Related Health Topics

Child maltreatment includes all types of abuse and neglect of a child under the age of 18 by a parent, caregiver, or another person in a role of authority (e.g., a coach, teacher, or church leader). There are four common types of maltreatment:

Read more about detecting and preventing child maltreatment.

Elder abuse is often committed by people who are responsible for caring for an elder, or who are people that the elder trusts. Elder abuse can include both abuse and neglect and can take many forms, including physical, sexual, emotional, psychological, or financial abuse and neglect.

Read more about detecting and preventing elder abuse.

Human trafficking is a significant public health issue and a crime where traffickers uses of force, fraud, or coercion to compel a person into commercial sex acts or labor against their will. Human trafficking, modern day slavery, and/or trafficking in persons are all interchangeable terms referred to as the exploitation and profit at the expense of adults or children by compelling them to perform labor or engage in commercial sex. All health care providers, particularly those engaged in primary care, emergency care, reproductive health, mental health, and pediatrics, are well-positioned to identify and assist trafficked individuals and those at-risk.

Even though trafficked individuals are often tightly controlled and hidden from public view, a surprising proportion of survivors report having accessed medical care while under the control of their traffickers. Therefore, health care providers who can provide efficient and compassionate assistance to patients and are educated about risk factors and clinical signs of human trafficking have the potential to play a key role in addressing this problem.

There are two recognized forms of human trafficking:

• Sex trafficking: recruitment, harboring, transportation, provision, obtaining, patronizing, or soliciting of a person for the purpose of a commercial sex act 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. (22 U.S.C. § 7102(11)(A)).
• Labor trafficking: 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. (22 U.S.C. § 7102(11)(B)).

A-M-P Framework

Human Trafficking = Action (by trafficker) + Means (trafficker conducts) + Purpose (compels the victim to perform)

• Action: induce, recruits, harbors, transports, providers, or obtains
• Means: Force, Fraud, or Coercion
• Purpose: Commercial Sex or Labor/Services

The complex layers and issues of the human trafficking present well beyond understanding the definition. To understand the complexity, it is important to raise awareness of historical trauma and slavery.

Read myths and truths about human trafficking.

Resources for Providers

• Blue Campaign Exit Disclaimer: You Are Leaving www.ihs.gov  – from the U.S. Department of Homeland Security, raising public awareness about human trafficking
• National Human Trafficking Hotline Exit Disclaimer: You Are Leaving www.ihs.gov – 888.373.7888
• National Human Trafficking Training and Technical Assistance Center Exit Disclaimer: You Are Leaving www.ihs.gov 
• SOAR for Indigenous Communities Exit Disclaimer: You Are Leaving www.ihs.gov 
• Polaris Project Exit Disclaimer: You Are Leaving www.ihs.gov 
• SAMHSA Tribal Training and Technical Assistance Center Exit Disclaimer: You Are Leaving www.ihs.gov 
• Tribal Resource Tool Exit Disclaimer: You Are Leaving www.ihs.gov 
• National Action Plan to Combat Human Trafficking (NAP) Exit Disclaimer: You Are Leaving www.ihs.gov 
• HEAL Trafficking Exit Disclaimer: You Are Leaving www.ihs.gov 

Intimate Partner Violence (IPV) is a major issue in many American Indian and Alaska Native communities. IPV can take different forms, such as physical abuse, sexual abuse, and emotional abuse. Anyone can be a victim of IPV, no matter their age, gender, or sexual orientation.

Read more about detecting and preventing Intimate Partner Violence.

American Indian and Alaska Native women and girls are disproportionately affected by violence, with grueling homicide rates more than three times higher than other races and ethnicities. Violence does not discriminate, and this includes the intersections between trafficking, sexual assault, domestic and intimate partner violence, among other victimizations. IHS remains committed to address violence inflicted on American Indian and Alaska Native individuals, families, and communities and work to support the continued pursuit for justice.

In 2023, President Joe Biden has signed a Presidential Proclamation declaring May 5 as Missing or Murdered Indigenous Persons Awareness Day, citing the Administration’s steadfast commitment to working with tribal nations to achieve justice and healing for victims and families across Indian Country.

Resources

• National Center for Missing & Exploited Children Exit Disclaimer: You Are Leaving www.ihs.gov 
• National Missing and Unidentified Persons Systems (NamUS) Exit Disclaimer: You Are Leaving www.ihs.gov 
• Sex Trafficking in Indian Country: Victim/Survivor Resource Book Exit Disclaimer: You Are Leaving www.ihs.gov  - Tribal Law and Policy Institute
• Tribal Community Response When a Woman Is Missing Exit Disclaimer: You Are Leaving www.ihs.gov 
• Tribal Justice and Safety – Department of Justice & MMIP Exit Disclaimer: You Are Leaving www.ihs.gov Tribal Resource Tool Exit Disclaimer: You Are Leaving www.ihs.gov 

Strangulation is a form of asphyxia, external pressure or obstruction applied to the neck to restrict air and blood flow. There are four types of strangulation: manual (use of hands, arms, legs, etc.), ligature (use of cord, rope, scarf, etc.), hanging (suspended with gravitational pull), and positional (due to position of body and pinned to object, bed, wall, etc.). Individuals who have been strangled are at significant risk for morbidity and mortality. Signs and symptoms following strangulation or not, individuals should receive proper screening, assessment, and treatment, including resources and follow-up care.

Signs and symptoms of strangulation can include, but are not limited to:

• Pain, tenderness, and/or swelling to neck and head
• Bruises to neck
• Abrasions to neck (either from the perpetrator or from defensive injuries)
• Petechiae to conjunctiva, scalp, face (singular or multiple)
• Subconjunctival hemorrhage
• Airway symptoms (difficulty swallowing, voice changes, hoarseness, coughing)
• Breathing changes (dyspnea or difficulty breathing)
• Dental fractures, tongue swelling, bleeding to oral cavity
• Neurological symptoms (headache, dizziness, loss of consciousness with or without incontinence, memory loss, weakness)

Resources for Providers:

• International Association of Forensic Nurses, Non-Fatal Strangulation Tool-Kit Exit Disclaimer: You Are Leaving www.ihs.gov 
• Training Institute on Strangulation Prevention Exit Disclaimer: You Are Leaving www.ihs.gov - Recommendations for the Medical/Radiographic Evaluation of Acute Adult, Non-Fatal Strangulation