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Current Trends in Sex Trafficking Research

Cecilia allan, georgia m winters, elizabeth l jeglic.

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Corresponding author.

Accepted 2023 Feb 21; Issue date 2023.

This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

Purpose of Review

Sex trafficking is a significant global problem that results in millions of individuals being sexually exploited annually. This paper will provide an overview of recent research in the field of sex trafficking and evaluate findings to provide recommendations for future research and policy work.

Recent Findings

In recent years, there has been an increase in research focused on understanding sex trafficking and how it can be prevented. Specifically, recent studies have explored characteristics of sex trafficking cases, risk factors for experiencing sex trafficking, recruitment and maintenance processes, identification and intervention techniques, and treatment approaches.

While there have been significant strides to better understand sex trafficking across the globe, numerous areas require further exploration. Additional research conducted internationally and with adults who have experienced sex trafficking is needed to better understand methods that can identify individuals at risk for being trafficked, enhance early detection, and provide services to trafficked individuals.

Keywords: Sex trafficking, Commercial sexual exploitation, Risk factors, Recruitment, Treatment of sexually trafficked individuals, Identification of sexually trafficked individuals

Introduction

Sex trafficking is one of the fastest growing global criminal enterprises [ 1 ], with reported cases in 115 countries [ 2 ••]. It is estimated that in 2016, nearly four million adults and one million minors were forced into sexual labor [ 3 ]. While exact definitions may vary by country, sex trafficking as defined in the United States (U.S.) refers to the “recruitment, harboring, transportation, provision, or obtaining of a person for the purpose of any commercial sex act where such act is induced by force, fraud or coercion, or when the person induced to perform sex acts is under the age of 18 years” [ 4 ]. Sex trafficking has serious consequences to the individual and society [ 5 ]. Experiencing sex trafficking has been shown to increase rates of physical illness [e.g., 5 ] as well as mental health conditions [e.g., 6 – 8 ] and can lead to social stigmatization and/or criminalization of trafficked individuals [ 8 ]. Sex trafficking also has a significant impact on society, sustaining organized crime, and depriving citizens of basic human rights and feelings of security [ 9 ]. Thus, determining methods of identification and prevention are of great importance. As such, this review will provide an overview of recent research (2019 to 2022) in the field of sex trafficking and critically evaluate findings to communicate suggestions for future research and policy work. The review will include a description of the characteristics of sex trafficking cases, risk factors for experiencing sex trafficking, recruitment and maintenance processes, identification and intervention techniques, and treatment approaches. Although the majority of research focuses on trafficked individuals who are under 18 at the time of exploitation, the information described throughout this review includes both child sex trafficking (CST) and adult sex trafficking (AST).

Characteristics of Sex Trafficking Cases

Globally, sexual exploitation (i.e., sex trafficking) is the most common form of human trafficking representing 50% of the cases of trafficked individuals [ 2 ••]. While it is estimated that almost five million individuals (adults and children) are trafficked for the purposes of sexual exploitation internationally [ 3 ], it is expected that this number has recently increased due to higher levels of unemployment resulting from the COVID-19 pandemic [ 2 ••]. Further, the global prevalence of sex trafficking is likely underestimated given the lack of a standardized definition [ 10 , 11 ] in addition to various individualized (e.g., failing to recognize experiences of victimization, nonreporting due to fear of individuals who perpetrate trafficking or law enforcement) [ 10 , 12 , 13 ] and systematic (e.g., lack of a central database to track occurrences) [ 14 ] barriers.

According to the UNDOC [ 2 ••], females experience sex trafficking at disproportionate rates, with women and girls, respectively, representing 77% and 72% of the individuals experiencing sexual exploitation. Others have estimated these rates to be even higher with some sources suggesting that up to 99% of sexually trafficked individuals are women and girls [ 3 , 15 •]. Most trafficked individuals enter sex trafficking before the age of 18, with the average age of first sex trafficking experience ranging from 12 to 15 years [ 15 •, 16 •]. Individuals who identify as part of the LGBTQ + community have twice the odds of being trafficked compared to those who identify as heterosexual [ 17 ]. This is hypothesized to be the result of familial discrimination and a lack of available services which increase their chances of experiencing other risk factors (e.g., homelessness) and leads to a higher likelihood of engaging in sex trafficking to meet basic needs [ 17 ]. Furthermore, while in lower income countries children are more likely to be trafficked for labor, in high and upper-middle income countries such as those in North America and Europe [ 2 ••], children are more likely to be trafficked for sexual purposes. Research also suggests domestic trafficking is more common than international trafficking [ 18 ••].

While most trafficked individuals are female, most individuals who perpetrate sex trafficking are male [ 15 •, 19 , 20 ••]. However, recent studies suggest that the prevalence of female individuals who perpetrate sex trafficking may be increasing, with estimates ranging from 16 to 32%. Differences in rates of female individuals who perpetrate sex trafficking may be related to location, as research conducted in the Netherlands identified that individuals who perpetrate sex trafficking internationally are significantly more likely to be female than individuals who perpetrate sex trafficking domestically (21.5% versus 12%) [ 18 ••].

The type and size of the sex trafficking organizations may vary based upon several factors. For instance, Veldhuizen-Ochodničanová and colleagues [ 20 ••] found that individuals who perpetrate sex trafficking domestically in the U.S. were more likely to work independently and have a single individual they were victimizing while individuals who perpetrate sex trafficking internationally were more likely to work in organized groups and have a larger number of individuals they were victimizing (i.e., over 10). Kragten-Heerdink and colleagues [ 18 ••] identified support for these findings in an international context, with individuals who perpetrate sex trafficking internationally reporting victimizing more individuals than those who perpetrate sex trafficking domestically in the Netherlands.

Risk Factors

Numerous factors contribute to the likelihood of being sexually exploited. Several studies have identified risks for experiencing CST in the U.S., including child maltreatment (e.g., prior sexual abuse), involvement in foster care, a history of running away, alcohol and substance use/abuse, poor mental health, justice system involvement, unstable home environments, peer or family influence (e.g., witnessing others engage in sex work), identifying as part of the LGBTQ + community, severe physical disabilities, and/or low cognitive abilities [ 8 , 16 •, 17 , 19 , 21 – 25 ]. Similar risk factors have also been reported in Canada and Israel [e.g., 21 , 26 ]. Research comparing domestic and international trafficking suggests that risk factors may differ depending on the context. For example, Kragten-Heerdink and colleagues [ 18 ••] found that individuals who were sexually trafficked domestically were more often described as vulnerable due to factors such as age, homelessness, and difficulties in the home (e.g., abuse), whereas those sexually trafficked internationally were more often described as vulnerable because of their disadvantaged background (e.g., poverty and lack of education) and/or a need to provide for others.

