Click on the image above to be direct­ed to Fr McTavish’s article

Devastating consequences of sex trafficking on women’s health

On the first of Novem­ber, I cel­e­brat­ed the Holy Mass of All the Saints at a cen­ter for reha­bil­i­ta­tion of female sur­vivors of sex traf­fick­ing. They are being tak­en care of by Reli­gious Sis­ters who have a spe­cif­ic ded­i­ca­tion in this area.¹ The Sis­ter in charge com­ment­ed to me that same-sex attrac­tion (SSA) was com­mon­ly observed among such girls, includ­ing sex­u­al­ized behav­ior with the same sex. I was asked how we should con­sid­er this phe­nom­e­non of SSA in this con­text and how best to help these young vic­tims. The expe­ri­ence of vis­it­ing the shel­ter made me reflect on the health consequences—physical, men­tal, and spiritual—of the trau­mat­ic expe­ri­ence these girls have been through.

I would like to answer this pas­toral ques­tion of female SSA, post-sex traf­fick­ing by first look­ing at the broad­er pic­ture of human traf­fick­ing for sex­u­al pur­pos­es and briefly show­ing its dev­as­tat­ing impact on women’s health glob­al­ly. Next, I will share some spe­cif­ic points of Catholic moral teach­ing on pros­ti­tu­tion and human traf­fick­ing before con­sid­er­ing the spe­cif­ic role of health­care work­ers in iden­ti­fy­ing and assist­ing vic­tims of traf­fick­ing. The Reli­gious Sis­ters’ gen­er­al approach in min­is­ter­ing to the vic­tims of sex traf­fick­ing and pros­ti­tu­tion will then be out­lined, before clos­ing with some pas­toral con­sid­er­a­tions regard­ing the expe­ri­ence of SSA in this spe­cif­ic context.

Human Trafficking

Ear­li­er this year Arch­bish­op Bernardi­to Auza deliv­ered a lec­ture titled “The Holy See and the Fight Against Human Traf­fick­ing” (Auza ²⁰¹⁷). He esti­mat­ed that thir­ty-six mil­lion peo­ple were traf­ficked in 2016. Arch­bish­op Auza stat­ed that:

accord­ing to the 2016 Glob­al Report on Traf­fick­ing in Per­sons released two months ago by the UN Office on Drugs and Crime, human traf­fick­ing is a 32 bil­lion dol­lar indus­try, run­ning third behind arms and drug traf­fick­ing. Fifty-one per­cent of the vic­tims are women, 21 per­cent are men, 20 per­cent girls and 8 per­cent boys. (Auza ²⁰¹⁷)

For women vic­tims of traf­fick­ing, 72 per­cent of them are traf­ficked for sex­u­al exploita­tion. This would mean that glob­al­ly approx­i­mate­ly 13 mil­lion women are sex traf­ficked annually.

The “Traf­fick­ing in Per­sons Report” (TIP report) released by the U.S. Depart­ment of State explains “‘Traf­fick­ing in per­sons’ and ‘human traf­fick­ing’ have been used as umbrel­la terms for the act of recruit­ing, har­bor­ing, trans­port­ing, pro­vid­ing, or obtain­ing a per­son for com­pelled labor or com­mer­cial sex acts through the use of force, fraud, or coer­cion” (U.S. Depart­ment of State ²⁰¹⁶, 30). Traf­fick­ing can be for var­i­ous pur­pos­es such as forced labor and organ retrieval, but by far the major­i­ty of vic­tims are traf­ficked for sex­u­al pur­pos­es. The same TIP report defines sex traf­fick­ing in the fol­low­ing way:

