How to Combat Human Trafficking: The Role of Advanced Practice Nurses

October 18, 2021

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One hand passes money to another hand.

In the words of American Nurse Journal, human trafficking, also known as modern slavery, “is no different from slavery of ancient times: it’s a brutal, highly profitable business with no regard for its victims.”

Trafficking falls into three basic categories: forced sexual exploitation, forced labor, and domestic servitude, though the latter two are sometimes considered together for statistical purposes. Women and girls account for 71% of modern slavery or trafficking victims, notes the International Labor Organization (ILO). The ILO includes cases of forced marriage in its figures and estimates that worldwide, some 40.3 million people were victims of trafficking in 2016, the latest year for which its figures were available.

The U.S. Department of State’s 2021 Trafficking in Persons report called trafficking an “inhumane cycle of discrimination and injustices” that the department intends to combat with “year-round engagement with governments, advocates, and the private sector to build a more effective anti-trafficking strategy rooted in equity.”

Human trafficking and nursing are undeniably connected. Trafficking victims may live in plain sight and frequently seek or need medical care. Many of our nation’s primary caregivers, including advanced practice registered nurses (APRNs), are qualified to identify and assist victims of human trafficking.

Human Trafficking Statistics

According to Human Rights First, human trafficking is a $150 billion industry worldwide. Its victims are forced to work in agriculture (11%), domestic work (24%), construction, manufacturing and mining (47%), and sex work (19%).

In the U.S., specific human trafficking statistics are harder to come by. The Global Slavery Index (GSI) reports that the reason “is largely due to federal privacy laws.” However, the GSI estimates that “on any given day in 2016 there were 403,000 people living in conditions of modern slavery in the United States.”

The Polaris Project’s 2019 Data Report noted that the U.S. National Human Trafficking Hotline identified 22,326 victims and survivors of human trafficking in the U.S. in 2019 alone, the majority (14,597) were victims and survivors of sex trafficking. The report also found that the average age of sex trafficking victims at the time the trafficking began was 17, while labor trafficking victims were 22.

These statistics underscore the important role that nurses and other health care workers play in helping to identify and provide aid to suspected victims of human trafficking.

A Nurse’s Role in Fighting Human Trafficking

Nurses are often the first — and sometimes only — professionals able to interact with trafficking victims.

According to an article at HEALTrafficking.org by Claire Zangerle, DNP, MBA, RN, NEA-BC, “An estimated 88% of sex trafficking survivors sought medical care during their exploitation, mostly through an emergency department or an outpatient clinic.”

Nurses need to be aware of their own unconscious biases, the article continues.

“As nurses, we must acknowledge our own feelings in these areas,” Zangerle writes. “For example, a prostitute who presents in the clinic or emergency department may not be engaging in the profession by choice. A teenage girl who repeatedly presents with a sexually transmitted disease may not be amoral but forced into prostitution. A malnourished man with a tattoo and paranoid behavior may not be mentally ill, but in a labor trafficking situation.”

Because they are a patient’s first touch point, nurses are ideally positioned to identify and communicate with victims of human trafficking, particularly those trafficked for sex. Knowing nurse practitioner terms and understanding the complexities of trafficking can help APRNs and other nurses provide the best care.

The Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) recommends that nurses be alert to signs such as:

The presence of cotton or debris in vagina or rectum
Problems with jaw or neck
An inability to keep appointments
A lack of identification
The presence of tattoos or branding scars
The presence of a person who does not allow the individual to speak or who does not want to leave the person alone during the interview and/or care
Inconsistent stories (conflicting stories or misinformation)
The use of a language other than English
A lack of documentation of age-appropriate immunizations and health care encounters

Once they identify suspected victims of human trafficking, nurses should follow situation-specific interview techniques to avoid causing additional harm for the victim and inviting harm for themselves.

Helping Suspected Victims of Human Trafficking

The U.S. Department of Health and Human Services (HHS) provides a screening tool called the Adult Human Trafficking Screening Tool (AHTST) for health care providers who suspect they are treating victims of human trafficking. According to this tool, there are several actions to be taken.

1. Establish a One-on-One Relationship

Remove all others from the room prior to screening.
Ensure that no one else can hear the conversation.
Allow the individual to choose where to sit.

2. Meet the Individual’s Physical Needs

Offer a snack or drink.
Show the individual where the restrooms are located.
Ask if the individual needs anything.

3. Use Nonthreatening Body Language

Keep your body open and loose, not leaning forward and tense.
Move at a predictable, steady pace.

4. Engage the Individual

Remain calm and maintain eye contact.
Keep a warm, natural facial expression.
Use active listening skills, like repeating what the individual says in different words, so the individual knows you understand.

5. Adapt the Screening Process to the Individual’s Needs

Use mirroring to accommodate the individual’s pace and style of language.
Provide the individual the option to choose a male or female screener.

6. Use Empathic Language

Keep your language nonjudgmental.
Try to understand what the individual might be feeling.

In addition, the AHTST recommends that providers be prepared for trauma reactions and ready to employ stress management exercises, including breathing techniques and the 5-4-3-2-1 technique, which “can calm a person and help them stay anchored to their present surroundings (as opposed to becoming lost in traumatic memories or dissociating) by simply asking them to name five things they can see in the room, four things they can feel, three things they can hear, two things they can smell, and one good thing about themselves.”

Finally, health care providers should be prepared to make appropriate referrals for services, including agencies that can help victims meet their basic needs, such as food and shelter.

A Program That Understands What Nurses Face

A program that understands the struggles nurses face in their clinical work, such as how to combat human trafficking, knows how to equip you for similar challenges in the future. Ohio University’s online Master of Science in Nursing (MSN) program prepares Bachelor of Science in Nursing (BSN) graduates for advanced nursing careers, such as family nurse practitioner (FNP), adult-gerontology acute care nurse practitioner (AGACNP), psychiatric mental health nurse practitioner (PMHN), and nurse educator.

Designed with a curriculum to help you thrive, this program features classes like Assessment and Intervention for Families, and Primary Care of Adults and Older Adults. Discover how the University’s online MSN program can prepare you to achieve your professional goals.