Human trafficking (HT) is a global humanitarian and public health crisis. It is a crime that is happening in plain sight with its victims walking among us. Sadly, HT goes grossly undetected because of a lack of understanding, misperceptions, and lack of knowledge about its identification. Although addressed on social media, news outlets, and portrayed in Hollywood films, HT’s reality is often quite different from the sensationalized ways (chains and ropes, abductions by ‘white vans’) in which it is depicted. Victims of HT are frequently held captive through psychological restraints and coercive manipulation rather than overt force, even as they endure egregious acts of abuse that result in levels of trauma equivalent to that of war veterans.
Sparing no age, gender, race, socioeconomic status, or geographic location, HT infiltrates all nations and facets of life. It is a financially motivated crime, globally yielding approximately $350 billion dollars annually, an enormous profit that is tax-free and generated off the sale of human cargo.
Human trafficking defined
HT, also known as modern slavery, is a crime against a person for labor or services which compels that individual through use of force, fraud, or coercion. It is the exploitation of human vulnerabilities for the purpose of monetary gain. Although sex and labor trafficking are the two most widely recognized forms of trafficking, there are a number of other forms. These include, but are not limited to, forced criminality, forced surrogacy, forced marriages, domestic servitude, organ trafficking, and child soldiering.
With the massive expansion of technology-driven digital communication and virtual connection, these modalities are used by perpetrators to commit these crimes. Online platforms are the reigning domain, as a countless number of buyers have access to an unlimited number of victims. Sex or labor can be ordered online as easily as an item from Amazon.
Vulnerabilities
Victims of HT have one common denominator. Each has a vulnerability which can be exploited. And let’s face it, we all have vulnerabilities. This illustrates the fact that anyone can become a victim, as there is no prejudice or bias as to who gets recruited into “the life.”
Preying upon vulnerabilities, traffickers seek out weaknesses or voids and psychologically manipulate their victims into believing they can fill them. Victims are lured by false promises and then exploited. Some of those vulnerabilities include but are not limited to:
Age, including minors and older adults
Sexual orientation or gender identity questioning
Unstable housing, unhoused, “couchsurfing”
Involvement with the foster care, child welfare or juvenile justice systems
Socioeconomically challenged
Natural disasters and crises (hurricanes, earthquakes, fires, warfare)
Addiction, history of substance use
Prior abuse (sexual, physical, emotional), adverse childhood experiences (ACEs)
Mental, cognitive, or physical disabilities
Social media use and online gaming (such as Roblox, Minecraft, or Fortnite)
Human trafficking and health care
Although HT is primarily viewed as a law enforcement or social services issue, victims of HT often access health care. One U.S. study found that approximately nearly 90% of survivors reported being seen by a health care professional (HCP) while being trafficked, yet the majority were never identified nor offered services. These individuals are coming in to be seen for diverse acute, chronic, and mental health concerns but remain completely invisible to us.
In an illicit drug or arms trade, once that product is sold, it cannot be sold again; but humans can be sold over and over again, leading to significant physical ailments and complex trauma. The health care encounter is an opportunity to disrupt the cycle of victimization by treating and responding to victims, and by mandatory reporting in cases involving minors. Yet without prompt identification, the clinical encounter remains a missed opportunity, one that we may never get again with that client.
Health care professionals’ HT preparedness
Studies show that licensed HCPs are not educated on HT and anti-trafficking measures and report lack of knowledge in identification skills and lack of confidence in knowing how to respond to these victims. One study highlights the significant gap in education that exists in prelicensure RN programs across the country, with over 90% of participants reporting minimal to zero minutes of exposure to HT content.
Red-flag indicators of HT
Although there are numerous findings in the clinical setting, the following list provides some cues that are most commonly associated with trafficked individuals:
Suicidality
Addiction/near overdose (mechanism of control used by traffickers and/or a coping mechanism for victims)
STIs/STDs, UTIs (especially if occurring frequently)
Ectopic pregnancy, multiple pregnancies/abortions
Neonatal abstinence syndrome
Domestic violence/intimate partner violence
Controlling/domineering companion (male or female) who is unwilling to leave the client alone
Signs of abuse (multiple bruises in various stages of healing; burn or bite marks)
Nonfatal strangulation
Delay in seeking treatment
Multiple cellphones, multiple hotel keys (cards)
No ID, or not in possession of ID (developmentally appropriate)
Tattoos (form of branding) of crowns, $ symbol, roses, “property of” with name or initials, profane language
Nurses can make a difference
Nursing professionals are ideally situated to identify, treat, respond to HT and act as mandated reporters in cases involving minors, but only if we are properly educated. Remaining ill-prepared is causing us to fail an entire vulnerable population.
Nurses are consistently voted the most trusted health care professionals. It is our ethical duty to become properly educated on this crisis, and ensure that our future colleagues are, too. By incorporating HT and anti-trafficking content into prelicensure programs, along with frequent reinforcement through professional development, we can not only break the cycle of further victimization for HT victims we identify, but potentially prevent other victims from falling prey to exploitation.
Call to action
There are actions you can take today in combating HT:
Become properly and comprehensively educated on HT.
Raise awareness on the pervasiveness and magnitude of this crime.
Visit Nurses United Against Human Trafficking to become educated, equipped, and empowered with its comprehensive anti-trafficking training.
Share what you learned with your colleagues and encourage them to do the same.
If you are a nurse educator, integrate essential content such as how to identify the red-flag indicators of HT and how to appropriately respond to these clients using a trauma-informed approach.
Advocate for the integration of HT content into prelicensure nursing curricula to better prepare our future colleagues for practice.
Advocate for mandatory continuing education and professional development on this topic for all licensed HCPs.
Conclusion
Nurses play a crucial role in identifying, treating, supporting, and advocating for individuals caught in the throes of trafficking. These victims must be promptly identified and treated with a unique standard of care that is trauma-informed and victim-centered.
Remember, we nurses are also parents, grandparents, aunts/uncles, and older siblings. This education extends beyond our role as professionals, as HT may be occurring within our homes or with our loved ones. No demographic is spared, as traffickers prey upon those with vulnerabilities. HT is happening all around us. We just don’t see it because we don’t know how to recognize it. Stop this vicious cycle today by becoming properly informed.
Recommended resources
https://www.nuaht.org/
https://www.nursesunitedagainsthumantrafficking.org
https://www.dhs.gov/blue-campaign
https://endsexualexploitation.org/
https://www.missingkids.org/home
https://polarisproject.org/
Francine Bono-Neri, PhD, RN, APRN, PNP, FAAN, has been director-at-large, ANA-NY, 2018-2020; a Jane Eleanor Knox NEF Scholarship recipient (2019); president of LINAPNAP, 2021-2022; an Inspiring Global Nurse Award recipient, 2024; an International Ceca Award recipient, 2024; and co-founder & president of Nurses United Against Human Trafficking (NUAHT)
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