Saving Lives: The Role of The Pharmacist in HIV

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In this episode, we continue our conversation about Pharmacy and Human Trafficking.

Listen to Part 1 of our interview here.

“BE THE CHANGE”

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What you will learn

  • Understanding Human Trafficking
  • The pharmacists Role in Human Trafficking
  • Learn more about signs of human trafficking in your practice
  • Human Trafficking Resources

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Transcription

Michelle: Hi, this is Michelle Sherman, president of Michelle RX pharmacist consulting services and your host of the conscious pharmacist podcast. Welcome to today’s episode. This is part two. Last week, episode 25, we had a great episode with Dr. Chris, Christina Madison and today we’re going to have the second part of our discussion. Part two, we’re going to talk about pharmacy and human trafficking. So it’s my pleasure to have dr Madison back on the show. And before we talk about human trafficking dr Madison just finished this week’s training for who, who students at Roseman University, HIV testing and counseling, which is so important. If we as pharmacists want to be healthcare providers and end up providing prep, we need to be able to know how to do HIV tests and cancel patients, especially when they get a positive test. So did you want it to tell our listeners, welcome back to the show and talk a little bit about your training as well?

Christina: Yeah, absolutely. So first and foremost, thank you so much for having me back. I really just felt like when we, you were speaking earlier, we could have talked for at least another hour or so. I feel very fortunate that you have asked me to come back on this show and, and just really enjoy the podcast and all of the guests that you’ve had. So thank you for including me in that array of amazing guests and being part of the pharmacist podcast network. So the training that we were able to do, which was pretty awesome. We partnered with the Southern Nevada health district, which is actually where I previously practiced. And they offer in the community training usually for those who are doing disease investigation work or those who work with the vigils who are substance using to help them to be able to do HIV testing and counseling in the field.

Christina: But what we were able to do is actually have this HIV testing and counseling training. It’s a three-day training being that’s offered by the health department and it’s certified by the state of Nevada to allow for individuals to have that appropriate training to be able to give those preliminary positive results and link patients to care if they do end up becoming positive. When we test Zain rapid testing. So we had a total of 15 students that participated in the training. They’re all final year pharmacy students and it was pretty amazing to see their evolution over the three day period and the fact that they just got really comfortable asking some of those sensitive questions about people’s risks and really being able to provide compassionate and culturally appropriate care. We also talked about, you know, making sure that we have no judgments and talking about safety. So you know, if somebody was given a preliminary positive and they were in a domestic violence situation or maybe felt unsafe with their partner, how to address that. So I think it’s, it’s relevant and it’s really relevant to our conversation today. And, and ultimately from my perspective, anything I can do to help my students to be able to be more marketable in our current pharmacy climate as well as help their community is a win-win for everyone involved.

Michelle: Oh, absolutely. That’s, that’s fantastic. You know,, for us to put ourselves out there as healthcare providers and really make impacts in our communities that it is so important to be able to test for HIV. So congratulations. That’s like a great, great, great program. And I mean, it’s,

Christina: It’s even more important now with SB one 59, you know, it’s coming. So we need to be prepared.

Michelle: Oh, absolutely. If we’re going to be providing prep at the pharmacy, we’ve got to be able to do all their testing onsite and nobody more equipped in us as pharmacists to do that. And then one, one more thing since our last, our last show is you finally launched your, your website, the public health pharmacist.com and it is amazing. You did a great job and it’s, it’s really, really a great site and I’m looking forward to everything you have to offer on there.

Christina: Well, thank you very much. You know, I, as I mentioned before, my, my goal is to help my community, but ultimately I want to empower other pharmacists to be able to provide these kinds of advanced clinical services in their communities as well. So it not only helps, you know, the pharmacist and their professional journey, but it also helps our communities and moves our profession forward. So it’s, it’s beneficial for everyone involved. And if I can, you know, do that in a, in a way that is meaningful to the pharmacist that I’m able to help in addition to being able to help those in the community. I think it’s just, it’s, it’s amazing and that’s, that’s really what my passion is and how I want to serve, serve you know, serve my community and also serve the profession of pharmacy because we are changing and evolving and I want to be on the forefront of that.

