As the States and the Administration implement PPACA however, it has become clear
that numerous obstacles to widespread viral suppression remain. Although PPACA
contains dramatic reforms, the States possess substantial influence over their
implementation. This has provided state actors with opportunities to sidetrack and dilute
their impact. Furthermore, even if the States were completely compliant with PPACA’s
provisions, the law would still fail to address important health care access issues for
people living with HIV/AIDS.
In the public insurance market, legal challenges brought by protesting states have
dramatically decreased the impact of the Medicaid expansion. Meanwhile, the law does
nothing to address the longstanding problem of low Medicaid reimbursement rates,
which has contributed to a shortage of participating physicians nationwide. In the
private insurance market, PPACA institutes market reforms that include a requirement
that insurance providers cover a basic level of health care. However, the Administration
has ceded the authority to define what these requirements entail to the States, many of
whom are openly hostile to PPACA’s implementation. Only when these issues have been
addressed can PPACA begin to achieve its goal of comprehensive, affordable health care
for not only people living with HIV/AIDS, but all Americans.
The Health Consequences of Sex Trafficking and Their Implications for Identifying
Victims in Healthcare Facilities
Laura J. Lederer and Christopher A. Wetzel........................................................................... 61
This paper reports on focus groups conducted with 107 domestic victims of sex
trafficking in which they discussed the health problems they experienced during
trafficking. In addition, the project examined victims' interactions with various types of
healthcare providers. The focus groups revealed that nearly all victims experienced
serious physical and mental health problems while being trafficked, including serious
communicable and other diseases, injuries resulting from violence, substance abuse, and
reproductive health issues. The paper summarizes data about the health problems
reported by significant numbers of survivors to present a fuller picture of the health
consequences that victims of trafficking suffer. A majority of survivors sought healthcare
at some point during the time they were trafficked. The paper also reports on the contact
victims had with health care providers, including hospital emergency wards, urgent care
clinics, neighborhood clinics, women's clinics, Planned Parenthood clinics, and general
practitioners. Many providers were unaware of the fact that they were treating a
trafficking victim, and unaware of the force, fraud, and coercion involved in trafficking.
The paper discusses common physical and mental health symptoms and other warning
signs that can assist medical professionals in recognizing possible trafficking victims. It
also makes policy and program recommendations for medical care providers to enhance
their roles as identifiers of trafficking victims. These recommendations include
suggestions for interviewing possible victims and methods for helping victims obtain
broader assistance, including criminal justice assistance where warranted. Other
recommendations include mandatory training about trafficking in persons for healthcare
providers, mandatory posting of the national trafficking hotline phone number and
specialized resources to make available to victims.
