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Given this scenario of dependence, domination, and mind control, maybe the one stroke of luck young Danielle had was that the cops who picked her up treated her as a victim of child sex trafficking. It’s a reaction that Lloyd has worked hard to bring about. She was a leading supporter of New York State’s Safe Harbor for Exploited Youth Act—a law, passed in 2008, that mandates that youths under 18 who are arrested for prostitution receive services and treatment, rather than prosecution as criminals. It’s because of this law that instead of racking up a rap sheet, along with a possible sentence in juvenile detention and a likely return to the same life, Danielle has gotten an intervention that could make a difference. She now has a place to live (off the streets), and group and individual counseling from Lloyd and her staff at the Girls Educational and Mentoring Services (GEMS). This is the New York City–based group that Lloyd founded in 1998, which now serves more than 300 sexually victimized girls each year.

Part of the task of counseling, Lloyd explains, is disentangling the twisted notions of love and family life these girls unwittingly have incorporated from growing up in nonfunctional, often violent, households. These distortions (such as: sex is naturally accompanied by the infliction of physical and emotional pain) were further reinforced by their dependence on and abuse by pimps who, ironically, may have provided a more structured routine and sense of identity than they’d known before. At the same time, a related thread that often runs through these girls’ experiences, writes Lloyd, is that of “giving and giving and giving—taking care of their pimps, taking care of their johns’ ‘needs’—an ingrained pattern that often goes back to childhood when they took care of family members, whether it was younger siblings or parents.” Intertwine these threads and you get a sinister kind of codependence that’s hard to break free from, along with a sense of self so deflated and beaten down that it can be hard to convince these girls that they’re worthy of a better existence.

At GEMS, these girls learn they aren’t the only ones whose sense of normal has been skewed beyond the ken of almost everyone else. There, they find a community that allows them to open up about their pasts and begin to hope, and to encourage each other toward a less dangerous future. The fact that Lloyd herself is a survivor of similar circumstance—throughout the book, she intersperses her own harrowing story with those of the girls she helps—provides them with an example that underscores that a different future is possible. At times, this back-and-forth structure gets a bit confusing, and the girls whose stories she tells (like that of Danielle) are mostly seen in snippets, rather than as full case histories that would allow us to understand their struggles, as well as their successes, in more detail. But Lloyd presents their dilemmas with sympathy and passion, making it clear that these preteens and teens don’t “choose” a life in which they’re routinely sold for sex and are open targets for rape, physical abuse, and HIV infection: rather, it’s their lack of choices and chances that make them easy pickings for the sex trade.

Physician Randy Christensen has also made it his life’s work to help kids and young adults whose choices have been narrowed to nil. He’s affiliated with the Phoenix Children’s Hospital, but his office is a giant, 38-foot Winnebago that’s been redesigned as a hospital clinic on wheels. As he and his nurse-practitioner make the “rounds” through tough, urban neighborhoods known for their high population of street kids, their motto could well be, “Have medicine, will travel.”

The scenes of the ill youths that await them at every stop remind me of a modern-day Grapes of Wrath: “Once the word got out a van was parked nearby and offering medical care,” Christensen writes, “there was almost a stampede: toddlers held in the arms of big sisters, cousins holding the hands of cousins, sheepish parents holding crying babies in their arms.” Of course, none of them has health insurance—or even the basic ID that would allow them to apply for government programs (those programs that are still funded). As a result, in addition to treating ailments no child should have to suffer from—like virulent bacterial diseases resulting from living in rat-infested squats—Christensen must grapple with bureaucracies to secure whatever additional care they need. Through it all, he harbors no illusions about the depth of his patients’ needs, doing his best to refer them to public or nonprofit agencies that will provide shelter, food, counseling, and a new home base from which to get an education.

He even achieves some notable successes, far beyond acute medical care. He reunites a girl who’d run away from her sexually abusive father with an aunt who agrees to care for her. He encourages another runaway to check out a group home, where she gains the confidence to forge a plan to train as a nurse. Yet for all his efforts, he can’t cut through the layers of paperwork to find psychiatric help, so some of the most emotionally needy children remain lost souls on the streets.

Christensen is steadfast in his mission. But it’s hard for him, as a physician—and for us, as readers—to escape a rising sense of frustration at the limits of what one lone mobile medical unit, or any individual program, can do. Ultimately, if there’s a message conveyed by his book, and by Lloyd’s, it’s that the horror stories of homeless youth are real, and need to be addressed. They can be seen each day on the streets we ourselves travel. The projects led by Christensen and Lloyd are nothing less than inspiring. And if they, and/or their books, help develop more awareness, more funding, and more programs like these, all of us may be able to sleep a little sounder.

New York City–based Diane Cole is the author of the memoir After Great Pain: A New Life Emerges, and writes for many national publications. You can reach her at djcole86@gmail.com.

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