Demographic characteristics of the participants

Interviews were conducted in Kampala between March 2020 and November 2020 with a total of 108 participants. Of them, 72 participants had lived experience of sex trafficking, 31 participants had been subjected to forced labor, and 5 participants had been exposed to both types of exploitation (two analyzed as sex trafficking victims, one analyzed as a forced labor victim, and two analyzed in both groups). Most interview participants were female (80%) and the median age was 18 years (min 11, max 30 years). The interviews conducted with victims of forced labor focused on children under 18 years of age and consequently, interview participants exposed to forced labor were younger (median age 14 years versus 20 years) and had lower education levels than sex trafficking survivors (Table 1). Participants who were sex trafficking survivors were more frequently female than participants who were forced labor victims (97% vs 42%). Almost all interviews were conducted in Luganda.

Table 1 Participant demographics

Participants’ lived experience was explored through a public health lens. Various human trafficking risk factors, barriers to seeking help, and health impacts of exploitation and harm were identified (Fig. 2). Key findings are presented in Table 2. Similarities and differences were observed between the experiences of victims of forced labor and victims of sex trafficking. Of note, participant quotes are presented to highlight experiences, risk and protective factors, and barriers and facilitators of interest, and therefore do not always contain all the data used to determine whether participants’ experiences met criteria for human trafficking.

Fig. 2

Patterns in the lived experience of forced labor and sex trafficking victims

Table 2 Key interview findings by human trafficking stage

Warning: results section contains potentially disturbing content including graphic descriptions of violence, child abuse, sexual assault, and bestiality, which may be emotionally challenging to engage with. Reader discretion is advised.

Vulnerability resulting from life-circumstances pre-trafficking

Broadly, vulnerability could be split into two main categories, namely vulnerability resulting from financial hardship and vulnerability stemming from an abusive home situation. These vulnerabilities could co-occur. Participants described living in difficult circumstances in which there was insufficient money to meet basic survival needs including food, clothing, and medicine. Often, multiple family members were dependent on a single income. The need to repay a debt caused by medical costs, funeral costs or gambling addiction compounded financial hardship in some cases. One participant described, “My mother has some debts in the village, however her debts are ever unending, school fees debts for my young siblings and also before the death of my father he left so many debts” (Forced labor, Female, age 11).

Financial difficulties repeatedly had a clearly identifiable trigger – the death of (one of the) the family breadwinner(s), usually a parent. Approximately half of all interview participants reported the death of a family member or caretaker. Causes of death varied and included disease, war, natural disasters, and suicide.

From primary one up to primary four, life was very easy because my dad was still there. I used to stay with my dad and my mum, and that is why life was very easy, but since my dad passed away, life became very hard. From primary five to primary six, up to primary seven, it was very hard because I was the one who was paying my [school] fees, struggling for it, and my mum didn’t have enough money. – Sex trafficking, Female, age 22

In situations of financial hardship, school fees were often an expense that could no longer be covered causing participants to drop out of school which explained the very limited education among interview participants. One participant regretted the consequences of her family’s economic circumstances for her schooling saying, “I stopped in primary six truthfully, because of school fees issues…I liked studying, but did not have the chance” (Sex trafficking, Female, age 18). In these dire circumstances of poverty, any work opportunity or offer to take the responsibility for a child or a child’s school fees off a parent’s hands, was considered very welcome. A participant described how her mother was presented with a financial opportunity saying, “So when she [participant’s mother] failed to get money, there was a friend of hers who told her that there was someone who wanted a maid this side of [medium size urban neighborhood in southern Kampala], so I came. But my mother was told that I was going to be a house girl, so I came thinking that too” (Sex trafficking, Female, age 17).

