Barriers to disclosure — A major challenge for health care providers is the difficulty in identifying victims. Victims rarely self-identify because of multiple factors including fear of the trafficker, distrust of authorities, feelings of shame and hopelessness, trauma bonds (ie, Stockholm syndrome), and threats [20,26,27]. Threats used by traffickers can include acts of retribution against children or other family members, deportation, or criminal prosecution, in addition to psychological and physical harm. Further, some victims may not fully understand the nature of their situation and may not realize they are being trafficked because they receive housing, food, or clothing [28]. Similarly, when human trafficking is carried out under the guise of romance, trafficked persons may believe they are simply involved in a troubled romantic relationship and fail to recognize their exploitation.
In addition to being potentially dangerous, disclosure can also be emotionally difficult and is an act demonstrating significant courage [2]. One interview study of 17 survivors of childhood trafficking reported that patients do want clinicians to ask about trafficking, clinicians should emphasize confidentiality and privacy, and that, when done with appropriate privacy, being asked about trafficking is not retraumatizing [27]. Some victims may make multiple visits to a health care setting before deciding if they can safely reveal their situation. Lastly, discussing trafficking may be easier for the individual when the provider is of the same sex, ethnicity, or age range.