Michelle: No, absolutely. And I’m looking so forward and I’m sure all our listeners too to see you see what comes you know, of your programs and everything else like that.

Christina: Yes. And I look forward, to collaborating with you as well in the future.

Michelle: Absolutely. And you know, I, we’ve known each other for a while and we both do a lot of like HIV patient education and you know, as an HIV pharmacist we can, we can only directly impact our patients within our very own community. And, with what you’re trying to do on your site is, it is very valuable because one, you can only directly Cristina with patients in front of you, deal directly within your community by teaching others how to do this. You really helping the community all over the country. So it’s a fantastic offense to test excite and a Conway to see what else comes out of it.

Christina: Yeah. Wonderful. Well, thank you for the opportunity to allow me to discuss it on your podcast.

Michelle: Absolutely. So now let’s, let’s get down to the topic for today is human trafficking and the role of the pharmacist. You are very involved in working in human trafficking. And can you share with us what it is, what you do and how we as pharmacists can, can really make an impact in this area?

Christina: Yeah, absolutely. So just to give you a little bit of background of how I even got started in this. I have a colleague of mine she’s amazing. Her name is Kimberly Miles. She is a phenomenal philanthropist, a woman on a business owner. And in 2015, she started an organization called be a Shiro foundation and be a shero foundation is their entire mission and goal is to provide resources and support for young women and girls who have been either abused, neglected, or exploited and help like-minded agencies be a resource for these women who’ve been victims of sex trafficking. And earlier this year Kimberly approached me and asked if I wanted to potentially join their executive board. Obviously we’re all busy and we all have many hats that we wear and you know, she’s very convincing. And Kevin, my knowledge base and my history with, you know, women’s health and specifically sexual health, it just seemed like a natural fit.

Christina: And they had someone that was previously the board that was a medical doctor and they didn’t have anyone on their board with a healthcare background. And so I joined the board in July of this year and have had an opportunity to speak to some local agencies about sex trafficking and human trafficking and what that is. And I just feel really fortunate that I’ve been able to use this as kind of part of my platform for all things. Harm reduction strategies, sexual health, HIV testing. It kind of all really aligns with my own personal mission to provide more assistance to the community and to give a voice to those in the community that are vulnerable.

Michelle: Well that’s, that’s remarkable. I mean it’s so needed. I, I was looking at the national human trafficking hotline dot.org and it was mind-blowing, looking at different States and looking at the different statistics. It’s really a massive problem and I think, you know, the community at large needs to be aware of this and a way of identifying people that are in that situation and we need to do something about it. And you know, as pharmacists, we’re, we’re poised right there to be able to do that.

Christina: Yeah. I mean, as the most accessible healthcare provider, we are at the frontline, especially at the community pharmacy setting of potentially witnessing somebody who may be a victim. And so I just want to take a moment to actually say what the definition of human trafficking is. So sex trafficking is part of human trafficking, but you don’t have to be sex traffic to be a victim of human trafficking. So the United Nations office of drugs and crime defines human trafficking as the recruitment, transportation, transfer Harbor or receipt of a person or act by the means of threat or use of force or other forms of coercion, abduction, fraud or deception. And that that person is being abused based on their power or their position in a vulnerability or that they are receiving payment or benefit to achieve the consent of that person and having control of that other person for the purpose of exploitation.

Christina: And that exploitation could be prostitution, forced labor or service or slavery or similar practices. So if we look at the statistics, every 30 seconds, a person is a victim of human trafficking. And in 2012 it was an estimated 21 million people who were victims of forced labor, which included sexual OISE, exploitation for labor exploitation. And a majority of those individuals were living and working in our communities. And we’re not being noticed. So, you know, almost 5 million of those victims were specifically victims of sexual exploitation. So this is a huge problem. It’s all over the country and it’s in our communities and we need to mindful and we need to look around because you know, these women and girls, and it’s not just women and girls, it’s men too. They are being exploited at an alarming rate.

Michelle: Wow. So, so what, as pharmacists, you know, for instance, if we were working in a community pharmacy or even, you know, an advanced practice clinic setting, what would be signs or what would we look for is pharmacists too to alert the authorities or investigate further in a patient we might have before us?

