|
| A) | The smuggled individual has been forced or coerced into a country. | ||
| B) | The smuggled individual willingly volunteered to enter the new country. | ||
| C) | Specific gender differences exist, as those who get smuggled into the new country are typically men. | ||
| D) | The perpetrators who smuggle the individual into the new country often utilize legal means to get them in. |
In essence, this definition involves three elements: the transport of the person, the force or coercion of the victim, and the abuse and exploitation [47]. The United Nations Office on Drugs and Crime divides the definition of human trafficking into three sections: the act, means, and purpose [7]. The act, or what is done, generally refers to activities such as recruitment, transportation, transfer, harboring, or receipt of persons. The means of trafficking consists of threats or use of force, coercion, abduction, fraud, deception, abuse of power or vulnerability, or giving payments or benefits to a person in control of the victim. Finally, these acts are carried out for the purpose of exploitation, which includes sexual exploitation, forced labor, slavery or forced servitude, and the removal of organs [7]. It is important to remember that human trafficking is not human smuggling. Human smuggling involves an individual being brought into a country through illegal means and is voluntary. The individual has provided some remuneration to another individual or party to accomplish this goal [8].
| A) | The selling of runaways for sexual services across international borders | ||
| B) | The selling of minors to those in other countries for sex purposes and for financial gain | ||
| C) | The selling, buying, and/or trading of children for sexual services within the United States | ||
| D) | The selling and buying of minors for primarily domestic work, such as housekeeping, but that eventually turns sexually abusive |
In 2019, the National Human Trafficking Hotline recorded 14,597 sex trafficking cases to their hotline in the United States [150]. The TVPA of 2000 is a U.S. federal statute passed by Congress to address the issue of human trafficking and offers protection for human trafficking victims [10]. This statute defines sex trafficking as, "the recruitment, harboring, transportation, provision, or obtaining of a person for the purpose of a commercial sex act" [10]. A commercial sex act is, "any sex act on account of which anything of value is given to or received by any person" [10]. In other words, it usually involves the illegal transport of humans into another country to be exploited in a sexual manner for financial gains [11]. However, it does not always involve the transport of victims from one region to another; such cases are referred to as "internal trafficking" [112]. Victims of sex trafficking could be forced into sex work, stripping, pornography, escort services, and other sexual services [12]. Victims may be adult women or men or children, although there is a higher prevalence of women and girls. The term "domestic minor sex trafficking" has become a popular term used to connote the buying, selling, and/or trading of children younger than 18 years of age for sexual services within the country, not internationally [12,113,156]. An element of force, fraud, or coercion is not necessary, as the victims are children and inherently vulnerable [113]. In the United States, the children most vulnerable to domestic minor sex trafficking are those who are homeless, abused, runaways, and/or in child protective services [12].
| A) | Sex trafficking victims tend to be younger than sex workers. | ||
| B) | Victims of sex trafficking often do not get paid for their sexual work, while sex workers usually do. | ||
| C) | Sex workers have more options in regards to sexual activity, partners, and the hours they prefer to work. | ||
| D) | Sex trafficking victims experience higher levels of physical and psychological abuse than their sex workers counterparts. |
Although highly controversial, it is said that sex trafficking victims differ from sex workers in that sex trafficking victims are forced to involuntarily perform sexual services and are often not paid for their "work." Sex trafficking involves the use of force and coercion and can encompass other forms of criminal sexual activities, including forced erotic dancing, "mail-order brides," and pornography [112]. On the other hand, individuals involved in sex work make a decision to provide sex services for a fee. The decision to enter sex work does not eliminate the possibility of being a victim of trafficking if one is held against his/her will through physical and/or psychological abuse [27]. It is also important to remember that this does not necessarily mean sex work is a choice these individuals would have made if other options were available or that they have a choice in selecting their sexual partners and/or sexual activities [13]. Controversies continue, and in the United States, the definition of sex trafficking appears to have broadened in recent years. For example, persons who pay for sex using online platforms are not often classified as sex traffickers [155].
