The life situations of people who are trafficked are almost always complicated, whether they are under a trafficker’s control, trying to leave, or are already out of a trafficking environment. In addition, trafficked people may not self-identify as trafficked. Rather they may feel that these are merely the restrictions of their circumstance. They are usually beset with physical, psychological, social, legal, and financial circumstances that can be overwhelming. 3 Human trafficking became a federal crime with passage of the Trafficking Victims Protection Act of 2000 (TVPA) revised and Human trafficking in Texas In 2009, the Texas legislature created the Texas Human Trafficking Prevention Task Force to respond to the growing human trafficking crisis and designated the attorney general as the presiding officer. 11 The Task Force develops legislative recommendations to attack the crime and policies to protect victims. A 2016 report by the University of Texas at Austin, School of Social Work estimated that there are approximately 79,000 minor and youth victims of sex trafficking and 234,000 workers who are victims of labor trafficking. 12 Minor and youth sex trafficking has an estimated economic impact to the state of nearly $6.6 billion while labor trafficking victims are exploited at an annual cost of almost $600 million. 12 In 2020, the latest year for which data are available, there were 987 human trafficking cases reported in Texas, 185 arrests for human trafficking, and 28 convictions. 11,13 There were also 97 arrests for compelled prostitution with 18 convictions. 11 Of the 1,080 cases of human trafficking in 2019, most were for sex trafficking (739 cases), with labor trafficking being the next- most common (116 cases). 13 Most victims were female (824 cases
updated in 2015. 10 The goals of the TVPA were to prevent severe forms of human trafficking, both in the United States and overseas; to protect victims and help them rebuild their lives in the United States; and to prosecute traffickers and impose federal penalties. Prior to enactment of the TVPA, no comprehensive federal law existed to protect victims of trafficking in the United States or to prosecute their traffickers. Congress has reauthorized and amended the TVPA several times, but its fundamental purpose and legal authorities remain the same. vs. 131 for men), and adult (659 cases vs. 216 cases involving minors). [ Note : statistics are non-cumulative because cases may involve multiple victims.] An important caveat to all statistics about human trafficking is the difficulty of obtaining accurate data, which is a limitation of research into this issue that has been pointed out in the reports of the Texas Human Trafficking Prevention Task Force and other organizations working to reduce human trafficking. 11 Barriers to acquiring accurate data include the avoidance by victims of the criminal justice system due to fears of reprisal, deportation, or incarceration; failure of health care workers or emergency responders to ask about human trafficking or to probe causes of apparent violence; and a lack of coordination and data integration between the various levels of governmental agencies (local, state, federal) and other organizations (e.g., non-profits, hospitals) that may have data on human trafficking. These barriers and the limitations of existing data suggest that the true scope of human trafficking is larger than can be reliably estimated at the present time. 8
AN ESSENTIAL ROLE FOR HEALTHCARE PROVIDERS
A number of organizations representing healthcare providers have issued statements recognizing human trafficking as a public health issue and acknowledging the importance of building awareness of human trafficking among health care providers. 14-17 The American Medical Association, for example, in its 2015 statement, says: "Physicians should be aware of the definition of human trafficking and of resources available to help them identify and address the needs of victims. The AMA will help encourage the education of physicians about human trafficking and how to report cases of suspected human trafficking to appropriate authorities to provide a conduit to resources to address the victim's medical, legal and social needs." 15 Healthcare professionals are uniquely positioned to identify and intervene on behalf of trafficking victims. Outside of law enforcement, healthcare settings are among the few places Identifying potential victims of human trafficking Certain patient behaviors and/or companion behaviors can alert health care professionals to a potential human trafficking case. 9,22 One common clue is the presence of a person who seems to control both the patient and the situation. Survivors report that their traffickers completed health-related paperwork for them and communicated with clinic staff and health care providers on their behalf. 9 The physical proximity of the traffickers perpetuated their coercion and control of the victims, preventing them from communicating with health care personnel directly. 9 The presence of an overbearing or controlling companion should trigger concern, and most recommendations suggest that in order to allow patients the opportunity to speak for themselves, clinic or hospital staff should attempt to interview and assess all patients privately. This may require the use of an independent interpreter, since many survivors have limited English proficiency. 9 Trained non-clinical workers could be instrumental in helping to maintain separation during potential victim identification interviews in a manner that does not alert potential traffickers to victim identification efforts. Non-clinical staff, such as
where the lives of human trafficking victims may intersect with the rest of society, if only for brief periods. 18 In a study of 98 sex trafficking survivors, 88% had at least one encounter with a health care provider while they were being trafficked, with 63 percent of these encounters happening in an emergency department. 19 One study noted that human trafficking victims in the U.S. may interact with a range of health care personnel, including primary care providers, sexual and reproductive health care workers, dentists, and providers of traditional or alternative remedies. 9 Trafficking victims may even be found working within health care facilities. Unfortunately, studies have demonstrated that medical care providers are often unprepared to identify trafficking victims. 20,21 receptionists, security guards, and accounting personnel, who are made sensitive to these matters through training, may observe patterns and know when and how to respond if a potential trafficker repeatedly presents for multiple patients as a companion, translator, or medical bill payer, regardless of whether these personnel interact with the patients themselves. Multilingual non-clinical staff who may share a common language with trafficked persons of limited English proficiency may be able to develop a rapport with trafficked persons that facilitates trust and frank communication based on their language or cultural commonalities. It is recommended, therefore, that health care organizations think broadly about the types of employees who are appropriate to receive training about human trafficking in order to enhance opportunities for identification of and response to potential trafficking situations. 23 A human trafficking victim may develop a mindset of fear, distrust, denial, and conflicting loyalties. Foreign victims of trafficking are often fearful of being deported or jailed and, therefore, they may distrust authority figures, particularly law enforcement and government officials. Many victims of both
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