H EALTH P ROBLEMS AIDS, Contraceptives, and Psychological Problems
H YPO : W HAT TO DO ? (R ED F LAGS ) You’re in the midst of your first week of rounds in Boston Medical Center’s Emergency Room—a major step and a right of passage for an up and coming medical student. A man brings an unconscious girl into the emergency room at 3:00 AM. It is November, and she is wearing only a small black dress. He tells doctors he found her on the side of Mass Ave. He says he thinks that she might have been hit by a car. All of her visible Injuries are to her face: she has a fractured jaw, a broken nose, and noticeable swelling. When the girl is awake and stable, she gives her name and says she is 18. She has no ID with her, but given her size and features, she appears to be much younger.
You are interested in public health and migrant workers' rights. It's been a week since you began your summer internship with the Migrant Health Support, a non-profit organization providing medical care for undocumented migrant workers in California. Yesterday, you visited a migrant farmworker camp to assist some people with labor related injuries. As you entered the camp, you saw four Latina girls who looked like 10-13 years old going entering a truck. It looks like they had just finished providing sexual services to a few of the migrant farmworkers. Your internship supervisor gives the girls some condoms before they are driven away. When you ask your supervisor why she gave them condoms, she answers: "Those girls are from poor families in Mexico trying to make money through prostitution. They are young, but what can we do? If we report it to the police, both the migrant farmworkers and the undocumented prostituted girls may be deported. As medical workers, we take oath to 'do no harm,' so I just give them condoms to prevent them from getting STDs and HIV/AIDS."
HIV IN I NDIA /N EPAL (S ILVERMAN S TUDY ) Among 287 repatriated Nepalese sex-trafficked girls and women, 109 (38.0%) tested positive for HIV. Girls trafficked prior to age 15 years were at increased risk for HIV.
E DUCATING J OHNS Do johns care that they are VERY likely to contract AIDS? Why do they continue to use the victims? Solution : Informing clients of the risks of HIV infection. Worth it?
P OSSIBLE S OLUTIONS - HIV A UN representative has seen the staggering statistics about STDs and human trafficking in the world today. He observes that Amsterdam has legalized prostitution and requires the sex workers to be tested every day of work in order to ensure the positive health of their customers. Also, they require the customer to show an updated certificate of an STD test. The STD rate is actually less in Amsterdam than that of other cities such as Seoul. He considers supporting worldwide prostitution with the requirements same as those in Amsterdam. Is this a rational choice? Does he have a point here? He knows he cannot stop human trafficking for good, but this may help ensure the health of sex workers and prostitutes.
P RIVATE D OCTORS (B URKE ) Pimps and brothel owners bring in private doctors or other medical practitioners rather than bringing victims of sex trafficking to hospitals to avoid the risk of detection possible by contact with a hospital. What do you think of these doctors?
P OSSIBLE S OLUTIONS Amnesty allowing for HIV tests and antiretrovirals in government hospitals and red- light districts. Could that add to the trauma? Compensation for pimps/madams for participating. Demand these doctors inform law enforcement about the poor living conditions Harsher punishments for sex trafficking generally
C ONTRACEPTIVES FOR S EX S LAVES U.S. Anti-prostitution pledge for US aid "No funds [...] may be used to promote or advocate the legalization or practice of prostitution or sex trafficking." "No funds [...] may be used to provide assistance to any group or organization that does not have a policy explicitly opposing prostitution and sex trafficking.“ Brazilian government turned down $40 million in anti-HIV/AIDS AOSI v. USAID (2 nd Cir)– injunction preventing the government from requiring these organizations to sign the anti-prostitution pledge
Q UESTIONS OF A NTI -A BORTION P LEDGE ? Would condoms make sex workers more productive? Could victims actually demand the use of condoms from clients anyways? Could increasing the use of condoms, actually increase the amount of prostitution and trafficking? How else could the U.S. appeal to the anti- abortion sentiment, but send the monetary aid to where its needed?
P SYCHOLOGICAL P ROBLEMS Hossain and Zimmerman Study Injuries and sexual violence during trafficking were associated with higher levels of PTSD, depression, and anxiety. Sexual violence was associated with higher levels of PTSD. More time in trafficking was associated with higher levels of depression and anxiety Stage Model of Trafficked Victims Is it important to distinguish the health issues that arise during different stages of the trafficking process as Zimmerman does?
P SYCHOLOGICAL P ROBLEMS Why is it necessary to do studies on things that seem to have such obvious conclusions (i.e. sexual violence leads to PTSD)? Iva (3-4pm) Can people really be cured of mental problems or be reintegrated into society? Do you think non-trafficked or enslaved prostitutes suffer from similar problems?
P REVIOUSLY A BUSED They also found that 40% of the women had experienced pre-trafficking abuse Can anyone confidently discern that the trauma experienced during the trafficking experience is always the cause of the metal issues? OR could it be that there are some pre-existing conditions which made sufferers particularly vulnerable to trafficking? How do the traffickers find people already suffering from mental issues?
R ETURNING H OME Are suggestions such as "effective responses" to trauma as "no blaming of victim" and "providing a supportive environment" realistic within the victim's home country? How would this be accomplished? Immigration Status: should asylum be given if you are suffering from mental instead of physical problems?