CHILD SEX TRAFFICKING 1
Child Sex Trafficking: The Distinct Effects That Sex Trafficking Have on Children
Jaquasia C. Vandross
Department of Counselor Education and Family Studies, Liberty University
Author Note
I have no known conflicts of interest to disclose.
Correspondence concerning this article should be addressed to .
Email: @liberty.edu
CHILD SEX TRAFFICKING 2
Abstract
Child sex trafficking is a geographically broad-based and growing concern across urban,
suburban, and rural communities in the United States. It surpasses racial, religious, ethnic,
gender, and socio-economic boundaries, although some youth appear to be at greater risk,
including those who are racial and ethnic minorities; Lesbian, Gay, Bisexual, and Transgender
(LGBT); runaway and homeless; and economically disadvantaged. Child sex trafficking
experiences can lead to sexual, physical, and emotional consequences and severe short and long-
term lifelong health, social, educational, legal, and economic problems for survivors. This paper
aims to explore these short and long-term consequences of child sex trafficking, as well as the
frequently occurring comorbidities, cultural considerations, and recommended treatment
methodologies.
Keywords: child sex trafficking, mental health, health,
CHILD SEX TRAFFICKING 3
Child Sex Trafficking: The Distinct Effects That Sex Trafficking Have on Children
Introduction
As defined by the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-V,
2013), Exposure to traumatic events “is a common experience of childhood, with more than 60%
of children exposed by the age of sixteen and more than 30% exposed to multiple events”. For
this paper, traumatic events can include parental or caregiver divorce, incarceration, mental
illness, as well as neglect, abuse, bullying, and living in unsafe environments, among others
(Felitti et al., 1998; Parker et al., 2022, p127). Exposure to these traumatic events can potentially
lead to post-traumatic stress and other typical childhood emotional and behavioral concerns.
Literature suggests that there is a link between childhood trauma and adult psychopathology and
impairment (Felitti et al., 1998; Petruccelli et al., 2019; Price et al., 2021; Parker et al., 2022).
Child Sex trafficking (CST) is a form of trauma. Sex trafficking is more than an issue of
crime; it is the most pervasive and least recognized infringement of fundamental human rights
globally. Victims of CST endure sexual abuse, physical abuse, psychological abuse, and torture.
They are deprived of basic needs such as food and shelter, as well as the prohibition of contact
with support systems such as family, friends, and spiritual services. The repetitive occurrence of
these traumas results in the accumulation of adverse physical health consequences, including
neurological, cardiovascular, pulmonary, gastrointestinal, dental, and reproductive issues.
Additionally, traumatic injuries such as bone fractures, strangling, lacerations, and contusions
may also occur (Lederer & Wetzel, 2014). Adverse mental and behavioral health outcomes can
include post-traumatic stress, depression, anxiety, emotional dysregulation, and suicide (Lederer
& Wetzel, 2014; Landers et al., 2017; Jaeckl & Laughon, 2020).
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Researchers, clinicians, law enforcement, and health personnel must be able to identify
indicators/symptoms of sex trafficking as well as the long and short-term effects so that they are
better able to recognize, support, and advocate for these victims. It is equally imperative that
policymakers begin to acknowledge and address the severity of child sex trafficking so that
comprehensive programs and interventions can be developed that cater to this specific population
and their immediate and long-term needs (NSCTN, 2018).
Understanding Trauma
A Board Definition of Trauma
Trauma, as defined by SAMSHA (2019), is “an event, series of events, or set of
circumstances that is experienced by an individual as physically or emotionally harmful or life-
threatening and that has lasting adverse effects on the individual’s functioning and mental,
physical, social, emotional, or spiritual wellbeing.” Amongst the events that can be perceived as
traumatic include natural disasters, abuse, neglect, and bereavement (SAMSHA,2019). Trauma is
not discriminatory. It is not limited to age, sex, religion, ethnicity, culture, disability, or
socioeconomic background. However, for this paper, childhood trauma, also known as Adverse
Childhood experiences (ACEs), will be used.