When an adult engages in a com­mer­cial sex act, such as pros­ti­tu­tion, as the result of force, threats of force, fraud, coer­cion or any com­bi­na­tion of such means, that per­son is a vic­tim of traf­fick­ing. Under such cir­cum­stances, per­pe­tra­tors involved in recruit­ing, har­bor­ing, entic­ing, trans­port­ing, pro­vid­ing, obtain­ing, patron­iz­ing, solic­it­ing, or main­tain­ing a per­son for that pur­pose are guilty of sex traf­fick­ing of an adult. Sex traf­fick­ing also may occur with­in debt bondage, as indi­vid­u­als are com­pelled to con­tin­ue in pros­ti­tu­tion through the use of unlaw­ful “debt,” pur­port­ed­ly incurred through their trans­porta­tion, recruit­ment, or even their “sale”—which exploiters insist they must pay off before they can be free. An adult’s ini­tial con­sent to par­tic­i­pate in pros­ti­tu­tion is not legal­ly deter­mi­na­tive: if one is there­after held in ser­vice through psy­cho­log­i­cal manip­u­la­tion or phys­i­cal force, he or she is a traf­fick­ing vic­tim and should receive ben­e­fits out­lined in the Paler­mo Pro­to­col and applic­a­ble domes­tic laws. (U.S. Depart­ment of State ²⁰¹⁶, 30)

Health Consequences²

In the work of Led­er­er and Wet­zel, one vic­tim not­ed the following:

Dur­ing that time I saw 10 to 20 men a day. I did what he said because he got vio­lent when I sassed him. I took all kinds of drugs — even though I didn’t real­ly like most of them. Over the years I had pimps and cus­tomers who hit me, punched me, kicked me, beat me, slashed me with a razor. I had forced unpro­tect­ed sex and got preg­nant three times and had two abor­tions at [a clin­ic]. After­ward, I was back out on the street again. I have so many scars all over my body and so many injuries and so many ill­ness­es. I have hepati­tis C and stom­ach and back pain and a lot of psy­cho­log­i­cal issues. I tried to com­mit sui­cide sev­er­al times. (Led­er­er and Wet­zel ²⁰¹⁴, 61)

Most female vic­tims of sex traf­fick­ing end up in forced pros­ti­tu­tion and/or the pornog­ra­phy indus­try. Melis­sa Far­ley states that “through­out his­to­ry, regard­less of its legal sta­tus, pros­ti­tu­tion has had a dev­as­tat­ing impact on women’s health” (Far­ley ²⁰⁰⁴, 1097). This can be seen in the many phys­i­cal and psy­cho­log­i­cal con­se­quences of this destruc­tive lifestyle. Some find­ings include the following:

• Sex­u­al vio­lence and phys­i­cal assault are the norm for women in all types of prostitution.

• Health prob­lems include exhaus­tion, fre­quent viral ill­ness, STDs, vagi­nal infec­tions, back aches, sleep­less­ness, depres­sion, headaches, stom­ach aches, and eat­ing disorders.

• Post-trau­mat­ic stress dis­or­der is a con­se­quence of pros­ti­tu­tion as are mood dis­or­ders such as dis­so­ci­a­tion and depression.

• Pros­ti­tut­ed women are at a high­er risk of being mur­dered. (Far­ley ²⁰⁰⁴, 1087-125)

Drug and alco­hol abuse is a com­mon find­ing among pros­ti­tut­ed women. In most it serves as a mech­a­nism to par­tial­ly numb the hor­ror and mis­ery they experience.

The hand­book Car­ing for Traf­ficked Per­sons: Guid­ance for Health Providers reports that “as is the case with vic­tims of tor­ture, indi­vid­u­als who have been traf­ficked are like­ly to sus­tain mul­ti­ple phys­i­cal or psy­cho­log­i­cal injuries and ill­ness­es and report a com­plex set of symp­toms (IOM et al. ²⁰⁰⁹, 17). Where the vic­tim is a minor (younger than 18 years of age) the TIP report notes that “Sex traf­fick­ing has dev­as­tat­ing con­se­quences for chil­dren, includ­ing long-last­ing phys­i­cal and psy­cho­log­i­cal trau­ma, dis­ease (includ­ing HIV/AIDS), drug addic­tion, unwant­ed preg­nan­cy, mal­nu­tri­tion, social ostracism, and even death” (U.S. Depart­ment of State ²⁰¹⁶, 30).

