The following was originally published as the preface from Sex Trafficking: A Clinical Guide for Nurses, and is republished here for National Slavery and Human Trafficking Prevention Month.

This is not an easy book to read. Many of the images described in these pages will stay with the reader for weeks, but that is a small price to pay for an awareness of this new pandemic. It is critically important that we stop modern-day slavery. Although this phenomenon has been growing for more than a decade, there is little health care literature describing, explaining, or providing information on how to care for survivors.

Like many of my colleagues, I was simultaneously stunned and horrified to learn that slavery exists today. Not only “over there,” but right here in our own communities. Earlier reports of human trafficking were distant and, while disturbing, those reports described a problem that would surely disappear on its own. Not only did it not disappear, it has been growing while we slept. We can no longer deny our complicity in this practice. To quote Pogo, “We have met the enemy ... and he is us” (Kelly & Crouch, 1982, p. 157). I do not mean to imply that health care providers are actively participating in modern slavery. We are made complicit by our ignorance and our unwillingness to see or know the stories of people who silently pass right by us. Dr. de Chesnay and her coauthors have presented an account of the modern slave trade that is compelling, informative, and an unmistakable “call to action.”

The U.S. Department of State Trafficking in Persons Report 2012 (2012) estimates there are 27 million people currently living in slavery. More than any other time in the history of the world, and the numbers of people enslaved are rising rapidly. There are many reasons proposed for this sudden increase in a practice long thought extinct. Probably, the most compelling reason is that criminal exploitation of people generates over $32 billion in profits for the traffickers each year, and is now the fastest growing criminal activity in the world (Polaris Project, 2010).

But there is more. All of us are involved, as consumers. In Chapter 2, Mark and Keisha Hoerrner explain the links between slavery and the supply chain. Insisting that the manufacturer of the goods you buy knows how the goods are produced and can prove that no slaves were involved in the manufacture will go a long way toward ending this practice. Go to to complete an assessment of how and where forced labor affects your life and how you can join the fight.

The most effective intervention to date has been the passage of laws that prevent traffickers from operating in a local jurisdiction; the United States has been actively writing legislation to address the many aspects of trafficking. However, laws are not enough. It is imperative to raise the veil of silence that hides slavery in our own neighborhoods. In the United States, there are 14,000 to 15,000 people trafficked across the border each year (American College of Obstetricians and Gynecologists, 2011). The organization, Not for Sale (2012), sponsors an interactive map with locations throughout the United States that have been sites of human trafficking The first step toward ending slavery is recognition that it exists.

A variety of websites offer tools to help health care providers identify and assist survivors of trafficking. For example, The Polaris Project (2010) has created a Medical Assessment Tool, and other materials directed to educate nurses and other frontline health care providers ( on how to recognize a survivor, and then who to contact and what to do. The United Nations International Children’s Emergency Fund (UNICEF) has created the Training Manual to Fight Trafficking in Children for Labour, Sexual and Other Forms of Exploitation (2009). These manuals (a series of three, plus an exercise book and facilitators’ manual) provide concrete information about how to identify, and help children who are being exploited. Another tool was created by experts in the field of trafficking survivors and the UN.GIFT/UNODC, in cooperation with the Austrian Criminal Intelligence Service and the Austrian NGO LEFOE-IB to create VITA, a Victim Translation Assistance Tool, at This free program can be downloaded to a laptop or smartphone. The audio tool has 35 basic phrases that were carefully designed to communicate with a suspected victim of trafficking. The phrases have been translated into 40 different languages. This very handy program was designed to assist law enforcement officers or victim service providers with victims who do not speak their language to increase the success rate in identifying and rescuing victims of trafficking.

Zimmerman, Hossain, and Watts (2011) call for a growing awareness of the health implications of trafficking. They have created a conceptual model that could be used to identify intervention points in the process of trafficking, to outline periods when health care providers should be involved in referrals and service planning, and/or provide a framework that could be used to develop research in this area. Although trafficking in people has been growing steadily for the past decade, the involvement of public health and health care providers is just beginning. Other disciplines have moved quickly to establish a variety of organizations dedicated to the abolition of slavery. So, there is hope, and we are not alone in the fight. There are already initiatives that have been showing promise in rescuing and recovering survivors. Health care is ready to join the chorus of disciplines focused on defeating this problem.

Melanie S. Percy, PhD, RN, CPNP, FAAN

University of Medicine & Dentistry of New Jersey

School of Nursing

Newark, New Jersey



American College of Obstetricians and Gynecologists. (2011). Human trafficking. Committee Opinion No. 507. Obstetrics and Gynecology, 118, 767–770.

International Labour Office. (2009). Training manual to fight trafficking in children for labour, sexual and other forms of exploitation. Geneva, Switzerland: International Programme on the Elimination of Child Labour (IPEC). Available at:

Kelly, W., & Crouch, B. (Eds.). (1982). The best of Pogo (157pp.). New York, NY: Simon &Schuster.

Not for Sale. (2012). Slavery map. Available at:

Polaris Project. (2010). Human trafficking, international trafficking. Available at:

Polaris Project. (2010). Medical assessment tool. Available at:

The Campaign to Rescue and Restore Victims of Human Trafficking. (2010). Rescue & Restore Campaign Tool Kits, for Health Care Providers. Washington, DC: US Department of Health and Human Services, Administration for Children and Families. Available at:

United States Department of State. (2012). 2012 Trafficking in Persons Report—United

States of America. Available at:; [accessed 19 July 2012].

Zimmerman, C., Hossain, M., & Watts, C. (2011). Human trafficking and health: A conceptual model to inform policy, intervention and research. Social Science & Medicine, 73, 327–335