The ACE Study
Kaiser Permanente and the Centers for Disease Control and Prevention (CDC) conducted
a joint study that provided the groundwork for trauma research and intervention. The study,
which took place in San Diego, California, from 1995 to 1997, acquired data from approximately
17,000 adult participants. The study's findings linked adverse childhood experiences (ACEs) to
various chronic medical conditions, risky behaviors, mental illness, substance use, and eventual
early morbidity, revealing that adversity experienced early in a child's life has a significant
CHILD SEX TRAFFICKING 5
impact on both short- and long-term outcomes (Felitti et al., 1998). For this paper, as defined by
the CDC, ACEs are traumatic events, such as abuse or neglect, that occur in childhood before the
age of eighteen (2019). These ACEs are further separated into seven categories: psychological,
physical, or sexual abuse; violence against the mother; living with household members who were
substance abusers, mentally ill or suicidal, or ever imprisoned (Felitti et al., 1998).
How Trauma Affects Health
Exposure to trauma in early childhood has been linked with elevated risk for multiple
forms of psychopathology (Laughlin & Lambert, 2017). For this paper, trauma exposure includes
being involved in and/or witnessing one or more forms of traumatic experiences. Depending on
socioeconomic, environmental, cultural, and historical factors, the impact of trauma exposure
can vary significantly (Ho et al., 2019).
Mental Health. Post-Traumatic Stress Disorder (PTSD) has been significantly linked to
child maltreatment (Bruijen et al., 2019; Liu et al., 2023). According to the National Center for
PTSD, 15% to 43% of girls and 14% to 43% of boys experience at least one trauma before the
age of 18. Of those children and teens, 3% to 15% of girls and 1% to 6% of boys are diagnosed
with PTSD (2022). The exposure type and intensity impact the degree to which an event results
in PTSD. Other risk factors to consider are gender, previous trauma exposure, preexisting
psychiatric disorders, parental psychopathology, and social support (National Center for PTSD,
2022). Among other adverse mental health concerns, anxiety disorders, depression, conduct
disorder, self-harm, and suicidality have been mentioned (DSM, 2013; Landers et al., 2017; Liu
et al., 2023).
Physical Health. A large body of research has revealed that adverse childhood
experiences (ACEs) have long-term effects on physical health (Sanderson et al., 2021;
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Alhowaymel et al., 2023). The severe nature of childhood adversities and the cumulative burden
of chronic stress and life events can lead to cardiovascular, endocrine, and immune system
dysfunction (Danese & McEwen, 2012; Pechtel & Pizzagalli, 201; Alhowaymel et al., 2023).
Moreover, ACE researchers have provided evidence that supports the relationship between ACEs
and diabetes (Lynch et al., 2013), obesity (Iniguez & Stankowski, 2016), and hypertension
(Alhowaymel et al., 2023).
Understanding Child Sex Trafficking
Definitions
According to the United Nations Office on Drugs and Crime (UNODC), human
trafficking affects almost every country in the world, whether as a country of origin, transit, or
destination for victims. Article 3(a) of the Palermo Protocol (2000) defines trafficking in persons
as:
“The recruitment, transportation, transfer, harboring or receipt of persons, by means of
the threat or use of force or other forms of coercion, of abduction, of fraud, of deception,
of the abuse of power or of a position of vulnerability or of the giving or receiving of
payments or benefits to achieve the consent of a person having control over another
person, for the purpose of exploitation. Exploitation shall include, at a minimum, the
exploitation of the prostitution of others or other forms of sexual exploitation, forced
labor or services, slavery or practices similar to slavery, servitude, or the removal of
organs.”
The crime consists of three essential elements: the act (the recruitment, transportation, transfer,
harboring, or receipt of persons), the means (the threat or use of force or other forms of coercion,
abduction, fraud, deception, of the abuse of power or of a position of vulnerability or of the
giving or receiving of payments or benefits to achieve the consent of a person having control
over another person) and the purpose (exploitation). Each of the elements as mentioned above
must be present to constitute a trafficking offense (The United Nations, Palermo Protocol 2000).
