Overview of included sources.

A total of 3521 sources were identified for screening. The database search yielded 3525 sources, the global email listserv yielded 5 additional grey literature sources for screening, citation searching did not yield any additional sources, and 9 duplicates were removed. Of the 3521 studies screened, 211 were reviewed in full, and 41 sources were ultimately included (see Fig 1). For readability, references have been removed from this section, however, characteristics for each study are detailed in Table 1.

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Table 1. Characteristics of included studies.

https://doi.org/10.1371/journal.pone.0324795.t001

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Fig 1. PRISMA flowchart.

https://doi.org/10.1371/journal.pone.0324795.g001

The greatest number of included sources (n = 24) were text and opinion. These included book chapters on healthcare practice (n = 9), published clinical recommendations (n = 4), critical analysis pieces (n = 4), opinion pieces (n = 4), task force reports with healthcare-related action items (n = 2), and an informational resource from an anti-trafficking organization (n = 1). Original research studies (n = 13) included qualitative research (n = 11), prevalence studies (n = 2), and a cross-sectional study (n = 1). Two of the qualitative research studies and the cross-sectional study were PhD dissertation research. Case reports (n = 2) included one patient case report and one organizational case report.

The earliest publication year for an included source was 2008, and the number of sources increased significantly in later years, with 9 sources published in 2022, and 4 sources published in 2023.

Quality of the sources was overall high for text and opinion sources, qualitative research, and case reports. For all text and opinion pieces, the source of opinion was clearly identified and had a standing in the field of expertise, the interests of people who experience trafficking was the central focus of the opinion, the conclusions were the result of a logical analytical process, and there were references to existing literature with any incongruence addressed. Within the included qualitative research studies, all were well-designed with congruence among their stated perspective, methodology, research question/objectives, data collection methods, representation and analysis of data, and interpretation of results. However, the included qualitative research studies frequently did not include a researcher positionality statement and did not comment upon the influence of the researcher on the research and vice versa (n = 6). Both case reports included a detailed description of the patient/organization, and they both outlined successes, challenges, and takeaways. The patient case report clearly described the patient’s condition, assessment, treatment, and post-treatment condition.

Due to notable quality issues in the quantitative research studies, we chose to include these sources while explicitly discussing their limitations..

Focus and scope of sources.

Most sources were geographically focused on the United States (U.S.), including original research with a U.S. population, clinical practice guidelines for U.S. healthcare providers, critical analysis focused on U.S. issues, policy analysis focused on a U.S. region, and a case report of a U.S. anti-trafficking organization [11,20, 28–48]. There were two Canadian sources, both qualitative research studies focused on indigenous populations [49,50]. One policy analysis focused on the United Kingdom [51]. One patient case report focused on Italy [52]. One qualitative study discussed ethnic minorities in Israel [53]. Another qualitative study recruited participants from multiple countries, and a few text and opinion pieces discussed global issues [54–56].

Most sources (n = 21) focused specifically on sex trafficking [11,20,28,29,31,33–37,39,44–48,52,53,55]. Only one source focused on labor trafficking [38], and the remaining sources (n = 18) included all types of trafficking [30,32,40–43,49–51,55,57–63]. Although the majority of sources (n = 19) were not focused on a specific gender or age demographic, there were 12 sources focused on women, girls, and/or gender minorities (transgender women and two-spirit people) [11,29,31,32,34,35,37,42,44,49,52,56] as well as 10 sources focused on children, youth, and/or girls [11,28–30,34–36,41,54,63].

Fifteen sources focused broadly on BIPOC or racial/ethnic minorities. 9 sources focused on Black or African American people [11,28–30,35,37,39,44], 4 sources focused on Indigenous or Native American people [20,32,49,50], 3 sources focused on East and Southeast Asian people (Korean, Chinese, Thai, and Hmong) [31,34,56], and 7 sources discussed multiple groups [41,43–45,48,54,61].