Process of Recruitment and Maintenance

One method of improving identification of those being trafficked is through knowledge and recognition of the tactics and processes by which individuals become sexually exploited. Often, individuals have preestablished relationships with those who perpetrate their sex trafficking (e.g., family and friends) and tend to become involved due to economic need [ 19 ]. Using a sample of 26 individuals who had experienced sex trafficking in the U.S., Reed and colleagues [ 27 ] identified three types of relationships that lead to CST: (1) friends, (2) romantic relationships, and (3) family. For more than half of their sample (54%), friends had influenced involvement in sex work, either through peer pressure or modeling a way to survive/obtain money [ 27 ]. Others (31%) had romantic relationships with “boyfriends” who later became pimps, using coercion or violence to force the trafficked individual into sex work and keeping the money for themselves [ 27 ]. Familial involvement in sex work was also identified as a pathway towards involvement in CST in 15% of the cases [ 27 ]. In another recruitment model developed in the U.S., Roe-Sepowitz [ 15 •] proposed that individuals who perpetrate sex trafficking tend to recruit by targeting vulnerable children (e.g., runaways, those who respond to overtures of romance) and promising money, drugs, alcohol, or a place to stay. The author also noted use of various methods of control such as sexual, physical, and psychological abuse to condition trafficked individuals and prevent them from leaving [ 15 •].

In an effort to synthesize the research on the behaviors and tactics involved in the trafficking process, Winters and colleagues [ 28 ••] conducted a review of the literature (including both sex trafficking and child sexual abuse) and proposed the Sexual Grooming Model of Child Sex Trafficking (SGM-CST). According to the SGM-CST, the behaviors and tactics used by individuals who perpetrate sex trafficking can be conceptualized into five stages: (1) victim selection, (2) gaining access and isolation, (3) trust development, (4) desensitization to sexualized content and touch, and (5) postabuse maintenance [ 28 ••]. Victim selection involves choosing an individual to traffick based on specific internal and external vulnerabilities (e.g., drug addiction, intellectual deficits, inhospitable home environment, and unmet needs at home). Once the individual perpetrating the sex trafficking has identified a preferred individual, they begin to engage in behaviors aimed at accessing the child, such as manipulating their existing relationships or isolating the child from emotional supports and physical protective factors (e.g., areas with surveillance). The individual perpetrating the sex trafficking then focuses on gaining the trust and cooperation of the individual they are trafficking, as well as others in that individual’s life. This may involve presenting oneself as romantically interested, providing compliments and attention, or utilizing more materialistic tactics such as giving money and gifts. After trust has been established, the individual perpetrating the sex trafficking works to desensitize the youth to sexual content (e.g., asking sexually explicit questions) and contact (e.g., taking explicit photos and exposure to pornography). Lastly, individuals who perpetrate sex trafficking engage in postabuse maintenance to facilitate future abuse and/or prevent disclosure of the abuse. Both emotional manipulation (e.g., competition among trafficked individuals and instilling feelings of shame) and controlling behaviors (e.g., physical abuse, sexual violence, verbal threats, and blackmail) may be used at this stage. This model provides a framework for understanding the recruitment tactics of individuals who perpetrate sex trafficking and could help with prevention through identification, educational efforts, investigations, and prosecution of CST cases. The authors indicate that the next step is validating the SGM-CST using data from trafficked individuals [ 28 ••].

International research reveals use of similar methods of recruitment (e.g., through relationships), trust development (e.g., showing attention or gifts), and maintenance (e.g., deception, persuasion, psychological control, and threats) [ 21 , 29 ]. However, there appears to be some variation by country as studies from Spain and India show recruitment into sexual exploitation may occur as the result of prior engagement in domestic servitude or due to familial obligation. As examples, in Spain and Morocco, young girls from economically disadvantaged families in rural areas are often recruited to work as housemaids for wealthy families and are subsequently targeted by trafficking networks [ 30 ], while CST is considered normative among some castes (e.g., Bedia) in India to provide financially for the family [ 31 ].

It is also important to consider how these methods may vary depending upon the type of sex trafficking operation. For instance, Veldhuizen-Ochodničanová and colleagues [ 20 ••] compared differences between domestic and international sex trafficking processes in the U.S. They found differences in victim selection decisions, in that individuals who perpetrate sex trafficking domestically tended to select minors and individuals who had run away from home, whereas individuals who perpetrate sex trafficking internationally were significantly more likely to target poor, uneducated, or homeless individuals [ 20 ••]. In reference to methods of recruitment, they found that individuals who perpetrate sex trafficking domestically and internationally used some approaches at similar rates (e.g., romancing, promising interstate travel, and taking care of money/needs); however, significantly more international trafficking cases involved promises of a job or an American visa [ 20 ••]. The researchers also found significant differences in the strategies used to gain and maintain control. Specifically, individuals who perpetrate sex trafficking domestically were more likely to use drug dependence as a method of control, whereas those who perpetrate sex trafficking internationally were more likely to reference smuggling debt, deportation, and ID confiscation in order to maintain compliance [ 20 ••]. In a similar comparative analysis conducted in the Netherlands, researchers found differences in the use of violence as a means of coercive control, noting that this method was employed significantly more often by individuals who perpetrate sex trafficking domestically than those who perpetrate sex trafficking internationally [ 18 ••]. Overall, these findings suggest that consideration of the country and context (i.e., international versus domestic) is important when looking for indications of victimization.

Identification and Intervention

While research has identified risk factors and recruitment processes involved in sex trafficking, considerably less is known about the extent to which this knowledge has been applied by healthcare professionals, law enforcement, and educators to identify and intervene in cases of sex trafficking. The few studies which have been conducted appear to focus on North American-based professionals.

