Human Trafficking

Definition/Etiology:

• Recruitment, transport, harboring, or receipt of persons
• Threat or use of force
• Coercion, abduction, fraud, deception
• Abuse of power or of a position of vulnerability
• Giving or receiving of payments or benefits
• Having control over another person, for the purpose of exploitation
• Sexual exploitation, forced labor, slavery, or the removal of organs

United Nations International Labor Organization (ILO) estimates: 

• 40 million adults in modern day slavery
• 15 million in forced marriage
• Women and girls were disproportionately affected (71 percent of total)
• 152 million children, aged 5 to 17 years, were in forced labor around the world

Pathophysiology:

Risk factors:

• Girls 12-16 years at greatest risk
• LGBTQ
• Poverty
• Racial/ethnic minority
• Rural
• Lack of education
• Migrants
• Displaced by conflict or natural disasters
• Indigenous peoples
• Prior sexual abuse

Clinical Presentation:

Signs of trafficking:

• Cannot provide address when asked
• Inappropriate clothing for weather
• Inconsistent history 
• Mechanism of injury described does not match injury
• Stated age is older than appearance
• Accompanied by older unrelated adult
• Poor hygiene, dentition
• Signs of substance abuse, e.g. tracks, tooth decay from gumline
• Recurrent sexually transmitted infections
• Delayed presentation for healthcare

Physical exam:

• Unexplained injuries or injuries in various stages of healing
• Burns and scarring
• Branding or tattoos, including symbols, numbers, or bar codes that indicate which individuals “belong” to which trafficker
• Strangulation injuries
• Dental and oral injuries
• Traumatic head injuries
• Genital trauma
• Implanted radiofrequency identification chips
• Occupational injuries not linked clearly to legitimate employment

Collaborative Management:

• Collaborate with social worker 
• Utilize SANE as needed
• Try to get accompanying visitor out of the room so that patient can be interviewed alone
• National Human Trafficking Hotline 1-888-373-7888

Labs:

• Urinalysis, urine drug screen, HCG
• CBC, CMP
• Gonorrhea/Chlamydia swab
• RPR, HIV

Imaging: as per injury/illness

Evaluation | Patient Monitoring | Education:

• Reassure patient of safety
• Utilize police and security officers
• Preserve modesty 
• Provide food, water, warmth

Linchpins: (Key Points)

• If it feels like something is amiss, consult a social worker.
• Preserve forensic evidence.
• Watch for inconsistencies.
• Provide safe, reassuring environment.