The second main determinant of vulnerability that could be identified in the interviews was an abusive home life. Interview participants gave accounts of beatings, neglect, mistreatment, withholding of food, sexual abuse, and being forced to carry out all the housework. Often, the abusive situation started when there was a new influence in the family, someone who was not a blood relative. One participant recounted how the abuse started when she moved in with her stepmother after her mother passed away:

My mother got sick and they took her to the hospital … When she died, my father took me to his mistress in [medium size urban neighborhood in Northern Kampala], that’s where we were staying, but she would mistreat me and I didn’t have any peace. … She would cook food and only give to her children, yet I was the one who would do all the work. – Sex trafficking, Female, age 18

My father gives a lot of attention to my stepmother. When she tells him something we had not done, he beats us, ties us on ropes, he starves us and [makes us] work all day. She doesn’t want to give us what to eat [something to eat]. When my father comes back, she tells him that we don’t want to work. There was a day I washed clothes. I washed three basins full of clothes. These big ones while she was beating me with a mingling stick [kitchen utensil] in the back. My back is paining! She could abuse my siblings telling them things like "Was I the one who killed your mother? You children don’t work!" While she treated her children like princesses, I even don’t know. They could also abuse us like that. – Forced labor, Male, age 15

Participants who did not feel safe or well-treated at home were often driven to run away and find alternative living arrangements. One participant described how he decided to leave the village and try his luck elsewhere saying, “I felt tired of the village… because in the village, it was pain and mistreatment. I was tired of being tortured and beaten in the village like a thief. I got fed up and decided to go to the city.” (Sex trafficking, Male, age 17).

The life-circumstances pre-trafficking that culminated in vulnerability to human trafficking were similar for participants who experienced sex trafficking and participants involved in forced labor.

Risk factors for recruitment and travel & transit

Among the interviewees, there was a general trend of movement from the village where participants grew up to the “big city,” Kampala. For some participants, recruitment into exploitation took place while they were still living in the village. Other participants traveled to the city first and were recruited from there. Participants were recruited by family members, friends, acquaintances and sometimes strangers.

Recruitment in the village

For participants who were trafficked from the village, an “opportunity” was often presented by traffickers that leveraged the vulnerability caused by financial hardship or an abusive home situation. For those who entered forced labor, it was often a family member or an acquaintance that offered to take participants in, cover their school fees, or provide them with work. In some interviews, the venue for recruitment was at the funeral of one of the participant’s caretakers at a time when it was unclear who would support the child. Others were approached during sports tournaments and dance performances.

When my father passed on … after the burial, there was a lady who was too, too close friend to my mother. She spent mourning for one or two weeks when she was around. She said she can help me get a job, telling my mother, because my mother had no capacity to take care of us. My siblings were so many yet I was the elder, so she said I should go and work. – Sex trafficking, Female, age 18

Another participant recalled how acquaintances had offered to take her in and cover her school fees after her father passed away saying, “During father’s burial, there came his friends saying, ‘Am going to educate such a child. Give me this child'” (Sex trafficking, Female, age 16). The situation participants entered into, however, was rarely as promised. Instead of being sent to school, the children were put to work begging, selling, and collecting scrap. One participant described how her grandmother was deceived saying, “she said she would take me to school, so my grandmother accepted … because she didn't have money for my school fees. She just told me to go with her. When I reached there, it was only after one week and then she started giving me pancakes to sell” (Forced labor, sex unknown, age 11). Another participant spoke of false promises made by her uncle:

[I was] 5 years old when my uncle got me from the village and brought me here to Kampala in [small size urban location in the central business district of Kampala]. He told my parents that he was taking me to a certain school in Kampala that was offering full bursaries [scholarships] … My parents accepted because I was studying from the village and it was still hard for my parents to get school fees … I was so happy for the opportunity that I was offered, but to my surprise when I came to Kampala, things changed because after two days of my staying with them, the following day aunt decided to take me to the street so that we can beg together. I asked them, "What about the bursaries you told my father about?". My uncle told me not to question him but rather do as they say. – Forced labor and sex trafficking, Female, age 21

For participants that ended up in sex trafficking, the opportunity presented was usually a work opportunity in the city such as work in a house, hotel, or salon. Sometimes it was work that was already being done by a friend who appeared to be doing well. In many cases, the work opportunity turned out to be fictitious and what participants were actually being recruited for was commercial sex. One participant recalled how her friend visited and told her about her exciting life in Kampala saying,