Christina: Yeah. So there’s a few different signs. So if we suspect that someone is being trafficked you know, there’s a few questions that we can ask as well as some warning signs. So let’s go over the warning signs first. So one of the big ones is that the person avoids direct eye contact, right? They have visible signs of injury or physical abuse. They may look malnourished or disoriented. They lack their own personal identification, or the person that they are with is the person that’s holding onto their identification and they don’t allow the person to hold onto their own documents. They have very few personal belongings. They’ve seemed very nervous or hesitant to talk to strangers. They may not know their own address or their own phone number. If it’s a, in a situation where it’s a minor, they’re usually in a relationship with much older adults. They’re typically very fearful of law enforcement. They’re very rarely left alone. They seem very fearful or anxious and they are not allowed to contact their friends, friends, or their family.

Christina: So these are the warning signs. And then if we’re thinking about general questions that we could ask someone my GoTo is, are you okay and do you feel safe? But if you are in a situation where you can have that person by themselves, then you can ask them a few more poignant questions. So you can ask, are you being forced or have you been forced to do something that you didn’t want to do? If you had to, could you leave your current situation if you wanted to? Have you or anyone in your family ever been threatened if you tried to leave? Have you ever been physically harmed? Where do you sleep in to eat? Has anyone ever withheld food or water or sleep from you because you didn’t do something that they asked you to do? Do you have to ask for permission to do essential daily living activities?

Christina: Are there locks on your windows or doors that prevent you from leaving? And do you have your own personal identification or documents with you? So those are some general questions that you can ask if you suspect that somebody may be a victim of trafficking. And then obviously going into more detail about like physical abuse or physical harm you know, those things are very important. And then also, you know, if they wanted to leave, could they, you know, do they feel coerced? Do they feel threatened? Are they afraid of the person that they’re with? And if I asked if, you know, do you want me to contact someone for you? Would they feel like they were able to contact that person on their own? Especially if it was a family or a friend.

Michelle: And then depending on how they answer, then what would be the next steps if, if you were able to get them on their own. And

Christina: Yeah.

Michelle: Do you just contact the police, the sheriff, the authorities?

Christina: Yes. So there’s, there’s a couple of different things. So obviously it’s [inaudible] different in individual communities, but the best thing to do would be to contact the national human trafficking hotline. And there’s a text message that they can send so they can send, be free to text messages two, three, three, seven, three, three or they can call one eight eight three seven three, seven, eight, eight, eight. And it’s toll-free and it’s confidential and it’s over 200 languages that they can contact the national human trafficking hotline. There’s also a live chat, so you can go to the human trafficking hotline.org or if you just want to report it, you can report to those different contact information. And I can give that to you to add to the, to the notes for the call for today. But the key here is that if we see something, we need to say something.

Christina: In our area, obviously we have been a Shiro foundation. And so we use that as a resource and we’re able to recover these women and help them to get resources. And we have a few agencies here in town that will take the individual and we can provide temporary housing for them with the potential to, to able to give them permanent housing. So there’s a couple of, of agencies here in town, one that we, we work with often as living grace home. So that will help them. One thing that we have seen as far as a potential barrier is that a lot of the places that have the funding and have the ability to house these individuals do have a requirement that they are sober because they are sober living. And so if the trafficker is using substances to hold onto the person, they have to be substance-free.

Christina: And so we also are trying to partner with some of the substance use counseling and treatment facilities to help them to get into recovery so that they can qualify for some of those more permanent housing. So you could call the police, but again, they’re very fearful, usually of law enforcement. So if you asked that question, do you feel sell it safe or are you okay? Then you maybe can like to slip them a little card if they feel safe to take information from you that has this national human trafficking hotline information so that they can contact them because it’s national and it’s, and it’s all over the country. So they can call and they will be directed to resources in their area. Oh, that’s great. And then are they usually successful in getting them away from the traffickers? So I can give you an example.

Christina: So we had a young woman that had reached out and she was sitting, but we have another agency that we work with as, as part of my organization that’s an st Jude’s ranch for children. And so they help individuals in the foster care system. And so there was an individual that was in the foster care system that had alerted some of the individuals at st Jude’s about someone who they thought may have been a victim. And so she was actually a [inaudible] well to get away from her trafficker and had a child with her. And so she had made the decision that she was ready to leave, but she needed resources in order to get back to her support system. So we were able to make arrangements to get her a flight back home so that she could get out of that situation.

