U.S.-born citizens are victims of human trafficking typically exploited through sex trafficking. At least some of them interact with healthcare providers during their trafficking experience; yet a majority goes unidentified. Although protocols and training guides exist, healthcare providers often do not have the necessary skills to identify and assist victims of sex trafficking. Understanding where victims seek care and barriers for disclosure are critical components for intervention. Thus, this study interviewed survivors of sex trafficking to ascertain: a) healthcare settings visited during trafficking, b) reasons for seeking care, and c) barriers to disclosing victimization. An exploratory concurrent mixed-methods approach was utilized. Data were collected between 2016–2017 in San Diego, CA and Philadelphia, PA (N = 21). Key findings: 1) Among healthcare settings, emergency departments (76.2%) and community clinics (71.4%) were the most frequently visited; 2) medical care was sought mainly for treatment of STIs (81%); and 3) main barriers inhibiting disclosure of victimization included feeling ashamed (84%) and a lack of inquiry into the trafficking status from healthcare providers (76.9%). Healthcare settings provide an opportunity to identify victims of sex trafficking, but interventions that are trauma-informed and victim-centered are essential. These may include training providers, ensuring privacy, and a compassionate-care approach.

In 2000, the United States (U.S.) enacted the Trafficking Victims Protection Act, a law that defined Human Trafficking (HT). Between 2000 and 2019, every state has enacted laws criminalizing HT. In 2015, the U.S. government encouraged health-care providers to gain awareness of this issue and utilize identification protocols to screen and assist HT patient-victims. Although HT became part of the health-care discourse, few states have enacted laws requiring training for health-care providers or protocols for the identification of patient-victims. Thus, HT victims continue to go unidentified or under-screened in medical settings. The health outcomes of HT victims continue to be negatively impacted long after being trafficked; hence, intervention is crucial and requires a multi-disciplinary response. This analysis proposes the collaboration of medicine, public health, law, and human rights fields as an optimal model. It also provides the historical progression of federal and state human-trafficking laws and recommendations to ensure the protection of human rights of HT victims. Key recommendations include: (a) mandating continuous training of health-care providers for the identification of HT patient-victims, (b) mirroring federal laws at the state level to ensure the protection of HT victims’ human rights, and (c) collaboration across noted fields.

Human Trafficking (HT) persists in the US, despite multi-level measures designed to mitigate its societal costs. HT instruction for healthcare providers is growing, but there is a dearth of resources and training presenting obstacles for victims accessing suitable healthcare services. Voices of survivors are also scant in the literature, despite the fact that their recommendations would appear essential when designing best practices. This study aimed to methodically gather recommendations from sex trafficking (ST) survivors who sought medical care during their victimization. An exploratory concurrent mixed-methods design was used, and semi-structured interviews (N = 22) were conducted between March 2016 and March 2017, in San Diego, CA, and Philadelphia, PA. Data were analyzed through a coding system to identify meaningful analytical themes. Study participants were recruited through survivor-centered organizations, and their identification was kept anonymous and confidential. Findings included three main themes: (A) Red Flags; (B) supportive healthcare practices; and (C) resources for ST-patient study participants’ recommendations aimed to improve healthcare practice in response to their medical needs in a compassionate and caring manner, with trust building, rapport, and an opportunity to instill hope among ST-patients. Implementing Compassionate Care approaches when caring for ST-patients could positively impact patient–provider interactions, while creating opportunities for intervention.