The geographic skew towards the United States may be partly explained by the inclusion of only sources written in English. However, other English-speaking countries and regions were not as well-represented. One potential explanation for this geographic bias is that U.S.-based researchers more commonly engage in explicit discussions of racism, whereas sources from other regions, especially Europe, may frame their discussions around migration, socioeconomic disparities, or other structural factors without explicitly using the term ‘racism [64,65].’ Additionally, we recognize that the conceptualization and language used to describe racial and ethnic discrimination vary across global contexts. While the U.S. has a long history of structural racism tied to Indigenous genocide, African enslavement, internment of Japanese Americans, and exploitation of immigrant labor, other countries may discuss related inequities using different frameworks, such as caste systems, colorism, or tribal affiliations, rather than explicitly naming racism. This variation in terminology and framing may have contributed to the geographic distribution of sources in this review. Future research could explore how different linguistic and cultural contexts shape discussions of racial and ethnic inequities in healthcare.

This review further highlights well-documented biases in anti-trafficking research and interventions. These biases include a focus on sex trafficking versus labor trafficking and a focus on women and children. Sources focusing on men, boys, and/or transgender men were notably absent. Black and/or African American populations were the most discussed racial/ethnic group within the review. This is partly explained by the significant bias towards sex trafficking, which is more often experienced by Black/African American people than by other ethnic groups. None of the sources focused specifically on Hispanic/Latino people, which could be due to the lack of focus on labor trafficking that more often affects this demographic group. Additionally, Black/African American and Indigenous populations might have been discussed more often in the context of racism and ethnic bias, whereas Hispanic/Latino and Asian ethnic groups may have been discussed more often in the context of immigration. Finally, the discussion of intersectionality related to LGBTQ+ identifying people of color in this review is limited to indigenous two-spirit and transgender women.

Racism within healthcare.

In this section we summarize qualitative research, case reports, and text and opinion pieces via meta-aggregation. Two categories - “healthcare provider bias and discrimination” and “structural and sociocultural barriers to care” – include findings that describe racism occurring within healthcare settings against people who experience trafficking.

The “healthcare provider bias and discrimination” category is focused on interpersonal racism and includes findings that describe providers’ implicit and explicit biases, stereotyping, and discriminatory actions. Within this category, three subcategories emerged: “false culpability,” “invisibility,” and “unequal care.” Selected source quotes exemplifying these subcategories can be found in Table 2.

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Table 2. Select quotes, healthcare provider bias and discrimination.

https://doi.org/10.1371/journal.pone.0324795.t002

“False culpability” describes how healthcare providers unjustifiably place blame on BIPOC patients who experience trafficking. Important findings within this subcategory include adultification, hypersexualization, and criminalization of this population. Adultification describes how providers view BIPOC youth as less innocent, more responsible for their actions, and therefore less deserving of help [11,35,41,46,63]. Hypersexualization and stereotypes of sexual deviancy was predominantly described as affecting women of color, with providers more likely to write off signs of sexual exploitation as promiscuity in this population [11,63]. Providers were also described as more likely to view patients of color as criminals who choose to become involved in human trafficking, drug use, and other criminalized activities [11,32,35,41,43,44,63].

“Invisibility” describes healthcare providers’ failure to see the unique challenges experienced by BIPOC patients who experience trafficking as well as a failure to address their specific needs. Sources described how stereotypes of false culpability, as outlined above, can obscure exploitation and struggles [11,35,59]. Another important finding was a “color-evasive” attitude from providers that downplayed the role of race [46].

“Unequal care” describes how biases, stereotypes, and discrimination – including issues outlined in false culpability and invisibility – lead to healthcare inequities. Findings described that BIPOC patients who experience trafficking are deterred from care, are denied care, and receive differential treatment [30,42,43,50,54,63].

The category “structural and sociocultural barriers to care” describes racism that is perpetuated through institutional norms and structural barriers to negatively impact the healthcare of BIPOC patients who have experienced trafficking. Within this category, four subcategories emerged: “carceral environments,” “BIPOC erasure,” “cultural barriers,” and “fear of arrest/deportation.” Selected source quotes exemplifying these subcategories can be found in Table 3.

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Table 3. Select quotes, structural and sociocultural barriers to care.

https://doi.org/10.1371/journal.pone.0324795.t003

Findings within the “carceral environments” subcategory describe how healthcare environments potentially re-traumatize BIPOC patients who have experienced trafficking due to parallels with incarceration and/or traffickers’ methods of control [43]. This includes the presence of security or police in healthcare spaces, involuntary holds, and judicial involvement [28,43].