Christina: But you know, they have to be ready and they have to have that support. And so she was able to get away from her trafficker and make that phone call. And then we had a friend that was able to help us to be able to locate her as well, and we were able to get her a bus ticket and we were able to get her home. So, but that’s, you know, those are amazing examples. We just had you know, several women recovered by the FBI here in Las who was pretty great. So you know, it depends, but you know, there are several things that are kind of the components. First and foremost is identifying that they may be a victim and then second, are they, do they feel like they can leave because when they leave they have to have that support.

Christina: Right. And so that’s, that’s the other part of it. So once they leave, they need to have that support. And then we need to do things like helping them with substance use if they’re actively substance-using, we have to get them stable housing. And then we also need to do training programs to help them to have gainful employment. Right. And be able to make money on their own, not selling their bodies and other places in the country that human trafficking is more prevalent than others, like certain States, or is it luck every way? I mean, we probably have just barely reached the surface on what the problem actually is because we’re starting to see more awareness. But there are some areas of the country where we’re seeing more so than others. And I think that we’re seeing legislation being passed. So for instance, Florida just passed legislation in July of this year now requiring healthcare professionals to go through human trafficking training so that they have the tools to be able to identify individuals who are at risk and be able to get the help that’s needed.

Christina: So that just happened in Florida. We also see that there’s legislation that was passed in Michigan saying that there was a requirement now for pharmacists to go through human trafficking training so that they can identify those individuals and be able to give them assistance at the community pharmacy setting. So again, I can speak to Nevada. We’re, we’re ranked 28th right now for human trafficking, but, you know, I live in and work in Las Vegas. So I know that the problem is probably bigger than what’s actually being reported, but there’s been so many, you know, specific successes that we can speak to that, you know, individuals who’ve been recovered and have been able to, you know, get out of their situation. And, you know, that’s, that’s what I, I’m hoping that we can focus on and kind of build on in the future. You know, Ashton Kutcher, he’s been, you know, out there talking to Congress about why we need to talk about how these girls are victims, how we need to help them.

Christina: You know, Steve Tyler, he’s, he’s funded Janie’s house for abused girls. You see all these, you know, celebrities now that are [inaudible] get involved in trying to bring attention and awareness to the problem. So you, that we need more of that. We need more you know, good publicity and good media versus the bad media. Like what happened with, you know, Jeffrey Epstein, you know, that that was sort of the, I think the tipping point. I think when we look at, you know, these men that have been getting away with these things for years and people just turned a blind eye or they threw money at it. You know, we need to have legislation on the books that allow for persecution and prosecution of these men and individuals that are, you know, trafficking these women or the ones that, not just the traffickers, but then, the men who are purchasing these women. No one’s going after them. Right? Because if there’s no demand, then there’s no supply. Right? We got to change the laws. We got it. You know, you gotta think about what’s going to make an impact. And if there are no laws that are supporting this and we don’t take away the, you know, the impetus to want to do this bad behavior, then it’s just gonna keep going.

Michelle: Oh, absolutely. And you’re right. I mean to, to all those, those men who thrown the money at it and you know, taking these girls and everything, it’s like you want to say to them, it’s just like, what if that was your daughter? Would you be letting her do this or forcing her to do this? And exactly right down that food chain, they have to make all those people accountable, to protect these women. And in many cases, boys do. Yeah.

Christina: Yeah. I mean the statistics, you know, I know a lot of people feel like it’s only a woman’s problem, but it’s not, you know, I mean it’s, it’s boys and men and unfortunately the victims blame themselves and that’s why they don’t seek help. Right. And then obviously the threat of physical harm, you know, that’s, that’s huge. You know, and as I mentioned before, you know, these individuals, you know, they can be men, they can be women. A lot of times they’re from vulnerable populations, like the LGTBQ community and our immigrant population because they come here and they want a better life for themselves, but then they end up not being able to find work. And they become vulnerable. And these traffickers, they see that and that’s, that’s why they go after them.

