Vol 23, 2014 Annals of Health Law 81
HEALTH CONSEQUENCES OF SEX TRAFFICKING
these goals and assist medical care providers in their vital role as identifiers
of trafficking victims.
Based on the reported symptoms of survivors, a number of particularly
widespread health-related consequences of trafficking should serve as
warning signs to medical professionals. The most suggestive physical
symptoms are injuries from physical violence, since this was a nearly
universal experience for the survivors in the study. Signs of being kicked,
punched, or beaten, all of which at least two thirds of respondents reported,
should be a major “red flag” along with any signs of forced sex (reported by
81.6%), and head or facial injuries (each reported by more than half of
survivors). While these may also be signals of domestic violence, their
presence in patients seeking multiple abortions or treatment for sexually
transmitted or serious communicable diseases may help healthcare
providers to distinguish possible sex trafficking situations. Indications of
extreme forms of violence (such as strangulation, stabbing, cigarette burns
or gunshot wounds) also may be important clues for identification since
these would have far fewer alternate explanations. One researcher notes
that tattoos identifying the victim as the “property” of a particular trafficker
could also alert care providers, 52 though these may be difficult to recognize.
In addition, those psychological symptoms that were particularly
common among trafficking victims should be useful warning signs.
Depression was the most common symptom for survivors ( 88.7%) and
anxiety, irritability, nightmares, low self-esteem, and feelings of
shame/guilt were all reported by more than 70% of survivors as well. The
combination of these symptoms should therefore arouse suspicion when
displayed by patients who repeatedly require reproductive health services,
when an older or controlling male figure is present with the patient, and
when the patient also presents signs of physical abuse. The well-documented rates of PTSD in trafficking victims, 53 ( 54.7% of survivors in
this study) make it another important clue to identifying trafficking victims.
Indications of attempted or repeated self-harm would likewise be a reason
for considering trafficking as a possibility in these context, since 46.2% of
respondents reported suicide ideation and 41.5% had attempted suicide.
The presence of sexually transmitted diseases or infections is another
major identifier because nearly two-thirds ( 67.3%) of survivors reported
having at least one such disease. Multiple or serial cases of such diseases or
52. Reena Isaac et al., Health Care Providers’ Training Needs Related to Human
Trafficking: Maximizing the Opportunity to Screen and Intervene, 2 J. APPLIED RES. ON
CHILD 1, 10 (2011).
53. See, e.g., Farley & Barkan, supra note 27, at 42 (reporting that 68% of victims met
criteria for PTSD and 76% met criteria for partial PTSD).