Classification

Var­i­ous clas­si­fi­ca­tions have been used to enu­mer­ate the wide spec­trum of health con­se­quences of pros­ti­tu­tion and sex traf­fick­ing. Led­er­er and Wet­zel report the fol­low­ing cat­e­gories: phys­i­cal health symp­toms; psy­cho­log­i­cal symp­toms; repro­duc­tive issues; vio­lence, abuse, and humil­i­a­tion; and sub­stance abuse (Led­er­er and Wet­zel ²⁰¹⁴). Willis and Levy list the fol­low­ing:³ infec­tious dis­ease, preg­nan­cy, men­tal ill­ness, sub­stance abuse, vio­lence and mal­nu­tri­tion (Willis and Levy ²⁰⁰²). No attempt will be made here to pro­duce a defin­i­tive review of the myr­i­ad health con­se­quences of sex traf­fick­ing. The point is rather to show the com­plex­i­ty and vast range of dele­te­ri­ous effects of traf­fick­ing for sex­u­al pur­pos­es on the affect­ed indi­vid­ual.⁴ It is also of note that same-sex attrac­tion post-traf­fick­ing is not mentioned.

To ful­ly con­sid­er the neg­a­tive impact of sex traf­fick­ing on women, we should not over­look the con­se­quences in the wives, part­ners, or girl­friends of the men who buy the bod­ies of traf­ficked women. The sin of the male has far-reach­ing con­se­quences in all his rela­tion­ships with sig­nif­i­cant oth­er women in his life. Not only will he place his, let us say, wife at some med­ical risk (con­sid­er the risk of infec­tion from HIV, for exam­ple), but moral­ly he will be fail­ing to give his wife the puri­ty and qual­i­ty of love that he promised through the sacra­ment of marriage.

Let us now look at some aspects of Catholic Church teaching.

Selected Elements of Catholic Moral Teaching on Prostitution and Human Trafficking

Specific Role of Healthcare Professionals

In one study, 88 per­cent of traf­fick­ing vic­tims report­ed access­ing health­care facil­i­ties dur­ing their expe­ri­ence of being traf­ficked and, of these, 63 per­cent were seen at an emer­gency depart­ment (Led­er­er and Wet­zel ²⁰¹⁴, 77). In the ini­tial inter­view some red flags that may indi­cate a sit­u­a­tion of traf­fick­ing are:

• Some­one else is speak­ing for the patient

• Patient is not aware of his or her loca­tion, the cur­rent date, or time

• Patient exhibits fear, anx­i­ety, PTSD, sub­mis­sion, or tension

• Patient shows signs of phys­i­cal or sex­u­al abuse, med­ical neglect, or torture

• Patient is reluc­tant to explain his or her injury

• Patient reports an unusu­al­ly high num­bers of sex­u­al partners

• Patient does not have appro­pri­ate cloth­ing for the weath­er or venue

• Patient uses lan­guage com­mon in the com­mer­cial sex industry

• Patient is under the age of 18 and is involved in the com­mer­cial sex industry

• Tat­toos may be present (or oth­er forms of brand­ing that say “For sale,” “Prop­er­ty of …,”) (Nation­al Human Traf­fick­ing Resource Cen­ter ²⁰¹⁶, 1)

Addi­tion­al help­ful reminders for health­care staff are giv­en in the hand­book Car­ing for Traf­ficked Per­sons: Guide­lines for Health Providers:

1. To con­sid­er each con­sul­ta­tion as an oppor­tu­ni­ty for improv­ing the health of the traf­ficked person.

2. The safe­ty of traf­ficked per­sons, self and staff is paramount.

3. Pro­vide good care and avoid dis­crim­i­na­tion. Any prej­u­dice or dis­dain on the part of the health­care work­er should not inter­fere with good care.

4. Be pre­pared with refer­ral infor­ma­tion and con­tact details for trust­ed sup­port per­sons. It is help­ful if health­care work­ers are famil­iar with the pro­to­col in their hos­pi­tal of what to do if they sus­pect that the patient is a vic­tim of trafficking.

