INTRODUCTION
Human trafficking is a complex worldwide problem affecting many aspects of society. This problem transcends national borders and affects all countries, all types of victims, and healthcare systems worldwide. Human trafficking is considered a form of modern slavery involving the commercial exchange and exploitation of humans for the purpose of receiving benefits or monetary gain (UNOCD, 2003). Most human trafficking victims interact with the healthcare system while being trafficked; therefore, health care systems have an important role in identifying and responding to trafficked persons (Leslie, 2018). Understanding the role of the health care system, the best methods to identify trafficked individuals, and respond to their needs is key to addressing this problem. Safety professionals can play an important role in supporting and advising the healthcare system as they develop and implement policies related to human trafficking.
Definition of Human Trafficking
The United Nations Office of Drugs and Crime defines human trafficking as the “recruitment, transportation, transfer, harboring or receipt of persons, by means of the threat or use of force or other forms of coercion, of abduction, of fraud, of deception, of the abuse of power or of a position of vulnerability or of the giving or receiving of payments or benefits to achieve the consent of a person having control over another person, for the purpose of exploitation” (UNOCD, 2003). Exploitation can include the “exploitation of the prostitution of others or other forms of sexual exploitation, forced labor or services, slavery or practices similar to slavery, servitude or the removal of organs” (UNODC, 2003). The United States defines sex trafficking and labor trafficking separately. Sex trafficking is defined as the, “recruitment, harboring, transportation, provision, obtaining, patronizing, or soliciting of a person for the purposes of a commercial sex act, in which the commercial sex act is induced by force, fraud, or coercion, or in which the person induced to perform such an act has not attained 18 years of age” (United States, 2000) Whereas labor trafficking is the, “recruitment, harboring, transportation, provision, or obtaining of a person for labor or services, through the use of force, fraud, or coercion for the purposes of subjection to involuntary servitude, peonage, debt bondage, or slavery, (Trafficking Victims Protection Act (TVPA) 22 USC § 7102).” (United States, 2000).
Prevalence of Human Trafficking
Estimating the prevalence of human trafficking in the United States is extremely difficult. The methods used to derive estimates of human trafficking are rarely described in the literature or government reports. Human trafficking estimates are most often derived from incomplete criminal justice data or data from human trafficking service agencies or hotlines, both of which likely underestimate the scope of the problem. According to the Women’s Center, every year between 18,000 and 20,000 human trafficking victims are brought into the United States (USDOJ, 2015). Since 2017, there have been 56,504 cases of human trafficking reported to the National Human Trafficking Hotline (Polaris, 2018). In 2015, the US Department of Homeland Security and the US Department of Justice opened 2,847 investigations of suspected human trafficking cases and prosecuted 377 defendants for human trafficking crimes (US Department of State, 2016). Also, in 2015, federally funded victim service agencies in the United States reported 3,889 open client cases (Nichols, 2015). These estimates are thought to represent a small fraction of all human trafficking cases in the United States. Recent attempts to quantify the number of human trafficking victims in the United States include innovative sampling methodologies and analytic strategies to better estimate the prevalence of human trafficking in hard-to-reach and vulnerable populations (White, 2019). A study including child welfare, legal services, and law enforcement data in and around Ohio from 2014 through 2016 found over 1,000 human trafficking victims in that state alone (Anderson, 2019). Garnering credible prevalence estimates of human trafficking, calculating the number of new cases (incidence) per year, and estimating the proportion of the population experiencing victimization is of the highest priorities in understanding this public health problem and in enacting policies and programs that are effective.
Characteristics of Trafficked Persons
The characteristics of trafficking victims can vary widely. Trafficking victims can span all races, genders, ages, and sexual orientations. Data from more than 23,000 trafficking survivors interacting with the National Human Trafficking Hotline in 2018 provide a snapshot of victim characteristics (Polaris, 2018). According to this data, the three predominant types of trafficking cases encountered were (1) sex trafficking such as escort services and pornography; (2) labor trafficking such as domestic labor, agricultural, and travelling sales; and sex and labor trafficking combined such as massage, health and beauty; bars, strip clubs and cantinas, and (3) other illicit activities. Of the victims the National Hotline interviewed, 47% were adults, 21% were minors, and one-third of victims did not disclose their age. Most trafficking victims interacting with the National Hotline were female (65%) or of unknown gender (22%). Approximately 13% of trafficking victims interacting with the National Hotline were male. While most victims of human trafficking who were served by the National Hotline did not disclose their race/ethnicity, those that did were more likely to be an ethnic or racial minority: 37% were Latino, 28% were Asian, 18% were African American and 15% were White (Polaris, 2018).
Risk Factors
According to the 2018 Human Trafficking National Hotline, the major risk factors for human trafficking were: recent migration or relocation; substance abuse; unstable housing; being a runaway or homeless youth; or having a mental health concern (Polaris, 2018). The predominant methods used by perpetrators of human trafficking included isolation and confinement, economic abuse, threats, emotional abuse, and physical abuse. While the Human Trafficking National Hotline data provide some preliminary profiles of the characteristics and risk factors of those who are victims of human trafficking, these statistics should be viewed with caution given that victims interacting with these services may not represent all victims as they are predominantly self-selected (Polaris, 2018).
The imprecise estimates of prevalence and poor understanding of risk factors should not prevent the implementation of meaningful screening and prevention programs to identify and assist victims who have been trafficked. It has been estimated that 80 to 90 percent of human trafficking victims are seen by a healthcare provider while still being trafficked, making healthcare organizations an ideal place to recognize, identify, assist, and refer victims (Leslie, 2018). This paper reviews the evidence associated with identification methods for healthcare professionals and issues associated with responding to trafficking victims.