Purpose: Human trafficking (HT) is a local, national and international problem with a range of human rights, public health and policy implications. Victims of HT face atrocious abuses that negatively impact their health outcomes. When a state lacks protective laws, such as Safe Harbor laws, victims of HT tend to be seen as criminals. This paper aims to highlight the legal present gaps within Missouri’s anti-trafficking legislation and delineates recommendations for the legal protection of victims of HT and betterment of services needed for their reintegration and healing. Design/methodology/approach: This case-study is based on a policy analysis of current Missouri’s HT laws. This analysis was conducted through examining current rankings systems created by nationally and internationally recognized non-governmental organizations as well as governmental reports. Additionally, other state’s best practice and law passage of Safe Harbor legislations were examined. The recommendations were based on human rights and public health frameworks. Findings: Missouri is a state that has yet to upgrade its laws lately to reflect Safe Harbor laws. Constant upgrades and evaluations of current efforts are necessary to protect and address HT at the state and local levels. Public health and human rights principles can assist in the upgrading of current laws as well as other states’ best-practice and integration of protective legislation and diversion programs to both youth and adult victims of HT. Research limitations/implications: Laws are continually being updated at the state level; therefore, there might be some upgrades that have taken place after the analysis of this case study was conducted. Also, the findings and recommendations of this case study are limited to countries that are similar to the USA in terms of the state-level autonomy to pass laws independently from federal law. Practical implications: If Safe Harbor laws are well designed, they have greater potential to protect, support and assist victims of HT in their process from victimization into survivorship as well as to paving the way for societal reintegration. The creation and enforcement of Safe Harbor laws is a way to ensure the decriminalization process. Additionally, this legal protection also ensures that the universal human rights of victims are protected. Consequently, these legal processes and updates could assist in creating healthier communities in the long run in the USA and around the world. Social implications: From a public health and human rights perspectives, communities in the USA and around the world cannot provide complete protection to victims of HT until their anti-trafficking laws reflect Safe Harbor laws. Originality/value: This case study, to the best of the authors’ knowledge, is a unique analysis that dismantles the discrepancies of Missouri’s current HT laws. This work is valuable to those who create policies at the state level and advocate for the protection of victims and anti-trafficking efforts.

Human trafficking (HT) is a violation of human rights and a serious public health concern. Recently, efforts have focused on training frontline personnel, among others, to identify, intervene, and assist survivors of HT. Yet, there is scant research among public health students and practitioners about their awareness, knowledge, and self-efficacy in addressing HT. Training the future public health workforce is essential for addressing this problem. This cross-sectional mixed-methods study collected data utilizing a 33-item survey among current graduate students (N = 85) of public health enrolled at a U.S. Northeastern University. The primary aim of this study was to assess public health graduate level students’ awareness, knowledge, and self-efficacy regarding HT intervention. A secondary aim was to gather students' recommendations for curricula development purposes. Statistical analyses included univariate and binary analysis of quantitative data and a thematic two-step coding process for the analysis of the qualitative data.. Findings revealed study participants had a strong awareness of HT, but a low level of knowledge and self-efficacy in identifying and assisting victims. Most study participants desired to integrate HT-related training into current courses. Results may be used to inform the development of curricula at higher level education and public health institutions.

Today, millions of children, women, and men are suffering gross human rights violations in every corner of the world, including the United States (US) and manifested through Human Trafficking (HT). This type of victimization is a public health concern and a human rights issue. US-born victims are typically commercially sexual exploited through sex trafficking. Once victimized, they become an extremely hidden population. Yet, they interact with healthcare providers (HCP) when seeking medical care at some point during their period of victimization. Although few protocols and trainings to identify HT victims in healthcare settings exist, only a limited number of hospitals and healthcare facilities implement them. Therefore, sex trafficking victims go unidentified. There is scant research investigating patient-healthcare provider interactions from the survivor of sex trafficking (SST) perspective. Therefore, this study sought to: 1) identify the type of healthcare settings sex trafficking survivors frequented during their victimization period and reasons for their visit; 2) explore SST's perceptions about their interactions with HCPs; and 3) document survivors' recommendations on how to best screen, identify, and assist victims of sex trafficking within healthcare settings. This study utilized an exploratory, concurrent mixed-methods research approach with a triangulation design model. Recruitment took place in San Diego, CA and Philadelphia, PA. A 48-item questionnaire and semi-structured interview guide were utilized to collect data. Data analyses were based on descriptive and inductive processes. Participants were US-born and self-identified as SST (N=21). Almost one-half of them were white (47.6%), followed by Blacks (23.8%). On average, SST were victimized for 4.9 years. Most commonly sought healthcare settings were Emergency Departments (ED) and community care clinics, specifically Planned Parenthood (PP). SST's non-disclosure of their victimization to medical professionals was high, 61.9%. Participants' recommendations to the healthcare community encompassed three types: 1) Knowledge and Skills; 2) Attitudes and Behaviors; and 3) Safe Plans and Resources. This study confirmed previous findings that sex trafficking victims seek care at different types of healthcare settings and reasons for seeking medical care. Most importantly, it presented noteworthy insights regarding barriers limiting SSTs from disclosing their victimization to HCPs, and thus contributes key facts with which to identify and intervene on behalf of sex trafficking victims within healthcare settings. Keywords: healthcare providers, healthcare settings, interactions, sex trafficking, United States