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Trafficking and Trauma: Insight and Advice for the Healthcare System From Sex-trafficked Women Incarcerated on Rikers Island

Ravi, Anita MD, MPH, MSHP*; Pfeiffer, Megan R. MSW, MS; Rosner, Zachary MD; Shea, Judy A. PhD

doi: 10.1097/MLR.0000000000000820
Award-Winning Manuscripts from APHA 2016

Background: Sex-trafficked persons experience significant trauma while exploited, resulting in complex health issues and barriers to health care. Incorporating survivor perspectives is critical in optimizing health care delivery for this population.

Objectives: We interviewed sex-trafficking survivors regarding their experiences with trauma while being trafficked and elicited advice about health care delivery.

Research Design: Qualitative interviews were conducted in New York City’s Rikers Island jail from July to September 2015.

Subjects: In total, 21 English-speaking women who had experienced sex trafficking were the subjects of the study.

Measures: Interview domains included: interpersonal violence, behavioral health, and health care delivery advice.

Results: Interviewees described experiencing severe and chronic trauma perpetrated by traffickers and sex buyers. Substance use was the primary method of coping with trauma. With regard to mental health, interviewees noted diagnoses of depression, anxiety and posttraumatic stress disorder, low self-esteem, and challenges in intimate relationships. Health care delivery themes included approaches to discussing trafficking in health care settings, concerns regarding sexual assault examinations, and suggestions for improving direct-services and prevention programming.

Conclusions: With this perspective into the complex intersection of trauma and behavioral health that sex-trafficked women can experience, health care providers can better understand the context and recommendations regarding trauma-informed care practices for this population. Our results also offer several avenues for future studies with regard to discussing trafficking in clinical settings and an opportunity for stakeholders to incorporate survivor-based input to improve health care for this population.

*Institute for Family Health

Department of Medicine, University of Pennsylvania

New York City Health and Hospitals, Correctional Health Services

Supported by the University of Pennsylvania’s Leonard Davis Institute of Health Economics.

Presented at the 144th Annual American Public Health Association Meeting and Exposition at Medical Care Section Student Awards Session, October 31, 2016, Denver, CO.

The authors declare no conflict of interest.

Reprints: Anita Ravi, MD, MPH, MSHP, 16 E. 16th Street, New York, NY 10003. E-mail:

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.