Maureen Salamon

June 26, 2017

PHILADELPHIA — In young women, a history of abortion, pelvic inflammatory disease, or sexually transmitted infection should trigger suspicions of human trafficking, said an expert here at the American Association of Nurse Practitioners 2017 National Conference.

"For somebody you might consider to be promiscuous, you need to consider an alternate paradigm," said Jessica Peck, DNP, associate professor of nursing at Texas A&M University College of Nursing in Corpus Christi.

Worldwide, there are 30 million victims of human trafficking, and there are 800,000 new victims each year, said Dr Peck, who serves on the board of the National Association of Pediatric Nurse Practitioners, which plans to launch a national initiative on trafficking next year.

Sex trafficking is often top-of-mind when human trafficking is discussed, but human trafficking also encompasses labor, child soldiering, baby trafficking, and organ harvesting, she explained. The annual trafficking market is $32 billion and is the fastest-growing criminal industry in the United States. By contrast, the annual revenue of Starbucks is $19 billion, she added.

Human trafficking victims are "recruited" not only through outright kidnapping, but also by being lured with false promises, manipulated by debt bondage, and even sold by parents or guardians, she explained. Some members of the audience were visibly shocked by the information they were hearing.

Once recruited into trafficking, the average life expectancy of a victim is only 7 years.

An estimated 87% of rescued trafficking victims had at least one encounter with a healthcare provider during captivity, but they were not recognized as victims. "Once recruited into trafficking, the average life expectancy of a victim is only 7 years, so we want to rescue them quickly," said Dr Peck.

She issued a call to action for nurse practitioners, and encouraged them to learn how to recognize and treat human trafficking victims. "You are the front-line responders. You play a vital role in helping identify and respond," she told the audience.

Nurse practitioners should watch for patients who are dirty or unkempt, infected with lice or scabies, suffering from addiction, or "branded" with prominent tattoos by their traffickers, especially very young patients or those accompanied by someone who won't let them speak for themselves, she explained.

Other signs of trafficking include being unable to identify where they live, go to school, or what day it is; having no money or form of identification; and suffering from dental or head and neck trauma, which could be due to beatings or forced oral sex. Mental health symptoms of trafficking victims include anxiety, depression, post-traumatic stress disorder, and Stockholm syndrome.

"In an adult setting, there are assumptions and stigma and it may not be viewed as human trafficking," Dr Peck told Medscape Medical News. "And in a pediatric population, we may encounter a teenage patient who is drug-addicted or a runaway and we look at it through that lens," without thinking or asking questions about human trafficking.

"There is no such thing as a child prostitute," she added, noting that one in three runaways is approached by a pimp within 48 hours. "They are victims of human trafficking."

Helping the Victims

If human trafficking is suspected, the first priority — beyond medical care for any emergent conditions — is to separate the patient from the trafficker, Dr Peck said. This can be achieved, she explained, by ordering x-rays or other tests that the patient must receive alone. The healthcare provider can then consult the Polaris Project website for questions to ask the patient, which also provides the number for the National Human Trafficking Hotline.

"The main thing is you need to establish trust and recognize that this is a bigger issue than just you can handle," she said, "and if they want help, you can connect them to resources."

Many human trafficking victims will deny their status, and even become angry or belligerent upon questioning. Others might confess their status, and nurses can help these victims access psychological care, housing services, addiction care, legal and spiritual support, and job and life skills training.

You watch Law & Order and see that stuff on TV, but what are we doing in our profession to help?

Audience member Susan Smetana, APN, from AdvantageCare Physicians in Brooklyn, New York, told Medscape Medical News she hadn't previously considered the issue of human trafficking in her practice, but is grateful nurse practitioners are advocating for victims.

"You watch Law & Order and see that stuff on TV, but what are we doing in our profession to help?" she asked.

Carolyn Bogdon, MSN, who recently graduated from Marymount University in Arlington, Virginia, has yet to begin practicing as a nurse practitioner, but noted that she will bring this information on human trafficking into practice when she does.

"One thing that really stuck out to me was when Dr Peck compared the revenue of human trafficking to Starbucks' revenue," Bogdon said. "It really hit home how prevalent and what a business this is."

Dr Peck, Ms Smetana, and Ms Bogdon have disclosed no relevant financial relationships.

American Association of Nurse Practitioners (AANP) 2017 National Conference: Presented June 23, 2017.

Follow Medscape Nurses on Twitter @MedscapeNurses and Maureen Salamon @maureensalamon

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