Integrating curricula on human trafficking into medical education and residency training.

Today in the United States , human trafficking occurs in cities, suburbs, and rural areas across all 50 US states.1 “Severe forms” of human trafficking are defined under the US Trafficking Victims Protection Act of 2000 as the following: (1) sex trafficking in which a commercial sex act is induced by force, fraud, or coercion, or in which the person induced to perform such act has not attained 18 years of age or (2) the recruitment, harboring, transportation, provision, or obtaining of a person for labor or services, through the use of force, fraud, or coercion for the purpose of subjection to involuntary servitude, peonage, debt bondage, or slavery. According to data collected by the US Human Trafficking Reporting System between January 2008 and July 2010, 83% of confirmed sex trafficking victims were US citizens, and 95% of confirmed labor trafficking victims were foreignborn nationals. Moreover, 87% of sex trafficking victims were younger than 25 years, compared with 38% of labor trafficking victims.2 Health outcomes associated with human trafficking include infectious diseases such as tuberculosis and human immunodeficiency virus (HIV)/AIDS, noninfectious diseases such as dental disease and malnutrition, reproductive health problems, substance abuse, mental health problems including posttraumatic stress disorder, depression, and suicidal ideation, and physical injuries from violence experienced during enslavement.3,4 From a public health perspective, trafficking may be an important means of HIV transmission, as suggested by one study that found a 38% HIV prevalence among repatriated sex-trafficked Nepalese women and girls, with a 60% infection rate among girls trafficked prior to 15 years of age.5 The health care profession may be one of the few professions likely to interact with trafficking victims while enslaved. A 2011 study found that 50% of trafficking survivors interviewed reported having visited a physician while trafficked.6 Key informants working closely with trafficking survivors were also interviewed and 100% described additional clients who had received medical care while under their trafficker’s control.6 Low awareness and a lack of guidance or protocols for responding to human trafficking in the health care setting are particularly salient barriers to a more effective health sector response in the United States.3 A recent study demonstrated that a brief educational intervention for health professionals increased their knowledge about human trafficking, as well as selfreported recognition of human trafficking victims.7 In the same study, an overwhelming majority of respondents— 79% preintervention and 92% postintervention— agreed or strongly agreed that it was important for them to know about human trafficking for their professions.7 Calls for Educational Training About Human Trafficking Multiple health professional organizations have issued calls for their member physicians to receive educational training about human trafficking. These organizations—including the American College of Obstetricians and Gynecologists (2011), the American Medical Association–Medical Student Section (2012), the Christian Medical & Dental Associations (2013), and the American Academy of Pediatrics (2014)—have been joined by similar calls from allied health professions, including nursing and social work. Following the January 2014 release of the US government’s Federal Strategic Action Plan on Services for Victims of Human Trafficking in the United States: 2013-2017, the US Department of Health and Human Services launched the SOAR to Health and Wellness Network, a pilot initiative to educate health care professionals on how to identify and serve victims of trafficking. For more information, please refer to the US Administration for Children & Families website at http: //www.acf.hhs.gov/press(press release dated January 14, 2014).