In the first of this two-part series, human trafficking will be addressed. The second part will address how to implement a screening tool in an emergency department or urgent care setting. Human Trafficking, also known as modern slavery, and comes in many forms (State.gov., n.d.). Methods of force, coercion, and fraud are just some of the tactics used by traffickers to deceive others into their business. Examples of human trafficking include sex, labor, domestic servitude, forced marriages, debt bondage and even organ trafficking. Human trafficking does not discriminate, anyone and everyone is vulnerable to being a victim of human trafficking.

Human Trafficking in Iowa

Iowa is not immune from the horrors of human trafficking. According to the National Human Trafficking Hotline (2024), in 2023 Iowa received 200 signals (i.e., phone calls to the hotline, texts, online chats, filling out a form, and/or via email). Of those 200 signals, 68 were from victims/survivors themselves. There were 72 cases that involved 128 victims, but each case could have more than one victim. It can also be noted that in Iowa the main form of trafficking in Iowa is sex trafficking, followed by labor trafficking, with a mix of a victim being involved with sex and labor trafficking. More adults were reported compared to minors and more females than males (Human Trafficking Hotline, 2024).

Human trafficking happens for multiple reasons, but the main one is because of vulnerability. Statistics show that those who have substance abuse issues, mental health concerns, sexual orientation, children involved in foster care, homeless/runaways, poverty, and housing concerns are all factors in being preyed upon by traffickers (Polarisproject.org, 2024). Even natural disasters can become a factor in being susceptible to human trafficking. Traffickers will often lure their victims because they will find a connection with them and then exploit it. Others will use their power, status, and money to control them. Those who have government positions, doctors, lawyers, and business owners are some examples of traffickers, while other traffickers could be family members, romantic partners, or a boss. Traffickers use physical and emotional abuse, threats towards their families, isolation, and money to control victims.

Who is Being Trafficked

Although all can be trafficked, certain populations are unfortunately targeted more than others. When looking at labor trafficking, 45% are Hispanic, and 7% are Asian (Polaris Project, 2021). Approximately 6% of Caucasians/Whites are exploited for sex trafficking and 5% are of Asian descent, with Blacks at 4%. When the statistics of Iowa are examined, the population includes 6.7 % Hispanic, 4.1% Black/African American, and Asians make up 2.3% (US Census, 2020). Iowa has an 11.3% poverty rate, and 0.09% homeless rate, and there is a 3.6% of those who identify as LBGQTI+ (Williams Institute, 2019). Thus, it is important to look at these statistics to understand who is most vulnerable to being trafficked.

There are many locations, physically and not, where traffickers seek out their victims. The Internet is the most popular at 65% and Facebook is the most popular website (Polaris Project, 2021). Following the internet are locations where people gather, such as bus stations, mental health facilities, rehab centers, and strip clubs at 24%, schools rank third with 5%, detention facilities in fourth at 4%, and finally group/foster homes at 2%. Females are most likely to be trafficked at 64% (sex and labor trafficking) with males following at 7%. Finally, 7% of the youth homeless population is trafficked (Polaris Project, 2021).

What do Trafficked Victims Look Like

There is nothing that distinguishes one trafficked person from another. This is what makes it difficult to pinpoint a person who has been subjected to being trafficked. However, there are certain red flags of trafficking that can help identify them. When looking at a person who might be involved in trafficking, the trafficker might brand their victim. Tattoos that say “Daddy,” princess crowns, barcodes, a money bag with a dollar symbol, and even their trafficker’s name, such as “Property of” (Clark, 2023). The tattoos do not just have to be on the skin, but can be found on the inner lower lip. As easy as those branding tattoos may be to identify, other red flags are not as easy and can be indicative of other properties. Other ways of identifying trafficking victims are to look for minors who look older than their age, not being in possession of their own identification, someone always speaking on their behalf, chronic injuries such broken bones, frequent UTIs or STIs, malnourishment, lack of personal hygiene, or even all of sudden have a positive change of appearance. A few other red flags include signs of physical abuse, rehearsed conversation, excess cash and the mentioning of “daddy” or an older boyfriend. Although these are some of the human trafficking red flags, these can also be indicative of other forms of abuse (Clark, 2023).

It is also important to note that those living in affluent areas can be trafficking victims or can be traffickers. Anyone and everyone can be a trafficker or a victim. Exploitation can happen regardless of who people are. Reasons for trafficking someone can be from wanting to feel powerful to needing to carry on a substance abuse habit.

The Role of the RN in Stopping Trafficking

The first is to learn more about human trafficking to help others. Polaris Project (www.polarisproject.org, A21 (https://www.a21.org) , Office of Victims of Crime (https://ovc.ojp.gov/), and many other organizations have training, whether in person or online, where one can learn more about the topic. It is important to not confront the victim or the trafficker. Instead, call the police or security in the facility where the victim is identified. Tell them how the victim is presenting. Memorize the Human Trafficking Hotline number: 1-888-373-7888. Let the victim know you are them for them, and talk to the survivor, not at them. Become involved in the local community to bring about awareness. Contact state representatives to see what can be done.

Conclusion

Human trafficking is modern-day slavery hiding in plain sight (Marburger & Pickover, 2020). Victims range from minors to adults, blacks to whites, heterosexuals to LGBTQIA+. They can be rich or poor, educated, or not have had the chance to make it through grade school. Their signs of abuse can be absent to have been branded and bruised. As healthcare providers, we must learn more to serve this section of society who did not ask for this and help them out. We took the Nightingale Pledge to uphold the welfare of those placed in our care, and this is an instance where we need to do so.

References

Clark, K. (2023). Human trafficking: Red flags, common myths, and health effects. Radiologic Technology, 94(6), 471-475.

Marburger, K., & Pickover S., (2020). A comprehensive perspective on treating victims of human trafficking. The Professional Counselor, 10(1), 12-24. https://doi.org/10.15241/km.10.1.13

National Human Trafficking Hotline. (n.d.) https://humantraffickinghotline.org/en/statistics/iowa. https://humantraffickinghotline.org/

Polaris Project. (2024) . https://polarisproject.org/wp-content/uploads/2020/07/Polaris-Analysis-of-2021-Data-from-the-National-Human-Trafficking-Hotline.pdf.  www.polarisproject.org

United States Census Bureau. (2020). https.www.data.census.gov. www.data.census.gov/profile/Iowa

United States Office of State. (n.d.). https://www.state.gov/policy-issues/human-trafficking/. www.state.gov