In this Oct. 9, 2018 photo, Linda Marino poses with photographs of her son, Samuel, at her home in Tolland, Conn. Samuel Marino died in a 2009 car crash that relatives believe was intentional after becoming a victim of a male sex trafficking ring. Advocates are calling for more recognition and services for male victims. (AP Photo/Dave Collins)

In this Oct. 9, 2018 photo, Linda Marino poses with photographs of her son, Samuel, at her home in Tolland, Conn. Samuel Marino died in a 2009 car crash that relatives believe was intentional after becoming a victim of a male sex trafficking ring. Advocates are calling for more recognition and services for male victims. (AP Photo/Dave Collins)

TOLLAND, Conn. (AP) — Like many victims of a Connecticut sex trafficking ring that preyed on troubled young men and teenage boys for more than 20 years, Samuel Marino never told his family or police about being coerced into sexual relations with much older men.

Marino ended up carjacking vehicles from two different women in 2009 and leading police on a chase that left him dead at just 26 years old. In a handwritten note found years later in a raid on one of the suspected sex trafficking ring leader’s homes, Marino wrote he was angry, ashamed and disgusted at how he was taken advantage of.

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“He couldn’t deal with the torture and the shame of being prostituted and also of being an addict,” said his mother, Linda Marino, who found out about the sex trafficking only after the arrests were announced two years ago. “I’m sure he felt hopelessness and despair. The pain of not being able to help my son Sam when he was going through this is insurmountable.”

Police said they identified at least 15 victims of the Connecticut trafficking ring but believe there could be dozens more. The operation appeared to date to the 1990s and was discovered only after a state probation officer reported it to authorities in January 2016, police said. One of the victims had told the probation officer about being trafficked, officials said. Two men have pleaded guilty to trafficking-related charges and a third is expected to go on trial early next year.

The case has illuminated what victims and advocates call the underreported scourge of male sex trafficking. While both male and female trafficking victims suffer trauma and other psychological scars, data suggest men and boys are less likely to come forward and when they do they are more likely to have difficulties finding counseling and other services, victims and advocates say.

The suspects targeted teenage boys and young men who were developmentally disabled, mentally ill and addicted to drugs, police said. One of the defendants, Robert King, found some of his victims at drug rehab centers. He would allegedly give them drugs, including heroin and cocaine, and take them to other men for sex acts so they could earn money to pay him back for the drugs, according to arrest warrants.

King, 53, of Danbury, pleaded guilty in August to conspiracy to commit human trafficking and is expected to be sentenced to 4 ½ years in prison after cooperating in the trial of another defendant, wealthy Glastonbury businessman Bruce Bemer, whose lawyers said he is not guilty of the charges. A third defendant, William Trefzger, 74, of Westport, pleaded guilty in February to patronizing a trafficked person and was sentenced to a year in prison.

The trafficking ring left behind a trail of devastation. The victims suffer a variety of psychological ailments including post-traumatic stress disorder and repeated flashbacks, according to lawsuits filed by several victims. And their families continue coping with the trauma in the aftermath.

One man, known only as “Victim #1” in arrest warrants, suffers from severe mental health disorders and isn’t capable of living independently. He was searching dumpsters for returnable bottles when he met King, he told police.

Another young man, described only as “Victim #2” in arrest warrants, has severe psychological disorders. He told police he was paid $50 to $80 for sexual encounters with older men. He said King threatened to kill him if he told anyone about the trafficking ring, which left him traumatized. He told a health care provider he was embarrassed and worried that people may think he was homosexual when he was not, an arrest warrant said.

It is not uncommon for male victims to worry about their masculinity and sexual orientation being questioned, said Robert Lung, a Colorado state judge and member of the U.S. Advisory Council on Human Trafficking. And while all victims of trafficking and sexual assault are often hesitant to come forward due to fear and other issues, Lung said there are fewer services, including counseling, available to men because most providers focus on treating women.

“The perception by society is boys and men are not victims,” said Lung, who, like other members of the advisory council, is a sex trafficking survivor. “I can count on one hand the number of organizations that are specific to boys and men in the country. And that’s a pretty big problem.”

He cited a 2010 study by John Marshall Law School professor Samuel Jones that found only two of the 222 institutions and programs that received federal government funding for anti-trafficking efforts were committed to fighting the trafficking of men and boys.

The Advisory Council on Human Trafficking, appointed by President Trump in March, is expected to make numerous recommendations in a report due early next year. Lung hopes one of them includes providing incentives to providers to treat more male trafficking victims.

Accurate data on the sex trafficking of men and boys is lacking and estimates on the number and gender of victims varies widely, advocates said.

The National Human Trafficking Hotline, run by government-funded Polaris, says 8,524 human trafficking cases were reported in the U.S. last year, including both sex and labor trafficking. Of those, 1,124 cases, or 13 percent, involved male victims. Other studies and research have said the percentage of male victims is much higher, more than half in some reports including a 2008 study of the sexual exploitation of children in New York City by the John Jay College of Criminal Justice.

One report last year estimated that 4.8 million adults and children worldwide were sex trafficking victims in 2016. But the report, by the International Labour Organization, the Walk Free Foundation and the International Organization for Migration, said women and girls accounted for 99 percent of all victims.

A 2016 study funded by the U.S. Department of Justice that interviewed nearly 1,000 youths involved in the sex trade found 36 percent were male. About 53 percent of those victims were heterosexual, 36 percent were bisexual and 9 percent were gay, according to the study by the Center for Court Innovation and the John Jay College of Criminal Justice. Some reports indicate gay and transgender men and boys are more at risk for becoming sex trafficking victims. Advocates, however, say victims’ sexual orientation is irrelevant.

Samuel Marino, the Connecticut victim who died in a car crash, revealed his feelings in a typo-filled note police say they found in 2016 in King’s Danbury trailer home while executing a search warrant. The note references King.

“I felt so angry at Bob at myself,” he wrote. “Guilty ashamed and discusted. What hapend was an act of survival. I was ... taken advantage of. It wasn’t my falt It wasn’t my falt It wasn’t my falt.”