Several studies in the U.S. have examined how to improve identification of sex trafficking in healthcare settings. One commonly studied tool is the Short Screen for Child Sex Trafficking ( SSCST ), a 6-item measure which includes questions relevant to risk factors (e.g., physical violence, running away, sexual history, and substance use) [ 32 •]. Peterson and colleagues [ 33 ] examined the use of routine screening for CST using a modified version of the SSCST in emergency departments. They found that the modified SSCST improved specificity when children present with a high-risk chief complaint (e.g., sexual assault, physical assault, and runaway) by increasing CST identification rates from 1.3% to 11.3% during comprehensive follow-up evaluations [ 33 ]. Similarly, Hurst and colleagues [ 34 ] examined the effectiveness of an electronic self-report version of the SSCST . In a sample of 212 patients, 22 of the 26 patients who had experienced sexual exploitation (84.6%) screened positive for trafficking using the tool. Results suggest that this self-report method was helpful in identifying CST and may be useful in busy clinical environments to ensure additional evaluation services are provided for those who screen positive for CST [ 34 ].

In addition to utilizing screening tools, research has highlighted the importance of training professionals who frequently encounter trafficked individuals on identification procedures. Research conducted with service providers (e.g., counselors, medical personnel, law enforcement, and educators) who frequently interact with those who may be experiencing sex trafficking suggests that training can be an effective method of improving identification and access to services.

Service Providers

It appears that many service providers have received at least some training on the identification of CST. To examine the effectiveness of training programs aimed at improving identification of CST, Preble and colleagues [ 35 •] used snowball and purposive sampling targeted at members of antitrafficking networks to survey a range of service providers (e.g., law enforcement, child protective services, and medical personnel; n  = 107) in a midwestern state in the U.S. Ninety percent of respondents indicated that they had received training for CST, most often related to the definition of human trafficking, vulnerability factors, and identification of trafficked individuals. However, the authors propose that continued definitional confusion among professionals who had received training may suggest that current methods are not sufficient for improving identification of trafficked individuals [ 35 •].

Awerbuch and colleagues [ 36 ] examined the impact of a full-day educational intervention for U.S. professionals working with individuals who may be experiencing CST (e.g., nurses, counselors, police officers, and social workers). They found that the training, which included a description of CST, impacts of screening and identification, an explanation of trauma bonding, and skills for communicating with trafficked individuals, was effective in increasing sex trafficking knowledge among some practitioners [ 36 ]. The Commercial Sexual Exploitation of Children (CSEC) is another training manual which has had positive impacts on increasing identification of trafficked individuals in the U.S. [ 37 ]. Modules in this program explore (1) an overview of CSEC, (2) pathways and precursors, (3) understanding impacts, (4) victim identification and engagement, (5) effective service delivery, (6) investigating cases, (7) working with cases, and (8) medical and mental health care of trafficked individuals [ 37 ]. Kenny and colleagues [ 37 ] provided nine three-hour training sessions over the course of six months and found statistically significant differences between pretest and posttest scores on a measure of sex trafficking knowledge. Professionals (e.g., therapists, transportation workers, and social workers) reported that they had a greater ability to identify and recognize trafficked individuals, an improved understanding and knowledge of CST, an increased ability to communicate with and engage trafficked individuals, and a heightened desire to educate others on this problem after receiving the training.

Of note, researchers have identified variations in the definition of sex trafficking as a barrier that impedes identification of trafficked individuals, which may impact the quality and effectiveness of trainings. Preble and colleagues [ 35 •] found that, despite previous training, many respondents indicated confusion regarding definitional aspects of sex trafficking. When examining service providers’ understanding and identification of CST, Gonzalez-Pons [ 38 ] found that the persistence of myths related to CST and a lack of definitional understanding interferes with identification of trafficked individuals and service delivery.

Law Enforcement

Trafficked individuals may come in contact with law enforcement due to suspicion regarding the commission of delinquent behavior. Interrogations by police can create mistrust thereby decreasing the likelihood of disclosure and identification [ 39 ]. Consequently, research has started to focus on law enforcement responses to sex trafficking. Miller and colleagues [ 40 ] examined the effectiveness of the Law Enforcement First Responders Protocol for Commercially Sexually Exploited Children ( FRP ), a training program that aimed to help law enforcement officers identify those who had been trafficked while avoiding criminalization of these individuals under prostitution laws in the U.S. While overall effectiveness on identification rates was not discussed, the authors note that by encouraging officers to connect trafficked individuals with services rather than criminalize behaviors, the program allowed many trafficked individuals to access important medical services [ 40 ].

Other Professionals

Gaps have been identified in that training may not be provided to some professionals who have a high likelihood of interacting with individuals who have been sexually trafficked (e.g., medical providers and educators). For example, although educational and medical societies recommend that students learn to recognize and provide care for sexually trafficked individuals, Talbott and colleagues [ 41 ] were able to identify only four programs which aimed to train medical students on identification and intervention. A Canadian study of medical professionals ( n  = 125) found that 40% of physicians and 51% of other health professionals (e.g., nurses and psychologists) had never received training related to CST and did not feel comfortable making identification judgments [ 42 •]. Further some research suggests that healthcare providers may be more attuned to general signs of child maltreatment rather than having specific knowledge regarding risks of CST [ 42 •, 43 ].

Similarly, it appears that educators have little guidance on how to identify signs of CST among their students [ 44 ]. Chesworth and colleagues [ 44 ] proposed a protocol outlining how schools could respond to concerns of CST and help with identification. This included (1) taking action when sex trafficking is disclosed or suspected and reporting even if uncertain, (2) informing and involving relevant personnel, (3) working collaboratively to decide who to include in the report process, (4) submitting a report to Child Protective Services, and (5) following up after the report with the student and family to ensure they are getting proper services.

Given the physical and psychological impact of sexual exploitation, once trafficked individuals are identified, clinicians and service providers must work to implement treatment programs that will address the unique needs of this population. Importantly, counselors and mental health workers may need to take on a multifaceted role when working with trafficked individuals, helping to simultaneously address substance use, trauma, family issues, and physical care needs [ 45 ]. Cross-culturally, one of the most important factors in making a positive impact when working with trafficked individuals is promoting feelings of safety by communicating acceptance and understanding [ 46 – 48 ]. Other factors that have been found to facilitate treatment engagement include using a harm reduction and trauma-informed lens to understand behavioral patterns, develop trusting relationships, share decision-making responsibilities, and encourage client autonomy by being flexible [ 46 ]. To date, no treatment has been developed specifically for individuals who have experienced sex trafficking; however, a variety of approaches developed for those who have gone through other forms of trauma have been examined for use with trafficked individuals.

