New study shows need for better awareness, training and intervention on sex trafficking in the healthcare system

Victims’ 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 McGill University’s Ingram School of Nursing (ISoN).

“Unfortunately, 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,” says Johane Lorvinsky, RN, MSc(A), one of the study’s co-authors and a former graduate student at the ISoN.

The study was conducted in Montreal, Quebec, in conjunction with the directors of “Les Survivantes”, a unit within the Service de police de la Ville de Montréal (SPVM) that raises awareness of trafficking while supporting and educating service providers who interact with sex-trafficked individuals. “This is a very hard to reach population,” 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. “The problem is largely hidden but experts believe that is far more prevalent than the 1700 police-reported human trafficking cases in Canada from 2009–2018, of which sex trafficking is the largest subset,” 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.

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

“There is definitely a need for more evidence-based research to inform protocol and care delivery for this extremely vulnerable population,” 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

"Sex trafficking survivors’ experiences with the healthcare system during exploitation: a qualitative study" by Johane Lorvinsky, John Pringle, Françoise Filion and Anita J. Gagnon was published in PLOS ONE. 

About McGill University

Founded in 1821, McGill University is home to exceptional students, faculty, and staff from across Canada and around the world. It is consistently ranked as one of the top universities, both nationally and internationally. It is a world-renowned institution of higher learning with research activities spanning three campuses, 12 faculties, 14 professional schools, 300 programs of study and over 39,000 students, including more than 10,400 graduate students.