The following signs of trafficking victimization are culled from several sources and encompass both labor trafficking victims as well as sexual and underage trafficking victims.

In the United States, sex trafficking often starts when the victim is between 12 and 14 years of age. Victims come from varied backgrounds and often have experienced some type of trauma or hardship. These include: homelessness or run away from home; history of neglect or sexual/physical abuse; family history of substance misuse, psychiatric problems, violence, and/or criminality; history of juvenile justice or child protective services involvement; lesbian, gay, bisexual, transgender, or other identity issues; and mental/behavioral problems.

Victims might have been involved with a gang or lived in areas with transient male populations such as military bases, truck stops, or convention centers.

Also, victims might be immigrants who lived in countries with political or social upheaval and police corruption.

While considering a patient’s background, healthcare professionals also should be mindful of any physical injuries that could signal that the patient is a trafficking victim. These include: malnourishment and/or dehydration; bruises and other injuries consistent with physical and/or sexual abuse, restraint, confinement, or torture; bald spots on scalp or branding on skin; scars, burns, or bite marks; and trauma on torso, genitals, neck, or medial thighs in patterned appearance.

When giving a patient a physical exam, healthcare providers also might notice urinary tract infections or signs of sexually transmitted diseases, vaginal or rectal trauma, or a barcode tattoo below undergarments. Possible victims may demonstrate general signs of stress, anxiety, exhaustion, and depression, as well as aggression or oppositional behavior. These patients might avoid eye contact and show fear, shame, or paranoia.

Through verbal and nonverbal cues, healthcare professionals may notice symptoms of PTSD, suicidal ideation, or dental problems such as loose or missing teeth. Patients might report that they have had an abortion or experienced physical trauma during pregnancy or complain of stomach, jaw/neck, or chronic back pain.

There are other behaviors a patient could demonstrate during his or her visit that should raise red flags. These include an inability to produce identification documents, fearful reactions at the mention of law enforcement and general distrust of authority figures, inconsistencies in stories, and an inability to accurately describe their place of residence or other whereabouts.

A potential trafficking victim may appear isolated from everyone except for one person. There could be a “manager” or some other type of handler with the patient who seems to answer questions for the patient; carry the patient’s ID, passport, money, or other possessions; or try to explain that the patient does not speak English.

During exam sessions, if patients offer clues about their background or identity, they might allude to a large debt that cannot be repaid. These patients might hint that they live or work in places with high security, opaque windows, barbed wire, or security cameras. This could signal that the patient is not free to leave or act as desired, which should be cause for concern.

SOURCES

  1. Greenbaum J, Crawford-Jakubiak JE; Committee on Child Abuse and Neglect. Child sex trafficking and commercial sexual exploitation: Health care needs of victims. Pediatrics 2015;135:566-574.
  2. Center for the Human Rights of Children, Loyola University Chicago. Building child welfare response to child trafficking, 2011. Available at: https://bit.ly/2NFsCvH. Accessed July 23, 2018.
  3. National Human Trafficking Hotline. Recognizing the signs. Available at: http://bit.ly/2uzFpbN. Accessed July 23, 2018.
  4. O’Malley P. Human trafficking: Signs that you should know. Premier Health Nurse Newsletter, March 29, 2017. Available at: http://bit.ly/2LqBWCT. Accessed July 23, 2018.