Many different factors contribute to trafficking in persons (U.S. Department of State, 2019).
intervention for those being trafficked, including individuals who may be unaware of the full consequences of their current situation. Legal action against trafficking has increased dramatically since the TVPA of 2000. However, many of these arrests continue to involve only the victims. Both labor and sex trafficking have legal implications. Those in the sex industry fear legal prosecution for prostitution. Foreign nationals involved in labor or sex trafficking may fear deportation. Similarly, they may be forced to carry illegal arms and or substances as part of their trafficking and have previous arrest records. Traffickers can also feed into this fear as a means of manipulation, convincing them that the victim is the one who will be arrested, not the trafficker. Successful prosecution of trafficking crimes in U.S. agriculture, sweatshops, suburban mansions, escort agencies, brothels, lounges/bars, and strip clubs has been recorded (Domoney et al., 2015). Multijurisdictional trafficking networks present a challenge in identifying the perpetrators for criminal prosecution. Immediate notification of a suspected case that may be potential human trafficking assists the Human Trafficking Prosecution Unit of the Department of Justice to provide victim assistance resources, legal guidance, and coordination among districts prosecuting overlapping criminal networks on a timely basis (Domoney et al., 2015). Certain factors, such as previous abuse or homelessness, make individuals more vulnerable to trafficking. Traffickers target marginalized persons, often those with a weaker social support system, as well as those who have limited financial support. Traffickers may seek individuals with limited communication abilities, such as limited knowledge of the indigenous language, because this vulnerability makes it more difficult for trafficked persons to leave the trafficker or report the abuse. Living in rural areas increases vulnerability to human trafficking, because sparsely populated regions make the act of trafficking easier to hide. People whom have been trafficked themselves may also become a trafficker later. Warning signs Individuals who are trafficked are exposed to various health risks, including occupational exposures and physical, sexual, psychological, and social trauma (International Centre for Missing and Exploited Children [ICMEC], 2019). Individuals are at risk for these health conditions before, during, and after being trafficked. Health conditions such as mental health disorders, including depression and anxiety, and substance use disorders may persist even after successfully escaping trafficking. Additionally, preexisting conditions, can exacerbate and complicate health problems that occur as a result of trafficking. Patients who are potentially trafficked may present with one telling symptom or multiple comorbidities. Recognizing these clinical symptoms and diagnoses as cues can lead to better identification of trafficked individuals (ICMEC, 2019). Clinicians can use social history and contextual cues when identifying trafficked persons. Clinicians need to draw connections between the methods and patterns of trafficking and the health consequences. Situational red flags include the constant presence of another person, usually a male, who typically stands across the room or positions himself over the patient. The victim may briefly glance at the person controlling her when she answers questions about her history (ICMEC, 2019).
Healthcare Consideration: The Joint Commission (2018) listed helpful information on how healthcare professionals can identify human trafficking victims in their recent publication Quick Safety 42: Identify human trafficking victims . https://www.jointcommission.org/resources/news- and-multimedia/newsletters/newsletters/quick-safety/ quick-safety-42-identifying-human-trafficking-victims/ Evidence-Based Practice The first and greatest challenge is identifying victims or those who are at greatest risk of being trafficked. The 2019 Trafficking in Persons (TIP) Report identifies a list of populations that have increased vulnerabilities to trafficking in the United States. These groups may seem to have little in common, but they are all at a greater risk for trafficking. These populations include: ● Children in the child welfare and juvenile justice systems. ● Runaway and youth. ● Children working in agriculture. ● American Indians and Alaska Natives. ● Migrant laborers. ● Foreign national domestic workers in diplomatic households. ● Employees of businesses in ethnic communities. ● Populations with limited English proficiency. ● Persons with disabilities. ● Rural populations. ● Lesbian, gay, bisexual, and transgender (LGBT) individuals. ● Persons who are incarcerated. (UNDOC, 2018; U.S. Department of State, 2019) Many maladies can be attributed to the effects of trafficking, and some are more common than others depending on the type of trafficking; for example, sexually transmitted infections (STIs) and pelvic inflammatory disease are more common in people who are sex trafficked than in those who are trafficked for labor, although it is not exclusive to sex trafficking (ICMEC, 2019) Unfortunately, psychological and physical violence may not be novel to those who are trafficked. Note that some of the signs of trafficking are not unique to trafficking. For example, there may be overlap in cases of intimate partner violence. Regardless, further screening is warranted to help identify patients who may be victims of trafficking or other violent crimes (ICMEC,2019) Psychological Trafficked persons often experience posttraumatic stress disorder (PTSD), depression, suicidal ideation, drug addiction, and associated symptoms as a result of psychological violence (Chisolm-Straker & Stoklosa, 2017). An international study reported 38.9% of subjects had PTSD and 61.2% had depression among the more than 600 trafficked men, women, and children (Kiss et al., 2015). Overall mood and demeanor, eye contact, response clarity, and orientation of the patient should be noted. Suicidal ideation, anxiety, depression, and signs of post-traumatic stress disorder are some of the common problems reported
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