Strategies to combat these biases involve education and awareness programs for healthcare professionals. These programs help individuals recognize and acknowledge their biases, fostering a more empathetic and unbiased approach to patient care. Additionally, implementing policies and procedures prioritizing equitable treatment for all patients
can play a pivotal role in reducing healthcare disparities. Ultimately, confronting implicit bias in healthcare is essential to creating a more just and equitable healthcare system where everyone receives fair and equal treatment regardless of their background or characteristics.
INTRODUCTION
Human trafficking is an extreme and heinous violation of human rights that persists around the globe, including throughout the U.S., despite extensive efforts to eradicate this atrocious crime. Human trafficking is a crime involving the exploitation of victims for the purpose of compelled labor or commercial sex acts through the use of force, fraud, or coercion. Force in the context of human trafficking includes physical restraint, physical harm, sexual assault, and/or beatings, and may also include monitoring and confinement to control victims (National Human Trafficking Hotline, 2023). Fraud includes false promises of employment, living conditions, love, marriage, or a better life, and may also include withholding promised wages, or contract fraud (National Human Trafficking Hotline, 2023). Coercion may include threats of harm to self or others, debt bondage, psychological manipulation, or document confiscation, as well as fear-inducing threats to share information or pictures with others or report to authorities (National Human Trafficking Hotline). The most vulnerable victims are typically women and children; however, victims of human trafficking can be any age and any gender. Although multiple organizations publish data and statistics concerning human trafficking, at present there is no consensus on the total number of human trafficking victims in the U.S. Many victims of human trafficking never disclose the nature of their situation, and because of this, it is impossible to estimate the actual Important Terms: Victim or Survivor The terms victim and survivor can both be used to refer to individuals who were trafficked. The term victim has legal implications within the criminal justice process and generally refers to an individual who suffered harm because of criminal conduct (Department of Justice [DOJ], 2014). Much of the current body of literature uses this term to denote a patient/individual who is actively being trafficked (Combs & Arnold, 2021).
number of human trafficking victims. Other inherent systemic difficulties—such as lack of coordinated data and inconsistent definitions of key terms—add further challenges to accurately estimating the number of trafficked people regionally as well as globally (Sprang et al., 2022). Because of this, healthcare providers and organizations involved with trafficked persons have been called to “increase their capacity to identify and refer people in trafficking situations and provide sensitive and safe services to people post- trafficking” (World Health Organization [WHO], 2012). Healthcare professionals are uniquely positioned to identify and intervene on behalf of trafficking victims, as 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 (Trossman, 2008). Despite numerous multidisciplinary and multiagency efforts to reduce human trafficking in the U.S., this public health crisis persists. In 2021, the National Human Trafficking Hotline (NHTH) received a total of 51,073 substantive signals (phone calls, SMS, webchats, online tip reports, or emails) regarding instances of human trafficking, which resulted in 10,360 confirmed unique cases of human trafficking (NHTH Data Report, 2023). Because of this, healthcare providers across the U.S. must become well- versed in identifying individuals who may be in a trafficking situation and supporting them to safety. Survivor is a term used by many in the health services field to recognize the strength it takes to continue a journey toward healing in the aftermath of a traumatic experience. This term is also used to refer to a patient/individual who has been rescued and is no longer being trafficked (Combs & Arnold, 2021).
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 (Texas Attorney General, 2024). The goals of the Task Force are to serve as a collaborative and multidisciplinary body that strives to coordinate anti– human trafficking efforts at the local, state, and federal levels (Texas Attorney General, 2024). It serves as a communication hub that brings together coalitions from across the state to provide direction, consistent messaging, and sharing of best practices (Texas Attorney General, 2024). A report released by the National Human Trafficking Hotline for the state of Texas indicated the organization received a total of 3,534 substantive signals that originated from a Texas location, which was the second highest signal volume among all 50 states and Washington, D.C. (NHTH Data Report–Texas, 2023). Each request submitted to the Hotline is evaluated for potential human trafficking. Of the 3,534 signals received, 917 were determined to be unique instances of human trafficking (NHTH Data Report–Texas, 2023). Over 70 percent of the incidents were determined to be sexual in nature and
included venues such as illicit massage/spa businesses, hotel/motel-based or residential-based commercial sex, pornography, escort/delivery services strip club– and bar- based, truck stop-based, and online or unknown venues (NHTH Data Report–Texas, 2023). Fourteen percent of incidents were labor related and included incidents such as domestic work, construction, agriculture, restaurant/ food services, health and beauty services, illicit activity, and retail/other small businesses. Six percent of incidents were both sex and labor related, and in 8% of incidents, the type trafficking was not specified (NHTH Data Report– Texas, 2023). This same 2023 report indicated 67% of victims were adults and 26% were minors; 83% of victims identified as female, 15% identified as male, and 1% identified as another gender; and 7% of victims were U.S. citizens/legal permanent residents and 17% were foreign nationals (NHTH Data Report–Texas, 2023). 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
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