Learning Objectives
By the end of this section, you will be able to:
- Discuss the definition of human trafficking, and describe at-risk populations, traffickers, and regional trafficking trends in the United States
- Describe the nursing care for the person who has been trafficked, including how to recognize and treat those people
- Construct a nursing care plan for the person who has been trafficked
Human trafficking is a crime that involves the exploitation of people for forced labor or commercial sex (United Nations Office on Drugs and Crime, 2020). Human trafficking is a global problem that includes women, children, and men. Nurses and health-care providers should identify and provide help for people being trafficked.
Human Trafficking: Definition
The targeting, relocation of, detention of, or receiving of a person by any means possible to achieve control over that person for exploitation is considered human trafficking (WHO, 2012). The National Human Trafficking Hotline (NHTH; 2024, p. 1) defines trafficking as “stealing freedom for profit.” People are trafficked for many different forms of forced labor and sexual exploitation. Victims of human trafficking are forced to work excessively long hours, live in overcrowded or unsafe conditions, experience physical abuse and malnourishment, and are unable to move freely or leave their place of work or residence (Hodge & Lietz, 2018; Piscitelli & Pienaar, 2019). Consequences of human trafficking include physical and relationship problems, psychologic issues, and chronic health conditions (CDC, 2022b).
Factors Related to Human Traffickers
Human traffickers do not have a common background, race, gender, or nationality. Traffickers can be strangers, family members, partners, or acquaintances. Signs of possible trafficking for labor situations include the following: a person in an overwhelming romantic relationship is suddenly showered with gifts and money by a person with a large age difference or large difference in financial status; a person is developing a close relationship with a person solely known on social media; a person is being offered a job that seems too good to be true; and a person is being recruited for a job that requires the person to move far away, but the recruiter is vague and reluctant to answer questions about the job (NHTH, 2023). People who are being trafficked for sex may want to stop participating in commercial sex but cannot leave the situation; they live where they work or are transported between home and workplace by guards. They may work in a strip club or illicit massage business where they are pressured to perform sex acts for money; or they have a controlling person (parent, guardian, partner, etc.) who will not allow them to speak or be alone with anyone (NHTH, 2023).
Populations at High Risk for Human Trafficking
Some groups are at higher risk for human trafficking, such as women and children. One-third of adolescents who have run away from home are recruited into sex trafficking within 48 hours of being homeless (Camak 2022). People living in poverty or unsafe situations, undocumented immigrants, and those with a history of abuse or trauma are at higher risk (CDC, 2022b; International Labour Organization, 2022). People of color and LGBTQIA+ persons are also at higher risk than other demographic groups (NHTH, 2023). Traffickers recognize and target people who are at higher risk, such as runaways, those with drug or alcohol use issues, or those with a caregiver or family member with substance use issues (NHTH, 2023). Identifying victims of human trafficking can be challenging because they may be kept in isolation, have limited contact with others, or be forced to deny their situation. Traffickers prey on populations at high risk for trafficking by developing trust, rescuing them from bad situations, helping them, and then demanding they “repay” the kindness through servitude (Camak, 2022).
Regional Trends in the United States of America
Human trafficking occurs everywhere; however, Asia and the Pacific region have the highest number of victims of human trafficking (McGeough & Van Schooneveld, 2023). Asia and the Pacific reported 29.3 million cases of human trafficking, while the Americas reported 5.1 million cases (McGeough & Van Schooneveld, 2023). In North America, most human trafficking victims are women subjected to sexual trafficking (McGeough & Van Schooneveld, 2023).
In 2020, 2,198 people were referred to the U.S. Attorneys’ Department of Justice for human trafficking, which is a 62 percent increase in 10 years. Human trafficking cases have been reported in all 50 states, with an increase in trafficking by a family member, guardian, or intimate partner (U.S. Department of State, 2022). California, Texas, and Florida have the highest numbers of reported cases of human trafficking (National Human Trafficking Hotline, n.d.), likely due to their large populations, international borders, and transportation networks. Other areas with major urban centers (New York, Michigan, and Georgia) also attract traffickers (National Human Trafficking Hotline, n.d.).
Preventing Human Trafficking
Programs to increase community awareness of human trafficking and to address exploitation are designed to prevent trafficking (CDC, 2022b). Strategies to encourage healthy relationship behaviors, foster safe homes and neighborhoods, identify and address vulnerabilities during health-care visits, reduce demand for commercial sex, and end business profits from trafficking-related transactions have been suggested by the CDC (2022b). The United States enacted the Victims of Trafficking and Violence Protection Act of 2000 in an effort to prevent human trafficking (2000).