“BIPOC erasure” describes how deficits in healthcare providers’ training and knowledge related to human trafficking hinders their ability to adequately care for BIPOC patients. Important findings include limited training in human trafficking compared to issues that are prevalent in White populations, a lack of focus on racial dynamics and culturally relevant strategies during human trafficking trainings, and a lack of focus on labor trafficking [29,35,38,46].

“Cultural barriers” describes aspects of health systems and healthcare provision that impede access to adequate healthcare services for people of color. Findings highlighted linguistic limitations related to a lack of bilingual providers or insufficient interpreting services [31,44,52,54,60]. Sources also described a lack of culturally responsive or culture-specific services as well as an over-reliance on Western models of care [31,32,43].

“Fear of arrest/deportation” describes fears among BIPOC patients who have experienced trafficking, that engagement with the healthcare system will lead to punishment from law enforcement and judicial systems. Important findings within this subcategory included fears about healthcare providers reporting to or sharing information with police, child protective services, and/or immigration enforcement [28,51,57,59]. Additionally, sources described that these fears are driven by requirements to cooperate with law enforcement in order to access services [28,57].

Based on these findings, it is clear that racism continues to occur in healthcare settings, at multiple levels, and in ways that negatively impact the care of BIPOC patients who experience trafficking. Broadly, the evidence in this scoping review suggests two major threads within discrimination: BIPOC patients who experience trafficking are more likely to be treated as culpable or criminal, and their needs are more likely to be ignored by providers and systems. This multi-level racism leaves them with justified fears about healthcare institutions and persistent barriers to equitable care.

Healthcare practice recommendations.

Three categories - “broad recommendations,” “assessment,” and “treatment” – outlined best practices for providing equitable healthcare to BIPOC patients who have experienced trafficking. Findings within the “broad recommendations” category included recommendations for providers’ overall approach to the patient encounter, especially the patient-provider relationship. Subcategories within “broad recommendations” included “cultural responsiveness,” “understanding context,” “relationship-building,” “acceptance,” and “power/agency.” Selected source quotes exemplifying these subcategories can be found in Table 4.

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Table 4. Select quotes, broad recommendations.

https://doi.org/10.1371/journal.pone.0324795.t004

The “cultural responsiveness” subcategory included recommendations for tailoring one’s clinical practice to patients from racial/ethnic minority cultures. Findings centered on enhancing cultural knowledge, cultural awareness, and cultural humility to improve care for BIPOC patients who have experienced trafficking. Sources recommended enhancing cultural knowledge related to both illness framing (symptom expression, language used to express illness, healthcare expectations, cultural taboos around sexual health and mental illness) and broader culture (cultural values, norms, beliefs) to improve the quality of care [31,39,46,54,56,60,63]. The importance of providing care in the patient’s primary language was also emphasized [29]. Recommendations for practicing cultural humility included actively updating and adapting intervention strategies, accepting that cultural knowledge is never complete, asking questions rather than making assumptions, acknowledging one’s own cultural biases, and recognizing individuality within cultural groups [41,56,63].

“Understanding context” includes recommendations for developing an understanding of a patient’s life, journey, and social context, especially contextual factors that providers may not have experienced themselves. A key finding was that providers needed to better understand and recognize structural factors that impacted patients’ lives, especially structural racism, historical racial oppression, and the impact of intersectionality (poverty, gender, immigration status, etc.) [39,43,59]. A related finding was the importance of understanding “risk factors” and “vulnerability” as the result of structural forces rather than as individual attributes [11,42,43,57]. Other important recommendations included educating oneself on patients’ political and legal contexts (e.g., laws related to trafficking, political environment in a patients’ country of origin), understanding patients’ social context (family and community), and asking about patients’ individual experiences of racism, bias, and oppression [36,43,44,46,50].

“Relationship-building” includes recommendations for establishing a trusting and productive patient-provider relationship. Findings within this subcategory emphasized the importance of listening and relating to patients. Specific recommendations for listening included allowing patients space to tell their stories before providing recommendations, meeting disclosures with support and belief, and creating space to share trauma related to racial and intersectional oppression [28,31,35,44,50,57]. Recommendations pertaining to relatability included capitalizing on shared race/ethnicity, making a genuine effort to put oneself in a patients’ shoes, and caring on a more personal level [28,29,31,57,60].