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With regards to Child sex trafficking, Article 3(c) and (d) of the Palermo Protocol (2000)
defines child sex trafficking as:
“The sex trafficking of minors is the recruitment, harboring, transportation, provision,
obtaining, patronizing, or solicitation of a person under the age of 18 for the purposes of a
commercial sex act, defined as any sex act for which anything of value is given or
received by any person.”
In the United States (US), sex trafficking of minors is considered a form of child abuse and is
often referred to using the terms domestic minor sex trafficking (DMST) and commercial sexual
exploitation of children (CSEC). While these terms have been used interchangeably, they have
very distinct meanings. Olsen et al. (2020) defines CSEC as: “The sexual exploitation of children
for a monetary or nonmonetary financial or economic gain benefiting a particular party and the
sexual exploitation of children for a monetary or nonmonetary financial or economic gain
benefiting a particular party” (para.1). The complexity in defining human trafficking derives
from the fact that the signatory parties of the Palermo Protocol rely solely on their own
interpretations of the protocol's meaning. However, for this paper, Child Sex Trafficking (CST)
and the corresponding definition will be used.
Prevalence of CST
Despite generating considerable attention in the mass media and academic literature,
accurate prevalence estimates of CST remain elusive. The wide range of reported numbers,
ranging from a few thousand to multiple millions, are based primarily on assumptions or
ambiguous methodologies (Stransky & Finkelhor, 2012). The unavailability of reliable estimates
results from multiple factors, including the complex nature of the problem, variations in the
definitions, limits to data collected, underreporting by the exploited person(s), and lack of
training of law enforcement, government agencies, and healthcare personnel (Kragten-Heerdink
et al., 2018; Nemeth & Rizo, 2020). Among other factors that contribute to the difficulty in
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identifying and tracking human trafficking are governments' corruption and poor priority for
addressing and preventing human trafficking.
Concerning the above complexities, the United Nations International Labor Organization
estimated that in 2017, 1 million children were trafficked for commercial sexual exploitation
(ILO, 2017). Women and girls are disproportionately affected by human trafficking, accounting
for 71% of all victims (ILO, 2017). The data mentioned above is not aggregated nationally due to
a lack of consistency in reporting and definition, among other factors.
Risk Factors
There is limited research that speaks to the factors that increase a youth’s risk for
victimization of CST. Among those factors are childhood maltreatment trauma (e.g., sexual,
physical, and emotional abuse and neglect); running away from home or being “thrown away;”
homelessness; poverty; and the resulting engagement in survival sex. Additional risk factors
mentioned are dysfunctional home environments, parental substance use, and exposure to family
members or peers trading sex, as well as child welfare and juvenile justice involvement;
placement in foster care; educational achievement challenges; mental health disorders; and
substance use (Franchino-Olsen, 2019; Jaeckl & Laughon, 2020).
Notably, exposure to childhood adverse experiences contributes to subsequent
vulnerability to being trafficked. Many trafficked youth have a history of childhood sexual abuse,
physical abuse, neglect, traumatic loss, separation from caregivers, and family and community
violence (Hopper, 2017). These experiences can severely impact social-emotional development,
thus affecting the child’s understanding of personal safety, sexual boundaries, and healthy
relationships, leaving them vulnerable to exploitation and trafficking (Hopper, 2017; NCTSN,
2018).
CHILD SEX TRAFFICKING 9
In addition to the above, 50%-90% of trafficked youth are often involved in or have
histories with the child welfare system, foster care placement, and juvenile justice systems (Child
Welfare Information Gate, 2015; Hopper, 2017; NCTSN, 2018), making them targets for CST.
Many of these prevention programs and interventions typically have a cut-off age of eighteen.
With the loss of structural and financial support, youth are placed at higher risk for further
trafficking.
