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Population Health for Nurses

31.4 Human Trafficking

Population Health for Nurses31.4 Human Trafficking

Learning Outcomes

By the end of this section, you should be able to:

  • 31.4.1 Define human trafficking.
  • 31.4.2 Differentiate between labor trafficking and sex trafficking.
  • 31.4.3 Examine national human trafficking statistics.
  • 31.4.4 Describe tactics traffickers use to control their victims.
  • 31.4.5 Discuss how to recognize a victim of human trafficking and how to safely intervene.
  • 31.4.6 Explain the nurse’s role in addressing human trafficking to uphold nursing’s mission to society.

According to the Department of Homeland Security, human trafficking (HT) involves using force, fraud, or coercion to obtain labor or a commercial sex act (USDHS, 2022). The national Blue Campaign to End Human Trafficking (2023) refers to HT as “the business of stealing freedom for profit.” Every year, millions of men, women, and children are trafficked worldwide, including in the United States. HT can happen in any community, and victims can be any age, race, gender, or nationality. Language barriers, fear of their traffickers, and/or fear of law enforcement frequently keep victims from seeking help, which often makes human trafficking a hidden crime (U.S. Department of Justice, 2019). Human trafficking has been called the fastest-growing criminal industry in the world. If one thinks of these victims in the same manner as a predator does, as a product or commodity, the rapid increase makes sense. For example, a person can be sold for a sex act numerous times, while a drug or weapon can only be sold once. The internet has facilitated the rapid, exponential expansion of human trafficking (United Nations Office on Drugs and Crime, 2021). Human trafficking is committed against a person’s will, and the economic sectors that profit the most include agriculture, restaurants, manufacturing, domestic work, entertainment, hospitality, and the commercial sex industry.

According to UNICEF (2017), human trafficking is the only industry in which the supply and demand are the same thing: human beings. High demand drives supply. Increasing demand from consumers for cheap goods incentivizes corporations to find cheap labor, often forcing those at the bottom of the supply chain to exploit workers. Increased demand for commercial sex—especially with young people—incentivizes commercial sex venues, pornography, and prostitution to recruit and exploit children. Traffickers target vulnerability, and systemic inequalities and disparities make certain groups more vulnerable to exploitation. Mass forced displacement (such as from war, natural disasters, religious persecution, or economic collapse), conflict, extreme poverty, lack of access to education and job opportunities, violence, and harmful social norms like child marriage are all factors that push individuals into trafficking situations. Traffickers look for people who are living in poverty, are desperate, lack legitimate job options, lack educational opportunities, and/or are looking for a way to escape violence (U.S. Department of Justice [DOJ], 2019; USDHHS, n.d.; UNICEF, 2017).

The Difference Between Labor Trafficking and Sex Trafficking

The Trafficking Victims Protection Act (TVPA) of 2000 defines the crime of sex trafficking as the “recruitment, harboring, transportation, provision, obtaining, patronizing, or soliciting of a person for the purpose of a commercial sex act in which a commercial sex act is induced by force, fraud, or coercion, or in which the person induced to perform such act has not attained 18 years of age” (22 U.S.C. § 7102(11)(A)). In another major criminal industry, labor trafficking, individuals are compelled against their will to provide work or service through the use of force, fraud, or coercion. Traffickers frequently target vulnerable populations, such as children, individuals without lawful immigration status, those with debts, and those who are isolated, impoverished, or disabled of any race, religious affiliation, gender identity, or socioeconomic background. Victims of labor trafficking are rarely able to seek help. Victims may be hindered by language barriers or physically unable to seek help if their employer restricts and monitors their movements. U.S. citizens, foreign nationals, and women, men, and children of any race, religious affiliation, gender identity, or socioeconomic background can be victims of forced labor (HHS, n.d.; DOJ, 2022). Certain risk factors may make some individuals more vulnerable to forced labor than others, including (Department of Homeland Security, 2022b):

  • Unstable immigration status
  • Language barriers
  • Poverty and lack of basic needs like food, shelter, and safety
  • The psychological effects of a recent or past trauma
  • Lack of social support systems such as friends, family, and community
  • Physical or developmental disabilities

Common types of labor trafficking include people forced to work as domestic servants, farmworkers coerced through violence to harvest crops, or factory workers held in inhumane conditions with little to no pay. In the United States, domestic work is the most common form of labor trafficking (International Labour Organization [ILO], 2023; Department of Homeland Security, 2022b).

