Pornography, a multimillion-dollar industry, is viewed as an acceptable outlet for sexual gratification, yet it creates victims (50 percent of sex-trafficking victims have been involved in pornography) and buyers/johns who may turn to the sex trade when watching provocative films no longer satisfies their desires.⁴

When a girl is sold, the money almost always goes entirely to her pimp. The profits of this illegal business are enormous because girls may be sold many times per night and many nights per week.

Recognition and Treatment

Victims of sexual trafficking undergo immeasurable physical and emotional abuse. Traffickers (pimps) go to great lengths to ensure their victims continue to service as many buyers as possible. Pimps may use the “lover boy” approach of promising love, marriage, or a brighter future to victims—or may physically and psychologically coerce victims. Victims are given a false sense of “love” from professional con artists in one of the oldest con schemes in history. Basic human needs, including food, shelter, and clothing, are withheld from victims for not reaching their quota (a minimum daily earnings expectation determined by pimps). Victims are threatened, beaten, and raped into staying with traffickers and often feel they have nowhere else to turn. Ironically, even when fearful, victims will appear to enjoy themselves during their transactions. The appearance of enjoyment by the victims helps johns ignore that what they’re doing is a heinous crime.

DMST victims commonly have experience with authority figures who fail to protect them, including their parents, foster parents, teachers, and case managers. They are often purchased (i.e., raped for profit) by clergy members, physicians, police officers, and other professionals. They have been taught not to trust. This, along with the fact that victims often do not consider themselves victims or in need of rescue, makes it difficult to emancipate these girls. They may have Stockholm Syndrome and relate to their abusers/pimps. Sex-trafficking victims may present in the ED as “difficult patients”: rebellious and disrespectful.

A realistic goal for a visit with a sex-trafficking victim is to convey that you are trustworthy and nonjudgmental and that your ED is a safe, accepting place for her. A major breakthrough/rescue within one encounter is unusual but, nevertheless, worth the effort.

As an emergency medicine provider, you will need keen interviewing skills and the ability to convey openness and kindness to a victim. It is crucial to aggressively pursue any opportunity to interview the patient while separated from the individual who may have brought her in for evaluation. This may display to the victim that you recognize something is amiss and you are willing to intervene. She is fearful and will not ask to speak with you alone. You must take on the burden of attempting separation for her safety. A realistic goal for the visit is to convey to the victim that you are trustworthy and nonjudgmental and that your ED is a safe, accepting place for her. A major breakthrough/rescue within one encounter is unusual but, nevertheless, worth the effort.