Symptoms Of Child Sex Trafficking
Healthcare providers are one of the few professionals who are likely to interact with
victims of human trafficking (Isaac, 2011; Bespalova, 2016). Studies have found that up to 88%
of CST victims had come into contact with the healthcare system while being trafficked
(Chisolm-Straker, 2016; Family Violence Prevention Fund, 2020). According to Lender et al.
(2014), victims are more likely to seek care from emergency departments (63.3%). Among other
healthcare entities visited by victims actively being sex trafficked were Planned Parenthood
clinics (29.6%), private practices (22.5%), urgent care clinics (21.4%), women’s health clinics
(19.4%), and neighborhood clinics (19.4%) (Lederer & Wetzel, 2014). De Chesnay (2013)
recommends the following as red flags: Patient accompanied by a person who dominates, Patient
may lie about age, Disoriented to time or place, Inconsistencies in accounts of injury or illness,
Branding-unusual or men’s name tattoos, Fearful or highly anxious/submissive, Not in control of
own documents, Sexually transmitted diseases, and/or frequent bacterial/yeast infections.
Long and Short-Term Affects of Child Sex Trafficking
CST is a pervasive issue that can lead to serious short and long-term severe adverse
health concerns. Victims experience a variety of acute and chronic physical and mental health
consequences, including violence-related injuries; sexually transmitted infections (STIs),
CHILD SEX TRAFFICKING 10
including HIV/AIDS; unintended pregnancies and abortions (typically self-inflicted); substance-
use complications; self-harm behaviors; anxiety; major depression; PTSD; and suicidal ideation
(Hossain et al., 2010; Finkelhor et al., 2011; Lederer et al., 2014; Cole et al., 2016; Landers et al.,
2017; Jaeckl & Laughon, 2020).
Health. Individuals trafficked into any form of labor are at high risk of sexual assault,
sexually transmitted infection (STI), HIV, and, in many cases, irreparable damage to their
reproductive health (Jaeckl & Laughon, 2020). A study by Johnston et al. (2016) reported that
20% to 48% of female CST survivors detained in the juvenile justice system had tested positive
for an STI. Similarly, a study by Verma et al. (2015) reported that out of 198 adolescent female
CST survivors, roughly 60% tested positive for HIV. Silverman (2011) noted that female juvenile
CST victims are more vulnerable to HIV than adult female sex workers. This is primarily
attributed to the increased likelihood of lacerations caused by repeated trauma to the immature
genital tract in girls, as well as larger areas of cervical ectopy (Silverman, 2011). Furthermore,
trafficked women are also in danger of unwanted pregnancy. Bick et al. (2017) found that
twenty-eight (29%) of the ninety-eight women who took part in an extensive study of tracking
survivors reported one or more pregnancies while trafficked, with twelve (42.8%) of these
women reporting at least one termination of pregnancy, while actively being trafficked.
Mental and Behavioral Health. Mental health disorders are disproportionately
represented among CST victims (Jaeckl & Laughon, 2020). The most common mental health
diagnoses reported in CST survivors were conduct disorder, emotional dysregulation, depression,
anxiety, PTSD, self-injury, and suicidality (Jaeckl & Laughon, 2020; Fraley & Aronowitz, 2019;
Hershberger et al., 2018; Landers et al., 2017). In a study by Landers et al. (2017), findings
revealed that 7.9% of youth exhibited problems adjusting to the symptoms of PTSD (e.g.,
CHILD SEX TRAFFICKING 11
nightmares, flashbacks, and anxiety), approximately one-quarter of youth exhibited evidence of
antisocial behavior (e.g., such as lying, stealing, manipulating others, and engaging in violence),
30% of youth presented with severe conduct problems, 50% of youth presented with anxious
moods and depression was present in 60% of youths.
Substance Use. Literature suggests that substance use is common among victims of CST.
Traffickers may use opioids or other substances to coerce victims into sex trafficking, or they
may facilitate substance use to keep victims from exiting. However, in most cases, victims of
CST use substances to cope with the trauma of CST victimization (Langston et al., 2022).