| A) | The laws pertaining to bonded labor mandate that the debt become generational. | ||
| B) | The legal contractual agreements indicate that the families' next generations will assume the debt. | ||
| C) | The victims may agree to work not realizing that they contracted themselves to work for low wages with high interest rates and other accruing fees that can never be repaid. | ||
| D) | None of the above |
In many cases of bonded labor, the initial loan may be welcomed by the individual. However, the victims do not realize that with the low wages, unspoken high interest rates and other continually accruing fees, and the perpetrator's manipulation of the "accounts," laborers can never repay the loans. Some estimate that half of all persons in forced labor are bonded laborers. The majority of bonded labor cases occur in India, Bangladesh, and Pakistan [114]. Some families find themselves in a cycle of poverty as the debt cannot be paid off and is passed down from generation to generation [15]. Bonded labor can involve laborers in brick kilns, mines, stone quarries, looming factories, agricultural farms, and other manufacturing factories [15]. In the United States, individuals may be trafficked to work long hours in garment factories, restaurants, and other manufacturing sectors. Frequently, the employer/captor will take away victims' identifications, monitor their movements, socially isolate them, and/or threaten deportation if they do not comply [16]. Migrant workers are at high risk of forced labor [27].
| A) | form of forced labor. | ||
| B) | form of sexual trafficking. | ||
| C) | form of child work in many developing countries. | ||
| D) | term that refers to trafficking confined to the United States. |
Domestic servitude refers to a category of domestic workers (usually female) who work in forced labor as servants, housekeepers, maids, and/or caregivers, often in private homes. In some cases, young women are lured with the promise of a good education and work, and when they arrive in the United States, they are exploited economically, physically, and/or sexually. Their passports or identification papers are taken away, and they are told they have to pay off the debt incurred for their travel, processing fees, and any other bogus expenses. Because they do not speak English, they find they have no other recourse but to endure exploitive working conditions [17]. Unfortunately, as in many sectors of forced labor, there are no regulations to monitor the conditions under which domestic servants operate [16].
| A) | They serve as cheap labor. | ||
| B) | Studies show children have no moral conscience. | ||
| C) | Demographically, they make up a large percentage of the population. | ||
| D) | They tend to be more easily molded and submit to orders without question. |
It is estimated that at any one time 250,000 to 300,000 children younger than 18 years of age are currently serving as child soldiers [72]. Traffickers prefer to recruit children to serve as soldiers because they are inexpensive and more easily molded and shaped to comply and obey without question [25]. They are also more likely to kill fearlessly and recklessly. Child soldiers are treated as adults, without any regard to how the physical and psychological rigors of war will affect them psychologically and developmentally. In Uganda, where children are kidnapped or recruited as child soldiers relatively often, the Lord's Resistance Army has been known to initiate new child soldiers in brutal ritualized killings of others so as to terrorize them into submission and annihilate any moral conscience they may have about killing [25]. In Afghanistan, children have been recruited by the Taliban and have served as suicide bombers [114].
| A) | It helps to perpetuate the cycle of poverty. | ||
| B) | It makes identifying potential victims more difficult. | ||
| C) | The Internet can create a greater supply of slaves, which then brings down the cost. | ||
| D) | Young women may be purchased to perform sexual acts, with graphic images then sent via the Internet for purchase. |
The rampant use of digital technology, such as the Internet, greatly facilitates sex trafficking. The relative anonymity of online contact can empower traffickers to recruit or sell victims. Graphic images of women and children engaged in sexual acts can be easily disseminated over the Internet [46]. Traffickers may employ the Internet for advertising, marketing to those interested in making pornography [46]. In addition, social media sites such as Facebook, Craigslist, and Instagram have been used as a means of facilitating trafficking (e.g., by connecting and grooming potential victims) [80; 123; 124; 164; 165]. Newsgroups offer opportunities for those interested in locating women and children for sexual exploitation.
| A) | Beliefs that girls are less valued than boys makes them more dispensable. | ||
| B) | Values that emphasize collectivism may encourage victims to sacrifice themselves for their family. | ||
| C) | Myths that certain races or ethnicities are more erotic and exotic do not affect sex trafficking patterns. | ||
| D) | In some cultures, it is believed that children in lower socioeconomic/cultural groups should be taught early on to understand their positions in life. |
Race and ethnicity have been inextricably linked to sexual violence and victimization. Myths regarding sexuality in certain cultures or racial fetishization may affect trafficking patterns. For example, there is an over-representation of Asian women on American Internet pornography sites in part due to popular myths sexualizing, eroticizing, and exoticizing Asian women. This has translated into trafficking, as traffickers respond to the demand for young Asian women and girls in part fueled by these stereotypes of exotic, docile, submissive, and eager-to-please Asian women [17]. These stereotypes devalue and dehumanize people, which is the underlying core of human trafficking. This contributes to the acceptability of the exploitation of individuals, particularly members of marginalized groups [125].