One approach that has been found to be effective when working with those who have experienced CST is trauma-focused cognitive behavior therapy (TF-CBT) [e.g., 37 , 49 •]. This manualized treatment builds on cognitive behavioral principles and uses gradual exposure to help youth and caregivers acknowledge and process trauma while learning and applying coping skills [ 49 •]. TF-CBT has been found to result in significant reductions in symptoms of posttraumatic stress disorder, depression, and deviant behaviors and lead to improvements in self-regulation, hope for the future, and positive affect in multiple countries (e.g., the United States [ 37 , 49 •, 50 ], Cambodia [ 51 ], and India [ 52 ]).

Other treatment approaches include using a mentoring model. My Life My Choice, a U.S.-based treatment program for trafficked youth, pairs youth experiencing CST or those at very high risk of becoming involved in CST with a trained adult mentor who has lived experience with sexual exploitation [ 53 •]. This program has been found to have positive outcomes, improving coping skills and reducing the likelihood of experiencing sex trafficking, engaging in delinquent behavior, and being justice-involved [ 53 •]. Other researchers have found similar support for the inclusion of those with lived trafficking experience in treatment programs [e.g., 54 ]. Yet, despite the benefits of including individuals with lived experience in the treatment process, they are not typically involved in program development [ 55 ].

Conclusions and Recommendations

In recent years, there has been a research focus on better understanding sex trafficking. Empirical data has shown that sex trafficking has become a significant global problem that results in millions of people being sexually exploited each year. While there have been advances in research that shed light on the nature and extent of the problem, there remain many areas in need of further exploration. Below, we detail recommendations for future research and practice.

Recommendations

Sex trafficking is increasingly being understood as a unique form of human trafficking. As such, there should be a universal definition for sex trafficking, both domestically and internationally. Currently, there are a wide range of definitions used across different jurisdictions, which may lead to a lack of clarity and impede detection and prosecution. Relatedly, sex trafficking should be defined as a separate construct from human trafficking more generally; for example, the UN defines human trafficking, but does not have a clear definition of what constitutes sex trafficking. Ultimately, universal definitions for sex trafficking can be beneficial in ensuring a common language across jurisdictions thus improving detection, prevention, and research efforts. Having a common definition of sex trafficking would also be beneficial in prosecuting those who perpetrate sex trafficking across jurisdictions and international borders.

Sex trafficking is a global issue. As such, information sharing between jurisdictions and across countries should be encouraged by legislators to improve international prevention and identification efforts.

Much of the literature on sex trafficking has been conducted in the U.S., with some single studies being conducted in other areas (e.g., Europe and South Asia). Additional research examining the similarities and differences that may exist internationally is needed to adequately identify, prevent, and intervene in cases of sex trafficking. This is especially important since it has been suggested that the perpetrators, tactics, and characteristics of targeted individuals may differ depending on the location, including whether trafficking occurs domestically or internationally [e.g., 18 ••, 20 ••].

Research on sex trafficking in recent years has largely focused on cases involving minors. More research with adults who have been trafficked is needed to better understand the extent of the problem, as there is some evidence that AST may be more common than CST [ 3 ]. Additionally, it would be important to understand how cases of AST and CST may differ, in terms of risk factors for experiencing sex trafficking, recruitment and maintenance tactics, consequences of sex trafficking, and effectiveness of screening, training, and treatment for these populations.

There are other subpopulations of trafficked individuals that warrant further examination. For example, individuals from the LGBTQ + community are at an increased risk of experiencing CST [ 17 ]; however, literature has focused largely on young, presumably heterosexual, girls. This is especially notable in the treatment literature, as there are a lack of materials and programs designed to address the unmet needs of LGBTQ + trafficked individuals [ 24 , 56 ]; as such, additional research examining how to best provide treatment for this population is needed.

The research regarding training professionals on prevention and intervention tends to focus on health professionals. While medical and mental health professionals have an important role to play in treatment, it is often front-line workers such as school personnel, hospitality workers, transportation workers, and law enforcement officers who have first contact with trafficked individuals and those suspected of being trafficked. Thus, they may have an important role to play in prevention, detection, and prosecution of individuals who perpetrate sex trafficking. For example, research has shown that interviewing styles of law enforcement officers can influence trafficked individuals’ willingness to disclose and provide details about sexual exploitation experiences [ 39 ]; as such, training should be tailored to working with this population. Relatedly, policies requiring the training of front-line workers should be implemented to enhance the likelihood of accurate detection and early intervention.

Given that vulnerable individuals are often selected by those who perpetrate sex trafficking [ 15 •, 28 ••], policies advocating for the provision of services (e.g., after school programs, affordable counseling, and work programs) that provide guidance and supervision to at-risk populations should be developed.

In sum, there have been strides to better understand sex trafficking across the globe; however, there remains numerous areas that need further exploration. Additional research is critical, as this will shed light on methods that can be used to identify vulnerable populations, recognize cases of sex trafficking as early as possible, and provide services to those who were sexually trafficked or perpetrated these behaviors.

Declarations

Conflict of interest.

The authors declare no competing interests.

Ethics Approval

All reported studies/experiments with human or animal subjects performed by the authors have been previously published and complied with all applicable ethical standards (including the Helsinki declaration and its amendments, institutional/national research committee standards, and international/national/institutional guidelines).

