Purpose: Much of the current research about sexually exploited youth draws from street youth services or programs for exiting, yet clinical services may reach a different population. The primary aim of this study was to describe the abuse experiences of sexually exploited runaway adolescents assessed at a hospital-based child advocacy center. We also sought to identify risk behaviors, attributes of resiliency, laboratory results for sexually transmitted infection (STI) screens, and acute and non-acute genital injuries from video-colposcopic exams.
Methods: This study used a retrospective mixed-methods design with in depth forensic interviews of sexually exploited adolescents, together with their responses on a modified Minnesota Student Survey screening tool, physical exams with video-colposcopy and STI laboratory results (N ¼ 57, 50 girls and 7 boys). Forensic interview transcripts were analyzed using content analysis methods along domains of experience and meaning of sexual exploitation events. Univariate descriptive statistics characterized trauma responses and health risks.
Results: Patients ranged in age from 12-19, 25% were African American, 25% White, 21% multi-ethnic, 19% Hmong, 8% American Indian, and 4% were Latino. Qualitative analysis identified that the first sexual exploitation events for many victims occurred as part of seemingly random encounters with procurers when youth needed money, a cell phone, transportation, drugs or shelter. Many were asked “Are you interested?” brief moments after meeting someone. Some youth initially refused solicitation stating, “I’m not that sort of girl.” Older adolescent or adult women recruited some youth working for a pimp, and their loyalty was to this intermediate recruiter. However, half the youth did not report a pimp/boyfriend/trafficker involved in setting up their exchange of sex for money, substances, or other types of consideration; some described purposefully being “independent” and marketing themselves by posting their own ads to exchange sex for money: “I felt rich, like it was a good quick way to make money. It was my idea; no one talked me into it.” Many youth used avoidance strategies to cope, such as “just not thinking about it” or “wanting to forget this whole thing. It just makes me angry.” However, 78% scored positive on the UCLA PTSD tool; 57% reported DSM IV criteria for problem substance use; 71% reported cutting behaviours, 75% suicidal ideation, and 50% had attempted suicide. 18% had signs of penetrating traumatic genital injury, 37% tested positive for Chlamydia, while only 32% reported condom use at last intercourse. Most youth were still attending school but had extensive truancy, and 40% had an individualized education plan.
Conclusions: Contrary to common depictions, sexual exploitation may occur when youth are still attending school; they may be solicited relatively quickly as runaways, yet exploitation is not always linked having a pimp. Avoidant coping does not appear effective, as most patients exhibited significant symptoms of trauma. Awareness of variations in youth’s sexual exploitation experiences may help researchers and clinicians understand potential differences in sequelae, design effective treatment plans, and develop community prevention programs.
Sources of Support: Children’s Hospitals and Clinics of Minnesota Educational and Research Committee and the Canadian Institutes of Health.
