1. Wickline, Mihkaila Maurine MN, RN, AOCN, BMTCN


An argument for applying an antiracist lens.


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I recently worked for an agency serving people affected by the sex trade. No amount of resilience I had developed in 25 years working with cancer patients had prepared me for the suffering I encountered. To a person, the individuals I served were trafficked in their youth and were experiencing severe health consequences from years in the sex trade. The commercial sexual exploitation of children (CSEC) exists so the sex trade can flourish. Estimates of the annual U.S. prevalence of CSEC are elusive but range from 60,000 to 200,000. The reality is that while you can only sell drugs once, you can sell children repeatedly, making the trafficking of people highly lucrative.

Figure. Mihkaila Mau... - Click to enlarge in new windowFigure. Mihkaila Maurine Wickline

Children at highest risk for trafficking have often experienced sexual and physical abuse, poverty, community or family instability, foster care involvement, and homelessness. As I engaged with survivors, it was difficult not to notice the overrepresentation of people of color, and I was filled with urgency for upstream intervention. A 2019 report on CSEC in Seattle and King County, Washington, found that the mean age of first exploitation was 14.4 years, with more than 500 youths sold for sex regularly, a number roughly equivalent to 1% of students in Seattle's public schools. In 2017 in King County, Black individuals made up only 7% of the population, yet Black youths were 52% of minor victims of sexual exploitation, according to the Office of Juvenile Justice and Delinquency Prevention.


The current momentum in our nation, especially among our youth, to right the wrongs of systemic racism provides us with one potential approach for dialogue with students about the problem of CSEC. Empowering youth with the knowledge needed to avoid contributing to the exploitation of others may help to dismantle this societal evil.


Consider LeTishia, a Black eighth grader at an urban middle school. (LeTishia is a composite of many young survivors in Seattle.) She blends in easily with her iPhone, her book-filled backpack, and the sometimes awkward veneer common to her age. But unlike most of her peers, LeTishia has an older "boyfriend" who sells her to his "friends" for sex. She formed an emotional connection to her trafficker when he began offering needed attention. Although she hates the physical encounters, she does not consider leaving him because the trauma bond-the attachment she feels to her abuser-is well established.


There are too many children like LeTishia, trapped in the sex trade from an early age, with diminishing hope as their experiences take a physical, mental, emotional, and spiritual toll. The health effects of the sex trade are well documented and include injuries, sexual assault, sexually transmitted infections, unintended pregnancies, malnutrition, depression, suicidality, and posttraumatic stress disorder.


Nurses can advocate for including CSEC as part of comprehensive sex education in public schools. This education will be strengthened if it acknowledges the need to rectify the racial injustice that continues to play a role in our society and in the sex trade. We should provide youth with age-appropriate information about CSEC, starting from prepuberty and continuing through high school. The curriculum should be cocreated by survivors and advocates, centering voices that reflect the trafficked population. Firsthand accounts from buyers exist that could inform curriculum by targeting the attitudes that may lead individuals to become buyers. Seattle Against Slavery and the Chicago Alliance Against Sexual Exploitation have developed school-based programs focused on creating allies against gender- and race-based violence that could be used as models.


Nurses can use our voices to speak up for the health of communities harmed by CSEC. We can lead change by taking every opportunity to learn about the issue, partner with local antitrafficking agencies as health advocates, and support an antiracist CSEC curriculum for public schools to embolden the next generation to take a stand against exploitation.