What should medical students know about the global sex trade?

Medical students, especially those working in teaching hospitals in major cities such as Houston, are likely to encounter female victims of sex trafficking during their training. They need to know how to recognize medical signs of such abuse, how to sensitively take the victim/patient’s history, and how to help her interface with appropriate social and legal services. In order for physicians to better understand the web of violence and shame that often renders these women difficult to communicate with and to help, an understanding of how the global sex trade works is essential. Sex trafficking is worse than a crime; it is a grave abuse of human rights-a form of modern slavery. Sex traffickers prey on vulnerable women worldwide who search to escape from poverty, economic collapse, or conflict zones by offering them the hope of legitimate employment in wealthier countries. However, it is a bait and switch: the women are forced into prostitution upon arrival. The improvements in transportation, information technology, and communication technology that have led to a huge increase in legitimate trade have unfortunately also extended the reach of criminal organizations and increased the volume of illicit trade. Trafficking is a big business that requires recruiters, brokers, contractors, employment agents, travel agents, document forgers, transporters, employers (procurers), enforcers (guards, extorters), and money launderers; and it is enforced by violence, not contract law. The mythology, impact of male demand, epidemiology, infrastructure, ethics, and societal responses to what is now considered a form of modern-day slavery requires attention from medical students and health care personnel who need to learn of these escalating societal developments. This chapter covers physical findings and psychological indicators that suggest a patient is a potential trafficking victim and will provide a list of probing questions to use in the taking of her history. It begins with an overview of the global sex trade, starting with the definition of the act emphasizing the use of force, fraud, or coercion.