By Adaora Ntukogu
Photo By: Senior Airman Alexandra Singer
The exact incidence and prevalence of human trafficking worldwide is unknown, however, human trafficking is regarded as the third largest criminal activity in the world. Human trafficking is a form of modern slavery; it occurs when a trafficker exploits an individual with force, fraud, or coercion to make them perform some kind of work. Sex trafficking is a type of human trafficking and involves the use of force, fraud, or coercion to make an individual engage in commercial sex acts. According to the International Labor Organization’s 2012 estimate of forced labour, 4.5 million individuals are victims of forced sexual exploitation globally, which is likely an underestimation. With the surge of sex trafficking worldwide, it is important to acknowledge the mental health needs of survivors, as well as the barriers to seeking treatment.
Mental Health Needs of Sex Trafficking Survivors
There are various factors that affect the nature of the exploitation each individual experiences. Traffickers often employ abusive and violent tactics to maintain control over those they force into exploitation. As a result, trafficked individuals experience significant emotional and psychological trauma with serious effects on their health and well-being.
No defined profile of a trafficked individual exists. Mental health outcomes differ from one trafficked person to another based on baseline health status and health risks prior to being trafficked; duration of trafficking experienced; and health conditions endemic to the geographic location of the exploitation. Survivors have diverse characteristics like gender, age, country of origin, race, and their own exploitation experience. These differences suggest that mental health practitioners must treat each individual and their experiences as unique. However, there are common patterns of abuse like manipulation and extreme violence which can be predictive of specific mental health outcomes.
The adverse health outcomes of sex trafficking are long-lasting. Survivors of human trafficking can suffer from a range of mental health problems, with the most prominent being post-traumatic stress disorder (PTSD), anxiety disorders, depression, dissociative disorders, and substance-related disorders.
The development of anti-human trafficking activities and initiatives as well as the recognition of the phenomenon of human trafficking in the field of mental health is fairly new. Therefore, there is little evidence-based research on the treatment of victims of sex trafficking.
In the absence of this research, mental health professionals working with this population must educate themselves on the evidence-based research related to the treatment of the common diagnoses to ensure the best mental health care possible. Current care methods for sex-trafficking survivors employ the use of evidence-based therapeutic treatments like cognitive-behavioral therapy. Cognitive-behavioral therapy is used for a range of psychological problems including depression, anxiety, anger, marital conflict, loneliness, panic, fears, eating disorders, substance abuse, alcohol abuse and dependence and personality problems. It focuses on identifying and changing current distressing thought and behavioral patterns which is imperative for survivors.
However, these therapeutic treatments may not work for all sex-trafficking survivors. Mental health is treated differently in other cultures. Many cultures do not differentiate psychological, emotional, and spiritual reactions from more physical reactions; rather, they focus on the impact of trauma on the body as a whole. Individuals may have differing views surrounding mental health and it is important that mental health professionals acknowledge and respect differences and provide culturally competent care.
Barriers to Treatment
There are also socioeconomic barriers to accessing mental health care and many individuals who can benefit from these therapeutic treatments are neglected.
While affordability is a major barrier to accessing care, “for most victims, shame is seen as one of the greatest barriers preventing them from seeking mental health services”. Survivors are often blamed for their victimization and their experiences are often minimized to sex work. Equating sex trafficking with sex work is harmful because it dehumanizes sex workers. The stigma indirectly suggests that sex workers are deserving of the corruption they experience. The shame of sexual exploitation can lead to social ostracism for trafficked women all across the world. For example, in Southern Africa, many trafficked women from poor rural areas are rejected by their families when they return. Many are forced to move to urban areas and remain in the sex industry in order to survive. The stigma forces many trafficked women and girls who return home not to seek the care they need to recover, even though assistance programs are available.
What Should We Be Doing Now?
A 2013 article titled “An international comparative public health analysis of sex trafficking of women and girls in eight cities” identified several key determinants of sex trafficking. Child sexual abuse, family dysfunction and early exposure to violence, financial insecurity, lack of formal education, and societal and cultural norms that reinforce inequalities were found to be major facilitators of sex trafficking. Public health officials should target interventions towards these populations that are at a greater risk of being trafficked.
The stigma equating sex trafficking with sex labor needs to be eradicated; this cannot be done without also destigmatizing and legitimizing sex labor. The terms “sex trafficking,” “sex work,” and “prostitution” are often conflated. Although both sex work and sex trafficking involve prostitution, sex work is a willing engagement in commercial sex while sex trafficking involves force and coercion. The concept of willing sex work, has been refuted by activists who argue that prostitution is always a form of exploitation and never a choice. Because sex work is criminalized in the United States and internationally, many sex trafficking survivors forego seeking help for fear of shame.
 Macias Konstantopoulos W, Ma ZB. Physical health of human trafficking survivors: Unmet essentials. In: Human trafficking is a public health issue. 1st ed. Springer; 2017:185–210.
 Macias Konstantopoulos, W., Ahn, R., Alpert, E. J., Cafferty, E., McGahan, A., Williams, T. P., … Burke, T. F. (2013). An international comparative public health analysis of sex trafficking of women and girls in eight cities: achieving a more effective health sector response. Journal of urban health : bulletin of the New York Academy of Medicine, 90(6), 1194–1204. doi:10.1007/s11524-013-9837-4