Examining National Human Trafficking Statistics

Based on the criminal nature of human trafficking and its subsequent underreporting, it is challenging to establish reliable statistics on its true prevalence in the United States. The hidden nature of the crime reduces the quality and quantity of available data and complicates efforts to identify individual victims. For these reasons, data and statistics may not reflect the full nature or scope of the problem.

The International Labour Organization (ILO) and the Walk Free Foundation, in partnership with the International Organization for Migration (IOM), released Global Estimates of Modern Slavery in September 2022. This report estimates that, at any given time in 2021, approximately 27.6 million people were in forced labor. Of these, 17.3 million were exploited in the private sector, 6.3 million in forced commercial sexual exploitation, and 3.9 million in forced labor imposed by the state. The definition of forced labor used in this report is based on ILO Forced Labour Convention, 1930 (No. 29), which states in Article 2.1 that forced labor is “all work or service which is exacted from any person under the menace of any penalty and for which the said person has not offered himself voluntarily” (ILO, 2022).

Tactics Used by Sex Traffickers

Sex traffickers recruit victims in the United States in shopping malls, junior high and high schools, foster homes, group homes, courthouses, restaurants and bars, bus stations, concerts, parks, libraries, and social networking websites (Figure 31.5). Caregivers should be aware that one of the most common ways that traffickers access children is through the use of social media sites like Facebook and Instagram (U.S. Department of State, 2023).

A drawing of buildings along a road shows all of the places human trafficking can take place, including highway rest areas, factories, night clubs, urban areas, restaurants, nail salons, shopping malls, suburbs, and farms and rural areas.
Figure 31.5 Human trafficking occurs in all areas of a community, often in plain sight. (See Blue Campaign, 2023; attribution: Copyright Rice University, OpenStax, under CC BY 4.0 license)

Traffickers are experts at finding moments when people are vulnerable, working the angles, manipulating reality, and leveraging fears. The methodical, intentional process of identifying and manipulating victims is called grooming. It is the most common way that people—adults and children—wind up in sex trafficking situations. Sex trafficking rarely begins with a violent abduction. While every situation is different, the overall grooming process usually involves the following steps:

  • Targeting the victim
  • Gaining their trust
  • Meeting their needs
  • Isolating them from social supports
  • Exploiting their weaknesses
  • Maintaining control of their actions

Using the grooming process, a trafficker gains full control over their victim and manipulates them into cooperating in their own exploitation. While spotting the grooming process from outside the relationship can be difficult, knowing and understanding the three types of traffickers/pimps—Romeo, gorilla, and CEO—could help prevent future victimization (ARK2Freedom, 2022; Switch 2023).

Romeo pimps capitalize on the victim’s need to feel loved, be seen, and feel desired. They use the “boyfriending” technique, romancing the victim and promising to fill their voids and vulnerabilities, encouraging the victim’s loyalty. Although they may use physical violence, Romeo pimps maintain control of their victim through psychological manipulation. They may cut the victim off by moving them away from family and friends and taking away their phone and other means of communication. The Romeo pimp is the most common tactic used when manipulating a potential victim into human trafficking. This method is frequently employed to lure minors, particularly runaway children, children from foster homes, or children who feel unwanted, abandoned, or rejected by their caregivers, such as LGBTQ+ youth.

Gorilla pimps fit the stereotypical image depicted in Hollywood movies. These pimps flaunt their wealth and control their victims through physical violence and force. Gorilla pimps often use money and drugs to lure their victims and extort those already in unstable situations. This is the most brutal type of pimp and the opposite of a Romeo pimp in that it involves no staged love or affection. Instead, gorilla pimps use routine violence to recruit and trap people in sex trafficking, making it clear that a victim’s job is to engage in sex for payment and failure to do so will result in severe consequences, usually involving physical and sexual abuse.

CEO pimps conduct their operations as they would a legitimate business. They often own a legal business to cover up their crimes. CEO pimps often look like average business executives. They are entrepreneurs of the sex trade and may keep books or engage in other legal and illegal endeavors for profit.

