Labor and sex trafficking are the two major forms of human trafficking occurring in the United States. Although U.S. discourse on human trafficking is excessively focused on forced commercial sexual exploitation, this should not be interpreted to mean that sex trafficking is more prevalent than labor trafficking. Indeed, accurate prevalence estimates elude our epidemiological understanding of the problem in the United States, though global research suggests that labor trafficking is the more prevalent form.
Notwithstanding the frequently invoked image of women and girls trafficked for commercial sex by predatory males, the truth is that victims and perpetrators of this crime exist in all combinations. Indeed, labor- and sex-trafficked persons can be male, female, transgender, and gender-nonconforming children and adults, much like the traffickers who exploit them. Despite human traffickers being typically thought of as ruthless, unscrupulous adults, it is important to recognize contexts in which the youth themselves engage, either under duress or of their own accord, in the trafficking of other youth. Examples include peer recruitment out of schools and residential homes, homeless youth “street families” (formed out of convenience and necessity) internally exploiting labor and sex, and youth gang leaders trafficking weaker youth for labor related to criminal activities and commercial sex. Thus, to broaden our conceptualization of human trafficking and maximize detection, clinicians must refrain from relying only on the recognition of sex trafficking and male perpetrator–female victim combinations.
Although the crime of human trafficking doesn’t discriminate based on age, gender, race, ethnicity, and immigration status, traffickers strategically exploit specific personal, social, and economic vulnerabilities that may disproportionately place certain demographic groups at higher risk for labor trafficking, sex trafficking, or both. For example, youth who are abused, are homeless, or identify as lesbian, gay, bisexual, transgender, and queer (LGBTQ) are at greater risk for trafficking than their non-abused, non-homeless, and non-LGBTQ counterparts. Linguistically, educationally, economically, and otherwise systematically disadvantaged adults and minors, such as immigrants and racial/ethnic minorities, are likewise at elevated risk. Understanding risk factors can help clinicians recognize at-risk and potentially trafficked persons while avoiding victim (and perpetrator) profiling that is based solely on visual cues and can result in missed opportunities to assist.
Due to the inherently abusive and violent nature of these crimes, trafficked persons suffer a wide range of physical, reproductive, and mental health morbidity (see Table 1). Studies suggest that trafficked persons are accessing medical care during their exploitation and emergency departments serve as a primary health care access point. In one study of sex-trafficking survivors, nearly 88 percent of survivors surveyed reported accessing care at least once while trafficked, and 63 percent of them reported doing so in a hospital emergency department. Survivors present with the same injuries and illnesses as other emergency departments patients. However, delayed presentations (eg, walking on a fractured ankle for a week before seeking care) should raise concern for something amiss.