Understanding Commercially Sexually Exploited Young Women's Access to, Utilization of, and Engagement in Health Care: "Work Around What I Need"

Purpose: We sought to understand the perspectives of commercially sexually exploited (CSE) young women regarding their health care needs, access, and use patterns. Methods: Twenty-one CSE young women participated in this mixed methods study. Data collection included brief surveys measuring health care use, followed by in-depth, semistructured interviews to gain insight into CSE young women's health care needs, barriers and facilitators to health care, use patterns, and recommendations for improving care. Data analysis techniques included descriptive statistics for the quantitative survey data and thematic analysis for the qualitative interviews. Results: Survey data demonstrated relatively high health care use across health care types, especially for reproductive and mental health treatment services. Barriers to care included being "on the run," fear of bad diagnoses, and trafficker control. The fierce autonomy conceptual model emerged from the analyses to describe participants' strong desire for self-determination in their health care decision making, including when to access care. Recommendations for improving care for CSE young women include preserving autonomy in health care decisions while meeting their basic needs, such as safety and shelter. Conclusions: Overall, the CSE young women expressed high health care needs. Despite experiencing significant barriers to accessing care, study participants frequently sought care in a variety of settings. Furthermore, they shared insights about how to improve engagement in health care among CSE young women. Improving CSE young women's engagement in care requires health professionals and health systems that foster a sense of safety, trust, and autonomy over health care decisions-a need intertwined with CSE young women's experiences of abuse, survival, and sexual exploitation. (C) 2019 Jacobs Institute of Women's Health. Published by Elsevier Inc.