Landers et al. (2017) found high rates of substance use in CST victims, with rates ranging from
50% to roughly 75%. In another study, 70% of CST victims were found to use drugs or alcohol,
while 50% were multiple drug users (Verma et al., 2015).
Recommended Treatment Options
Factors that contribute to risk and vulnerability to trafficking are complex, as are the
consequences and pathways to recovery. For starters, systems with which trafficked youth are
commonly involved (e.g., child welfare, law enforcement, educational, mental health, medical
services, runaway and homeless shelters, and refugee and immigrant services) need to implement
trauma-informed care and trauma-focused treatments that specifically cater to this unique
population and their needs (Cohen et al., 2017; NCTSN, 2018).
Moreover, policymakers can help ensure that the needs of CST survivors are effectively met by
implementing:
1. Comprehensive services to address an array of needs, including housing and placement,
educational and vocational assistance, mentorship programs to encourage involvement
CHILD SEX TRAFFICKING 12
with supportive adults, evidence-based mental health treatment centered on trauma,
medical care, and reproductive health services, and support for parenting.
2. Adaptable services and reimbursement systems that acknowledge the heightened level of
intensity and complexity required for trauma-informed interventions for child sex
trafficking survivors.
3. Comprehensive education and training for all professionals in child- and family-serving
systems and those working with refugees, immigrants, and asylees. The aim is to
establish a common understanding of child sex trafficking, its traumatic consequences,
and the connection to trauma-informed, evidence-based services and treatments.
4. Integration of child sex trafficking survivors in the development of policies, community
response procedures, and provision of comprehensive trauma-informed care.
5. Enhanced recognition and action towards marginalized groups such as exploited male
individuals, LGBTQ individuals, individuals experiencing homelessness and running
away, American Indian individuals, as well as refugee, immigrant, and undocumented
youth who have been overlooked or not adequately served.
6. Strategies and protocols that facilitate the smooth transition of young individuals into
adulthood while maintaining consistent support services throughout their journey of
leaving trafficking and recovering from its effects.
7. An assessment of all child sex trafficking programs that receive public funding and
research aimed at establishing and enhancing the body of evidence on effective
interventions. This includes newer initiatives like specialty dockets that aim to reduce
child trafficking, provide alternatives to detention, and improve the health and mental
CHILD SEX TRAFFICKING 13
well-being of young individuals. These evaluations and research findings should be
promptly shared with relevant stakeholders.
Counselors. Although sex trafficking research continues to expand in professional areas
such as psychology, nursing, education, law enforcement, and social work (Fedina et al., 2019;
Hickle & Roe-Sepowitz, 2014; Brown-James et al., 2021), a scarcity of human trafficking
research exist within literature (Litam & Lam, 2020; James et al., 2021). The lack of knowledge
in this area may hinder counselors' capacity to effectively recognize, support, and advocate for
youth survivors of CST (Litam & Lam, 2020). Brown-James et al. (2021) recommend the
following strategies for counselors to work with child sex trafficking survivors effectively:
1. Professional counselors must have an in-depth understanding of the multiple factors that
can contribute to an elevated risk of adolescents falling victim to child sex trafficking.
2. Professional counselors must educate themselves on human trafficking myths and victim
identification. Due to the lack of inclusion of sex trafficking topics in counselor education
programs, counselors are susceptible to propagating misconceptions about human
trafficking and internalizing exaggerated portrayals of child sex trafficking victims and
the nature of sex trafficking (Litam & Lam, 2020).
3. Professional counselors must establish a rapport with and use clinical judgment before
asking questions or performing assessments. Infusing trauma-informed strategies into
assessment procedures is essential for counselors working with sex-trafficked youth.
