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We want to present some of the larger, more surprising sequels to marriage equality nationwide. Five years after Obergefell, the status and recognition of same-sex marriages remains in question, even as marriage as an institution has become stronger and alternative institutions have survived. Institutions of commitment serve to bind and protect individuals and families during crises like the current COVID pandemic.

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Sex trafficking involves some form of forced or coerced sexual exploitation that is not limited to prostitution, and has become a ificant and growing problem in both the United States and the larger global community. Victims of sex trafficking acquire adverse physical and psychological health conditions and social disadvantages. Thus, sex trafficking is a critical health issue with broader social implications that requires both medical and legal attention.

Healthcare professionals can work to improve the screening, identification, and assistance of victims of sex trafficking in a clinical setting and help these women and girls access legal and social services. Human trafficking is a modern-day form of slavery that involves the illegal trade of human beings for the purpose of some form of forced exploitation.

The United Nations Office On Drugs and Crime UNODC defines human trafficking as any form of recruiting, transporting, transferring, harboring, or receiving a person by means of threat or use of force or other forms of coercion, abduction, fraud, or deception.

Human trafficking origins. Trafficking in Persons: Global Patterns. Victims of sex trafficking are forced into one or more forms of sexual exploitation. It is important to note that sex trafficking and prostitution are not synonymous and that prostitution is simply one type of work performed by victims of sex trafficking.

Sex trafficking is an umbrella term that may include commercial sex work such as prostitution, but also pornography, exotic dancing, stripping, live sex shows, mail-order brides, military prostitution, and sexual tourism. Although victims of sex trafficking can be of any age and of either sex, the majority are women and adolescent girls. Although many nations have outlawed the trafficking of females, it is still widely prevalent on a global scale.

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Cumulative of incidents of human trafficking between January and June Characteristics of Suspected Human Trafficking Incidents, — Prevalence of global human trafficking. There are several recurrent tactics of manipulation used to coerce victims into situations of sex trafficking Figure 4.

Most commonly, victims are promised a good job, education, or citizenship in a foreign country or offered a false marriage proposal that is turned into bondage.

Many victims are sold into the sex trade by parents, husbands, and ificant others, whereas others are unwillingly and forcibly kidnapped by traffickers. The most common tactic of coercion used among victims is debt bondagean illegal practice where the victim has to pledge personal services in order to repay some form of debt, such as transportation into a foreign country or living expenses.

Another tactic used is traumatic bondingwhere the victim is instilled with deeprooted fear coupled with gratitude for being allowed to live. Reproduced with permission from Prolaris Project. Finesse pimping involves using compassion, kindness, and psychological games such as luring victims through small gifts of cash, clothes, shelter, food, and drugs that make them feel obligated or indebted to the pimp.

Guerrilla pimping involves using violence, threats, intimidation, or aggression in order to recruit and then enslave the victim. Once women and girls become involved in the sex trafficking industry, it becomes very difficult for them to escape. Victims may face legal barriers, where the traffickers will confiscate or sequester all forms of immigration and citizenry documentation.

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Language barriers, fear, limited knowledge, and lack of money are other barriers that women and girls may face to prevent them from escaping the sex trafficking ring. In many parts of the world, legacy prostitutionor the involuntary enslavement of future generations of girls in the sex trafficking industry, becomes an expected societal norm.

In fact, human trafficking is the fastest growing area of organized crime and the third largest income revenue for organized crime after narcotics and arms sales. What makes this business unique is that women and girls sold into sex trafficking earn profits for their pimps and traffickers over a great of years, unlike the profits earned from drugs and narcotics that are sold and used only once.

The US Department of State estimates that anywhere from 14, to 17, people are trafficked in the United States annually. This facilitates trafficking, as it is easier to recruit and transport women, bribe officials, and forge passports and other travel documents.

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Victims of sex trafficking are likely exposed to adverse conditions that can negatively affect their physical, mental, and emotional health. Physicians, nurses, midwives, and other healthcare providers can play critical roles in helping to identify victims of sex trafficking as a first step in providing both assistance and advocacy for affected women and girls.

As a provider, one can play an essential role in providing interventions to improve physical and psychological health among victims and advocating on behalf of victims to help improve their social circumstances. Sex trafficking victims are particularly susceptible to sexually transmitted infections such as gonorrhea, syphilis, urinary tract infections, and pubic lice.