Michelle: Oh, absolutely. I mean, and that’s why this is so important and in such an important topic for this podcast because as healthcare providers when we engage with our patients, we have to be conscious. We have to have their consciousness to recognize what’s going on. And I think it’s our job to help those people that are vulnerable and who don’t have a voice. We have to, you know, hopefully, provide tools and give them options that they know they can get out of that situation if they wanted to.

Christina: Yeah, it’s so true. I mean, I’m just thinking of, I mean there was a report just in the news in September. There, it was in Ohio, which also has a continuing education program for pharmacists on sex trafficking as well. So 104 arrested in a child. 60 24 of the arrested men were accused of attempting unlawful sex with a minor. 43 women were arrested for selling sex. 36 men were arrested for trying to buy sex, and one man was arrested for promoting prostitution and those that were arrested, it included an emergency room physician and a church youth director. So with anyone, right? So that’s the thing that I want to make sure that I’m imparting in this is that it doesn’t have to be someone who you kind of thing is like the quintessential, like a quote-unquote pimp. It’s anyone who could be involved in this.

Christina: So we need to be mindful. We need to see these signs, we need to look out for these women in these girls, and we need to protect these vulnerable populations. Because if we don’t, this is the kind of stuff that happens. The other part of this too is that we need to decriminalize the girls, right? So it’s like they’re being revictimized because now they’re being, they’re being prosecuted because they were victims of sex trafficking, right? So now they’re going to jail and they’re the, they’re the victim, right? So that’s the other part of this too, that we really need to get after, right? And if we, if we don’t empower women to be mindful of their bodies and their agency, how do we expect for them to know and stand up for the rights?

Michelle: Oh, absolutely. Absolutely. And you write it just as you mentioned earlier, that the targets of the most vulnerable, a lot of like immigrant communities, marginalized groups, they, the LGBT community, people that they know don’t have a voice, so they’re not going to say anything.

Christina: Yeah. And that’s why I feel so passionate about this work and why it really aligns with what I do as my job. Right. So obviously I do this and we’re an all-volunteer organization. But it just really, it, it mirrors what I’m doing for my job in the community and I just feel like there needs to be more attention paid to it. And you know, I really want to leave my Mark and to say that I made a difference. And you know, this really, you know, goes along with my women’s health and my sexual health background and I’m so, I feel so thankful to have been invited to be part of this organization. And to really get some awareness out there in the community.

Michelle: No, that’s it. That’s extraordinary. And you know, we’ll put, we’ll put the film [inaudible] foundation in the, in the notes and the resources. So the listeners can take a look at that, that agency and also all the links to the website, the human trafficking hotline.org. And for all those pharmacists and others listening, you can go and look at the statistics in your very own state and see, you know, what, how, what an issue the human trafficking is in your very own state and see how you as pharmacists can, can now make a difference. And, you know I wanna thank you so much for you know, sharing this with us and on the show because it is a critical, critically important topic. Did you have anything else you wanted to add along these lines or anything else coming up that’s, that’s going on with you and your business and,

Christina: Yeah, so couple things. So I will be giving a webinar on December 4th for my amazing colleague who works out of Maryland. And it’s for cause engagement associates and I can give you the link. So I’ll be giving a webinar on the pharmacist’s role in public health. So that, that’ll be coming up on December 4th and then ultimately I just want to say, you know, that we all need a call to action, right? And to ask ourselves the why, so why do we do this work and why do we feel so passionate about what we do?

Michelle: Exactly. Yeah. If you, if you, if you don’t have a why in what we do, like every day it’s just a slung job and we don’t really make a difference. If you have a Y, there is no stopping you in what you can do for you, your peers, for you, for your patients and, and, and the like. Absolutely. And we will definitely put the information on this webinar or on the show notes as well, so, so people can sign up and attend that webinar for sure.

Christina: Awesome. Thank you so much again for your time. I am. It’s always a pleasure, Michelle, and keep doing what you’re doing is you’re super amazing.

Michelle: No. And you, you, you, you’re, you’re incredible. And again, thank you so much for, for sharing this very important information with us. In part two of the show, and I’m remember to all you pharmacists out there be the change.

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