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Peer-reviewed

Research Article

Are we seeing the unseen of human trafficking? A retrospective analysis of the CTDC k-anonymized global victim of trafficking data pool in the period 2010–2020

Roles Conceptualization, Formal analysis, Investigation, Methodology, Software, Supervision, Validation, Visualization, Writing – original draft, Writing – review & editing

* E-mail: [email protected]

Affiliation Migration Health Division, International Organization for Migration (IOM), Amman, Jordan

Roles Supervision, Validation, Writing – review & editing

Roles Resources, Validation, Writing – review & editing

Affiliation Epidemiological Surveillance Directorate, Jordan Center for Disease Control (JCDC), Amman, Jordan

Affiliation Faculty of Economics and Administration, Department of Health Services and Hospital Administration, King Abdulaziz University, Jeddah, Saudi Arabia

Roles Resources, Validation, Visualization, Writing – review & editing

Affiliation Faculty of Science, Department of Biology and Biotechnology, The Hashemite University, Zarqa, Jordan

Affiliation Faculty of Pharmacy, Zarqa Private University, Zarqa, Jordan

Roles Resources, Visualization, Writing – review & editing

Roles Methodology, Resources, Supervision, Writing – review & editing

Affiliations Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman, Jordan, Department of Clinical Laboratories and Forensic Medicine, Jordan University Hospital, Amman, Jordan, Faculty of Medicine, Department of Translational Medicine, Lund University, Malmö, Sweden

• Ala’a B. Al-Tammemi, 
• Asma Nadeem, 
• Laila Kutkut, 
• Manal Ali, 
• Khadijah Angawi, 
• Maram H. Abdallah, 
• Rana Abutaima, 
• Rasha Shoumar, 
• Rana Albakri, 
• Malik Sallam

• Published: April 20, 2023
• https://doi.org/10.1371/journal.pone.0284762
• Reader Comments

Human trafficking is considered a hidden global crime with unsubstantiated numbers. Despite the challenges in counting or measuring this crime, reports revealed the presence of around 40.3 million victims worldwide. Human trafficking results in severe detrimental impacts on both mental and physical health. Given the sensitivity and negative consequences of human trafficking on the global system and victims, and considering the scarce research in this area, our current study aimed at describing the (i) Sociodemographic profiles of anonymized victims, (ii) Means of control, and (iii) Purpose of trafficking, utilizing the largest anonymized and publicly available dataset on victims of human trafficking.

This is a retrospective secondary analysis of the Counter-Trafficking Data Collaborative (CTDC) data pool in the period from 2010 to 2020. The utilized dataset is called the k-anonymized global victim of trafficking dataset, and it is considered the largest global dataset on victims of human trafficking. Data from the k-anonymized data pool were extracted and exported to Statistical Package for Social Sciences, SPSS® version 27.0 for Windows (IBM Corp. Version 27.0. Armonk, NY) for quality check and analysis using descriptive statistics.

A total of 87003 victims of human trafficking were identified in the period from 2010 to 2020. The most age category encountered among victims was 9–17 years with 10326 victims (11.9%), followed by 30–38 years with 8562 victims (9.8%). Females comprised 70% of the sample with 60938 victims. The United States (n = 51611), Russia (n = 4570), and the Philippines (n = 1988) comprised the most countries of exploitation/trafficking. Additionally, the year 2019 witnessed the greatest number of victims registered for assistance by anti-trafficking agencies with around 21312 victims (24.5%). Concerning means of control, threats, psychological abuse, restriction of the victim’s movement, taking the victim’s earnings, and physical abuse were the most reported means. 42685 victims (49.1%) reported sexual exploitation as the purpose of their trafficking, followed by forced labor with 18176 victims (20.9%).

Various means and methods can be used by traffickers to control the victims to be trafficked for many purposes, with sexual exploitation and forced labor being the most common ones. Global anti-trafficking efforts should be brought together in solidarity through utilizing the paradigm of protection of victims, prosecution of traffickers, prevention of trafficking, and inter-sectoral partnerships. Despite being a global concern with various reports that tried to capture the number of trafficked victims worldwide, human trafficking still has many unseen aspects that impose a significant challenge and adds to the global burden in combatting this threat.

Citation: Al-Tammemi AB, Nadeem A, Kutkut L, Ali M, Angawi K, Abdallah MH, et al. (2023) Are we seeing the unseen of human trafficking? A retrospective analysis of the CTDC k-anonymized global victim of trafficking data pool in the period 2010–2020. PLoS ONE 18(4): e0284762. https://doi.org/10.1371/journal.pone.0284762

Editor: Lea Sacca, Florida Atlantic University Charles E Schmidt College of Medicine, UNITED STATES

Received: January 1, 2023; Accepted: April 6, 2023; Published: April 20, 2023

Copyright: © 2023 Al-Tammemi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: The data underlying the results presented in the study are available from CTDC ( https://www.ctdatacollaborative.org/dataset/global-k-anonymized-data-and-resources ).

Funding: The author(s) received no specific funding for this work.

Competing interests: The authors have declared that no competing interests exist.

1. Introduction

Generally, migration is defined as changing the place of habitual residence for a variety of reasons, and this can be temporarily or permanently, within the same country or through moving to another country [ 1 , 2 ]. Also, various geopolitical, technological, and environmental factors are shaping global migration [ 2 ].

From a legal perspective, migration can be categorized into regular migration which is considered an authorized movement managed by various official authorities around the world, or irregular migration which corresponds to unauthorized movement through illegal ways such as smuggling and human trafficking [ 3 ]. The term human trafficking is also known in the literature as trafficking in person (TIP) or modern-day slavery [ 4 ]. The United Nations (UN) defines human trafficking as “ the recruitment , transportation , transfer , harbouring or receipt of persons , by means of the threat or use of force or other forms of coercion , of abduction , of fraud , of deception , of the abuse of power or of a position of vulnerability or of the giving or receiving of payments or benefits to achieve the consent of a person having control over another person , for the purpose of exploitation ” [ 5 , 6 ]. Human trafficking is considered a crime and a severe multidimensional violation of human rights as well [ 7 ].

Human trafficking comprises three main elements [ 8 ]. For the purpose of understanding these elements, and how human trafficking occurs, a model called the Actions—Means—Purpose model (A-M-P model) has emrged [ 7 ]. Actions that may be taken by the perpetrator/trafficker include recruiting, harboring, obtaining, patronizing, soliciting, or transporting, while the means include force, coercion or fraud, and the purpose of trafficking is usually sex trafficking (commercial sex) or labor/service trafficking [ 9 ]. Concerning the dimensional aspects of the means in the A-M-P model, the force could be through physical assault, confinement, or drugging the victim, fraud could be through false promises, fake travel documents, or false advertising, while coercion could be either physical (e.g., threatening to hurt someone, threatening by a weapon) or psychological (e.g., threats against the victim or the family, threats to be sent to jail) [ 7 ]. Also, human trafficking as a concept differs from human smuggling as they are considered two distinct terms and crimes. While human smuggling requires the movement of victims across borders, human trafficking can occur without leaving the country [ 10 ]. Although both concepts differ, smuggled humans have a high vulnerability for being victims of human trafficking too [ 10 ].