Sex trafficking victims are often physically abused and tortured. A history of concussions and head trauma should also be taken to screen for traumatic brain injury, which may result in memory loss, dizziness, headaches, and numbness. Food deprivation represents an indirect form of physical harm that also should be considered by screening victims for malnutrition.

Providers should also screen for unwanted pregnancy resulting from rape and prostitution, sterility, miscarriage, menstrual problems, mutilations, and forced or coerced abortions.

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Infectious diseases such as tuberculosis, hepatitis, malaria, and pneumonia may be more prevalent among sex trafficking victims as a result of unsanitary and dangerous housing conditions, use of needles, and inadequate access to health care. Victims of sex trafficking may face moderate to severe psychological trauma from daily mental, emotional, and psychological abuse and torture. Post-traumatic stress disorder, acute anxiety, and depression are all common psychological issues among sex industry workers.

Providers should screen for feelings of helplessness, shame, humiliation, distrust, self-hatred, disbelief, denial, suicidal thoughts, disorientation, confusion, and phobias among suspected victims.

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Although there are insufficient data that report the social effects of sex trafficking, anecdotal evidence suggests that victims have a greater prevalence of illiteracy, homelessness, poverty, and societal isolation. Trafficked women engaging in sex work tend to have fewer resources, limited options, and increased vulnerability to violence and abuse than women who are not trafficked. Inthe US Department of Health and Human Services implemented a campaign to increase the awareness of human trafficking in healthcare workers who may unknowingly interact with victims in their day-to-day work.

The following is a series of questions adapted from the US Department of Health and Human Services that guide healthcare providers to screen an individual in order to determine whether she is a victim of sex trafficking.

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Health care professionals can work to improve the screening, identification, and assistance of victims of sex trafficking in a clinical setting and help these women and girls access legal and social services. National Center for Biotechnology InformationU. Journal List Rev Obstet Gynecol v. Rev Obstet Gynecol. Author information Copyright and information Disclaimer.

This article has been cited by other articles in PMC. Abstract Sex trafficking involves some form of forced or coerced sexual exploitation that is not limited to prostitution, and has become a ificant and growing problem in both the United States and the larger global community. Open in a separate window. Figure 1. Figure 2. Figure 3.

Same-sex marriage: understanding obergefell v. hodges

Methods of Coercion, Recruitment, and Enslavement There are several recurrent tactics of manipulation used to coerce victims into situations of sex trafficking Figure 4. Figure 4. Health Implications Victims of sex trafficking are likely exposed to adverse conditions that can negatively affect their physical, mental, and emotional health. Physical Sex trafficking victims are particularly susceptible to sexually transmitted infections such as gonorrhea, syphilis, urinary tract infections, and pubic lice.

Psychological Victims of sex trafficking may face moderate to severe psychological trauma from daily mental, emotional, and psychological abuse and torture. Social Although there are insufficient data that report the social effects of sex trafficking, anecdotal evidence suggests that victims have a greater prevalence of illiteracy, homelessness, poverty, and societal isolation.

Screening Questions to Identify Victims of Sex Trafficking Inthe US Department of Health and Human Services implemented a campaign to increase the awareness of human trafficking in healthcare workers who may unknowingly interact with victims in their day-to-day work. Where do you sleep and eat? Do you sleep in a bed, on a cot, or on the floor?

Have you ever been deprived of food, water, sleep, or medical care? Are you required to ask permission for physical necessities? What are your working and living conditions like? Are you able to come and go as you please?

The unfinished business of lgbtq+ equality: five years after obergefell v. hodges

Can you leave your job or working situation if you want to? Are there locks on your doors and windows so you cannot leave? Are you allowed to talk to people outside your home or job? Has anyone ever physically harmed you in any way? Have you ever been threatened if you try to leave your home or work?

Has anyone ever threatened your family?

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Has your identification or documentation been taken away from you? Is anyone forcing you to do anything that you do not want to do? Have you been or are you forced to have sex or perform sex acts?

Sex trafficking of women and girls

Conclusions Sex trafficking involves some form of forced or coerced sexual exploitation that is not limited to prostitution, and has become a ificant and growing problem in both the United States and the larger global community. Main Points. References 1. United Nations Office on Drugs and Crime, authors. Human trafficking and migrant smuggling.

Dovydaitis T. Human trafficking: the role of the health care provider. J Midwifery Womens Health. Hodge DR. Sexual trafficking in the United States: a domestic problem with transnational dimensions. Soc Work. Sex trafficking and the exploitation of adolescents. J Obstet Gynecol Neonatal Nurs. Philadelphia: University of Pennsylvania;