One holiday, she came back to the village and told me that Kampala was so interesting. …I had a tough mother. One day, she [my mother] beat me and my heart ran to [I thought of] my friend. I said, "Why don’t I pick my things and I go?". When we came to the city, she [my friend] never told me anything. … When we arrived at [medium size urban neighborhood near the central business district of Kampala], she took me into a house but the house had only girls; I later discovered that the house was like a lodge. Men come in and use you and give you some money around five to ten thousand shillings. – Sex trafficking, Female, age 21

Once they started their new work opportunity, several participants were subjected to forced sex for the first time. These participants described a distinct initial trauma, typically rape by a customer or (a family member of) their employer. After going through this, they either chose to endure in their employment because they felt like there was no other option, or they left the work opportunity and found themselves living on the streets. After this initial gateway experience many resorted to engaging in commercial sex, and ultimately experienced sex trafficking.

When I was brought here, I was taken to her [the recruiter, a family friend’s] home. I studied for some little time while coming from her home. She was married and her husband raped me, so I left home. I met a friend who brought me here. – Sex trafficking, Female, age 23

Sometimes, participants were indebted to the trafficker who had recruited them from the village, making it difficult to leave their current situation. One participant recounted how she was not able to leave when she found out what she would be doing and said,

Yes, and that lady gave me a room and told me that I was going to start working from there, but I told her that I won’t be able to do it. But she said that I would work whether I liked it or not and that I didn’t know anyone in Kampala and that they also had to do that in order to survive. But I told her that I won’t manage and she assured me that I would manage. So when we reached, after two days, men started coming to me. The first one asked me, "Do you know this?" So, I asked him what he meant, but he just told me, "Set-up yourself quickly, I have other things to do and I have somewhere I am going". So, I also didn’t have a choice. So after five days had passed, I was getting used to it. I had nothing to do, nowhere to go, but in my mind I wanted to run. But I didn’t have a phone maybe to call my mother, had nothing on me that could help me go back home, so I just let it be. After two months I was used to everything. – Sex trafficking, Female, age 16

Recruitment in the city

The second group of interview participants reported coming to the city of their own volition, being abandoned in the city, or being put on a bus to the city by family members. Once on the streets, participants needed to find a means to survive. The lack of a place to go, not knowing anyone in the city, and lack of income put participants at risk of human trafficking. The limited educational background that most participants had left few options for a stable income. Many younger participants described finding safety in numbers by joining groups of street kids for survival. They then typically started doing the work that other street kids did such as collecting scrap metal, bottles, or selling soap. One participant shared his experience of first arriving in Kampala saying,

I stayed there in the city and started hustling. While I was there, I found people speaking our mother tongue. I joined them. They were home people, they understood me and I clung on them. They took me to their place. When we reached there, they told me that it was hustling throughout to sustain you. They told me that their bosses needed money therefore you had to go and look for it. I went into scrap; they took me to trenches, they have given me drugs to sell. There are those people we sell to. That is how I started living with them. – Forced labor, Male, age 15

For interview participants with lived experience of sex trafficking, who were typically older than the forced labor participants, having dependents, often children, added to the pressure to find work by any means. It was difficult to meet their own survival needs as well as those of their dependents, and they began engaging in commercial sex acts to provide for the family unit, which ultimately became a situation of sex trafficking.

I had two children! I have no job! I commenced from where I had ended. I had to look for money for both children. I could not even imagine the number of men I had to sleep with to get what to eat and yet I also had to look for money for rent. – Sex trafficking, Female, age 30

Sometimes a bad situation can drag you into something that you would not wish to do. ... First of all, I have to buy myself food, secondly I need rent, thirdly I needed school fees to educate my child. – Sex trafficking, Female, age 27

Human trafficking internationally

A minority of interview participants reported being trafficked internationally including to Malaysia and Dubai. One male participant described how a friend presented him with a work opportunity abroad that would allow him to pay back a debt he owed the friend,