“Acceptance” includes recommendations for providing care in a way that meets people wherever they are in their recovery process. Recommendations within this subcategory included using a non-judgmental approach and positive regard during patient interactions [28,29,32]. Sources also recommended harm reduction, especially with regard to criminalized forms of employment and substance use [28,31,32].

“Power/agency” includes findings that recommend shifting power and agency towards the BIPOC patient who has experienced trafficking. These recommendations included making the patient an equal partner in treatment decisions, allowing patients to self-identify, and harnessing patients’ existing strengths and resilience [28,31,42,44,56,59].

The “assessment” category includes recommended assessment strategies for meeting the needs of BIPOC patients who have experienced trafficking. Subcategories included “holistic assessment,” “cultural responsiveness,” and “safety.” Selected source quotes exemplifying these subcategories can be found in Table 5.

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Table 5. Select quotes, assessment.

https://doi.org/10.1371/journal.pone.0324795.t005

The “holistic assessment” subcategory includes recommendations for assessment topics and tools that more effectively map out the needs of BIPOC patients who have experienced trafficking. Important recommendations included assessing the extent and types of social support available to a patient, potentially using tools like the bio-psychosocial assessment, the genogram, or the eco-map [42]. Sources also recommended mapping patients’ values and beliefs, especially those related to culture and spirituality [42,59]. It was also recommended that providers assess health more holistically to include both mental and physical health [44].

Findings within the “cultural responsiveness” subcategory focused on adapting assessment to a patient’s specific culture. Recommendations included asking about a patient’s cultural frame, assessing level of acculturation, and potentially using cultural mediators during assessment [52,56,59].

The “safety” subcategory included recommendations for assessing and ensuring safety. Findings emphasized the importance of creating a safe space for assessment and doing safety assessments privately [32,42,44]. The “treatment” category includes recommended treatment strategies for providing equitable, high-quality healthcare to BIPOC patients who have experienced trafficking. This category includes three subcategories: “expanding strategies,” “holistic support,” and “cultural and linguistic adaptations.” Selected source quotes exemplifying these subcategories can be found in Table 6.

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Table 6. Select quotes, treatment.

https://doi.org/10.1371/journal.pone.0324795.t006

“Expanding strategies” includes findings that suggest incorporating treatment modalities that go beyond talk therapy and Western models of care in order to better serve BIPOC patients who have experienced trafficking. Several sources recommended expressive, experiential, or somatic therapies, including expressive arts (dance, music, visual arts, poetry), narrative therapy, mindfulness, yoga, and acupuncture [29,31,32,35,37,44,45,56]. Interventions beyond the healthcare space, were also recommended. These included street outreach, interventions led by community members, and informal opportunities for intervention in settings like education [29,32,37].

“Holistic support” includes findings that recommend a more holistic treatment lens to make care more effective for BIPOC patients who have experienced trafficking. Findings emphasized the need for more integrated care and the need to consider sociocultural factors during treatment. Sources recommended integrating treatment for physical health, mental health, and substance use, as well as connecting patients to a range of services. These services included those to meet basic needs (housing, food, healthcare), as well as education, legal support, and life skills training [28,45,50,59]. Treatment recommendations related to sociocultural factors included leveraging and enhancing social connections within family and community as part of treatment, incorporating spirituality/religion into treatment, encouraging positive racial/ethnic socialization, and exploring historical narratives of racial/ethnic resilience [39,42,44,50,59].

The “cultural and linguistic adaptations” subcategory includes recommendations for providing culture- and language-related adaptations to existing treatment modalities in order to make them more effective for BIPOC patients who have experienced trafficking. Sources recommended that cognitive behavioral therapies be adapted to a patient’s culture (e.g., with ethnic-specific materials or race-related themes) [29,37,59]. Another recommendation was that services be provided in the patient’s primary language or with cultural interpreters [31,62]. Findings also emphasized the importance of making sure that healing practices align with the patient’s cultural context, that BIPOC cultural services are made available as part of care, and that BIPOC knowledge is incorporated into services [32,37,43,49,50,56]. BIPOC leadership, and especially leadership from BIPOC survivors was another important finding [37].

