BACKGROUND AND OBJECTIVES Survivors of child sex trafficking (CST) experience many health and social sequelae as a result of stigma, discrimination, and barriers to health care. Our objective was to obtain a cross-cultural understanding of these barriers and to explore the relationship between stigmatization and health outcomes through application of the Health Stigma and Discrimination Framework (HSDF). METHODS In-depth, semistructured interviews were conducted with 45 recognized CST expert service providers. Interview data were analyzed using established content analysis procedures and applied to the HSDF. RESULTS Barriers to medical and mental health services span each socioecological level of the HSDF, indicating the various contexts in which stigmatization leads to adverse health and social outcomes. Stigmatization of CST survivors is a complex process whereby various factors drive and facilitate the marking of CST survivors as stigmatized. Intersecting stigmas multiply the burden, and manifest in stigma experiences of self-stigmatization, shame, family and community discrimination, and stigma practices of provider discrimination. These lead to reduced access to care, lack of funding, resources, and trained providers, and ultimately result in health and social disparities such as social isolation, difficulty reintegrating, and a myriad of physical health and mental health problems. CONCLUSIONS The HSDF is a highly applicable framework within which to evaluate stigmatization of CST survivors. This study suggests the utility of stigma-based public health interventions for CST and provides a global understanding of the influence and dynamics of stigmatization unique to CST survivors.

中文翻译：

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关于贩卖儿童的健康和社会影响的全球视角。

背景和目标儿童性交易 (CST) 的幸存者由于耻辱、歧视和医疗保健障碍而经历了许多健康和社会后遗症。我们的目标是获得对这些障碍的跨文化理解，并通过应用健康污名和歧视框架 (HSDF) 探索污名化与健康结果之间的关系。方法 对 45 家公认的 CST 专家服务提供商进行了深入的半结构化访谈。访谈数据使用既定的内容分析程序进行分析，并应用于 HSDF。结果 医疗和心理健康服务的障碍跨越 HSDF 的每个社会生态层面，表明污名化导致不良健康和社会结果的各种背景。对 CST 幸存者的污名化是一个复杂的过程，各种因素驱动和促进将 CST 幸存者标记为污名化。交叉的污名增加了负担，并表现在自我污名化、羞耻、家庭和社区歧视的污名经历以及提供者歧视的污名实践中。这些导致获得护理的机会减少、缺乏资金、资源和训练有素的提供者，并最终导致健康和社会差异，例如社会孤立、难以重新融入社会以及无数的身体健康和心理健康问题。结论 HSDF 是一个高度适用的框架，可在其中评估 CST 幸存者的污名化。