With global migration returning to prepandemic levels, so returns the many benefits and challenges that arise via international migration. Among the challenges is human trafficking (aka, modern day slavery), including sex trafficking. Worldwide, the International Labor Organization estimates that 4.8 million people are trafficked for sex work annually. Individuals are disproportionately adult women (53%), adolescent girls, and sometimes children. It is against international law to traffic humans for any kind of work.
Sex trafficking is a criminal offense that is not only an international problem but also a homegrown issue that affects many people in the United States today. The US Department of State estimates that there are 24.9 million victims of human trafficking worldwide. Although it is difficult to estimate given the nature of the crime, there may be anywhere from 14,500 to 17,500 people trafficked into the US each year, excluding those trafficked within the US.1,2
Healthcare providers (HCPs) come in contact with 80% of victims of sex trafficking during their trafficking experience and are therefore uniquely positioned to identify them.3 Unfortunately, HCPs often fail to identify these individuals due to lack of institutionalized screening protocols, inability to talk privately with the individual, and personal biases.4 A mixed methods study performed in 2017 found that most HCPs were unaware of how to provide care to victims of sex trafficking.5 The purpose of this article is to describe resources for HCPs who may encounter individuals trafficked for sex work to improve their practice and care with these individuals. These resources can also be used in the development of curricular units for HCP students.
Continuing education resources
Training tools, which include handouts, videos, research papers, and presentations, come from multiple organizations at different levels. Some of the training materials come from the federal government, specifically the US Departments of Health and Human Services (HHS), Justice, and Homeland Security. There also are training tools provided by private organizations like the Polaris Project and Safe Horizon, organizations with extensive expertise in training people to recognize victims of sex trafficking in multiple contexts. Furthermore the healthcare community, including the American Academy of Pediatrics, American College of Emergency Physicians, Institute of Medicine, and hospitals like Mount Sinai and Stanford, have created resources for healthcare professionals. The Table provides brief descriptions and links to select resources.
The most comprehensive resource, created jointly by the HHS and the postgraduate Institute of Medicine, is SOAR to Health and Wellness Training.6 SOAR is an online modular CME/CE course available for HCPs, social workers, public health and behavioral health professionals that discusses the application of a framework to recognize and respond to human trafficking in healthcare or social service settings.6
Curriculum development resources
The initial foundation to better identify and treat trafficked persons is ideally provided in HCP education curricula. The aforementioned resources can be integrated as background materials for a curricular unit focused on sex trafficking. The specifics for person-centered, trauma- informed assessment and interventions to meet the immediate and long-term needs of victims of sex trafficking are found in these resources. Several of the resources provide guidance on medical documentation for legal purposes; confidentiality, safety, and protection of individual rights; and reporting requirements when trafficking is suspected. Beyond the use of these resources, educators may want to incorporate speakers representing law enforcement, social services, and advocacy groups. If feasible, hearing a firsthand account from a former trafficked individual can help students to better understand the context and lived experience under which a person is trafficked and the barriers and challenges they encounter.
HCPs have a role in all stages of a trafficked person’s journey from pre-departure to, ideally, reintegration stages. They also have a role in advocacy for public health policy and legislation addressing primary, secondary, and tertiary prevention.
Primary prevention focuses on stopping the occurrence of trafficking before violence occurs, secondary prevention entails providing a response to the immediate needs of the individual experiencing trafficking, and finally tertiary prevention encompasses long-term responses to promote healing and prevent re-victimization. Addressing these levels of prevention with students in a public health context highlights the need for increased awareness of trafficking, physical and mental health treatment of victims, and systemic implications.7 Resources that can be used to promote public health discussions include the Trafficking Victims Protection Act, the US government’s campaign to eliminate modern forms of slavery and protect trafficked victims. Another resource that may be used to promote discussion is the National Association of Nurse Practitioners in Women’s Health position statement on human sex trafficking, which “affirms the essential role of women’s health nurse practitioners and other advanced practice registered nurses who provide women’s and gender-related healthcare for adolescents and adults in identifying, assessing, and responding to the needs of trafficked individuals.”
Conclusion
The education of HCP students and practicing HCPs about human trafficking, including sex trafficking, is an important step toward raising awareness of this largely hidden problem. Continuing education and curricular strategies are needed to ensure current and future HCPs are prepared to address the short- and long-term needs of victims of trafficking. Education has the potential to spark interest in disseminating and evaluating outcomes of relevant evidence-based strategies at clinical, institutional, and systemic levels and conducting research to address gaps in knowledge. This research might include studies of what standardized curricular components would provide the optimal learning outcomes for students and build capacity within the health workforce to more accurately identify and provide person-centered care for trafficked persons.
Ranjani V. Shah is a women’s health nurse practitioner in New York City, New York, and Allison P. Squires is Associate Professor at Rory Meyers College of Nursing and Research Associate Professor in the Department of General Internal Medicine, Grossman School of Medicine, at New York University. The authors have no actual or potential conflicts of interest in relation to the contents of this article.
Womens Healthcare. 2023;11(3):42-44. doi: 10.51256/WHC062342
References
1 U.S. Department of State. About Human Trafficking. August 18, 2022. https://www.state.gov/humantrafficking-about-human-trafficking/.
2 ACLU. Human trafficking: Modern enslavement of immigrant women in the United States. American Civil Liberties Union. 2023. https://www.aclu.org/other/human-trafficking-modern-enslavement-immigrant-women-united-states.
3 Leslie J. Human trafficking: clinical assessment guideline. J Trauma Nurs. 2018;25(5):282-289.
4 Camak DJ. Recognizing and addressing the needs of sex trafficking victims. Online J Issues Nurs. 2022;27(2). https://www.doi.org/10.3912/OJIN.Vol27No02PPT53.
5 Powell C, Dickins K, Stoklosa H. Training US health care professionals on human trafficking: where do we go from here? Med Educ Online. 2017;22(1):1267980.
6 U.S. Department of Health and Human Services. Office on Trafficking in Persons. Soar to Health and Wellness Training. September 24, 2019. https://www.acf.hhs.gov/otip/training/soar-health-and-wellness-training.
7 de Chesnay M. Sex Trafficking: A Clinical Guide for Nurses. New York: Springer; 2013.
Web resources
A acf.hhs.gov/otip/about
B ovc.ojp.gov/program/human-trafficking/training-and-technical-assistance
D aap.org/en/patient-care/child-trafficking-and-exploitation
E acep.org/patient-care/policy-statements/human-trafficking/
F npwomenshealthcare.com/position-statement-human-sex-trafficking-2