5. Know­ing the vast range of neg­a­tive health con­se­quences of sex traf­fick­ing neces­si­tates the per­for­mance of a com­pre­hen­sive health assess­ment. (IOM et al. ²⁰⁰⁹, 27–29)

Addi­tion­al ques­tions maybe appropriate:

• Head/eyes/ears/nose/throat: Any his­to­ry of head trau­ma? Exam­ine the skull for bruis­es, depres­sions or healed lac­er­a­tions. Fre­quent headaches? Any pha­ryn­geal trau­ma (lac­er­a­tions, tears)?

• Neck: Any his­to­ry of strangulation?

• Car­dio­vas­cu­lar: Any trau­ma to the chest?

• Res­pi­ra­to­ry: Pos­si­ble expo­sure to TB? (Liv­ing con­di­tions? Num­ber of peo­ple shar­ing one bed­room? Ventilation?)

• Gas­troin­testi­nal: Abdom­i­nal trauma?

• Gen­i­touri­nary: Forced sex, or sex­u­al trau­ma that includes for­eign objects? Enure­sis or enco­pre­sis (a poten­tial result of sex­u­al abuse)?

• Mus­cu­loskele­tal: Repet­i­tive and non-repet­i­tive work-relat­ed injuries? Frac­tures? His­to­ry of phys­i­cal abuse such as burns? Contractures?

• Neurological/behavioral: Seizure activ­i­ty (may also need to con­sid­er pseu­do-seizures)? Sleep dis­or­ders (inabil­i­ty to fall asleep, fre­quent awak­en­ings, night­mares)? Any his­to­ry of head trauma?

• Nutri­tion: Any nutri­tion­al defi­cien­cies (food intake, con­tent)? Dis­or­dered eat­ing (e.g., anorex­ia or bulim­ic behavior)?

• Der­ma­to­log­i­cal: Burns (e.g., cig­a­rette burns, scalds from hot water)?

Areas of spe­cif­ic con­cern include men­tal health and sex­u­al and repro­duc­tive health. A thor­ough eval­u­a­tion and work up of these areas is often indi­cat­ed. Where med­ical evi­dence will be used in pos­si­ble assault/rape cas­es or for crim­i­nal pro­ceed­ings against traf­fick­ers, a spe­cial­ized foren­sic exam may be need­ed and should be con­duct­ed by suit­ably trained per­sons.⁶

It may be use­ful for health­care per­son­nel to receive suit­able train­ing to iden­ti­fy vic­tims of sex traf­fick­ing, and how to treat them, at the begin­ning of their pro­fes­sion­al train­ing, not just when they are in the field.⁷

Trauma in Carers

The neg­a­tive effects of sex traf­fick­ing may extend to the health­care staff car­ing for the vic­tims. This vic­ar­i­ous trau­ma (also known as com­pas­sion fatigue or sec­ondary trau­mat­ic stress):

refers to the neg­a­tive reac­tions that can occur when pro­fes­sion­als repeat­ed­ly wit­ness or hear about vic­tims’ dif­fi­cult expe­ri­ences of trau­ma, vio­lence, and abuse. The signs of vic­ar­i­ous trau­ma resem­ble post-trau­mat­ic stress dis­or­der, and can include emo­tion­al, behav­ioral, and phys­i­cal symp­toms, such as anx­i­ety, depres­sion, dis­turbed sleep, change in appetite, irri­tabil­i­ty, night­mares, loss of empa­thy, and numb­ness. (U.S. Depart­ment of State ²⁰¹⁶, 38)

IOM et al. report that “it is not unusu­al for peo­ple work­ing with traf­ficked per­sons to expe­ri­ence emo­tions of anger, pain, frus­tra­tion, sad­ness, shock, hor­ror and dis­tress. The work could also affect ener­gy lev­els and cause dis­turbed sleep, somat­ic com­plaints and hyper-arousal” (IOM et al. ²⁰⁰⁹, 97).