The findings from this scoping review suggest that there are many promising practices for providing more equitable care to BIPOC patients who experience trafficking. While there is significant overlap with trauma-informed care principles, the findings of this review suggest a heightened need to consider issues of power, trust, and acceptance when working with this marginalized patient population. The findings support moving away from the more individualistic and narrowly biomedical tendencies of Western medicine and towards clinical practice that considers interlocking physical, social, emotional, spiritual, cultural, and community needs.

Anti-racist interventions for healthcare.

Two categories - “individual/interpersonal level interventions” and “health systems interventions” – discussed anti-racist interventions for healthcare settings and providers to promote racial equity when caring for people who have experienced trafficking. “Individual/interpersonal level interventions” includes findings that focus on interventions at the level of the healthcare provider to improve their interpersonal interactions with BIPOC patients who have experienced trafficking. Subcategories within “individual and interpersonal level interventions” included “critical reflection,” “education on care models,” “education on social context and oppression,” and “expanding basic education on trafficking.” Selected source quotes exemplifying these subcategories can be found in Table 7.

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Table 7. Select quotes, individual/interpersonal level interventions.

https://doi.org/10.1371/journal.pone.0324795.t007

“Critical reflection” includes recommendations for HCPs to examine their thoughts, actions, and beliefs, and to intervene on those that are harmful to patients. The findings highlighted the need for healthcare providers to examine their personal biases and stereotypes related to race, ethnicity, intersectional identities, and privilege [29,41,43,44]. A related recommendation was for healthcare providers to reflect on how their personal values might conflict with those of their patient population [29]. The findings also emphasized the need for providers to subsequently examine the impact of biases on their patient interactions, clinical decision making, and care provision [43,44]. Sources described that this reflection process must be iterative and ongoing [43,50].

“Education on care models” includes recommendations for equipping service providers with care models that work for BIPOC patients. Findings within this subcategory highlighted models like trauma-informed care, strengths-based care, rights-based approaches, critically conscious approaches, and anti-oppressive practices [29,45,46,50,54,61]. Sources within this subcategory emphasized the importance of educating providers on care models that are based on experiential knowledge and BIPOC knowledge, in addition to teaching providers strategies that are tailored to specific cultural groups and contexts (e.g., low-income African-American girls) [23,44,61].

“Education on social context and oppression” includes findings that recommend healthcare providers learn about social context and systems of oppression as they apply to BIPOC patients who experience trafficking [34,35,38,40,45,54,59,61]. Key education topics recommended by sources within this subcategory included a foundational understanding of stigma, bias, discrimination, power, privilege, and oppression as well as more specific education on race, racism, intersectionality, and related concepts (i.e., colonialism and xenophobia). Sources recommended a focus on how these concepts are intertwined with trafficking.

“Expanding basic education on trafficking” emphasized the importance of expanding trafficking education to ensure that knowledgeable healthcare providers are accessible for BIPOC communities. Recommendations included mandatory trainings for all types of healthcare providers and training for school-based healthcare providers [26,29,45,59]. The importance of this training for dispelling myths and stereotypes was also emphasized [34].

The “health systems interventions” category includes anti-racist interventions at the level of health systems and healthcare institutions. Subcategories within this category included “representation and diversity,” “critical reflection,” “inclusive organizational culture,” and “inclusive policies.” Selected source quotes exemplifying these subcategories can be found in Table 8.

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Table 8. Select quotes, health systems interventions.

https://doi.org/10.1371/journal.pone.0324795.t008

The “representation and diversity” subcategory includes recommendations for improving BIPOC representation and diversity within healthcare spaces in order to reflect the population being served and empower BIPOC communities as a whole. An important finding across sources was the need to actively recruit, hire, and promote BIPOC healthcare providers, healthcare staff, and healthcare leaders, especially those who have lived experience of trafficking [28,29,32,36,40,46]. Sources emphasized that a workforce with strong BIPOC representation and diverse perspectives facilitates care innovation, increases comfort for BIPOC patients, and helps to address institutional racism. Another finding recommended using materials that represent that cultural diversity of the patient population [44].

“Critical reflection” includes findings that recommend collective reflection on healthcare disciplines and healthcare institutions to elucidate ways in which they perpetuate racism. Topics for reflection included the biases within research frameworks and healthcare practice paradigms as well as the barriers that are perpetuated via organizational/institutional practices and policies [11,39,43,61].

“Inclusive organizational culture” includes findings that highlight the need to address factors within institutional culture that disadvantage BIPOC patients who experience trafficking. Recommendations emphasized the need for a healthcare environment that does not tolerate bias and discrimination, values differences, and supports avenues for accountability [32,35,41,54,63].

“Inclusive policies” includes findings that recommend policy changes to help healthcare institutions and health systems provide equitable care to BIPOC patients who experience trafficking. This subcategory emphasized centering the needs of BIPOC patients who experience trafficking when developing policies as well as making anti-racism and reducing barriers for BIPOC patients an explicit goal [35,57]. More specific policy recommendations included increasing access to interpreters, making culturally responsive care more widely available, including labor trafficking within health system responses, and ceasing to share information with immigration enforcement [34,44,45,57].

The findings of this scoping review show that there are potential anti-racist interventions for healthcare at multiple levels. The findings support critical assessment of bias and clinical practices at the individual level in addition to structural biases and harmful policies at the institutional level. These findings also suggest that care for BIPOC patients can be improved through healthcare provider education that is both expanded to improve access for BIPOC populations and more focused on providing care to suit this population. A final overarching action item is the need for enhancing diversity and inclusion through provider hiring, and by creating an organization whose culture and policies are intentionally structured to be inclusive of BIPOC patients and BIPOC providers.

Beyond healthcare.

Three categories - “research, intervention design, and evaluation,” “partnerships and coalition-building,” and “advocacy” – addressed the role of healthcare providers and healthcare institutions beyond providing clinical care. “Research, intervention design, and evaluation” includes findings related to healthcare providers in the role of researcher or program designer, as well as findings related to how research informs healthcare practice and interventions. Subcategories within this category included “research deficits,” “research impact,” “holistic interventions,” and “co-creation.” Selected source quotes exemplifying these subcategories can be found in Table 9.

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Table 9. Select quotes, research, intervention design, and evaluation.

https://doi.org/10.1371/journal.pone.0324795.t009

“Research deficits” includes findings that describe how research shortcomings impact care for BIPOC patients who experience trafficking. Findings within this subcategory described that there is limited healthcare-focused research characterizing the problem of human trafficking in relation to race and intersectional identities [11,28,37]. Descriptive data, for example, is frequently not collected with race or intersectionality in mind. Sources also described a lack of research on the effectiveness of healthcare treatments for the population of BIPOC patients who experience trafficking [37]. Research measures are often not validated in BIPOC populations, and there is a lack of research on culturally congruent or expressive therapies that show promise for BIPOC patients who experience trafficking [11,59]. A final important finding is that very few human trafficking responses are evaluated with race in mind, and anti-racist healthcare interventions or anti-racist policies are rarely evaluated [31,46].

“Research impact” includes findings that touch on the broader impacts – both positive and negative – of research work. Sources emphasized that research evidence has a significant impact on program development and funding, as well as the ability to positively or negatively influence relationships with the community [28,34,44,50]. Findings highlighted the need to consider these potential impacts when undertaking research.

“Holistic interventions” includes findings that highlight the importance of healthcare-related interventions being embedded within a larger offering of services. Important services that were highlighted within this subcategory included basic needs (housing, food assistance, personal care items, transportation, and childcare), education and employment training opportunities, life skills teaching, legal assistance, case management, and home visits [28,31,37,49,62]. Sources also emphasized that holistic healthcare interventions should include access to culturally responsive care, alternative therapies, and substance use treatment [31,32,50]. Finally, sources highlighted the importance of community and social support, such as mentorship, peer support, access to community resources and community networks (e.g., indigenous community Elders), caregiver support, and community building [29,31,34,43].