4. After a child has been recognized as a victim of CST, counselors must be ready to employ
trauma-informed strategies that promote resilience, foster a sense of safety, and mitigate
the adverse effects of trauma. Trauma-informed practices prioritize safety as the
fundamental basis for working with clients. These practices aim to reduce self-harm,
CHILD SEX TRAFFICKING 14
foster trustworthy connections, and prioritize wellness by distancing individuals from
harmful situations.
5. Professional counselors can utilize multicultural and social justice competencies by
disseminating knowledge, advocating for clients within unsupportive structures, and
encouraging clients to advocate for their needs.
Human Trafficking Screening Tools. To effectively identify, support, and advocate for
youth victims of CST, Professional counselors can use human trafficking tools and resources.
The Comprehensive Human Trafficking Assessment Tool and Trafficking Victim Identification
Tool (TVIT) are available at no cost and can help counselors identify CST survivors (Brown-
James et al., 2021). Comprehensive Human Trafficking Assessment Tool (National Human
Trafficking Resource Center, 2011) is used to identify and assist potential victims of both labor
and sex trafficking. Whereas the Trafficking Victim Identification Tool (TVIT) yields valid and
reliable scores for identifying whether or not an individual is a victim of sex and labor trafficking
(Vera Institute,2014).
Cultural Considerations
CST surpasses racial, religious, ethnic, gender, and socio-economic boundaries. However,
some youth appear to be at greater risk, including those who are racial and ethnic minorities:
Lesbian, Gay, Bisexual, and Transgender (LGBT); runaway and homeless; and economically
disadvantaged (poverty). According to the UN (2009), “Human traffickers prey on people who
are poor, isolated, and weak. Issues such as disempowerment, social exclusion, and economic
vulnerability are the result of policies and practices that marginalize entire groups of people and
make them particularly vulnerable to being trafficked”. Individuals are not only susceptible to
trafficking due to the conditions of their countries. Given the magnitude of poverty and the need
CHILD SEX TRAFFICKING 15
for reliable income, trafficking victims accept fraudulent employment opportunities, which put
them in potentially dangerous situations, increasing their chances of being exploited (Chung,
2009; UN, 2009).
Biblical Worldview
The Bible provides direction and wisdom on how to live a righteous life. It also addresses
numerous aspects of human life, including the treatment and care of children. Within the pages
of the Bible, we find clear teachings that emphasize the importance of protecting and nurturing
children. The Bible consistently portrays children as a gift and a blessing from God. Psalm 127:3
states, "Children are a heritage from the Lord; offspring a reward from him." This verse
establishes a fundamental perspective on children, affirming their inherent value and
emphasizing their significance in God's plan. While the Bible does not explicitly use the
term child abuse, it does contain strong warnings against causing harm to children. In Luke 17:2,
Jesus warns, "It would be better for them to be thrown into the sea with a millstone tied around
their neck than to cause one of these little ones to stumble." This verse conveys the severity of
harming children and underlines the need for their protection within society.
As believers, if we suspect a child is being harmed or is at risk, we are obligated to report
what we have heard and/or seen. The Bible calls for justice and protection for the oppressed and
vulnerable, which includes children facing abuse. Proverbs 31:8-9 encourages individuals to
"speak up for those who cannot speak for themselves, for the rights of all who are destitute," and
"defend the rights of the poor and needy." This verse applies to all forms of oppression, including
child abuse.
Conclusion
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Child sex trafficking is a grotesque and heinous violation of human rights, casting a dark
shadow upon our society. This vile form of exploitation mercilessly preys on the vulnerable,
with fraudulent opportunities for employment, education, affordable living spaces, and reliable
income. Furthermore, CST exposes its victims to a myriad of physical and psychological
dangers. These children are subjected to physical violence, sexually transmitted diseases,
substance abuse, and psychological manipulation. The ramifications of such trauma are far-
reaching and long-lasting, affecting not only their physical and mental health but also their
overall well-being and ability to lead productive lives. To combat this gross misconduct on
human rights, we must establish a multi-faceted approach that caters to the unique needs of these
victims individually and as a whole.
CHILD SEX TRAFFICKING 17
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