Hav­ing con­sid­ered some salient fea­tures of the role of health­care work­ers in iden­ti­fy­ing and treat­ing vic­tims of sex traf­fick­ing, we now turn to an in-depth descrip­tion of the Sis­ters’ gen­er­al approach in min­is­ter­ing to the vic­tims of sex traf­fick­ing and prostitution.

Ministry to Victims of Sex Trafficking and Prostitution⁸

The infor­ma­tion in the fol­low­ing sec­tions, pre­sent­ed in ques­tion-and-answer style, was obtained in an inter­view with one of the Sis­ters involved in the ministry.

Same-Sex Attraction in Females Post-Sex Trafficking¹⁰

In the reha­bil­i­ta­tion cen­ter (men­tioned in the Intro­duc­tion sec­tion), it is observed that SSA is com­mon in women who have been vic­tims of sex traf­fick­ing. To pas­toral­ly assist such young women, it is help­ful to estab­lish a base­line of whether they had same-sex feel­ings or expe­ri­ences pri­or to their traf­fick­ing experience.

Some of the girls actu­al­ly did have SSA pri­or to traf­fick­ing. They explained that their same-sex feel­ings seemed to orig­i­nate fol­low­ing their expe­ri­ence of child­hood abuse at the hands of males. It is well known that such abuse may con­tribute to the devel­op­ment of lat­er SSA (McTavish ^2014b, 3–4). Fol­low­ing abuse, anti-male sen­ti­ments may devel­op, includ­ing fear, mis­trust, and a gen­er­al feel­ing of being unsafe around males. One girl shared that she ini­tial­ly had an inter­est in boys, but this dis­ap­peared after her expe­ri­ence of abuse, such that lat­er she became more con­fi­dent shar­ing only with oth­er girls. All these anti-male feel­ings were com­pound­ed when these girls sub­se­quent­ly became vic­tims of sex traf­fick­ing. Abuse alone pro­duces a deep wound­ed­ness in the psy­che of a young per­son, and how much more pro­found will the wound­ed­ness be after the expe­ri­ence of being traf­ficked. Deep wounds are not healed overnight, and the recov­ery process is usu­al­ly long and complex.

Some girls, with or with­out a pre­vi­ous his­to­ry of abuse, were known to have devel­oped same-sex feel­ings only after the expe­ri­ence of being traf­ficked. On review­ing the gen­er­al lit­er­a­ture sur­round­ing sex traf­fick­ing, this author can find no men­tion of SSA in females post-expo­sure to sex traf­fick­ing. The com­pre­hen­sive and high­ly influ­en­tial “Glob­al report on Traf­fick­ing in Per­sons” pro­duced annu­al­ly by the UN Office on Drugs and Crime does not make any ref­er­ence to this phe­nom­e­non, although the group of per­sons who are LGBT is men­tioned var­i­ous times and is sin­gled out for spe­cial con­cern.¹¹

Same-sex feel­ings devel­op­ing post-traf­fick­ing could be part­ly explained by the process out­lined above where the woman los­es trust and con­fi­dence with males and feels safer deposit­ing her feel­ings and heart in the arms of anoth­er female. In such cas­es the SSA could be tran­sient or pass­ing as the trau­ma heals. Often young females may have pass­ing attrac­tions or “crush­es” on oth­er girls. The late John Har­vey, founder of Courage, the Roman Catholic min­istry for per­sons with SSA, advised

The ado­les­cent girl often con­fus­es a “crush” she has on an old­er girl or a female teacher as a form of homo­sex­u­al­i­ty. She should be shown that she is sim­ply going through a stage of strong admi­ra­tion and needs to take care not to make an idol out of anoth­er per­son. Mean­while, she must con­tin­ue to seek friends with­in her peer group and learn to form good human rela­tion­ships with both sex­es. (Har­vey ²⁰⁰⁷, 34–35)

