title: An international comparative public health analysis of sex trafficking of women and girls in eight cities: achieving a more effective health sector response.
abstract: Sex trafficking, trafficking for the purpose of forced sexual exploitation, is a widespread form of human trafficking that occurs in all regions of the world, affects mostly women and girls, and has far-reaching health implications. Studies suggest that up to 50 % of sex trafficking victims in the USA seek medical attention while in their trafficking situation, yet it is unclear how the healthcare system responds to the needs of victims of sex trafficking. To understand the intersection of sex trafficking and public health, we performed in-depth qualitative interviews among 277 antitrafficking stakeholders across eight metropolitan areas in five countries to examine the local context of sex trafficking. We sought to gain a new perspective on this form of gender-based violence from those who have a unique vantage point and intimate knowledge of push-and-pull factors, victim health needs, current available resources and practices in the health system, and barriers to care. Through comparative analysis across these contexts, we found that multiple sociocultural and economic factors facilitate sex trafficking, including child sexual abuse, the objectification of women and girls, and lack of income. Although there are numerous physical and psychological health problems associated with sex trafficking, health services for victims are patchy and poorly coordinated, particularly in the realm of mental health. Various factors function as barriers to a greater health response, including low awareness of sex trafficking and attitudinal biases among health workers. A more comprehensive and coordinated health system response to sex trafficking may help alleviate its devastating effects on vulnerable women and girls. There are numerous opportunities for local health systems to engage in antitrafficking efforts while partnering across sectors with relevant stakeholders.
authors.affiliation: Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, 0 Emerson Place, Suite 104, Boston, MA, 02114, USA, wmacias@partners.org.
authors.forename: Wendy
authors.initials: W
authors.lastname: Macias Konstantopoulos
authors.forename: Roy
authors.initials: R
authors.lastname: Ahn
authors.forename: Elaine J
authors.initials: EJ
authors.lastname: Alpert
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Cafferty
authors.forename: Anita
authors.initials: A
authors.lastname: McGahan
authors.forename: Timothy P
authors.initials: TP
authors.lastname: Williams
authors.forename: Judith Palmer
authors.initials: JP
authors.lastname: Castor
authors.forename: Nadya
authors.initials: N
authors.lastname: Wolferstan
authors.forename: Genevieve
authors.initials: G
authors.lastname: Purcell
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Burke
mesh_terms: D002648:Child; D002650:Child Abuse, Sexual / Q000706:statistics & numerical data; D005195:Family Relations; D005260:Female; D006297:Health Services Accessibility / Q000458:organization & administration; D006301:Health Services Needs and Demand / Q000458:organization & administration*; D006304:Health Status; D064410:Human Trafficking / Q000706:statistics & numerical data*; D006801:Humans; D007407:Interviews as Topic; D015995:Prevalence; D011634:Public Health; D011477:Sex Work / Q000706:statistics & numerical data*; D012931:Social Environment; D012959:Socioeconomic Factors; D035862:Vulnerable Populations; D016387:Women's Health