[The friend] promised to take me to a money source so that we can work and earn. …The country he took me to was Malaysia. We arrived in a big house. We found some children, men, and girls going through torture and I asked my friend, "Is this the work you have brought me to do?" He said, "Don’t worry, this is where we get the money, and you yourself are the money." … Some of the boys would rape fellow boys. The girls were also raped. They would set cameras to record what we do and then take the recordings for sale to get money. – Sex trafficking, Male, age 19

The international setting compounded participants’ vulnerability to exploitation. Participants found themselves in a foreign country, often with no means of contacting their family, and frequently had their travel documents confiscated by the trafficker. One participant described, “I was taken to a foreign country without my family knowing, and the contacts I had were just written on a paper. But after reaching Malaysia, they took everything we had. So, I had no way I could contact my family even if I got a chance of contacting them” (Sex trafficking and forced labor, Female, age 21).

Exploitation and its impacts on health

Once recruited, participants entered into a life of exploitation, which resulted in impacts on their health.

Forced labor exploitation

Participants who were exploited through forced labor described being made to collect different items such as scrap metal, bottles, and boxes from the street for their exploiter to sell. Others were forced to beg or steal. Participants often had to work long days, six or seven days a week, and were given almost no time off. One participant reported having no reprieve saying, “There is no resting day unless when there is scarcity of maize [if all the maize has been sold or if it has not been brought to the market yet]. That’s when we rest. However, if it’s seen on market, we go back to work.” (Forced labor, Male, age 14).

[I start work] at 06:00 or 05:00 in the morning....I work until 20:00, that's when I come back and of course I am always feeling tired, yet I actually have to figure out what to eat.....from the time I come back at 20:00, I eat well with what I have gotten from [medium size urban market in the central business district of Kampala] and then I go to beg ... I beg until midnight and then I come back ...I work six days in a week. – Forced labor, Female, age 17

The work frequently took place by the roadside exposing participants to the risk of road traffic accidents and environmental hazards.

Apart from that big accident, I got there some minor accidents. I get like a motorcycle knocking me, but causing minor injuries … Kampala Capital City Authority always chases us and we pass through big trenches where sewage passes, but remember we don't wear shoes because we don’t have them. – Forced labor, Male, age 13

Participants reported being harmed while carrying out their work. Most of the abuse forced labor victims were exposed to was physical. Participants described beatings from strangers, groups of older kids on the street, from customers that they sold their goods to, and from their trafficker/employers. Abuse that was mentioned included beatings with electrical cords, pouring of boiling water over them, being hit with heavy canes, being strangled, and being kicked. Psychological abuse also occurred, and participants reported being subjected to verbal abuse including insults and shaming, being threatened with beatings, not being allowed to leave without permission, and sometimes having food withheld as punishment.

Yes she forces me, when I don’t want to work. … she drags me and starts beating me severely and then she tells me to go and work. So when I come back at night, she tells me to do the housework while beating me and sometimes she ends up not giving me food. … She tells me to treat her well that she’s my mother and father...she ties me up and starts beating me and sometimes she undresses me which shames me in the presence of people. She brings my history that I am an orphan and how she got me from the rubbish pit. Then she strangles me. For sure, this situation treats me so bad and I hate myself. – Forced labor, Female, age 11

While most abuse among forced labor victims was physical, sexual abuse also occurred. Young age contributed to the vulnerability of forced labor victims. They were often dependent on others for their housing or dependent on older street children for safety while living on the street. Multiple participants provided accounts of rape and sometimes sexual exploitation by these individuals that they depended on.

So I decided to keep in the traffic jam selling such that by the time Uncle comes back he does not harass me. … I could come back home at around 10:00pm in the night and immediately he asks money from me and accompanying them with utterances like "You are coming from men". There, he forces you into the sexual acts telling me that "If you got no money, do not waste me, come over here or else I will chase you out of my home" and yet I had nowhere to go. There I bear with and I give in to him. – Forced labor, Female, age 16

For many forced labor victims, the trafficker was a family member. Victims lived with this family member and were dependent on them for food, housing and other essentials. They typically had to hand over all the money they earned and were extremely isolated.