These racial stereotypes go beyond simply framing the victims in a particular manner [81]. They raise implicit questions regarding how the powers of state are depicted. In other words, the patriarchal attitudes of certain countries lead to "bad" or "backward" cultural practices or ways of being that then cause trafficking—setting up is a dichotomy of the "West" and "others" [81].
Although many are careful in linking cultural factors to the etiology of human trafficking for fear of imposing judgment on a particular culture, many maintain that cultural ideologies that tolerate sexual trafficking, bonded labor, and child labor may be a stronger factor than poverty in predicting trafficking rates [17,23]. For example, some cultures emphasize collectivism and prioritizing the needs of the family and group first before the needs of the individual. Some children may feel they have to sacrifice themselves for their family when traffickers promise money [17]. Traffickers also know that they can threaten to hurt victims' families to keep them from escaping [17].
Furthermore, in many cultures, boys are more highly valued than girls, and as a result, girls are considered more dispensable [17]. Sons are considered the family's social security, staying with the family while daughters marry into other families. Therefore, girls may be more likely to be sold into slavery than boys. In a study using court documents in China, in places where there was a higher sex ratio balance (i.e., fewer women than men), there were more instances of trafficking of women for forced marriages and the price was higher for women who were trafficked in these areas [166].
Child labor is also inextricably tied to cultural factors. In India, for example, child labor is common because it is believed that children in the lower levels of caste system (i.e., the "untouchables") should be socialized early to understand their positions in society [23]. It has been observed that when traditional cultural and societal norms about women's roles were relaxed in some European countries and more women entered the labor force, child labor decreased [23]. Ultimately, it is difficult to unravel the effects of poverty and culture because the pressures of poverty can lead families to use tradition as a justification to sacrifice young men, women, and children [23].
| A) | Informed consent issues | ||
| B) | Participants' fear of reprisals | ||
| C) | Excessively large sample sizes | ||
| D) | The hidden and invisible nature of human trafficking victims and perpetrators |
Another reason human trafficking has been a difficult topic to research is the hidden and invisible nature of its victims and perpetrators. This makes it difficult for researchers to use traditional sampling methods. Even if trafficked victims are identified, perpetrators can move them to new locations [30]. If and when researchers access this hidden population, victims are often reluctant to talk due to fear, shame, and the stigma associated with their experiences. Consequently, much of what has been studied has relied on interviews with professionals (e.g., lawyers, advocates, police/law enforcement, and other service providers), which has led to recommendations that are not based on firsthand accounts [84].
A host of ethical issues also arise for those conducting research in this area. Protecting study participants' identities is paramount, and consequently, study participants signing informed consent forms, which are often required by institutional review boards, becomes complicated. Understandably, victims and perpetrators often will not want to sign forms using their real names for fear of deportation, arrest, and/or reprisals [30].
| A) | Feminist perspective | ||
| B) | Human rights perspective | ||
| C) | Psychoanalytic perspective | ||
| D) | Migration and labor perspective |
Several perspectives have been employed to understand human trafficking and exploitation, including feminist, criminal justice/criminology, migration and labor, human rights, and labor rights perspectives. Each offers insight into how the problem is viewed and presented.
| A) | Feminist perspective | ||
| B) | Labor rights perspective | ||
| C) | Migration/labor perspective | ||
| D) | Criminal justice perspective |
A second lens used to frame human trafficking is a criminal justice or criminology perspective, which focuses on assigning blame and guilt, potentially charging the victim for criminal activities such as illegal migration or sex work [36]. Studies using a criminal justice/criminology approach attempt to understand the criminal processes and procedures (from arrest to prosecution) and barriers that emerge in each stage [170]. For example, entering the United States illegally is a crime, and law enforcement could view the trafficked person as a criminal co-conspirator [37]. This is important because the United States government is struggling to address the illegal immigration issue; those adhering to this perspective would view all "irregular" migrants in the United States as criminals first. When individuals are shown to have been abused and exploited, they are then recast as victims [28]. Similarly, human sexual trafficking is often equated with sex work and is viewed as morally sinful and evil [36]. This perspective conceptualizes trafficking as an elaborate system of organized crime networks that sponsors a hugely profitable industry [38].
