Supplemental Reading (Optional): Human Trafficking

Reading Page 2 (optional)

 

Sex trafficking vs. sex work

The module makes an effort to distinguish between sex trafficking and sex work. While there is certainly a relationship between the two concepts in some cases, not all sex workers are trafficking victims/survivors. Any efforts to curb sex trafficking should be clear on this distinction so as to not further criminalize and stigmatize those who engage in consensual sex work. In fact, some sex workers denounce the very language of “sex trafficking,” arguing that the language itself delegitimizes sex work (read more here). Links to an external site.

The World Health Organization (WHO) provides clear definitions that distinguish between these concepts:1 

Sex work: The provision of sexual services for money or goods.

Commercial sex: The exchange of money or goods for sexual services. It always involves a sex worker and a client and it also frequently involves a third party.

Sexual exploitation: Actual or attempted abuse of a position of vulnerability, power, or trust, for sexual purposes, including, but not limited to, profiting monetarily, socially or politically from the sexual exploitation of another.

Trafficking: The recruitment, transportation, transfer, harbouring or receipt of persons, by means of the threat or use of force or other forms of coercion, of abduction, of fraud, of deception, of the abuse of power or of a position of vulnerability or of the giving or receiving of payments or benefits to achieve the consent of a person having control over another person, for the purpose of exploitation.

 

To understand how anti-trafficking policies hurt sex workers, let’s look at FOSTA (Allow States and Victims to Fight Online Sex Trafficking Act) and SESTA (Stop Enabling Sex Traffickers Act), signed into law by President Trump in 2018. These laws, which purported to thwart sex trafficking operations, made websites liable for the content posted by users. This meant that if sex workers used a website to find and vet clients or collect payment, the website owners would be liable for facilitating “illegal” activities. As a result of the FOSTA-SESTA law, one of the largest websites for finding sex work clients shut down completely, leaving sex workers without a centralized and safe way to vet and review clients and build community. While the goal of the policy was to protect trafficking victims/survivors, it devastated sex workers, who were once again pushed to the margins and to more high-risk activities, such as street-based sex work.2

 

While there is absolutely overlap between sex trafficking and sex work, it is important to understand these concepts as a Venn diagram, rather than a circle. Victims of sex trafficking are not able to consent to sexual acts while under the control of another person. If they receive compensation in exchange for services, they are often not allowed to keep that compensation for themselves and must relinquish it to their traffickers; sex workers may engage in fully consensual acts for which they receive compensation. Consent is key here: is the person being forced, coerced, manipulated into performing sex work, or do they engage in consensual sex work rooted in their own autonomy and choice?

Venn diagram showing similarities and differences between sex work and victims of sex trafficking


Sex trafficking and consensual sex work are two extreme ends of a spectrum with many possibilities in between.  A consensual sex worker might pay for their own security guard, access to a club for finding clients, or an OnlyFans account – in essence, working as an independent contractor. There are also sex workers who willingly engage in paid sex acts, but don’t have full control of when, where, and with whom they do their work, or the income generated by it; for example, they may have a pimp who books their appointments and takes a percentage of the payment.
3 

 

It is important to avoid stereotyping and assumptions about sex workers. Common myths include:4

  • All sex workers have experienced sexual violence or trauma
  • All sex workers use substances
  • All sex workers are inherently exploited 
    • From the Equality Institute1: “Sex workers use their body as a tool to offer and fulfill services, much like many other industries such as carpentry, modeling, personal training, etc.”
  • Sex workers just need to “get a real job”
  • All sex workers started out as trafficking victims 

 

 

What are other ways I help a patient who has experienced severe trauma?

 

So-called “counter-ACEs” are positive childhood experiences and having few or none may be more influential on adult health than ACEs themselves. One way to prevent human trafficking is to help work to build up community environments and supports for children and families through advocating for policies such as increased social safety nets (such as universal healthcare), housing-first and affordable housing policies, universal preschool, and paid parental leave. Can you think of another local, state, or national policy that would support counter-ACEs like the ones listed below? Can you think of a way that as a physician, you could advocate on any level, for that policy, or otherwise volunteer to support healthy communities?

List of examples of ACEs and counter-ACEs

Source: Tait, Veronica. Psychology Today. Ways to Counter the Effects of Adverse Childhood Experiences, 2019. https://www.psychologytoday.com/us/blog/pulling-through/201910/ways-counter-the-effects-adverse-childhood-experiences Links to an external site.

 

For both youth and older individuals who have experienced severe trauma, making a referral to professional counseling/therapy is appropriate. While beyond the scope of this module, some evidence-based strategies for the patients’ healing might include:

 

 REFERENCES

  1. Unpacking harmful myths around sex work. The Equality Institute. April 27, 2020. Accessed April 10, 2024. https://www.equalityinstitute.org/blog/unpacking-harmful-myths-around-sex-work Links to an external site.
  2. Blunt D, Wolf A. Erased: The impact of FOSTA-SESTA and the removal of Backpage on sex workers, Anti-Trafficking Review. 2020; 14: 117-121. https://doi.org/10.14197/atr.201220148 Links to an external site.
  3. Links to an external site.What Is the Difference Between Human Trafficking and Sex Trafficking? DeliverFund. Updated Sept 20, 2023. Accessed April 10, 2024. https://deliverfund.org/blog/what-is-the-difference-between-human-trafficking-and-sex-trafficking/ Links to an external site.
  1. U.S. Department of Health and Human Services, Office on Trafficking in Persons. Myths and Facts About Human Trafficking. February 20, 2019. Accessed December 2, 2024. https://www.acf.hhs.gov/otip/about/myths-facts-human-trafficking