Trafficking of humans results in significant negative impacts on both mental and physical health due to the accompanying physical and psychological violence, in addition to poor living conditions [ 11 ]. Various psychological responses have been reported by victims including posttraumatic stress symptomology, depression, anxiety, aggression, irritability, poor sleep, insomnia, avoidance and isolation, phobias and panic attacks, substance abuse, hopelessness, distrust and fear of strangers, loss of interest in things, inability to plan for the future, fear of being permanently damaged, and fear of rejection [ 12 ].

In addition to the mental health impacts, human trafficking imposes detrimental consequences on victims’ physical well-being too. Victims of human trafficking do not have sufficient access to quality medical care due to various reasons, with financial constraints and the victim’s illegal status being the most common barriers [ 11 ]. Moreover, victims are more prone to food deprivation and poor nutrition, memory loss, chronic pain, infectious diseases including viral, parasitic, and bacterial diseases (e.g., hepatitis, tuberculosis, sexually transmitted infections, contagious skin infestations), and occupational injuries [ 12 ].

Human trafficking is considered a hidden global crime with unsubstantiated numbers. Despite the challenges in counting or measuring this crime, the International Labour Organization (ILO)’s 2017 report estimated the presence of approximately 40.3 million victims of human trafficking, of whom 29.4 million were identified as victims of forced labor trafficking reports revealed the presence of around 40.3 million victims worldwide [ 5 , 13 ]. Given the sensitivity, hidden nature, and negative consequences of human trafficking on the global system and victims, and considering the need for more research in this area, our current study aimed at analyzing part of the largest anonymized dataset on victims of human trafficking in the period 2010–2020, in light of the A-M-P model. More specifically, we aimed at describing the following: (i) Sociodemographic profiles of anonymized victims, (ii) Means of control, and (iii) Purpose of trafficking. More details about the dataset and the analysed variables are described in the methods section of this paper.

2. Materials and methods

2.1 study design.

This is a retrospective analysis of a publicly available dataset on global victims of human trafficking.

2.2 An overview of the dataset and data contributors

The dataset used in our analysis is based on the Counter-Trafficking Data Collaborative (CTDC) which is a collaborative hub on human trafficking that provides data through collaboration between various counter-trafficking agencies including the IOM, Polaris, Recollectiv (formerly: the Liberty Shared), The Portuguese Observatory on Trafficking in Human Beings (OTSH), and the A21 [ 14 ]. Additionally, Microsoft ® and Tech Against Trafficking are the technology contributors. The CTDC initiative’s donors are the U.S. Department of State Bureau of Population, Refugees, and Migration (PRM); the U.S. Department of Labour (DOL) through the International Labour Organization (ILO)’s Research to Action (RTA) project; the Global Fund to End Modern Slavery (GFEMS) under a cooperative agreement with the U.S. Department of State (DOS); the IOM Development Fund; and the Ministry of Foreign Affairs of the Netherlands (BZ) [ 14 ].

The created dataset by the CTDC initiative is called the global victim of trafficking dataset . It is considered the largest global dataset on victims of human trafficking. The required data are collected and updated by the contributing agencies and through the case management system [ 15 ]. Due to the sensitivity of human trafficking data, individual-level data were protected at two stages, the first stage is through the elimination of all personal identifiers from the dataset, and the second stage which corresponds to a more advanced level of protection is through a mathematical approach called k-anonymization [ 15 ]. The global K-Anonymized dataset that has been used in our analysis comprises data on more than 156,000 victims of human trafficking from around 189 countries from 2002 to 2021. The dataset used in our analysis is dated 15 July 2021, and it is publicly available to researchers and policymakers through the CTDC website ( https://www.ctdatacollaborative.org/dataset/global-k-anonymized-data-and-resources ).

2.3 Study population in the analysed period

The authors of the present paper have decided to analyze the data for the period 2010 to 2020 using the k-Anonymized global victim of trafficking dataset. In the mentioned period, 87003 victims of human trafficking were identified.

2.4 Description of the analysed variables

2.4.1 sociodemographic information..

This part comprised variables that are related to the year of registration (reflects the year in which the victim was identified and assisted by the counter-trafficking agency), data source (reflects the data collection method, whether through case management system or hotline service), gender (female, male, or transgender), age category in years (0–8, 9–17, 18–20, 21–23, 24–26, 27–29, 30–38, 39–47, 48+), majority status at registration (reflects whether the victim was above 18 years or under 18 years of age at the time of registration and assistance by the concerned counter-trafficking agency; thus, categorized as adult or minor), majority Status at exploitation/trafficking (reflects whether the victim was above 18 years or under 18 years of age at the time of trafficking or exploitation; thus, categorized as adult or minor), the victim’s nationality or the country of origin, and country of trafficking/exploitation (the country where a victim is first identified and assisted). Concerning gender classifications, the IOM started to include gender (not sex at birth) including the transgender/non-Conforming category in the survey questionnaire starting in 2017.

2.4.2 Means of control.

In this part, the means of controlling human trafficking victims are collected, and it includes control by debt bondage, control by taking the remunerations/earnings of the victims, control through restrictions of victim’s capability to access the needed daily living funds, control through threats, control through psychological abuse, control through physical abuse, control through sexual abuse, control through false promises, control through psychoactive substances, control through restriction of victim’s freedom of movement, control through restriction of access to medical care, control through excessive working hours, control through restricting the victims’ access to their children, control though threats of law enforcement and imprisonment, control through withholding necessities such as access to basic daily needs, and control through withholding or destroying official documents such as passports, work permits, or other legal or governmental documents. It is important to note that traffickers may use a combination of these means of control to exploit and enslave their victims.