Such girls in reha­bil­i­ta­tion, expe­ri­enc­ing same-sex feel­ings after being traf­ficked, may be seek­ing to ful­fill legit­i­mate needs for affec­tion and atten­tion from oth­er females, but need to learn how to do so in healthy, non-erot­ic ways. In a word, they need to “relearn” the virtue of chasti­ty. The Cat­e­chism defines chasti­ty as “the suc­cess­ful inte­gra­tion of sex­u­al­i­ty with­in the per­son and thus the inner uni­ty of man in his bod­i­ly and spir­i­tu­al being … The virtue of chasti­ty there­fore involves the integri­ty of the per­son and the inte­gral­i­ty of the gift” (Cat­e­chism ¹⁹⁹⁷, no. 2337). This will be espe­cial­ly chal­leng­ing for them as the expo­sure to the sex­u­al­ized world of traf­fick­ing may also make them more liable to sex­u­al expo­sure and even exper­i­men­ta­tion when in reha­bil­i­ta­tion.¹² Part of their recov­ery process is not only to process their expe­ri­ence of sex­u­al abuse but also to re-learn healthy ways of relat­ing to both sex­es. This is real­ly a train­ing in chasti­ty, which for all is a chal­lenge, but more so when these girls have been vic­tims of gross bound­ary vio­la­tions from sex trafficking.

A wide­ly accept­ed sec­u­lar view is to encour­age young per­sons with same-sex feel­ings to “come out.” This view how­ev­er is found­ed on an erro­neous cul­tur­al inter­pre­ta­tion that all sex­u­al feel­ings are equal­ly valid and should be pro­mot­ed and encour­aged. It is high­ly inap­pro­pri­ate when deal­ing with SSA post-sex traf­fick­ing as what we are like­ly deal­ing with may be a type of “pseu­do-les­bian­ism” post-trau­ma. The focus should be on “com­ing out” of the trau­ma. There is no appar­ent lit­er­a­ture on how best to reha­bil­i­tate a girl with SSA post-sex traf­fick­ing. Per­haps the next best thing is to glean what we can from expe­ri­ences of recov­ery from SSA in non-traf­ficked women. Janelle Hall­man, an expe­ri­enced ther­a­pist, tells us that the reha­bil­i­ta­tion of a woman with SSA

will be a lengthy process in which she reclaims, piece by piece, her heart and soul, which have been housed or deposit­ed in the oth­er woman. She must sal­vage the threads of her true self and reknit them around new per­cep­tions, impres­sions and beliefs that arise out of a cor­rec­tive expe­ri­ence of love, sup­port and accep­tance. (Hall­man ²⁰⁰⁸, 114)

With ther­a­py and coun­sel­ing the girl may be able to come to terms with the trau­ma expe­ri­enced. Sex­u­al behav­ior should be dis­cour­aged, with either sex, in the vul­ner­a­ble stages of recov­ery. Chasti­ty and re-inte­gra­tion of the per­son are noble goals for which to live and strive.

Some healthy con­tact with males may be ben­e­fi­cial in the recov­ery process; at least to show that some males can show them respect and not all need to be mis­trust­ed. How­ev­er, care should be tak­en in expos­ing these very vul­ner­a­ble girls to male con­tact as the Sis­ters informed me that there is a dan­ger that the girls can eas­i­ly fall for a male who shows them even the slight­est inter­est and attention.

The task of assist­ing in the reha­bil­i­ta­tion of girls who have been sex traf­ficked is a chal­leng­ing and daunt­ing one. These girls bring with them many deep wounds from abuse and traf­fick­ing that are not easy to min­is­ter to. How­ev­er, God’s grace is not lack­ing, and I com­mend the Sis­ters for their ded­i­ca­tion to their ardu­ous, but noble and hope­ful­ly reward­ing, charism. I enjoyed cel­e­brat­ing that Eucharist on Novem­ber 1, the Feast of all the Saints. In the Mass, each girl had come dressed as their favorite saint. It was a sight to behold, not only to see vic­tims of sex traf­fick­ing, but also to see the next gen­er­a­tion of pos­si­ble saints: Saint Philom­e­na, Saint Maria Goret­ti, Saint Tere­sa of Cal­cut­ta, and Saint Thérèse of Lisieux in the making.

Biography

Notes

References