Emergency contraception was not often used. The most common form of contraception was condoms, while just a few contributors additionally mentioned clinic visits for depot medroxyprogesterone acetate injections. Our research aimed to establish health experiences of domestically intercourse-trafficked ladies incarcerated on Rikers Island with regard to healthcare access, reproductive well being, and infectious diseases while trafficked. The Rikers Island Prison Complex in NYC consists of ten jails, together with one facility for incarcerated ladies: The Rose M. Singer Center (RMSC). The Institutional Review Boards of the NYC Department of Health and Mental Hygiene and the University of Pennsylvania accepted this examine. The most typical areas of healthcare provision whereas being trafficked had been emergency departments (EDs), jails, women’s health clinics akin to Planned Parenthood and free or Department of Health clinics. All three individuals who noted having an intrauterine system in place while trafficked also had elimination procedures throughout that time attributable to associated pain.
For some survivors, jail was the only place where they interfaced with formal medical care when trafficked. Traffickers additionally weighed the financial influence of survivors taking time to hunt medical care as an alternative of seeing buyers. Trafficking-ring survivors described cases where the trafficker would attempt to treat survivors’ accidents by purchasing medical supplies at the pharmacy or arranging for a personal contact (who survivors assumed to be a physician) to see the survivor at the location they had been held. Some contributors acknowledged that healthcare entry was limited by their traffickers as a result of concern that survivors would attempt to run away from or report the trafficker if allowed to seek care. For example, some survivors described prioritizing substance use over their healthcare needs, influencing their resolution not to hunt care. Others additionally expressed criminal justice-associated fears related to searching for care, such as not eager to be arrested in the ED if they had open warrants due to concern of arrest for substance use and prostitution.
RMSC accommodates a substance use housing space with devoted counseling and therapeutic programming. Some participants also discussed completely different methods they might use throughout visit registration, comparable to using a pretend identify or itemizing a pretend handle to facilitate receiving acute care in the event that they were without ID, which additionally sophisticated follow-up. For example, being prescribed a vaginal antibiotic suppository for nightly use or being counseled to not have sex for 7 days following STI treatment, although requirements of care, were not possible plans for trafficked individuals anticipated to see multiple consumers nightly. The most commonly discussed causes for searching for healthcare included STI and HIV testing, unintended pregnancies, acute, violence-associated points (comparable to rape, traumatic damage, and suicide attempts), and chronic illness administration (such as hypothyroidism or asthma). For instance, one HIV-positive participant didn’t receive treatment while trafficked resulting from fear of violence perpetrated by the trafficker if he discovered of the diagnosis, as it was anticipated that each one of his “girls” have been “healthy.” In instances the place traffickers permitted healthcare visits, some individuals described that either the trafficker or another trafficked girl would accompany the survivor to the appointment for intimidation and management functions.
Many contributors discussed stresses related to the potential for pregnancy while trafficked, due in part to worry of increased trafficker-perpetrated violence, since unintended pregnancies risked monetary loss for the trafficker. While some girls didn’t see patrons throughout this time, others described “stuffing,” whereby absorbent objects such as child wipes or make-up sponges have been inserted into the vagina so that the traffickers’ anticipated earnings quotas may proceed to be met. Others recalled being compelled to mask their accidents with a purpose to continue seeing consumers. Others described offering oral or anal sex instead or partaking in “thigh sex” (whereby ladies would hold their thighs together throughout intercourse, leading to non-penetrative sex) if patrons have been simultaneously utilizing medicine and fewer seemingly to note that they weren’t partaking in vaginal sex. Transportation and cost-associated obstacles typically led to later-time period procedures attributable to ensuing delays. Some members described boundaries to receiving check results comparable to having inconsistent entry to a stable telephone number or mailing deal with to obtain outcomes, or being unable to return for a scheduled observe-up go to as a result of trafficker and non-trafficker-related barriers famous above. For instance, one survivor stated that she wore sunglasses to mask bruising after being hit in order that her appearance would not impact “business.” Participants’ worry of retaliation by a trafficker for sure diagnoses similar to pregnancy and infection also limited or altogether prevented access to healthcare.