Social Service Providers’ Understanding of the Consequences of Human Trafficking on Women Survivors—A South African Perspective

Abstract

Human trafficking for forced labour or sexual exploitation often takes the form of forced migration. It is the third-largest crime industry in the world and has severe consequences on the women survivors. Trafficking violates the safety, welfare, and human rights of the victims and forces physical and psychological imprisonment on them. Despite the significant number of women being trafficked, little is known about the best ways to address their needs. This article highlights the understanding developed by social service providers in South Africa regarding the consequences of human trafficking on women survivors. Being aware of the complex challenges faced by women survivors of human trafficking enables social service providers to respond to their needs effectively through appropriate interventions and services. Data for this qualitative study were collected through one-on-one interviews and analysed using thematic analysis. Social service providers understand the following to be related to women survivors of trafficking: involvement in drugs and sex work, dependency on the perpetrator, lack of self-esteem, self-blame and shame, being disoriented, psychological challenges, lack of financial support, health issues, isolation, and loneliness. To be relevant and effective, services should be packaged in a manner that addresses all the challenges faced by women survivors of human trafficking.

1. Introduction

More than six million people globally were estimated to be in situations of forced commercial sexual exploitation on any given day in 2021 (International Labour Organization (ILO) et al. 2022). Human trafficking for forced labour or sexual exploitation is the third-largest crime industry in the world (ECPAT 2018). Trafficking is often a form of forced migration as trafficked persons are moved to a newer location. Forced migration, according to the International Organization for Migration (IOM) (2019), is “A migratory movement which, although the drivers can be diverse, involves force, compulsion, or coercion”. The IOM notes that this definition sometimes includes victims of trafficking. They are a significantly vulnerable group among forced migrants in the absence of physical, emotional, and social support, which other forced migrants, like refugees and displaced persons, might have access to.

While human trafficking often involves movement, it is not always considered forced migration. Human trafficking is characterised by coercion, fraud, or force used to exploit individuals for labour or sex (United Nations Office on Drugs and Crime 2025), whereas forced migration, as defined by de Haas (2021), involves involuntary displacement due to conflict, violence, or human rights violations. Therefore, while trafficking can be a form of forced migration, it is also a distinct crime with specific legal and ethical implications. Human trafficking is a human rights violation and a crime committed by a trafficker who exploits another person using force, coercion, or deception, or a combination of these methods (Hossain et al. 2010). Dixon (2008) asserted that human trafficking activities contravene fundamental human rights, denying trafficked women basic and broadly accepted individual freedoms. Trafficking also has broad economic, social, and cultural consequences for women survivors (Sambo and Spies 2020) who disproportionately face the brunt of being trafficked. Women are vulnerable to trafficking because they are frequently excluded from mainstream economic and social systems, such as employment, higher education, and legal and political parity (United Nations Office on Drugs and Crime 2025). The Advocates for Human Rights (2010) made a similar observation and asserted that traffickers primarily target women because they are disproportionately affected by poverty due to discrimination and other factors that impede their access to employment, education, and other resources. Traffickers prey on women’s vulnerable circumstances and may lure them into crime networks through deceit and false promises of decent working conditions and fair pay (Martin n.d.). Despite its widespread prevalence globally, it is difficult to accurately measure both the extent of human trafficking and its impact. Since trafficking in women is an underground activity, its consequences are also hidden, and adequate indicators are yet to be developed that will allow the anti-trafficking community to successfully measure the impact of this crime (Hossain et al. 2010).

Women often become victims of trafficking when they seek assistance to obtain employment, work permits, visas, and other travel documents. Victims of human trafficking can be found in all types of establishments and locations, in rural, suburban, and urban settings worldwide. In South Africa, children are trafficked within the country, from poor rural areas to urban centres, such as Johannesburg, Cape Town, Durban, and Bloemfontein; girls are subjected to sex trafficking and domestic servitude; and boys are forced to work in street vending, food services, begging, criminal activities, and agriculture (Yesufu 2020). Furthermore, the positioning of South Africa as a source, transit, and destination country for men, women, and children subjected to forced labour and sex trafficking (Yesufu 2020) makes a good case for this study’s choice of location.

The violations, which women experience in the jobs and institutions into which they are trafficked for personal domestic services or intimate body and sexual services, intrude into and invade their privacy and entire being in myriad and unimaginable ways (Advocates for Human Rights 2010). Trafficking has severe adverse consequences on the women survivors, including their sexual, social, physical, and psychological health (García-Vázquez and Meneses-Falcón 2024; Krushas and Kulig 2023). Studies on the mental health of trafficked populations have consistently revealed a significantly higher prevalence of depression, anxiety, and PTSD compared to the general population (Levine 2017; Ottisova et al. 2018).

Trafficking also has severe consequences for the safety, welfare, and human rights of the victims, who are compelled to endure both physical and psychological imprisonment (Sambo and Spies 2020). Many victims of sex trafficking also have secondary psychological issues, such as alcohol and drug abuse (Levine 2017). Trafficking is associated with high levels of physical and sexual violence prior to and during trafficking (Hossain et al. 2010) and a range of health problems in the post-trafficking period (Oram et al. 2012). Zimmerman et al. (2011) underscore that throughout each stage, trafficked persons may experience psychological, physical, and sexual abuse; forced or coerced substance use; social isolation and emotional manipulation; economic exploitation and insurmountable debts; and legal vulnerabilities.

