Information specifically documenting the needs of victims of human trafficking is limited and has focused primarily on international victims. However, research on prostitution and on homeless and runaway youth can provide some insights about the needs of domestic trafficking victims and can help increase understanding about the similarities and differences across the victim types.
Girls and women escaping prostitution report housing (both transitional and long-term) as an urgent need (Commercial Sexual Exploitation Resource Institute, 1998). Substance abuse treatment and mental health counseling are also common needs among this population. The use of substances and subsequent drug addiction is well documented among homeless youth exploited through prostitution. One study found that more than 75 percent of these youth abuse alcohol or drugs, while virtually all admit to some level of use (Yates, Mackenzie, Pennbridge, & Swofford, 1991). These rates were notably higher than among homeless youth not exploited through prostitution (R. Lloyd, personal communication, May 2007). While it is important to note that a significant percentage of girls enter prostitution with no history of drug or alcohol abuse (Farley & Kelly, 2000), some studies suggest that girls who become exploited through prostitution are likely to have begun using substances at an earlier age than their at-risk peers who do not become exploited in this way (Inciardi, Pottieger, Forney, Chitwood, & McBride. 1991; Nadon, Koverola, & Schludermann, 1998). Substance abuse is also a rampant problem among the male population. For example, one study found that 77 percent of the boys exploited through prostitution were regular users of marijuana (Harlan et al., 1981). Another study found that 42 percent of the prostituted boys could be classified as heavy drinkers or alcoholics and 29 percent were regular users of hard drugs (Allen, 1980). In 1989, the County of Los Angeles found that of all the runaway youth, both boys and girls, seeking medical assistance, 75 percent of those exploited through prostitution had a substance abuse problem compared with 36 percent of those youth not being prostituted (Klain, 1999). Both girls and boys also present with medical needs. Females trafficked in the sex trade have increased risk of cervical cancer and chronic hepatitis as well as HIV (Farley et al., 2003), thus requiring immediate and potentially long-term medical care. Boys are at particularly high risk of contracting HIV due to high rates of unprotected anal sex with adult men as well as frequent intravenous drug use (Flowers, 2001).
Rates of mental health problems are similar between girls and boys, though girls have been studied far more extensively (Flowers, 2001; Klain, 1999; Lankenau et al., 2005; Moxley-Goldsmith, 2005). Adolescent girls suffer severe emotional and physical consequences as a result of domestic trafficking. Survivors of prostitution demonstrate a high rate of dissociative disorders, self-destructive behaviors (including cutting), suicide attempts, and clinical depression (Farley, 2003; Farley & Kelly, 2000; Giobbe, 1993; Lloyd, 2005; Nixon et al., 2002). Additionally, as a result of the chronic trauma, prostituted girls often develop symptoms congruent with PTSD. One international study of prostituted children and adults, including male prostitutes, in five countries found that almost three-fourths met the diagnostic criteria for PTSD (Farley, Barel, Kiremire, & Sezquin, 1998; Silbert & Pines, 1981). The clinical manifestations of PTSD can limit an individuals ability to function effectively, decreasing the likelihood that he or she can take advantage of available resources and possibly minimizing any likelihood of leaving prostitution (Valera, Sawyer, & Schiraldi, 2001).
As with all victims of human trafficking, adolescent girls may display symptoms of Stockholm syndrome, otherwise most frequently seen among prisoners of war and torture victims (Graham & Wish, 1994). As a means of emotional and physical survival, the captive (the girl) identifies with her captor. She expresses extreme gratitude over the smallest acts of kindness or mercy (e.g., he does not beat her today), denial over the extent of violence and injury, rooting for her pimp, hypervigilence regarding his needs, and the perception that anyone trying to persecute him or help her escape is the enemy. She may lash out at law enforcement or anyone else attempting to help her exit, and insist that she is fine and happy in her current situation. Further, the manifestations of her trauma may make her reticent to trust those outside the Life who state they are trying to help her (Friedman, 2005; Raphael, 2004).
While presented here as separate needs or conditions, recognition of co-occurring disorders among adolescent victims of trafficking and the need for integrated treatment approaches, specifically for trauma, substance abuse, and mental health disorders, has gained momentum over the past 510 years (Austin, Macgowan, & Wagner, 2005; Battjes et al., 2004; Dasinger, Shane, & Martinovich, 2004; Dennis et al., 2002, 2004; Godley, Jones, Funk, Ives, & Passetti, 2004; Robbins, Bachrach, & Scapocznik, 2002). A number of studies indicate high rates of co-occurring disorders among adolescents. In one clinical study of youth in the mental health system, for example, about half had a co-occurring substance abuse disorder (Greenbaum, Foster-Johnson, & Petrilla, 1996). In the substance abuse system, estimates are even higher that as many as 7590 percent of drug abusing adolescents having a co-morbid mental health disorder (Eisen, Youngman, Grob, & Dill, 1992; Grella, Hser, Joshia, & Rounds-Bryant, 2001). Mood disorders (especially depression and anxiety), conduct disorders, and attention deficit hyperactivity disorder are most often cited as co-occurring with substance abuse disorders in adolescents (Crowley & Riggs, 1995; Wise, Cuffe, & Fischer, 2001). Given the high documented rates of co-morbidity in substance abusing clinical populations, Grella et al. (2001, p. 391) concluded that adolescent drug treatment programs should assume that co-morbidity among their patients is the norm, rather than the exception.
The needs of homeless and runaway youth parallel the needs of victims of human trafficking (international and domestic). These include the need for food, clothing, and housing; medical care; alcohol and substance abuse counseling and treatment; mental health services; education and employment assistance; and legal assistance (Robertson & Toro, 1999). In two studies, homeless youth reported wanting assistance with life skills training (Aviles & Helfrich, 2004; DeRosa et al., 1999). Other important service needs are assessment and treatment for exposure to trauma (Dalton & Pakenham, 2002; Steele & OKeefe, 2001) and risk of suicide (Martinez, 2006).
Overall, the needs of victims of human trafficking, whether international or domestic, sex or labor trafficking, can be characterized as complex, requiring multiple and comprehensive services and treatment representing a continuum of care (emergency, short-term, and long-term assistance) that can last for several years.