Seeing the signs: The subtle clues of human trafficking as seen in the clinic

Human trafficking is not something most optometrists expect to encounter in the clinic, but the truth is that it’s happening everywhere and is more common than we realize. It doesn’t discriminate by zip code and, unfortunately, it often hides in plain sight. As optometric health care providers who may interact with patients more frequently, we are in a unique position to recognize red flags and respond appropriately. As unsettling as it is to acknowledge, we can be part of the solution.

What is human trafficking?

According to the Trafficking Victims Protection Act of 2000, “severe forms
of trafficking in persons” include both sex trafficking and labor trafficking.¹ Sex trafficking involves the use of force, fraud, or coercion to compel a person to engage in a commercial sex act, or any commercial sex act involving a minor.¹ Labor trafficking, on the other hand, refers to the recruitment or use of labor or services through coercion, fraud, or force across various industries.¹

However, as survivor and advocate Jasmine Grace Marino explains, “One of the biggest misconceptions is that trafficking always looks like someone being physically restrained or obviously abused. Many providers think victims will ‘act like victims’—scared, disheveled, or eager to disclose.... Another misconception is that trafficking is always a violent, clear-cut crime involving strangers. Often, the trafficker is someone the victim knows, trusts, or even loves. It’s psychological bondage more than physical.”

Why should optometrists care?

Human trafficking is a public health crisis, and that includes ocular health. Victims may present to eye care providers for any number of reasons, including routine exams or ocular manifestations of trauma. In a 2024 report by the US Department of Justice, more than 1900 individuals were referred to US attorneys for human trafficking offenses, including both labor and sex trafficking.² This is likely a gross underrepresentation given how few victims come forward and how infrequently charges are brought against those trafficking.

Optometrists may be among the few health care professionals a trafficked individual encounters. As Marino urges, providers shouldn’t “assume silence means safety. Just because a patient doesn’t disclose abuse doesn’t mean everything is OK. Ask trauma-informed, nonjudgmental questions. Offer eye contact, dignity, and space to speak without their companion. That safe moment you create may be the first time someone has ever felt seen.”

It’s essential that optometrists be equipped to recognize the subtle physical, behavioral, and social signs of trafficking and know how to respond safely and effectively.

Who is at risk?

Anyone can be trafficked, but certain populations are disproportionately targeted, including the following:

• Children with histories of abuse, neglect, or foster care involvement
• Individuals experiencing homelessness or poverty
• Members of the LGBTQ+ community
• Migrant workers and undocumented immigrants
• People with substance use disorders
• Racial, ethnic, and indigenous minorities
• Survivors of interpersonal or sexual violence^3,4

During natural disasters or public emergencies, vulnerabilities to human trafficking increase dramatically.⁵ Displacement, separation from support systems, and language barriers make it even easier for traffickers to exploit individuals in crisis.⁵ In 2019, the National Center for Missing & Exploited Children estimated that 1 in 6 endangered runaways reported was likely victims of sex trafficking.⁶

According to the Polaris Project, trafficking occurs across both legal and illegal industries, and victims are controlled using a variety of coercive methods.⁵ More commonly, individual traffickers are often previously known by the victims, gaining their trust before exploiting them. Common control tactics include threats, intimidation, violence, debt bondage, emotional manipulation (ie, false romantic relationships), and isolation from friends or health care access.⁵^,⁷ These strategies make it incredibly difficult for victims to speak up, even when the opportunity arises.

Recognizing the red flags in the clinic

In specialties like eye care, where encounters are often brief and narrowly focused, it can be easy to overlook subtle relational dynamics. But our most powerful tool is our clinical intuition when something doesn’t add up—don’t ignore it.

“A major red flag is when a patient doesn’t speak for themselves or is overly controlled by someone accompanying them,” Marino said. “Another is inconsistent personal information, like not knowing their address or their [identification] not matching their stated story.” In an eye care setting, she notes that clues might include bruising around the eyes, repeated infections, or a lack of consistent glasses despite reported visual issues, which are signs that the patient may not be receiving adequate care or may have limited autonomy.

Always pay attention to how the patient responds to even simple questions. Do they hesitate? Do they glance at their companion for approval? Do they appear fearful? These seemingly small signals can be critical indicators that something deeper is going on. (See Figure.)

What can you do?

If you suspect trafficking, your first priority is safety—both yours and the patient’s. Never confront a suspected trafficker directly and avoid any action that might endanger the individual if they are being monitored. Instead, consider the following steps:

1. Create a safe space for the patient to speak privately if possible.
2. Avoid leading questions; instead, use open-ended, trauma-informed language.
3. Use trained interpreters when language barriers exist—never a companion.
4. Document objective findings if appropriate, and be mindful that your notes can become legal documents.
5. Know your resources and mandatory reporting laws in your state.

“Trust your instincts but follow up with compassion, not confrontation,” Marino said. “Don’t try to ‘rescue’ them on the spot, as that can put them in more danger. Instead, try to separate them from their companion for even a brief moment and ask open-ended questions in private. Have materials like hotline cards or local resources ready to discreetly hand off. If you’re unsure what to do, consult your hospital’s social worker or trafficking response protocol. Sometimes the most powerful thing you can do is plant a seed and let the survivor know someone cares.”

Equipping your office with discreet, multilingual educational materials can make a world of difference. Victims may not be able or ready to talk. Posters, wallet cards, and flyers in bathrooms or waiting areas may empower someone to reach out when it’s safe (see Sidebar).

This may not be something we encounter often in practice, if ever. And no, we’re not social workers or detectives. But that doesn’t mean we, as doctors and as human beings, are off the hook. We do have a responsibility to be aware of the risks and red flags, and we are not powerless. Every optometrist can learn to recognize the signs, ask questions with compassion, and connect patients with the help they may desperately need. Sometimes, a poster in your waiting room or a quick review of your state’s reporting protocols could be the only lifeline someone gets.

Spotlight: Bags of Hope

Programs like Bags of Hope meet survivors where they are—both literally and emotionally. They build trust, restore dignity, and provide practical resources without judgment. Health care providers can support this work by learning about local organizations, referring patients discreetly, and even getting involved through donations or volunteering. When clinicians and outreach efforts align, we start to weave a safety net, 1 thread at a time.

References:

1. Trafficking Victims Protection Act of 2000, 22 USC § 7102 (2000). Accessed September 4, 2025. https://www.congress.gov/bill/106th-congress/house-bill/3244

2. Bureau of Justice Statistics. Human Trafficking Data Collection Activities, 2024 Report. US Department of Justice. Accessed September 4, 2025. https://bjs.ojp.gov/document/htdca24.pdf

3. Centers for Disease Control and Prevention. About Sex Trafficking. U.S. Department of Health and Human Services, April 9 2024. Accessed September 4, 2025. https://www.cdc.gov/sexual-violence/about/about-sex-trafficking.html

4. The typology of modern slavery. Polaris. Accessed September 4, 2025. https://polarisproject.org/the-typology-of-modern-slavery/

5. The role of healthcare providers in combating human trafficking during disasters. Administration for Strategic Preparedness and Response. Accessed July 17, 2025. https://aspr.hhs.gov/at-risk/Pages/human-trafficking.aspx

6. Sex trafficking. National Human Trafficking Hotline. Accessed July 17, 2025. https://humantraffickinghotline.org/en/human-trafficking/sex-trafficking

7. Recognizing the signs. National Human Trafficking Hotline. Accessed July, 17 2025. https://humantraffickinghotline.org/en/human-trafficking/recognizing-signs