What are the barriers to achieving better health and wellness outcomes for youth with commercial sexual exploitation histories?

Complex Healthcare Journeys of CSE Survivors: CSE survivors encounter complex healthcare journey of youth. Here we highlight key challenges survivors may confront at different stages of their lives.

Physical, Psychological, and Systemic Barriers Across Stages: The study reveals that healthcare access for survivors of CSE is shaped by evolving physical (e.g., transportation, financial limitations), psychological (e.g., shame, mistrust), and systemic (e.g., lack of trauma-informed care) barriers at each stage of survivorship—before, during, and after exploitation. These barriers prevent access to care and hinder meaningful engagement and sustained healthcare relationships.
Impact of Past Negative Experiences: Negative encounters with healthcare providers, such as stigma, retraumatization, and lack of understanding of CSE experiences, can have lasting effects, leading to disenchantment with the healthcare system. These experiences often result in survivors avoiding care altogether, opting for self-care or alternative treatments, underscoring the importance of a trauma-informed, survivor-centered healthcare approach.
Barriers to Engagement After Exploitation: After exiting situations of exploitation, survivors are often most ready to seek healthcare but face significant challenges in accessing care. These challenges include financial constraints, PTSD, feelings of shame, fear of being judged or seen as a burden, and the ongoing trauma from their experiences. Survivors rely on peer support networks, community advocates, and healthcare navigators to engage with healthcare systems despite these obstacles.
Critical Need for Healthcare Navigators: Healthcare navigators could play a pivotal role in helping survivors connect with providers deep understanding of exploitation and comorbid issues such as trauma and addiction, CSE, and exploitation-related care and support systems that understand their complex needs. Navigators help mitigate systemic barriers such as fragmented care and lack of trauma-informed practices, fostering trust and improving survivors' ability to access consistent, high-quality care.
Reported Discrimination: In our survey, 11% of participants reported experiencing discrimination due to their history of CSE. Interviews with adult survivors further highlighted the profound impact of stigma and discrimination in healthcare settings. Many survivors expressed a preference for avoiding care altogether rather than enduring biased treatment related to their CSE history, substance use, race, gender, sexual orientation, homelessness, or other factors. These accounts underscore the significant barriers to healthcare access and the need for more inclusive, empathetic care environments.

Barriers to Healthcare Access Across Life Stages

Barrier Category	Before Exploitation	During Exploitation	After Exploitation
Physical or Tangible Barriers	Limited healthcare options, especially in underserved areas Financial constraints, parental negligence, lack of transportation Dependence on parents for access	Exploiters control access (transportation, financial) Limited clinic availability Health neglect normalized	Continuing financial/logistical barriers Difficulties finding safe healthcare spaces Limited access to gender affirming care
Psychological Barriers	Fear and distrust of healthcare due to trauma Guilt and shame around abuse/neglect Fear of "outside" help	Increased guilt, fear of consequences Trauma responses (hypervigilance, distrust) Fear of stigma and retraumatization	Lingering shame, PTSD Self-worth struggles Fear of stigmatization, need for validation
Systemic Barriers	Few trauma-informed providers Lack of CSE or any victimization screening in health settings Inconsistent care quality	Lack of trauma-informed care leads to retraumatization Survivor exploitation reflected in healthcare Poor communication, lack of CSE discussion	Ongoing lack of trauma-informed care Fragmented care systems Stigmatization and inconsistent follow-up