• The recruitment, harboring, transportation, provision, or obtaining of a person for labor or services, through the use of force, fraud, or coercion for the purpose of subjection to involuntary servitude, peonage (paying off debt through work), debt bondage (debt slavery, bonded labor or services for a debt or other obligation), or slavery (a condition compared to that of a slave in respect of exhausting labor or restricted freedom). Commercial Sex Act is defined federally as any sex act on account of which anything of value is given to or received by any person. 28 What are Examples of Human Trafficking? Many victims of human trafficking are forced to work in prostitution, but trafficking also occurs as labor exploitation in urban, suburban, and rural areas. Many victims are lured with false promises of well-paying jobs or manipulated by people they trust. 29 They are forced or coerced into prostitution, domestic servitude, or other types of forced labor (e.g., agriculture, construction, fisheries, mining industries). Victims can be found in legitimate and illegitimate labor industries, including sweatshops, massage parlors, agriculture, restaurants, hotels, street peddling, door-to-door sales, begging, and domestic service. 29 Although anyone can be at risk for being a victim of human trafficking, most are women and girls. 30 People at highest risk include those in extreme poverty, have minimal education, have a history of abuse or instability in their family of origin, or have some other vulnerability (for example, those who are disabled or who may belong to a marginalized or stigmatized gender, ethnic, or cultural group). 31 Traffickers use various techniques to control their victims and keep them enslaved. Some traffickers hold their victims under lock and key. More frequently, however, more subtle techniques are used such as: 32 Isolation from: • The public by limiting contact with outsiders and making sure that any contact is monitored or superficial in nature. • Family members and friends. Control: • Confiscation or control of passports or other identification documents. • Debt bondage through enormous financial obligations or an undefined or increasing debt. • Control of the victims’ money. Intimidation/threat: • Use or threat of violence toward victims or their family members. • Shaming victims by exposing humiliating circumstances to their families.
• Telling victims they will be imprisoned or deported for immigration violations if they contact authorities. 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 even 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. 33 What are the signs of Human Trafficking? Human Trafficking victim identification/warning signs include, but are not limited to: • A youth that has been verified to be under 18 and is in any way involved in the commercial sex industry, or has a record of prior arrest for prostitution or related charges • Has an explicitly sexual online profile • Excessive frequenting of internet chat rooms or classified sites • Depicts elements of sexual exploitation in drawing, poetry, or other modes of creative expression • Frequent or multiple sexually transmitted diseases or pregnancies • Lying about or not being aware of their true age • Having no knowledge of personal data, such as but not limited to: age, name, and/or date of birth Who is at risk? Youth at risk for human trafficking include those: • In the foster care system • Who identify as LGBTQ • Who are homeless or runaway • With disabilities • With mental health or substance abuse disorders • With a history of sexual abuse • With a history of being involved in the welfare system • Who identify as native or aboriginal • With family dysfunction The Role Healthcare Providers Can Play in Identifying Human Trafficking 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 where the lives of human trafficking victims may intersect with the rest of society, if only for brief periods. 34
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% of these encounters happening in an emergency department. 35 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. 32 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. 36,37 Identifying Potential Victims of Human Trafficking Certain patient behaviors and/or companion behaviors can alert health care professionals to a potential human trafficking case. 32,38 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. 32 The physical proximity of the traffickers perpetuated their coercion and control of the victims, preventing them from communicating with health care personnel directly. 32 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. 32 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 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. 39
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