Description

• Human trafficking (a.k.a. modern slavery) is a global crisis. Victims include men, women, and children. The United Nations defines human trafficking as a crime based on exploitation. In the United States, Victims of Trafficking and Violence Protection Act of 2000, human trafficking is described as the inducement, recruitment, harboring, transportation, obtaining, or providing of a person by force, fraud, or coercion for commercial sex or labor/services. Minors age <18 years involved in commercial sex are automatically considered human trafficking victims by federal law.
• Human trafficking is broadly categorized as domestic and international with further breakdown into sex and labor trafficking.

Epidemiology

Incidence

• Accurate data on the incidence and prevalence of human trafficking are difficult to find given the illegal and secret nature of the problem (1).
• 300,000 youth are at risk of exploitation for commercial sex in the United States (2). The National Center for Missing and Exploited Children estimated 100,000 children in the United States are commercially trafficked for sex each year.
• 88% of victims report that they were seen by a health care provider at some point during their bondage (3).
• 77% of trafficking victims in Oakland, CA, report that they saw a doctor regularly; 33% were on prescribed medications when they were recovered (4).
• 29% of 98 women who took part in a large study of trafficking survivors in the United Kingdom reported 1 or more pregnancies while being trafficked (5).

Etiology and Pathophysiology

• Labor trafficking victims can be found in a variety of industries such as farming, construction, hotels, factories, food service, landscaping, and domestic servitude (6).
• Sex trafficking victims can be found in a variety of areas, including strip clubs, massage parlors, truck stops, and brothels. Victims are often forced into pornography, street prostitution, and online escorting (6).
• Victims are often led to believe that no one except their exploiters have any interest in their well-being; many experience trauma and extreme negative self-image (6).
• Entry into human trafficking is generally a process rather than a single act-phases include recruitment, active exploitation, or reintegration (out of trafficking).
• In many cases, victims are isolated from their families and social networks. Frequent transportation across state lines and between various cities (the travel or destination/exploitation stage) adds disorientation, leaving many victims unable to provide an accurate history when they do see a health care provider.
• International victims are also separated from their country, native language, and culture. Many come from poor countries with unstable political environments (6).
• Whether domestic or international, systematic isolation and separation from key resources traps victims as survival can depend on the traffickers.

Risk Factors

• Homelessness, poverty, child abuse/neglect, substance use, sexual abuse/assault, domestic violence, and minority status
• Marginalized individuals including LGBTQI, migrant workers, and indigenous people are at increased risk.
• Females 12 to 16 years of age are at greatest risk.

Commonly Associated Conditions

• Sex trafficking victims are often exposed to STIs, including HIV; chlamydia; gonorrhea; hepatitis B, hepatitis C; and syphilis. PID, neurosyphilis, are among many long-term sequelae (6).
• Patients may present with a history of multiple unintended pregnancies and/or complications of pregnancy termination procedures.
• Trafficked persons often endure physical abuse and/or neglect. Multiple fractures; bruises in various stages of healing; burn injuries in odd locations; signs of malnutrition, poor dental health, and/or other untreated illness are most common.
• As a result of frequent transportation across city and state lines, victims often present with fragmented medical care. They may not be up to date on immunizations, age-appropriate screening, or have a confusing list of prescribed medications.
• Mental health issues (depression, generalized anxiety disorder, PTSD, dissociative episodes, substance abuse, suicidality, impulsivity, somatization) are common (6).
• Victims’ children are often exposed to domestic violence while their parents are in captivity. Many experience severe neglect and suffer from abuse themselves. Screen for adverse childhood events.