2.4.3 Purpose of trafficking.

This part reflects the purpose of trafficking of the victims, and it includes, forced labor, sexual exploitation and services, combined sex and labor services, forced marriage (a marriage that was imposed on the individual under the threat of a penalty), forced military service (military service that was imposed on the individual under the threat of a penalty), organ removal, as well as slavery and similar practices. Regarding sex services, this included prostitution, pornography, remote interactive services, and private sexual services.

2.5 Data analyses

Data from the k-anonymized global victim of trafficking dataset were extracted and exported to Statistical Package for Social Sciences, SPSS® version 27.0 for Windows (IBM Corp. Version 27.0. Armonk, NY) for quality check and analysis. Descriptive statistics were performed for categorical and numerical data. The age was presented in categories that were described in section 2.4.1. Other categorical variables were presented as frequency counts and percentages. The dataset has many missing values in various parts which represent data that were not collected/missed/could not be retrieved. Missing values were reported where appropriate.

2.6 Ethical considerations

The utilized dataset was already anonymized by the CTDC’s technological support agencies using a two-step anonymization. Also, no insititutional review board (IRB) approval is required for the utilization of the dataset as it is freely and publicly available to researchers and policymakers through the CTDC initiative website ( https://www.ctdatacollaborative.org/dataset/global-k-anonymized-data-and-resources ). This retrospective analysis involving human participants was conducted in accordance with the ethical standards of the 1964 Helsinki Declaration and its later amendments.

3.1 Sociodemographic profile of victims

A total of 87003 victims of human trafficking were identified in the period from 2010 to 2020 within the utilized dataset. The most age category encountered among victims was 9–17 years with 10326 victims (11.9%), followed by 30–38 years with 8562 victims (9.8%). 43656 victims (50.2%) were identified as adults (aged 18 years and above) at the time of registration for assistance by anti-trafficking agencies, whereas 6675 victims (7.7%) were identified as adults at the time of trafficking or exploitation. Females comprised 70% of the sample with 60938 victims. Approximately, 60.5% of the trafficking data were obtained through hotline services. Table 1 presents more details about the sociodemographic characteristics of the victims.

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https://doi.org/10.1371/journal.pone.0284762.t001

Concerning nationality or country of origin of victims, the top 10 countries -in descending order- were the Philippines (n = 11454), Ukraine (n = 7478), U.S (n = 6366), Moldova (n = 4984), Mexico (n = 2382), Cambodia (n = 2130), Indonesia (n = 1513), Myanmar (n = 1371), Nigeria (n = 1040), and Belarus (n = 884). 43101 victims (49.5%) had an unknown country of origin (missing value). On the other hand, the top 10 countries of exploitation/trafficking -in descending order- were the U.S. (n = 51611), Russia (n = 4570), the Philippines (n = 1988), Indonesia (n = 1784), Cambodia (n = 1029), Mali (n = 550), Thailand (n = 505), Malaysia (n = 501), Poland (n = 485), and Saudi Arabia (n = 355). Missing values related to the country of exploitation were (19072; 21.9%). The year 2019 witnessed the greatest number of victims registered for assistance with 21312 victims (24.5%), followed by 2016 (n = 18836; 21.6%), and 2018 (n = 18265; 21.0%). See Fig 1 .

https://doi.org/10.1371/journal.pone.0284762.g001

3.2 Means of control

The most reported means of control were threats (n = 12343), psychological abuse (n = 11980), restriction of the victim’s freedom of movement (n = 11059), taking the victim’s remunerations/earnings (n = 8588), physical abuse (n = 8187), whereas the lowest reported means of control was restricting victims’ access to their children (n = 360). Table 2 shows more details about the reported means of control.

https://doi.org/10.1371/journal.pone.0284762.t002

3.3 Purpose of trafficking

Around 42685 victims (49.1%) reported sexual exploitation as the purpose of their trafficking, followed by forced labor with 18176 victims (20.9%). See Fig 2 for more details. Concerning types of sex work for those who experienced sexual exploitation as a purpose of trafficking were prostitution (n = 13287; 15.3%), followed by pornography (n = 1866; 2.1%), private sexual services (n = 487; 0.6%), and remote interactive sex services (n = 118; 0.1%).

https://doi.org/10.1371/journal.pone.0284762.g002

4. Discussion

To the best of the authors’ knowledge, this is the first scholarly paper to analyze the largest publicly available data pool on human trafficking in the period 2010–2020, utilizing the K-Anonymized CTDC global victim of human trafficking dataset. The period 2010 to 2020 were particularly turbulent in the fight against human trafficking in light of the 2010 United Nations Global Plan of Action to Combat Trafficking in Persons.The current analysis aimed to describe the anonymized sociodemographic profile of victims, means of control, and the purpose of trafficking. Our paper provides a brief and initial insight into a very sensitive and complicated crime that is of global concern. As mentioned earlier, global migration is affected and shaped by many geopolitical and socioeconomic factors [ 16 , 17 ]. These factors may have negative impacts leading to an increased level of irregular migration (i.e., migration through illegal/unauthorized ways). Persons who enter the process of irregular migration become extremely vulnerable for exploitation and abuse by crime organizations involved in human trafficking [ 18 ]. Human trafficking or trafficking in person has been a global concern as it attracted public attention for the past 20 years due to its detrimental and harmful impact on both the mental and physical well-being of victims, its violation of the victims’ dignity, freedom and human rights, as well as its impact on global security [ 19 , 20 ]. There are many hazards associated with human trafficking that can be linked to exploitation-related risks (e.g., abuse, occupational hazards, unsafe living conditions, and poor nutrition), or global health (vulnerability to infectious and non-communicable diseases, occupational injuries, financial insecurity, mental health burden, and hazardous labor cycles) [ 5 ].

As mentioned earlier, the ILO’s report revealed the presence of more than 40 million people who were victimized through trafficking in persons [ 5 ]. Additionally, the same ILO statistics reported that most victims are females, which is also similar to what was found in our analysis. Also, the findings of our present study are consistent with the 2016 UNODC report which revealed that the majority of trafficked victims were women, girls, and younger children and accounted for 71% [ 21 ].

