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By Special Agent Janice Mertz

Volume 2, Issue 1, Summer 2013, Cancer InCytes Magazine


In June 2003, the FBI’s Criminal Investigative Division, Crimes Against Children Unit, collaborated with the Department of Justice’s Child Exploitation and Obscenity Section (CEOS), and the National Center for Missing and Exploited Children (NCMEC) to develop the Innocence Lost National Initiative to combat the growing problem of domestic commercial sexual exploitation of children through prostitution (hereafter referred to as child prostitution). 


The Innocence Lost National Initiative is a victim-centered approach which utilizes multi-disciplinary teams consisting of federal, state, and local law enforcement officers; the FBI’s victim specialists; and local social service providers to offer services to the victim once the child is recovered.  Understanding that no single jurisdiction can address the child prostitution threat, the FBI formed child exploitation task forces that exist around the country to target the criminal enterprises that are exploiting these children—some of whom are as young as nine years old.


The goals of the FBI initiative are straightforward:

1)  Recover missing children who are being exploited through prostitution and prosecute those responsible for their exploitation.

2)  Disrupt and dismantle criminal enterprises responsible for the victimization of children through prostitution.

3)  Provide training to investigators. 

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To date, more than 1,300 law enforcement officers have been trained regarding the prostitution of children.  The biggest challenge to law enforcement is the lack of adequate shelter, informed social service providers and specialized services for this unique set of victims. There are few secured facilities available for these child victims who often are at high risk of returning to the pimps and a cycle of revictimization.  The majority of children who become victims of pimps have run away from home, typically because of maltreatment or family dysfunction.  For the children who leave home without troubled backgrounds, are groomed, or abducted, prostitution becomes a highly traumatic experience, often referred to as “the Game.”


The bond the victim feels towards her pimp is strong. The pimp falsely promises a better life – especially since many victims have had early childhood experiences of abuse, exposure to domestic violence, and family dysfunction.  The Adverse Childhood Experiences (ACE) Study, conducted by Robert F. Anda and Vincent J. Felitti reveals that these past childhood traumas may often lead to a vulnerability to manipulation by pimps (1).  In this issue of Cancer InCytes, Vincent J. Felitti discusses the implications of the ACE Studies on children who are trafficked (2).    


The study focuses on ten categories of adversity (2): 

1. Psychological abuse (by parents)

2. Physical abuse (by parents)

3. Sexual abuse (anyone)

4. Emotional neglect

5. Physical neglect

6. Alcoholism or drug use in the home

7. Loss of biological parent before age 18

8. Depression or mental illness in the home

9. Mother treated violently

10. Imprisoned household member


Victims of child prostitution are all victims of the first three categories once they enter the Game.  The study provides a questionnaire that highlights verbal/physical/sexual abuse; neglect, lack of affection or support, which includes lack of medical attention; drug and alcohol abuse in the home; domestic violence in the home; and a history of mental illness in the family. 


The more adverse experiences to which one is exposed, the higher the score the individual receives.  In the initial study, one in four individuals was exposed to two categories and one in 16 to four categories.  If an individual was exposed to four of the eight categories, their risk for more severe neurodevelopmental/educational impairment, risky behaviors, and subsequent chronic health conditions dramatically increases (1, 2). 


Almost all victims who leave their homes willingly are attempting to fill a void in their life.  However, once the pimp has the victim under his control, the victim endures almost unspeakable violent abuse.  Victims are forced to have sex multiple times each night, and must relinquish all profits to the pimp.  Failure to meet their monetary quota will result in beatings, torture and in some cases, even death.  The ACE Study also notes that a score of 4 is associated with a likelihood of a person having 50 or more sexual partners in life, along with all the health risks involved (3). Multiple sexual partners increase the risk of sexually transmitted diseases, specifically the Human Papilloma Virus (HPV), which is a cause of cervical cancer.  The Centers for Disease Control and Prevention (CDC) recommends that preteen girls and boys receive an immunization series against HPV (4).   Child victims of trafficking are usually denied basic medical attention, let alone vaccinations or other types of preventive medical care.  According to the CDC, while different cancers can be linked to HPV, the majority are cervical cancers  (4).  Trafficking victims have higher risks of contracting hepatitis, HIV, and additional infectious diseases that may result in cancer and/or death. 


Repeated exposure to trauma over the lifetime of the individual has a direct effect on brain function and the ability of the child to disclose his/her abuse.  The disclosure is difficult for both the victim and law enforcement, as initial interviews are disjointed.  Victims deny their state and are distrustful of law enforcement.  The social, emotional, and cognitive impairment that they suffer may often be permanent, especially if there is an associated traumatic brain injury.  It must be understood that these children lack the maturity and knowledge to fully understand their actions and consequences.  While life on the streets quickly makes them “street smart,” their risk for substance abuse and physical violence remains dangerously high. 


Utilizing the multi-disciplinary team approach, agents recover these victims and remove them from the cycle of victimization.  Social service partners present on the team provide the much needed services that are necessary for recovery.  Since the inception of the Innocence Lost National Initiative, the successful task force approach has led to the recovery of 2,511 children, 789 indictments, 1,203 convictions, and nine life sentences for offenders in the federal system. 


If you have any information regarding the child prostitution threat in your area, report it to 1-800-THE-LOST, or  The FBI has personnel detailed to NCMEC to ensure the rapid dissemination of information to FBI child exploitation task forces around the country. 


Special Agent Janice Mertz is part of the FBI’s Violent Crimes Against Children Section, Criminal Investigative Division.




1. Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, Koss MP, et al.  The relationship of adult health status to childhood abuse and household dysfunction.  American Journal of Preventive Medicine. 1998; 14:245-258.


2. Felitti VJ. Childhood trauma is linked to chronic diseases in adulthood. Cancer InCytes 2013; 2(1):e.


3. Hillis SD, Anda RF, Felitti VJ, Marchbanks PA.  Adverse childhood experiences and sexual risk behaviors in women: a retrospective cohort study. Family Planning Perspectives 2001; 33:206-211.


4. The CDC on HPV: 


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