Health impacts of forced labor

The abuse and dangerous exposures victims of forced labor faced in their work resulted in physical injuries that sometimes necessitated hospital admission. Reasons for consulting a healthcare professional described by forced labor victims included road traffic accidents, stepping on broken glass, and injuries from blunt and penetrating force trauma inflicted by others. The impact of their experiences on mental health was also significant and participants described how their life burdened them, how they felt sad and hated themselves.

Sexual exploitation

Interview participants with lived experience of sex trafficking described sexual exploitation with varying degrees of control by the exploiter. The most common situation described was that of commercial sex at a bar or lodge where the exploiter determined which customers participants saw and which types of services they provided them. Customers were seen on the lodge or bar property. Sex trafficking victims were exposed to physical, sexual, and psychological abuse during their work. Physical abuse was perpetrated by customers and employers. Participants described beatings, strangulation, being hit with a belt, cable, or brick, and being stabbed.

I have ever been hit with a bottle; customer came and we did what we had to do. Then he told me that he had no other money yet he wanted another round. So, I told him I was leaving and going somewhere else. When I was leaving, he hit me with a bottle....I don’t really know, that’s when I stopped understanding. – Sex trafficking, Female, age 16

Yes, she [exploiter] cut me with a knife here. I had refused to do what she wanted me to do. She had told me to go and sleep with a man and get money because the man had promised her 50,000 UGX so she told me to sleep with him. I said "No, I will not. What if the man is already infected with a disease and I die?". She said to me, "Haven’t you heard what I told you?". She instead beat me, got a knife which was on a table that she used it to cut me. She told me to go inside the house and stay there, I will not be given food, so I went. – Sex trafficking, Female, age 15

Common triggers for violence towards victims included participant refusal of sex without a condom and disputes over the price of services. There were many accounts of customers refusing condoms, or removing the condom before sex.

When I told him about wearing a condom, he pulled out a knife and put it on me. When he put the knife on me, I plead for mercy. I pleaded with him to have mercy on me. He had really put the knife and told me that I didn’t know the person I was playing with. "I can kill you and leave you here dead and then move away. Where will you find me?" He ignored my plea and still fucked me without putting on a condom. – Sex trafficking, Female, age 27

We always feared contracting it [human immunodeficiency virus (HIV)], but as you know men of nowadays, they come with condoms but leave them at the table. You try to quarrel a bit but they are strong and would tell your boss. We were at the mercies of God. – Sex trafficking, Female, age 21

Initiation into sex trafficking frequently happened through rape, sometimes by multiple people, and in some cases was preceded by drugging the participant. One female explained,

When they took me to a room, they used me. The man used me. After him using me, he was using my anus. When I was sobering up, I felt myself weak. I did not understand what was going on. When I started gaining my sight, I was seeing three men. I did not understand. They were big. I was nude. They had gotten their phone and were taking pictures of me while laughing. I felt my anus paining a lot. I think they took when I was not sober. When I gained my consciousness, I understood that these men had sex with me through my anus. They got out. – Sex trafficking, Female, age 23

Vaginal, anal, and oral rape occurred. In a number of interviews, participants described being subjected to bestiality with dogs and horses.

He brought his two men and caught both my legs and hands. Then he put his dog on me. That day it was not easy because even the dog scratched me in the ear at the beginning. … He then told me that, "It is you who caused it to do this, but if you come when you are calm, it doesn’t hurt in any way". I also started to learn the behaviour of the dog… They could dress it on a condom. He did not want his dog to get sick. – Sex trafficking, Female, age 16

In the morning, girls would be taken to kennels to sleep with dogs; the dogs would have sex with them. The medicine that was injected in us would make the girls seductive to themselves and they would be put to the kennels and let the dogs do all they want to them. The girls would cry, but they had no way out because they would be tied. The medicine injected in boys would enlarge our penises and they would send us to the horses. The horses also seemed to be used to this kind of treatment. You would have to have sex with the horse. – Sex trafficking, Male, age 19

Participants were frequently verbally abused and threatened verbally or with weapons. Their movement was often limited by their exploiter and sometimes food was withheld. Participants had to work when they did not want to and sometimes had to work even when sick. Money was paid either directly to the exploiter who later gave a small proportion to the participant, or participants received money from the customers directly but had to give most of it to their exploiter. It was a common occurrence that customers would not pay after sex or paid less than they had promised. When participants received money from their exploiters, sometimes unexpected fees were deducted such as the cost of the room they worked from or the cost of their meals at the bar.