Our study found that the most reported purpose of trafficking is sexual exploitation, followed by forced labour. This is consistent with statistical reports released by the U.S Department of Justice regarding suspected human trafficking cases in the period 2008–2010 which found that 8 in 10 of the suspected incidents of human trafficking were classified as sex trafficking, while 1 in 10 incidents were classified as labor trafficking [ 22 ]. The same report found that the prominent subtype of sex trafficking is prostitituion which was also found in our analysis [ 22 ].

Also, human trafficking is affecting various populations regardless of age, gender, and nationality. Children/minors are also in danger of this crime as they can be trafficked for forced labor, forced military service, and sex trafficking [ 23 ]. In addition, certain populations have high vulnerability to being victimized through human trafficking such as minors, victims of child sexual abuse, foreign nationals, persons with extreme poverty, and lesbian, gay, bisexual, transgender, queer, and others (LGBTQ+) individuals [ 23 ].

5. Study implications and the way forward

To combat human trafficking, governments and organizations around the world have implemented a range of measures and strategies to prevent trafficking, protect victims, and prosecute traffickers [ 24 ]. These efforts may include (i) legal frameworks through laws and regulations to criminalize human trafficking and provide protections for victims, (ii) prevention efforts through awareness campaigns, education programs, and efforts to disrupt the demand for exploitation, (iii) protection and support for victims through providing safe and secure housing, medical and mental health care, and legal assistance to victims of trafficking, (iii) prosecution of traffickers through law enforcement and efforts to strengthen the criminal justice system to better respond to trafficking, and (iv) international cooperation through working together and sharing information and resources [ 25 , 26 ]. This may involve collaboration across borders and between different sectors, such as the law sector, social services, and non-governmental organizations (NGOs).

Additionally, global anti-trafficking efforts may include intelligence and information sharing through gathering and sharing information about human trafficking cases, trends, and networks, as well as using this information to inform law enforcement and victim services efforts [ 25 ].

Some examples of global anti-trafficking initiatives and laws are, a collaboration between the IOM, the European Union (EU), the United Nations Office on Drugs and Crime (UNODC) was established to counteract human trafficking through The Global Action against Trafficking in Persons and the Smuggling of Migrants—Asia and the Middle East (GLO.ACT Asia and the Middle East) in the period 2015–2019 [ 27 ]. Additionally, the UNODC has set a Global Initiative to Fight Human Trafficking (UN.GIFT) which was implemented in 2007 with the main objective of fighting human trafficking through raising public awareness, strengthening preventive measures, supporting and protecting victims, anti-trafficking law enforcement, implementing international commitment, strengthening partnerships, and providing funds for necessary services and initiatives [ 28 ]. Moreover, various anti-trafficking laws were established in various regions such as the 2006 Ouagadougou Action Plan to Combat Trafficking in Human Beings in the African Union, the Plan of Action Against Trafficking in Persons especially Women and Children—2015, the Convention Against Trafficking in Persons, Especially Women and Children—2015, and the Declaration Against Trafficking in Persons, Particularly Women and Children—2004 which were established by the association of southeast Asian nations [ 29 ]. The EU has been also active in implementing various measures to fight human trafficking through the 2012–2016 EU Strategy towards the Eradication of Trafficking in Human Beings, and 2011 Directive 2011/36/EU on Combating and Preventing Trafficking in Human Beings and Protecting its Victims. Furthermore, Arab states have joined the global anti-trafficking efforts through the 2012 Comprehensive Arab Strategy for Combating Trafficking in Human Beings, the 2010 Arab Initiative to Combat Trafficking in Persons, and the 2008 Arab Framework Act on Combating Trafficking in Persons [ 29 ]. The Americas as well have paid tremendous attention to the issue of human trafficking through the 2018 Hemispheric Efforts against Trafficking in Persons “Declaration of Mexico”, the 2014 Inter-American Declaration against Trafficking in Persons, and the 2010–2014 Working Plan to Combat Trafficking in Persons in the Western Hemisphere [ 29 ].

Looking at how various countries and nations are standing against human trafficking through various laws and initiatives, it is important to stress the point that anti-trafficking efforts are challenging due to the many complexities surrounding this issue. The UN has classified human trafficking as the third most profitable crime globally [ 30 ]. Also, human trafficking does not only have economic perspectives but also a public health one. The economic, social, and health impacts of human trafficking are still not thoroughly looked at and researched. According to recent statistics, human trafficking was estimated to be a $150 billion industry [ 31 ].

To successfully combat human trafficking, anti-trafficking efforts should be brought together in solidarity through inter-governmental and intersectoral partnerships involving governmental organizations, NGOs, the private sector, and communities [ 32 ]. Tackling a global threat like human trafficking does not have a smooth pathway. Therefore, a multi-faceted approach is required such as the 4Ps paradigm which includes: Protection, Prosecution, Prevention, and Partnerships is considered an essential approach to combat human trafficking [ 33 ].

Our study has limitations that should be taken into consideration while interpreting the findings. The CTDC K-Anonymized dataset has many missing values which may change some statistical figures if these missing values were collected. Also, the collected data through the CTDC initiative is not considered a random sample of all victims globally as the crime of human trafficiking can not be easily quanitified due to the hidden nature of this issue. Additionally, there is a possibility of recall bias that impacted the collected data and may have led to the missing values as victims of human trafficking might suffer from psychological traumas that negatively affect their ability to recall events. Another limitation to this study could be that the numbers of those exposed to human trafficking are underestimated and underreported so we cannot assume that the results are generalizable to the population of global victims or international migrants. Nevertheless, our findings provide an initial insight into some statistics related to human trafficking utilizing the CTDC collaborative hub, and we encourage further research in this field with the involvement of a longer period of analysis and utilizing more variables as well.

6. Conclusion

Human trafficking has detrimental consequences on the physical and psychological health of victims. Various means and methods can be used by traffickers to control the victims to be trafficked for many purposes with sexual exploitation and forced labor being the most common ones. Global anti-trafficking efforts should be brought together in solidarity through utilizing the paradigm of protection of victims, prosecution of traffickers, prevention of trafficking, and inter-sectoral partnerships. Despite being a global concern with various reports that tried to estimate the number of trafficked victims globally, human trafficking still has many unseen aspects that impose a significant challenge and adds to the global burden in combatting this worldwide threat.

Acknowledgments

The authors would like to thank the CTDC initiative and collaborators for providing the anonymized dataset publicly to researchers and policymakers.

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