥� says Ms. Lorvinsky. Visual cues included marks of physical abuse (e.g., cigarette burns, bruises) and/or sexual abuse, and dress code (e.g., 鈥渟tripper clothes鈥�). Behavioral clues were more subtle and included being anxious, stressed, fearful, pressed, and constantly texting, while contextual cues included stories inconsistent with injuries. 鈥淚ndividually, these signs may be insufficient to indicate trafficking, but in combination, they ought to raise alarm,鈥� explains Ms. Lorvinsky.

Training on sex trafficking in university curriculums and the workplace recommended

Study participants also noted that the attitudes of healthcare professionals played a key role in building relationships of trust, which are essential for disclosure of abuse. 鈥淐are was perceived as more impersonal, hasty and perfunctory in hospitals and private walk-in clinics. By contrast, in settings where healthcare professionals had higher exposure to marginalized groups such as community care centres and sexual health clinics, they provided non-judgemental, holistic care. Yet, even in these more positive environments, study participants reported that healthcare professionals who may have suspected abuse or trafficking did not act on their suspicions,鈥� says Ms. Lorvinsky.

Complicating matters further, in some cases, sex trafficked individuals lacked self-awareness of their situation. Once they were able to define their situation as one of sexual exploitation and felt ready to exit sex trafficking, they had no idea how to access resources that could help them to safely leave their abusers. Given these challenges, based on the accounts of study participants, the authors recommend a multifaceted approach for healthcare providers that includes:

• identifying personal biases and misconceptions about sex trafficking,
• training on sex trafficking in university curriculums and in the workplace,
• Routinely querying psychosocial wellbeing and assessing for signs of abuse and trafficking.
• developing screening tools to identify victims of sex trafficking,
• creating a catalogue of resources to meet the complex needs of survivors,
• establish a network of healthcare professionals trained in anti-trafficking responses,
• raising public consciousness of sex trafficking through awareness campaigns.

Further research needed

鈥淭here is definitely a need for more evidence-based research to inform protocol and care delivery for this extremely vulnerable population,鈥� concludes Ms. Lorvinsky. Accordingly, the authors suggest that future research should be geared towards the creation and validation of screening tools to identify trafficked individuals as well as best practice intervention guidelines.

About the study

""聽by Johane Lorvinsky, John Pringle, Fran莽oise Filion and Anita J. Gagnon was published in聽PLOS ONE.听

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