| A) | Feminist perspective | ||
| B) | Human rights perspective | ||
| C) | Criminal justice perspective | ||
| D) | Migration and labor perspective |
As with slavery in the 18th and 19th centuries, trafficking victims today have no choice over their abusive and exploitive conditions. Unlike the "older" forms of slavery, this modern form is an outcome of globalization [28]. The human rights perspective also argues that, to some extent, the general public indirectly contributes to the problem of human trafficking as consumers in the global market [28]. In a study of how human trafficking is socially constructed, the videos being examined portrayed general consumers and corporations as perpetrators of human trafficking in addition to pimps, crime organizations, and middlemen recruiters [40].
| A) | Promises of employment | ||
| B) | Convincing poor families to sell their children | ||
| C) | Collaborating with storefronts who pretend they are employment agencies | ||
| D) | All of the above |
Traffickers may recruit victims face-to-face or use technologies like e-mail, websites, or apps [172]. It has been suggested human traffickers employ seven general strategies to recruit and traffic victims [42,88,130,131,165,171,172]:
Kidnapping: Traffickers may kidnap their victims. They may lure them with food or treats or take them by force. Victims with few if any social ties are highly vulnerable, as no one will miss them or report their disappearance.
Targeting poor families: Traffickers may convince families to sell their children (often daughters). Because many families in developing countries live in abject poverty, traffickers will stress to victims' families how the money will help them to survive. Other traffickers may tell families that selling their daughter will provide her with more promising opportunities.
Developing a false romantic relationship with victim: A tactic often used with young girls, perpetrators pose as boyfriends by romancing victims, buying gifts, and proclaiming their love. Victims have a difficult time believing that their boyfriends would hurt or deceive them, making them easy targets for trafficking.
Fake storefronts: Some employment, modeling, or marriage agencies are fronts for illegal trafficking operations. A potential victim might be lured with the promise of employment, a lucrative modeling contract, or an arranged marriage in the United States. After victims have been lured in, traffickers come to assess their "product." Perpetrators may be family members or friends.
Legal storefronts: Some legal businesses in the tourism, entertainment, and leisure industries integrate trafficking activities into their business structure.
Recruiting local sex workers: Traffickers might purchase sex workers working in local night clubs from brothel owners or simply lure sex workers by promising them a more affluent future. Women doing sex work may later recruit younger victims.
Adoption: Traffickers might adopt a minor child and then child may be sexually abused, forced to perform labor, or sold.
| A) | For some human trafficking victims, the feelings of shame lead to self-destructive behaviors. | ||
| B) | Post-traumatic stress disorder is a universal diagnostic category and should be used for all human trafficking victims. | ||
| C) | There seems to be an association between those who had greater levels of revenge and higher levels of PTSD among former child soldiers. | ||
| D) | Some victims may have substance abuse problems because traffickers may force sex trafficking victims to take drugs in order to perform sexual acts. |
Victims of trafficking experience a host of psychological, mental health, and emotional distress. Depression, suicidal ideation, substance use, and anxiety are typically cited mental health problems [113,174]. Post-traumatic stress disorder (PTSD) is also common given the trauma many victims experience, including physical and/or sexual violence and abuse; victims forced into sex work experience continual, daily sexual assault [49,174]. In a study of 192 European women who were trafficked but who managed to escape, the overwhelming majority (95%) disclosed that they experienced physical and sexual violence during the time of their trafficked experience [50]. More than 90% reported sexual abuse, and 76% reported physical abuse.
Trafficked victims experience fear from the start of their capture through the transit phase and after they arrive at their destination. During the transit stage, many victims experience dangerous border crossings, risky types of transports, injury, beatings, and sexual assault [41]. Upon arrival to their destination, many trafficking victims have been socially isolated, held in confinement, and deprived of food [134]. All sense of security is stripped from them—their personal possessions, identity papers, passports, visas, and other documents [41,134]. The continual fear for their personal safety and their families' safety and the perpetual threats of deportation ultimately breed a sense of loss of control and learned helplessness. It is not surprising that depression, anxiety, and PTSD are common symptoms experienced by trafficked victims.