Human Trafficking, Explained

This video provides an overview of the pimps of human sex trafficking and the different tactics they use to groom potential victims.

Watch the video, and then respond to the following questions.

  1. What are two examples of vulnerabilities that pimps might identify and use to lure in potential victims?
  2. What are the three types of pimps? How are they different?
  3. How might a pimp use social media to traffic victims?

The Nurse’s Role in Addressing Human Sex Trafficking

Health care workers, including nurses, must be trained to recognize sexual slavery. Human trafficking will continue as long as there is demand for its victims. Health care encounters with nurses may be one of the only channels through which a victim is identified—for example, in the emergency department (ED), health care clinic, or primary care setting. Proper nurse education can lead to potential identification and intervention. Victims who are in a clinic or ED may rely on a nurse to ask the right questions at the right time. A nurse may be the only other human contact they experience in months or years, depending on their situation.

Unless they watch for signs and clues, a nurse may not recognize a victim. This is especially true if the abuser acts protective and caring or does not allow adequate time or conversation with the victim. Nurses must be sensitive and methodical in approaching a suspected victim. Knowing appropriate questions to ask the victim and abuser or using a screening tool can open dialogue and uncover possible victimization.

Indicators of Human Trafficking

Recognizing key indicators of human trafficking is the first step in identifying victims and can help save a life. Common indicators to help recognize human trafficking are listed below. You can also download or order the Blue Campaign indicator card in a wide variety of languages. The Blue Campaign indicator is a small plastic card that lists common signs of trafficking and how to report the crime.

  • Does the person appear disconnected from family, friends, community organizations, or houses of worship?
  • Has a child stopped attending school?
  • Has the person had a sudden or dramatic change in behavior?
  • Is a juvenile engaged in commercial sex acts?
  • Is the person disoriented or confused or showing signs of mental or physical abuse?
  • Does the person have bruises in various stages of healing?
  • Is the person fearful, timid, or submissive?
  • Does the person show signs of having been denied food, water, sleep, or medical care?
  • Is the person often in the company of someone to whom they defer? Or someone who seems to be in control of the situation, e.g., where they go or to whom they talk?
  • Does the person appear to be coached on what to say?
  • Is the person living in unsuitable conditions?
  • Does the person lack personal possessions and appear not to have a stable living situation?
  • Does the person have freedom of movement? Can the person freely leave where they live? Are there unreasonable security measures?

Not all indicators listed above are present in every human trafficking situation, and the presence or absence of any of the indicators is not necessarily proof of human trafficking.

Pay attention for the now commonly used nonverbal emergency SOS hand signal. The Canadian Women’s Foundation introduced the signal in April 2020 in response to increasing rates of domestic violence during the COVID-19 lockdown. The “Signal for Help” is designed to be displayed inconspicuously and is made by facing the palm outward, folding the thumb across the palm, and then closing the fingers over the thumb (Figure 31.6).

(See Department of Homeland Security, 2022a.)

Three side by side drawings show how to signal S O S with your hand. The first drawing shows a hand palm forward with all five fingers raised. The second drawing shows a hand palm forward, with four fingers raised and the thumb tucked into the palm. The third drawing shows a hand palm forward with the thumb tucked into the palm and the four other fingers curled down around the thumb.
Figure 31.6 The Canadian Women’s Foundation designed this emergency SOS Hand Signal as a response to increasing rates of domestic violence during the COVID-19 lockdown. (See Canadian Women’s Foundation, n.d.; attribution: Copyright Rice University, OpenStax, under CC BY 4.0 license)

The Roots of Health Inequities

A Public Health Perspective on Human Trafficking

The article “Multi-level Prevention of Human Trafficking: The Role of Health Care Professionals” provides an overview of key public health strategies aimed at addressing human trafficking. Primary prevention can be achieved by identifying social determinants through the critique of the economic, education, social welfare, criminal justice, and health care systems that continue to perpetuate the traumatization of individuals.

(See Greenbaum et al., 2018.)

Healthy People 2030

Violence Prevention

One goal of Healthy People 2030 is Prevent violence and related injuries and deaths. Recognizing that human trafficking is often linked to physical assaults and sexual violence, Healthy People 2030 provides evidence-based resources and prevention strategies at the school, family, and community levels.


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