_____________________________ Recognizing and Responding to Human Trafficking in Texas, 2nd Edition
• Social isolation or limiting contact with family members, friends, and outsiders; making sure any contact is monitored • Economic coercion (weaponized/predatory debt through enormous financial obligations, controlling or withholding victim’s money) • Confiscation or control of passports/identification documents • False claims of imprisonment or deportation if victims contact authorities/law enforcement Self-Assessment Question 1. Which of the following is not an example of human trafficking (either labor or sex trafficking)? A) Migrant/undocumented workers coerced into working as farmhands after being transported into the U.S. B) A consenting adult (>18 years of age) engaging in sexual acts in exchange for money C) Massage therapists at an unregistered massage parlor compelled to engage in sexual acts under threat of legal action being taken against them if they refuse
of their autonomy and independence (Stocklosa et al., 2022). While not all victims of trafficking have physical indicators that aid identification, many victims suffer serious health issues, which may include (National Human Trafficking Resource Center, 2016): • Addiction to drugs and/or alcohol to cope with or “escape” their situation, or as a method of control used by their traffickers • Symptoms of PTSD, phobias, panic attacks, anxiety, and depression • Sleep or eating disorders • Untreated chronic illnesses, such as diabetes or cardiovascular disease • Signs of physical abuse, such as bruises, broken bones, burns, and scarring • Chronic back, visual, or hearing problems from work in agriculture, construction, or manufacturing • Skin or respiratory problems caused by exposure to agricultural or other chemicals • Infectious diseases, such as tuberculosis and hepatitis, that are spread in overcrowded, unsanitary environments with limited ventilation • Reproductive health problems, including sexually
D) Hospitality/housekeeping service workers made to work for little to no pay due to threats made against members of their family
THE HEALTH IMPACT OF HUMAN TRAFFICKING
transmitted infections, urinary tract infections, pelvic pain, and injuries from sexual assault or forced abortions
The impact of human trafficking on its victims’ quality of life is devastating (Stoklosa et al., 2022; Richie-Zavalet et al., 2021). Victims frequently suffer physical abuse that results in traumatic injuries and chronic pain; suffer sexual abuse that increases their risk/occurrences of sexually transmitted infec- tions (STIs), pregnancies, and abortion-related complications; and suffer emotional abuse that may manifest as a variety of psychiatric or mental health illnesses such as posttraumatic stress disorder (PTSD), suicidal ideation, and substance use disorders. This physical, sexual, and emotional abuse also increases an individual’s risk of overdose due to substance use and/or death (Stocklosa et al., 2022). Victims also are frequently subjected to poor living conditions that expose them to malnutrition, dehydration, and other injuries (Stocklosa et al., 2022). Trafficking may be viewed as a process that moves through a series of stages (e.g., recruitment, travel/transit, exploitation, integration, and retrafficking or reintegration) that victims pass through. This view emphasizes the cumulative effect of all health risks across all stages of the trafficking process (Klabbers et al., 2023). Exploitation occurs, while not all trafficked persons are harmed, throughout all stages of the trafficking process, and conceptualizing traffick- ing as a process highlights the different time points at which different interventions could be more effective (Klabbers et al., 2023). Victims of human trafficking may lose most or all
THE ROLE OF HEALTHCARE PROVIDERS As previously mentioned, healthcare providers have a unique position and ability to identify, assess, and respond on behalf of trafficking victims. The primary focus of any interaction with a potential or known victim of human trafficking should be to address the chief complaint (acute illness or injury), establish healthcare facilities and providers as allies and safeguards from trauma and/or exploitation, and to offer additional resources when appropriate. It is not the responsibility of healthcare providers to elicit/coerce a disclosure of human trafficking or to investigate/confirm human trafficking. The responsibility of healthcare providers is to provide patient-centered care; to empower victims to seek additional support when appropriate; and above all, to respect the autonomy of the patient. CASE STUDY 1 A young woman named Rebecca presents to a local urgent care request- ing evaluation for genital sores and vaginal discharge. You notice on her intake information that she does not have insurance listed and indicates she is paying cash for this visit. Further review of her medical records shows that she does not have a permanent address listed and that she has presented on multiple occasions to this urgent care—in addition to other clinics/healthcare facilities—with similar symptoms. She is accompanied by a man named Derek, whom she claims to be her cousin, and who largely speaks for Rebecca, answering questions
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