In a study of 164 survivors of human trafficking who returned to Nepal, the authors examined the extent to which they experienced PTSD, depression, and anxiety [51]. All of the survivors experienced some level of these disorders, but the survivors who were trafficked for sex experienced higher levels of depression and PTSD compared to those who were not trafficked for sex. In a study with Moldovan survivors of human trafficking, researchers found that six months after their return, 54% had diagnosable mental health issue. Specifically, 35.8% met the diagnostic criteria for PTSD, 12.5% met the criteria for major depression, and 5.8% were diagnosed with an anxiety disorder [92].
There is also some evidence that trafficked victims may experience complex PTSD, a type of PTSD that involves an acute change of the victims' sense of self, their relationship with others, and their relationship with God or higher being [93]. These persons direct anger inwardly (toward themselves) in addition to toward their perpetrators, which results in a loss of faith in themselves and the world [93,129,134]. Perhaps due to self-directed anger and shame, some will engage in risky sexual behaviors, self-harm, and substance abuse. Some victims also have difficulty managing and expressing how they are feeling, while others experience dissociation [134]. In a systematic study, 41% of victims had signs of complex PTSD [175].
Substance abuse is also common among victims. In interviews, trafficked women discussed how traffickers forced them to use substances like drugs and/or alcohol so they could work longer hours, take on more clients, and/or perform sexual acts that they could not normally [41]. Other victims used substances as a means to cope with their situations. Trafficked individuals who are gender and/or sexual minorities report shame, confusion, and sexual identity issues if forced into heterosexual relationships [129].
Children forced into labor experience grueling hours and are frequently beaten by their captors. According to Clawson and Goldblatt, underage victims of domestic sex trafficking fluctuate through a range of emotions from despair, shame, guilt, hopelessness, anxiety, and fear [52]. Depending upon the level of trauma, some engage in self-destructive behaviors like self-mutilation or suicide attempts [174]. For some, their ambivalence toward the perpetrators may be confusing. On the one hand, they want to escape the abuse, yet simultaneously, they may have a sort of traumatic bond with the perpetrators [52]. Some may experience auditory hallucinations; however, it is important to not simply attribute these symptoms to psychosis [174,176].
| A) | Depression | ||
| B) | Stigmatization | ||
| C) | Somatic symptoms | ||
| D) | Gynecologic problems that result from rape |
In studies of trafficked women, headaches, fatigue, dizziness, back pain, pelvic pain, stomach pain, sexually transmitted infections (STIs), unwanted pregnancies, and gynecologic infections were common, generally the result of continual physical, psychological, and sexual abuse [50,113,178]. Victims of labor trafficking also experience health issues related to the type of work, including malnutrition, burns, hearing loss, respiratory symptoms from exposure to toxic chemicals, and traumatic injuries (e.g., limb amputations, broken teeth, bruises, abrasions) [136,157].
| A) | lack of sleep. | ||
| B) | poor nutrition. | ||
| C) | their rapid growth. | ||
| D) | their thinner epidermal layers. |
Under normal circumstances, young children are still developing physically; however, such adverse conditions can halt their development. The lungs of adolescent boys typically experience the most rapid growth around 13 to 17 years of age; working in conditions characterized by excessive toxic dust or unclean air makes them more vulnerable to developing silicosis and fibrosis [57]. In the United States, young children participating in agricultural work are at risk of the major traumas associated with farm work, such as injuries caused by tractors or falling from heights, in addition to those injuries associated with repetitive stress and exposure to toxins. Children have thinner layers of epidermis, which make them more vulnerable to the toxicity of pesticides, and this can ultimately increase their risks for certain cancers [57]. Children working in gold mines do intensive digging, lifting, and transporting and mix mercury with the crushed ore, often with their bare hands. Mercury toxicity can lead to neurologic symptoms such as loss of vision, tremors, and memory loss [96].
| A) | The suspected perpetrator | ||
| B) | A local social service agency | ||
| C) | Executive director of the agency | ||
| D) | The National Human Trafficking Resource Center. |
If answers to these questions indicate that an individual may be a victim of human trafficking, one should contact the National Human Trafficking Hotline at 1-888-373-7888. Under the child abuse laws, practitioners who are mandated reporters and who are suspicious that a minor is being abused should immediately report the abuse. For more information regarding specific states' reporting requirements, please visit https://www.childwelfare.gov/topics/systemwide/laws-policies/state.
