Responding to Human Trafficking among Refugees: Prevalence and Test Accuracy of a Modified Version of the Adult Human Trafficking Screening Tool

Abstract Background: Human trafficking is a human rights violation and urgent public health challenge. It involves the exploitation of a person by means of force, intimidation or deceit and causes severe health risks. Thoughit occurs all over the world, its true extent is still unknown. Refugees are especially vulnerable to human trafficking due to language barriers and difficult living conditions. Therefore, the purpose of this study was to design a screening tool to identify survivors of human trafficking among refugees in a German state registration and reception centre. Methods: In cooperation with the local authorities, we asked newly arrived refugees at an initial reception centre in Southern Germany about their experiences with human trafficking. We used a combination of the Adult Human Trafficking Screening Tool and a publication by Mumma et al. to address all forms of exploitation. The results were cross-checked by a short interview afterwards. Results: In total, 13 of the 176 asylum seekers had experienced trafficking, which corresponded to a prevalence of 7.3%. The questionnaire had a sensitivity of 76.9% and a specificity of 84.0% at a newly selected cut-off of six positive responses. In an exploratory descriptive analysis on subregions, refugees from West Africa had a substantially higher prevalence (33.3%) for human trafficking within our sample, especially women. However, when we excluded this region from our analysis, we found no significant gender difference for the rest of the sample. Conclusions: The screening tool distinguishes reliably those who had experienced human trafficking from other refugees. The high prevalence of trafficking in most regions, regardless of gender, suggests that more effort is needed to identify and protect all trafficked persons.