Nursing Care for the Person Who Has Been Trafficked
Nurses can help women subjected to trafficking by providing sensitive, empathetic care. The nurse is trained to recognize the signs of a person who is being trafficked in order to care for the person but also to report the trafficking incident. Nurses are required by law to report trafficking victims under the age of 18 years; unfortunately, nurses are not required to report adult victims of trafficking (Byrne et al., 2019; Camak, 2022). Intervening in cases of human trafficking is crucial to prevent further harm to victims. In some cases, it may be necessary to involve a professional interpreter, as victims may not speak the local language or be hesitant to share their experiences. Overall, nurses can raise awareness about human trafficking and take steps to identify victims and provide help.
How to Recognize Victims of Human Trafficking
Recognizing victims of human trafficking can be difficult for nurses and health-care providers due to the victims being threatened with physical violence or other consequences if they are discovered. Training can help nurses recognize signs of human trafficking, such as by looking closely at a patient’s location and occupation, by being attentive to behavioral and physical signs, and by using screening tools. For example, sex trafficking victims have been found on the street, in massage parlors, at escort services, at truck stops, and in hotels, brothels, and strip clubs (Camak, 2022). Behavioral signs that a person may be a victim of trafficking include acting fearful, anxious, depressed, submissive, or tense around someone they know; deferring to another person to speak for them; and avoiding eye contact (Department of Human Services [DHS], 2020). Physical signs can include evidence of physical or sexual abuse; signs of physical restraint, confinement, or torture; or signs of being harmed or deprived of food, water, sleep, medical care, or personal possessions (DHS, 2020). Table 9.3 provides nurses with examples of red flags of potential victims of human trafficking.
| Patient | Red Flags |
|---|---|
| Physical signs of trafficking victims |
|
| Characteristics of trafficking victims |
|
| Child/adolescent trafficking victims |
|
| Other signs of trafficking victims |
|
| Characteristics of traffickers |
|
Nursing Assessment and Diagnosis
Recognizing a person who has been trafficked is the first goal of nursing care; 50 percent to 80 percent of trafficked people have seen a health-care provider while being trafficked (Byrne et al., 2019). The nurse must develop a level of trust prior to assessing for signs of abuse. Many times, a person being trafficked is not allowed to speak for themselves; therefore, the nurse should find a way to interview the patient in private. The nurse must create a safe, nonthreatening environment for the interview. The nurse assesses the patient’s living and working conditions, amount of control over their life, mental health status, physical health, and psychosocial health (Byrne et al., 2019). The nurse can ask the following questions during the interview:
- Can you leave your job if you want?
- Can you come and go as you please?
- Have you been threatened or physically harmed in any way?
- Where do you sleep or eat?
- Do you sleep in a bed, on a cot, or on the floor?
- Do you have to ask permission to go to the bathroom, eat, or sleep?
- Has anyone threatened your family?
- Is anyone forcing you to do anything you do not want to do? (Camak, 2022)
Nursing assessment findings may include physical and emotional red flags. A person’s medical history might also have clues to a history of human trafficking, such as repeat abortions; lack of medical care; and history of PTSD, suicide attempts, and alcohol or drug addiction (Byrne et al., 2019).
Nursing diagnoses are centered on the actual or potential needs related to the physical and psychologic needs of the person being trafficked. The most common nursing diagnoses include:
- risk for injury related to physical abuse
- ineffective coping related to fear, stress, and lack of support
- hopelessness related to feelings of wanting to escape trafficking
- risk for injury related to lack of shelter
Legal and Ethical Issues
The Action-Means-Purpose Model
The nurse can use the Action-Means-Purpose Model (AMP Model) to determine if a patient meets the federal definition of human trafficking. If the nurse can confirm one element from each area of the model, the legal definition has been met. The elements are as follows:
- Action: induces, recruits, harbors, transports, provides, or obtains
- Means: force, fraud, coercion
- Purpose: commercial sex, labor, or services
(National Human Trafficking Hotline, 2024)
Nursing Plan and Implementation
The nursing plan for persons being trafficked includes a team approach with health-care providers, social workers, counselors, and possibly law enforcement. Nursing interventions should be individualized and compassionate, helping the patient to reestablish control, a sense of safety, and independence (Camak, 2022). The nurse provides supportive care and reassurance. Interventions can include providing resources for shelters and support groups, encouraging counseling, educating the person on legal assistance, and preventing further abuse.