“I\u27ll do whatever as long as you keep telling me that I’m important”: A case study illustrating the link between adolescent dating violence and sex trafficking victimization

Background: Approximately 10% of U.S. high school-attending youth are physically abused by a dating partner each year. Many sequelae of dating violence have been documented, but the dating violence literature is lacking information about commercial sexual exploitation as a possible outcome of an abusive dating relationship. Conversely, scholarship on sex trafficking victimization has documented that some girls are enticed into sex work by exploitative partners who initially pretend to be dating partners, but the research lacks specificity about why and how the girls become vulnerable to these destructive relationships. This case series chronicles the experiences of four women who were commercially sexually exploited in the U.S. as minors, identifies common themes cross their narratives, and organizes these themes into a proposed framework for understanding a possible pathway from safety to unsafe dating to sex trafficking victimization. Methods: We conducted in-depth qualitative interviews with four adult women who had firsthand experience as victims of domestic minor sex trafficking. Participants were recruited through an organization that serves sex trafficking survivors. A constructivist grounded approach was used for data analysis. Participants’ narratives are presented, as well as illustrative quotes that typify each of the primary themes identified. Results: There were six primary themes that emerged from the cases’ narratives. Factors that made girls vulnerable to entering into abusive dating relationships and subsequently to experiences as sex trafficked minors included: (1) feeling physically unattractive and unimportant; (2) lacking examples of healthy relationships; (3) experiencing sexual abuse that caused subsequent dissociation and emotional debilitation; (4) being flattered by romantic gestures early in an abusive dating relationship and becoming emotionally attached; (5) gaining confidence from dating someone with higher social status; and (6) experiencing short-term satisfaction from out-earning other sex workers. Secondary themes that merit further investigation included having conflicts with guardians, engaging in criminal behavior at the request of their dating partner, and developing substance dependence that made it difficult to exit sex work. Discussion: Findings support the conclusions that one pathway into commercial sexual exploitation for minors is via dating partners, and that some minors are motivated to engage in sex work out of devotion to their dating partners rather than fear of violent retribution. A proposed framework for understanding how youth become vulnerable to sexual exploitation by a dating partner includes pre-dating, early phase dating, and late phase dating factors. Some pre-dating factors, for example, include feeling insecure, being bullied by peers, and having conflict with a guardian. Early phase dating factors include being impressed by the high social status of a new love interest and romantic gestures. Late phase dating factors include engaging in criminal activity to please the dating partner, and being physically, sexually, financially and emotionally abused. Additional empirical research that replicates and expands the proposed framework is encouraged, with the long-term objective of improving both dating violence and sexual exploitation prevention initiative

Implementing a Pre-Exposure Prophylaxis Intervention for Safer Conception among HIV Serodiscordant Couples: Recommendations for Health Care Providers

Couples in HIV serodiscordant relationships frequently desire children. Although partners who are virally suppressed pose almost no risk of transmitting HIV to their partners, partners who are inconsistently on therapy may transmit HIV to their partners when attempting to conceive. Pre-exposure prophylaxis (PrEP) is an available safer conception strategy for these couples but is not consistently offered. We sought to better understand barriers to PrEP implementation for couples seeking conception and patient perceptions on what providers could do to encourage use. We conducted in-depth, qualitative interviews with 11 participants representing six couples taking PrEP for safer conception in a safety-net hospital in New England. Semi-structured qualitative interviews assessed the following: Relationship nature and contextual factors; attitudes and perceptions regarding PrEP for safer conception; experience within health care systems related to HIV and PrEP; and facilitators, barriers, and other experiences using PrEP for safer conception. Four key themes have important implications for implementation of PrEP for safer conception: Knowledge and understanding gaps regarding HIV and PrEP among both members of the couple, role of insurance and financing in decision-making, learning to manage and adhere to a treatment plan, and the need for providers to enhance knowledge and offer further support. Addressing barriers to safer conception strategies at multiple levels is needed to prevent HIV transmission within serodiscordant couples who desire children. Providers can play an important role in lowering these barriers through the use of multiple strategies

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries