Human trafficking is not only a global issue, but also a major public health concern within the United States. Studies suggest that up to half of trafficking victims seek medical attention at least once during their trafficking situation. This represents a large, often-missed opportunity for healthcare professionals to intervene. The injustices of human trafficking include forced labor, involuntary servitude, child soldiers, and sex trafficking. Some estimate that over 20 million men, women, and children are victims of human trafficking worldwide.  However, the scope of the problem is difficult to quantify, given the covert nature of the crime. The U.S. government no longer includes official estimates in its annual “Trafficking in Persons” reports. In 2004, the Department of Justice estimated that 14,500-17,500 trafficking victims were brought to the U.S. each year.  In addition to the victims brought illegally to this country, another 300,000+ youth within the U.S. are thought to be at risk of exploitation.  As many as 80% of trafficking victims are female, and one-third to one-half are minors.  Cases of child trafficking have been confirmed in all 50 U.S. states over the last decade. 
Here’s what pediatricians can do to help:
Increase awareness within your workplace and your community about the prevalence of human trafficking and signs and symptoms of trafficking victims. [4, 5, 6]
-Youth at highest risk include: runaway and homeless youth; individuals with prior involvement with the juvenile justice system or child protective services (including children in foster care); LGBTQ individuals; children with unstable home lives including caregiver substance abuse, mental illness, criminality, and domestic violence; and youth from countries with political upheaval or corruption.
-Victims often present to a medical provider for the following complaints: pregnancy testing, emergency contraceptive, sexually-transmitted infections, complications of substance abuse, physical injury, sexual assault, infections, and mental health concerns.
-Victims may present with a domineering adult or significantly older “boyfriend.” Other signs may include poor dentition, tattoos, evidence of substance abuse, or evidence of trauma.
-Human Trafficking Awareness Training: http://www.dhs.gov/xlibrary/training/dhs_awareness_training_fy12/launchPage.htm
Be prepared to identify victims in the healthcare setting and familiarize yourself with available resources for rescue and rehabilitation. 
-Comply with existing child abuse mandatory reporting laws.
-Contact law enforcement and/or CPS.
-Call the National Human Trafficking Resource Center Hotline: 1-888-373-7888
Educate yourself on current federal and state laws, and advocate for further provisions for the protection of child victims.
-Be aware that fear of deportation may prevent some noncitizen victims from seeking help. However, the Victims of Trafficking and Violence Protection Act of 2000 (now Title XII of the Violence Against Women Reauthorization Act of 2013) can protect victims of severe trafficking from deportation. [7, 8]
-Many states have “Safe Harbor” laws which acknowledge that trafficked children are victims of exploitation and not perpetrators of crime (prostitution). These laws protect victims of trafficking from being prosecuted as criminals and also provide rehabilitative services. 
-In 2010, the Texas Supreme Court made a landmark decision in the case, “In Re: B.W.” B.W. was a 13-year-old girl who was trafficked by her 32-year-old “boyfriend.” She was arrested and adjudicated delinquent for prostitution. The Texas Supreme Court ruled that children under 14 “lack the capacity to consent to sex as a matter of law.” Therefore, children under 14 are victims of sexual abuse and cannot be charged with the offense of prostitution. [9, 10]
-Texas Senate Bill 92 of the 83rd legislature was passed in 2013. It grants juvenile probation departments the authority to defer adjudication of minors involved in sex trafficking. Rather than punishing these victims, the bill allows for the establishment of diversion programs for treatment and rehabilitation of trafficked persons. [11, 12]
-The Polaris Project posts current legislation by state at this website: http://www.polarisproject.org/what-we-do/policy-advocacy. Stay informed and contact your legislators to support the fight against human trafficking.
Chelsea Ragland, MD
1] Konstantopoulos WM, Ahn R, Alpert EJ, Cafferty E, McGahan A, Williams TP, Castor JP, Wolferstan N, Purcell G, Burke TF. J Urban Health. 2013 Dec; 90(6): 1194-204. An international comparative public health analysis of sex trafficking of women and girls in eight cities: achieving a more effective health sector response.
2] U.S. Department of Justice. (2004). Assessment of U.S. government activities to combat trafficking in persons. http://www.justice.gov/archive/ag/annualreports/tr2004/us_assessment_2004.pdf
3] Todres J, Clayton EW. N Engl J Med. 2014 Apr 3; 370(14): 1282-3. Responding to the sexual exploitation of minors.
4] Barrows J, Finger R. South Med J. 2008 May; 101(5): 521-4. Human trafficking and the healthcare professional.
5] Institute of Medicine, National Research Council. Confronting commercial sexual exploitation and sex trafficking of minors in the United States: A guide for providers of victim and support services. Washington, DC: National Academies Press, 2014 Jun.
6] Greenbaum J, Crawford-Jakubiak JE, Committee on child abuse and neglect. Pediatrics. 2015 Mar; 135(3): 566-74. Child sex trafficking and commercial sexual exploitation: health care needs of victims.
7] Violence Against Women Reauthorization Act, 42 U.S.C (2013). http://www.gpo.gov/fdsys/pkg/BILLS-113s47enr/pdf/BILLS-113s47enr.pdf
8] U.S. Laws on Trafficking in Persons (U.S. Department of State). http://www.state.gov/j/tip/laws/
9] Sanborn RD, Lew D. Texas Bar Journal. 2012 Nov; 75(10): 778-81. Fighting human trafficking in Texas.
10] In re B.W., 313 S.W.3d 818 (Tex. 2010) http://caselaw.findlaw.com/tx-supreme-court/1527849.html
11] An act relating to the designation of a juvenile court and a program for certain juveniles who may be the victims of human trafficking, TEX FA. CODE ANN. §§ 51-52-54 (2013). http://www.capitol.state.tx.us/tlodocs/83R/billtext/pdf/SB00092F.pdf
12] Senate Research Center. (2013). Bill analysis S.B. 92 of the 83rd Texas Legislature. http://www.capitol.state.tx.us/tlodocs/83R/analysis/pdf/SB00092F.pdf#navpanes=0