Health impacts of sex trafficking

The health impacts of sex trafficking were significant. Health impacts could be grouped into three main categories, namely urogenital injuries (i.e., injuries of the urinary or genital organs), musculoskeletal injuries (i.e., injuries relating to bones, muscles, and soft tissues) and mental health consequences (i.e., disturbance in mood, cognition, and the ability to interact with others). Through their work, participants were at high risk of acquiring sexually transmitted infections (STIs) including HIV. One participant described the physical discomfort she felt saying, “I got sick; I first got these diseases that catch in the private parts. It would be hard for me to walk. I would feel pain. When I go to urinate, the urine wouldn’t come out properly, it would be hurting every time I urinated” (Sex trafficking, Female, age 18). Another participant reported contracting multiple STIs saying, “First of all, I contracted HIV/AIDS (acquired immunodeficiency syndrome). We get syphilis infections, candida and those others illnesses that is the second. The third illness that I see coming, if I don't fight for myself, is death.” (Sex trafficking, Female, age 21).

Rape and rough sex caused vaginal and anal injuries leading to the development of fistulas and incontinence problems. Participants described abdominal pain and localized genital pain impacting their ability to sit and to walk. One participant reported fecal incontinence saying, “I did not have brakes behind. Wherever I sat, stools would just flow out. I was treated badly. I could not even sit at times. I would feel a lot of heat at my bottom and pain.” (Sex trafficking, Male, age 17).

Multiple interview participants reported becoming pregnant through their work. Some participants kept the pregnancy and others sought an abortion.

I have only one child, she is 7 months old, but I was not ready to have a child because I was working on the streets and I got pregnant because I did not have safe sex … Yes, I was looking for clients and that is how I got pregnant. I could have aborted it, but I did not have money for abortion. And the little money that I had, I was using it for rent. – Sex trafficking, Female, age 20

Blunt and penetrating trauma inflicted by customers or exploiters resulted in bruises, wounds and fractures that sometimes required hospital care. A participant listed the different places where she had been wounded saying, “Some of us have scars. Like me, I have scars at my back. They cut me with a blade. I have scars in my face” (Sex trafficking, Female, age 20).

The experiences participants went through in their exploitation impacted their mental health. Multiple participants reported taking drugs or alcohol to be able to endure and described how others in their line of work had developed addiction. One participant explained how he used substances as a coping mechanism, saying “You still get some problems. Nowadays, if I am going to do it [sex work], I first sniff some fuel or take drugs to relieve the pain. They do it while I am high” (Sex trafficking, Male, age 17).

Some participants suffered from flashbacks and intrusive thoughts and displayed depressive symptoms. A minority of participants described times when they had suicidal thoughts and ideations. They told of feeling worthless.

Sometimes I pretend around so that they can pass and forget them, but am hurt inside. However much you see me eating and smiling, for sure I really don’t mean it. My heart is filled with something more than sorrow...You don’t know the sadness we have faced on this Earth! You don’t know what it means to sleep with a man you have just met on the street and then you have sex with him without you having feelings for him. – Sex trafficking, Female, age 30

Ongoing vulnerability

Lack of financial means was one of main factors contributing to ongoing vulnerability for both victims of sex trafficking and forced labor. While sex trafficking victims earned money through their work, after rent, food, and other basic necessities were deducted, there was usually little left to save. In many cases, the money participants earned was sent to help support dependents. Other lines of work usually earned less or required initial capital which participants did not have. Some participants reported being part of a savings club, or trying to put aside money themselves, but this was a slow process. For forced labor victims, there was the added complication that in many cases, the trafficker was a family member with whom they lived. This person was their source of housing, meals and all basic necessities. Participants had nowhere else to go, they were frequently underage, and because of their lack of education, had few other employment prospects. One participant explained the hopelessness of her situation saying, “No, l will stay with my stepmother [exploiter] because she’s the only family I have, however much she mistreats me. If I try to do it, she can call the chairman, people in the village, and also beat me to death” (Forced labor, Female, age 11).

