Addressing sex trafficking

As doctors who provide care to victims and survivors of abuse and exploitation, we’ve witnessed firsthand the severe consequences of human trafficking.

Not only do our patients suffer the immediate physical impacts of abuse, they also face chronic psychological trauma and the long-term social harms of stigmatization and lost opportunities.

Regardless of where you stood on Senate Bill 265, the bill defining sex trafficking in Hawaii, Gov. David Ige’s recent veto provides an opportunity to reassess the best ways to support people victimized by sex trafficking.

In our roles as physicians, we understand that focusing solely on the criminal justice system does not offer a comprehensive solution to the problem. Patients have confided that they are fearful of being jailed if they seek care at a hospital, that they can’t get a job because their background checks reveal past criminal records, that they are too terrified to testify because the trafficker threatened their children.

We cannot arrest and prosecute enough pimps and purchasers to end sex trafficking, and penalties and punishments, when successful, do not ensure that victims will undergo a healing process or obtain the educational and economic opportunities they so urgently need.

Our patients may feel too scared or hopeless to participate in the prosecution of their traffickers. They may not be ideal candidates for a successful prosecution, and district attorneys may not take up their cases.

Our patients may have gone through a failed prosecution, yet still need long-term services to deal with the burdens of their experiences. Or they may have been trafficked years ago and still require long-term therapy.

If a victim does not cooperate with the prosecution, if a district attorney does not take the case, or if the case fails, does that mean the person doesn’t deserve and won’t receive the support he or she needs to heal? We need solutions broader than the focus on prosecuting traffickers.

What happens when our patients’ interests do not align with criminal justice goals? Prosecutors’ foremost priority is to uphold the laws of the state, and in best cases, state interests overlap with victims’ needs. Sometimes, however, they are at odds.

We propose two guiding principles to help align the goals of different stakeholders and systems:

>> First, a public health framework provides the necessary structure to centralize services and promote the well-being of these most marginalized community members.

Community health centers can provide the necessary support network and care coordination that victims need in acute stages and long-term recovery. Provision of these services and victims’ access to care should not be contingent upon engagement or cooperation with the criminal justice system.

>> Second, a trauma-informed approach is critical to reducing re-traumatization and promoting healing. It also improves the chances that the goals of these different systems will better align with those of the victims and survivors.

For many patients, trafficking is just one of multiple traumas they have experienced throughout their lives. Distrust, anxiety and confusion are common and appropriate reactions, and should be acknowledged and compassionately addressed by health care and social service providers, as well as by law enforcement personnel.

Ige’s veto gives us the opportunity to look deeper at this complex issue to address the underlying causes, social determinants, and economic disparities that predispose our most vulnerable neighbors into being trafficked.

A trauma-informed, public health approach provides a broader perspective to focus on solutions that enable prevention, sustained healing, and long-term recovery.

Dr. Kimberly Chang is a co-founder of HEAL Trafficking, and a family physician at Asian Health Services in Oakland, Calif.; born and raised in Honolulu, she splits her time between Oahu and Oakland. Dr. Nicole Littenberg is a co-founder of HEAL Trafficking and co-founder/medical director of Pacific Survivor Center; she is a physician at a Honolulu community health center and a forensic examiner with the Sex Abuse Treatment Center.