| A) | Be spontaneous and act in accordance with what the victim says. | ||
| B) | Assess the level of secondary traumatization experienced by the victim. | ||
| C) | Bypass informed consent because it may be threatening to the victim. | ||
| D) | Assess if an interpreter is needed and ensure the interpreter is knowledgeable about the dynamics of human trafficking. |
Service providers should repeatedly weigh the risks and benefits of various actions when interviewing human trafficking victims [88,99,100]. The following interviewing recommendations were published by the World Health Organization to encourage service providers to continually and ethically promote human trafficking victims' safety during every phase of the interviewing process [66; 137; 183]:
Each victim and trafficking situation should be treated as unique; there are no standard templates of experiences. Listen carefully to the victim's story. Each story told is unique, and each patient will voice distinctive concerns. Believe each story, no matter how incredible it may seem. As rapport and trust build (perhaps very slowly), accounts may become more extensive.
Always be safe and assume the victim is at risk of physical, psychological, social, and legal harm.
Attend to urgent physical needs, including malnourishment, injury, and safety.
Evaluate the risks and benefits of interviewing before starting the interviewing process. The interviewing process should not invoke more distress. In other words, the interviewing process should not end up re-traumatizing the victim.
Do not rush to get to the screening process. Building trust and rapport is more essential.
Provide referrals for services where necessary; however, it is necessary to be realistic and not make promises that cannot be kept. Trust is vital because it has been severed on so many levels for trafficking victims. Give the patient the opportunity to select resources, and work with the patient to select appropriate referrals and resources.
Victims' readiness to change will not be based on what societal defines as "ready" or social expectations. Some victims will eagerly grasp new opportunities, while others may be fearful of potential traffickers' threat and be less receptive to help.
Determine the need for interpreters and if other service providers should be present during the interviewing phase. Ensure that everyone involved is adequately prepared in their knowledge about human trafficking, how perpetrators control their victims, and how to ask questions in a culturally sensitive manner. Keep in mind that often times, traffickers will offer to help with the interpreting. Using interpreters from the same community of the victim should be avoided to prevent breaches in confidentiality.
All involved should be prepared for an emergency plan. For example, is there a set plan for a victim who indicates he/she is suicidal or in danger of being hurt?
Always be sure to obtain informed consent. Remember the informed consent process is going to be unfamiliar to many victims. In addition, self-determination and autonomy have been compromised by continual threatens and being forced to commit dehumanizing acts. Avoid using legal and technical jargon. Although it may be tempting to start helping immediately, some patients will view this as a threat to their self-determination. Let the patient set the pace of the interview.
| A) | They do not have access to the Witness Protection Program. | ||
| B) | Counseling services are not culturally congruent and sensitive. | ||
| C) | The T-Visas are not issued with long enough time periods for the victim to adjust in the new country. | ||
| D) | The responsibility lies with the victim to provide evidence that he/she was coerced into the human trafficking situation. |
One of the criticisms of the Act is that it places the burden of demonstrating innocence and coercion on the victim [34]. The Act also fails to recognize the complex dynamics of human trafficking. For example, it focuses more on sex trafficking versus other forms [144]. Many victims have been abused and terrorized by the perpetrators, who they must now provide information and evidence against to stay in the country. Victims are continually fearful that they will be deported [34].
| A) | Secondary traumatization | ||
| B) | Greater levels of self-efficacy | ||
| C) | Inability to develop self-awareness | ||
| D) | Inability to detect transference issues |
The terms "secondary traumatization," "secondary traumatic stress," "secondary victimization," "vicarious traumatization," and "compassion fatigue" refer to the psychological impact of being in close contact with those who are directly affected by trauma and helping or wanting to help the victim. Figley has defined secondary traumatic stress as, "the natural, consequent behaviors and emotions resulting from knowledge about a traumatizing event experienced by a significant other" [68]. Vicarious traumatization consists of a "transformation of the inner experience of the therapist that comes about as a result of empathic engagement with patients' trauma material" [69]. Vicarious traumatization can include emotional and cognitive arousal symptoms such as increased emotional sensitivity, lack of well-being, intrusive thoughts, and difficulty concentrating [70].