Barriers to seeking help

While being exploited, participants experienced many barriers to seeking help. A major barrier was the lack of awareness of the organizations and resources available to them. Most participants were unable to list any organizations that could help them by name. Among participants that had sought help, the police and healthcare professionals were the most frequently approached. Participants recounted having reported stolen property, rape and in a few select cases, the trafficker, to the police. Physical injuries and STI symptoms were the most common reason medical staff were consulted. However, encounters with these professionals were not always positive experiences. One participant described how he was not believed when he reported sexual assault to the police,

At night, he wanted to sodomize me … While I was asleep, he started to remove my trouser. I ran away and went to the police. When I reached at police, I narrated my story, but they instead called me a mad person. They said that I didn’t wear my trouser properly and my words were false. – Forced labor, Male, age 13

The fact that many help services required money including services like filing a police report, receiving medication, and getting an abortion, acted as a deterrent to seeking help. In some cases, when participants did not have the required money, help services employees exploited participants’ vulnerability and requested sexual favors instead.

By the time you take there your case to him [police officer], and he is aware that you are a sex worker, he doesn’t take you as someone important … he wants to use you. Not once! Not twice! Many have been taken advantage of in the offices. You take there your case and the man says that, "If you want my help, first remove your underwear". Will you refuse? If you refuse, your case won’t be worked on. – Sex trafficking, Female, age 30

Fear also played a strong role in participants’ decision to not seek help. Participants reported feeling threatened by the trafficker who warned them that they or their family would be hurt or killed if they left or talked to anyone about the exploitation. Participants also feared the help services describing that sometimes help services were complicit in the abuse, worked together with the trafficker, or were the clients of their exploitation.

Going to the police … you might want to take there your issues and you find that they know her [exploiter]. So, there is nothing they are going to help with. Instead, you are the one who is considered to be in a mistake when you reach. I had a friend of mine sometime back who went there [the police], but it ended on her being imprisoned. She is the one who was taken to be having a criminal case. Like now the police that is nearby, they know our boss. So, even if went there, would be no help. – Sex trafficking, Female, age 23

Sometimes seeking help was made difficult by restrictions on freedom of movement and communication placed on participants by the trafficker.

Where would you report? There was nowhere to report. They could not even allow moving out of that house. …We were inside there as prisoners. At the gate, there was a security guard and he was commanded that anyone that dared to move out, bullet. There were even two of our friends that were killed when they tried to escape. – Sex trafficking, Female, age 24

Especially in those cases where the trafficker was a family member (mainly for those involved in forced labor) participants’ loyalty and personal ties to the trafficker caused them to be conflicted about seeking help. One participant described this dilemma saying, “I don’t want the police to arrest my mother, because [participant becomes emotional] I love her so much” (Forced labor, Female, age 12).

If the trafficker were to be arrested, participants would lose their source of income which caused some participants to be hesitant about seeking help.

Shame and fear of gossip also formed important barriers to seeking help. Participants were weary of confiding in others, and in many cases their family was unaware of the exploitation. A participant explained why she could not open up about her situation saying, “Some people are not easy. You tell them your problems and they will tell them to anybody else. So it is better to stay quiet and live on.” (Sex trafficking, Female, age 15).

Facilitators of help-seeking

A minority of participants were aware of different non-governmental organizations (NGOs) that offered assistance to victims of human trafficking. These organizations offered services like legal counsel and sometimes vocational training. In those cases where participants sought help, this sometimes had a positive impact. Incidents were described in which seeking help from the police led to the recovery of stolen goods and the arrest of perpetrators. Similarly, seeking medical care contributed to resolution of physical symptoms. Multiple participants also reported receiving help from strangers. Usually, this help was a one-off and consisted of receiving a small amount of money, some food, or assistance with transport. Support was also offered by friends and co-workers. Participants reported appreciating the ability to confide in them and share their experiences. The advice they received from their social network, however, was often not very useful and was usually limited to encouragement to endure.