“Co-creation” includes findings that emphasize the need for people who have experienced trafficking and racial oppression to be involved in research and intervention design. Sources highlighted the importance of involving those with lived experience in program design and evaluation, listening to their needs rather than assuming, centering BIPOC voices, and prioritizing experiential expertise over academic expertise [11,32,49,50,57]. Beyond listening, sources recommended providing opportunities for collaboration, reciprocal partnerships, co-creation, and leadership [28,32,37,57]. Findings also included the importance of paid involvement for those with lived experience, and the need to support education and career advancement for those with lived experience of trafficking and/or racism [50]. Another important finding was the need for accountability to people and communities who are affected by trafficking [28]. Sources recommended ongoing program evaluation by participants, consultations with key community members (e.g., Elders) and family members during program development, the use of youth and community advisory boards, and community engagement more broadly [28,37,50,51].

“Partnerships and coalition-building” includes recommendations for healthcare institutions and healthcare professionals to form partnerships and coalitions in order to better serve BIPOC patients who experience trafficking. Two subcategories emerged: “interprofessional partnerships” and “community partnerships.” Selected source quotes exemplifying these subcategories can be found in Table 10.

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Table 10. Select quotes, partnerships and coalition-building.

https://doi.org/10.1371/journal.pone.0324795.t010

“Interprofessional partnerships” includes findings that recommend for healthcare providers to partner with other professionals. Findings mentioned partnering with teachers and other education professionals, social workers, child services, researchers, other health professionals, the business community, legal professionals, and law enforcement [29,34,35,55,58,59,62]. Sources emphasized that these interprofessional partnerships provided opportunities for improved communication, development of collaborative policies (e.g., referral protocols), and continuity of care for people who have experienced trafficking [34,50,55,59].

“Community partnerships” includes findings that recommend for healthcare providers to partner with community members and community organizations. Sources recommended involving members and leaders of BIPOC cultural, religious, and community groups (e.g., first nations, Elders) in human trafficking responses, as well as grassroots community organizations that are involved in trafficking response already [34,43,49,50,62]. The importance of ensuring diversity and inclusion for BIPOC coalition members was also highlighted [34].

“Advocacy” includes recommendations for healthcare providers and/or healthcare institutions to become involved in advocacy work and education in order to best serve BIPOC patients who experience trafficking. Subcategories included “community engagement,” “political advocacy,” “supporting survivor advocacy,” and “community education.” Selected source quotes exemplifying these subcategories can be found in Table 11.

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Table 11. Select quotes, advocacy.

https://doi.org/10.1371/journal.pone.0324795.t011

Findings within the “community engagement” subcategory emphasized that healthcare providers are in a unique position to mobilize communities and/or create coalitions, so recommended that providers take advantage of this position in order to advocate for BIPOC patients who experience trafficking [34,39]. “Political advocacy” includes findings that call for healthcare providers and health systems to advocate for policies to improve outcomes for BIPOC patients who experience trafficking and to prevent trafficking among this population. Sources recommended advocating on behalf of communities of color, advocating for policies that address social determinants of health, advocating for policies that ensure equal rights and protections for BIPOC, and advocating for accountability from discriminatory systems [39,40,43,45,54,57].

“Supporting survivor advocacy” includes findings that recommend for healthcare providers to encourage BIPOC patients who experience trafficking to engage in advocacy. Recommendations included supporting leadership and empowerment for this patient population, providing opportunities to become role models and mentors, and encouraging political advocacy [35,37,44,59].

“Community education” includes findings that suggest that providers engage in education to better serve BIPOC patients who experience trafficking. Recommendations included educating patients on their rights, raising community awareness about trafficking, and disseminating accurate information about trafficking [34,35,39].

Based on the findings in this section, healthcare providers have multiple avenues for preventing human trafficking and mitigating its negative effects in BIPOC populations. The findings placed major emphasis on the importance of community connections with regard to research co-creation, collaborative responses to trafficking, advocacy, and education. Survivor inclusion and leadership – in research, program design, and advocacy – is another actionable step. There is also a strong emphasis on healthcare provision being one element of a more coordinated, multi-faceted response. Finally, there are several identified areas for further research: describing the intersection of race and human trafficking as it applies to healthcare, further researching treatment effectiveness for BIPOC patients who experience trafficking, and assessing the effectiveness of anti-racist interventions within a healthcare setting.