The association between poor mental health and factors related to HIV acquisition and disease progression (also referred to as HIV-related factors) may be stronger among conflict-affected populations given elevated rates of mental health disorders. We conducted a scoping review of the literature to identify evidence-based associations between mental health (depression, anxiety, and post-traumatic stress disorder [PTSD]) and factors related to HIV acquisition and progression in conflict-affected populations. Five electronic databases were searched on October 10, 2014 and updated on March 7, 2017 to identify peer-reviewed publications presenting primary data from January 1, 1994 to March 7, 2017. Articles were included if: 1) depression, anxiety, and/or PTSD was assessed using a validated scale, 2) HIV or HIV-related factors were a primary focus, 3) quantitative associations between depression/anxiety/PTSD and HIV or HIV-related factors were assessed, and 4) the study population was conflict-affected and from a conflict-affected setting. Of 714 citations identified, 33 articles covering 110,818 participants were included. Most were from sub-Saharan Africa (n = 25), five were from the USA, and one each was from the Middle East, Europe, and Latin America. There were 23 cross-sectional, 3 time-series, and 7 cohort studies. The search identified that mental health has been quantitatively associated with the following categories of HIV-related factors in conflict-affected populations: markers of HIV risk, HIV-related health status, sexual risk behaviors, and HIV risk exposures (i.e. sexual violence). Further, findings suggest that symptoms of poor mental health are associated with sexual risk behaviors and HIV markers, while HIV risk exposures and health status are associated with symptoms of poor mental health. Results suggest a role for greater integration and referrals across HIV and mental health programs for conflict-affected populations.

This study aimed to further understand typologies of trafficking that occur in the home, by an individual’s intimate partner (IP) or family members and this overlap with extant knowledge on perpetrator manipulation via the Power and Control Wheel. Inductive and deductive techniques were used to analyze secondary data from a federally funded anti-trafficking program in a Midwest metropolitan area recorded between 2008 and 2017. Cases were included if there was indication of sex or labor exploitation initiated by an IP, family member, or other in the domestic setting via elements of abuse; 59 cases of 213 met this criteria. Most cases included the IP as the trafficker, followed by family members, then others in the domestic setting. Abuse was more commonly used than the threat of abuse. From the Power and Control Wheel, the most frequent types of abuse were using privilege, physical abuse, economic abuse, isolation, and sexual abuse. Case typologies included: those with elements of sex trafficking, specifically forced commercial sex by an IP or family member; those with elements of labor trafficking such as domestic servitude (with or without childcare provision abuse), exploitation in a family business by an IP or family member, or work environments by family and non-family; those with elements of sex and labor trafficking included servile partnerships and forced marriage. Trafficking exploitation by an IP, family member, or in the domestic setting is not uncommon. Intimate relationships with a trafficker, psychological coercion, and threats may reduce reporting of abuse, subsequent provision of services, and result in misclassification as victims of IP violence. This study sheds light on various typologies of trafficking and exploitation in the domestic setting, further expanding the anti-trafficking movement’s evidence base for intervention and prevention and adding complexity and nuance to the pathways to trafficking exploitation.

Solidarity groups were established in eastern Democratic Republic of Congo to provide female survivors of conflict-related sexual violence an opportunity to generate income, establish networks of support, and cope with atrocities. Qualitative data were collected from 12 members of solidarity groups to explore factors that contributed to members’ mental health. All women identified some improvement (physiological, psychological, economic, or social) since joining the solidarity group, but none of the women were free from ailments. Our findings suggest that a multifaceted intervention in women’s own communities has the potential to improve multiple aspects of women’s lives, including mental health.

Objective: The objective of this study was to determine the number, risk factors, and demographic characteristics of potential human trafficking victims from tips reported to a social services agency in a major Midwest metropolitan area from 2008 through 2017. Methods: The agency, comprising 90 employees serving more than 10 000 persons annually, received federal funding to raise awareness about trafficking and to identify and support persons who are at risk for trafficking through training, coalition building, direct outreach and service, and case management. We, the authors, counted the numbers of tips and potential victims reported to the agency by year, type of trafficking, economic sector, sex, region of origin, and age and looked for new risk factors for trafficking. Results: Data were available for 213 tips received from September 1, 2008, through June 30, 2017, and for 82 potential victims identified from July 1, 2011, through June 30, 2017. Labor trafficking (126 tips, 57 potential victims) was more common than sex trafficking (59 tips, 17 potential victims). The number of tips varied during the study period. Tips and potential victims were diverse and included male and female children and adults. Most victims were from Mexico (n = 68), the United States (n = 47), Asia (n = 31), and Central and South America (n = 23). Potential victims were exploited in several industries including agriculture, construction, commercial sex, and landscaping. New risk factors for trafficking were exploitation within marriage and work in the sales industry. Conclusions: Domestic and foreign-born men, women, and children are all at risk for labor and sex trafficking. Direct outreach to foreign-born victims should be a priority. The new risk factors should be explored.

Street-based sex work is criminalized throughout much of the U.S. Diversion programs have shown mixed results. This study examined the effect a quasi-experimental intervention (prostitution diversion program, n = 149) had on prostitution rearrest compared with a waitlist control group (n = 77) among N = 226 individuals arrested for prostitution in Baltimore. In both groups, n = 64 (28.32%) were rearrested for prostitution over 30 months. Tests of differences compared groups with a significant difference in gender only. A Cox proportional hazard model examined differences in survival time (to recidivist prostitution arrest) between individuals in the control and intervention groups at 6, 12, 18, 24, and 30 months. Results indicate that participation in the intervention did not have a significant effect on decreasing prostitution arrests over time. History of prior prostitution arrest was a significant predictor (hazard ration [HR] = 1.12, p = .02) of rearrest.Lack of program success suggests that barriers to exiting prostitution are substantial, despite availability of supportive services, and that diversion programs may not be the best intervention strategy for all sex workers. Future research should identify motivators for exiting and how to reduce exiting barriers.

Summary: The U.S. Trafficking Victims’ Protection Act of 2000 established specialized victims’ services and law enforcement directives to protect victims/survivors of sex trafficking through investigation and aftercare services. Yet, gaps remain in our understanding of services needed and the best approaches to improve outcomes. Using cross-sectional electronic survey data from 107 service providers to human trafficking victims across Missouri, this study examines (1) victims’ service needs, (2) agencies’ ability to provide services, (3) victim sub-populations that agencies are able to serve, and (4) the rural/urban availability of anti-trafficking services. Findings: Service providers, including social workers, counselors, law enforcement, and medical professionals reported that the most needed services for victims included case management, counseling, crisis services, shelter, and medical assistance. However, out of 15 possible victim services, only two were provided in-house by the majority of agencies. Additionally, respondents identified populations they were frequently unable to serve including incarcerated victims, tribal victims of violence, and refugees and immigrants. Urban counties were served by a significantly higher mean number of respondents compared to rural counties. Applications: Findings raise concerns that some of the most critical services needed for best practice response may not be easily accessible for victims, particularly in rural regions. In addition, many providers are tasked with addressing multiple service needs with limited resources. Efforts to increase cross-discipline training, interdisciplinary collaboration, and funding for basic services are needed to ensure adequate and accessible services for survivors. Recommendations for future research and coordination of an effective response are noted.