Furthermore, moral castigation, illegitimacy, and invisibility characterise the jobs that trafficked women are engaged in, and they often experience an overlap between living space and workspace; such circumstances exacerbate abuse experienced by trafficked women, which are manifested in greater physical confinement; more stringent surveillance; control over their personal and work lives, bodies, and beings; and greater subservience and debt bondage (Zimmerman et al. 2011). They opine that such conditions intensify the exploitation of women through, for example, longer hours of work, no time off, and innumerable clients.

Despite the significant number of women and children victimised by sex trafficking, little is known about how the effects on their health may vary depending on when victims were exploited or how they compare to individuals who have not experienced trafficking (Krushas and Kulig 2023). Recognition of the complex nature of trafficking in women and how it impacts a country is pivotal in informing action taken in response to and, ultimately, in sustaining the success of countermeasures for human trafficking (Dixon 2008). Furthermore, despite many organisations globally rendering services to trafficked persons, there is inadequate knowledge about the best ways to address their complex needs (Levine 2017).

Service providers who work with survivors should be aware of the severe and interrelated consequences of human trafficking. They should also know that the experiential world of the survivor is not static and includes the conscious and unconscious experiences, which are only known to the survivors (Sambo and Spies 2020). The consequences of trafficking for women survivors are complicated, intertwined, and often intersect (Ottisova et al. 2018). Establishing the needs of women is essential in informing interventions and services provided by social service practitioners who render services in the field of human trafficking. However, human trafficking in South Africa remains under-studied from all perspectives. The extant literature on human trafficking in South Africa lopsidedly focuses on providing an overview of human trafficking (see Motseki and Mofokeng 2022; Van der Watt 2018), as well as legislation (see Aransiola and Zarowsky 2014) and its ineffectiveness (see Bello and Olutola 2022; Bello and Olutola 2018; Buthelezi 2015). There is limited literature looking at the experiences of women survivors of human trafficking (see Sambo and Spies 2020), and even fewer studies that look at the intersections of social services and the experiences of women survivors of human trafficking in the South African context.

The recent literature on the intersection of trafficking in women and social work has focused on the service provisions available (see Botha and Warria 2019) and challenges faced by workers in providing these services (see Botha and Warria 2021). However, this article highlights the understanding developed by social service providers in South Africa regarding the consequences of human trafficking on women survivors, some of which relate to the availability of and challenges in accessing the service provisions. This exploration is invaluable precisely because these professionals often provide the first response to the women survivors and are often invested in their deepest, fragile, and traumatised aspects. Notably, they are often the professionals who see and recognise the traumatic value of the experiences of the vulnerable populations, even before individuals themselves do (Tessitore et al. 2022). The study, therefore, adds immense value to this field of work, as the awareness of the complex challenges faced by women survivors of human trafficking enables social service providers to respond to their needs effectively through appropriate interventions and services.

Against this backdrop of the meagre literature on the experiences of women survivors of human trafficking, the intersections of social services for this vulnerable population in general, and in the South African context in particular, as well as the prominence of trafficking in their context, this article highlights the understanding developed by social service providers regarding the consequences of human trafficking on women survivors through their work, which can be valuable for social service providers globally.

2. Methodology

This study was conducted using a qualitative approach, specifically, employing a collective case study. The data for this study were collected within a period of six months in 2018. By using a qualitative approach, the research attempted to gain first-hand knowledge of the understanding developed by social service providers regarding the consequences faced by women survivors of human trafficking. A collective case study through semi-structured one-on-one interviews with an interview schedule was used to immerse the researchers into the perceptions of social service providers on the consequences (Fouché and Schurink 2011).

The population of this research study was social service providers (social workers, social auxiliary workers, housemothers, and outreach workers) working in five organisations that are rendering services to women survivors of trafficking in the Gauteng Province, South Africa. Social workers render professional social work services, and social auxiliary workers assist social workers in their engagements. House mothers provide physical day-to-day care in the centres for trafficked women, and outreach workers are engaged in community sensitisation and awareness activities. The researchers used non-probability sampling techniques, specifically, a purposive sampling method. These sampling criteria relied on the researchers’ judgment of which participants possessed information pertaining to this study (Strydom 2011b). The researchers acknowledge the potential differences in the understanding developed by the social service providers, depending on their affiliations with the organisation. Purposeful sampling, therefore, was specifically employed to carefully select organisations with an established presence in the province. This methodological choice was based on an educated assumption that the length and the breadth of an organisation’s presence in the field correspond to the depth of its (including its employees’) understanding of the issue. This approach allowed an in-depth investigation that was based on the saturation point of qualitative information. The inclusion criteria for participants in this study were the following:

Working for an organisation rendering services to women survivors of human trafficking in Gauteng

Belonging to the following group of social service providers: social workers, social auxiliary workers, housemothers, and outreach workers

Being conversant in English

Being employed by the selected organisation for at least 12 months

Being willing and available to participate in this study voluntarily

One-on-one interviews were held until the point of data saturation. Data were saturated after 14 interviews with social service providers. Data were analysed using Creswell’s spiral model of qualitative data analysis, executed through several methodical phases (Creswell 2014). Data were manually coded. Initially, the researchers undertook systematic transcription and recording of data gathered during one-on-one interviews, employing audio recorders and handwritten notes with participants’ consent. In the subsequent phase of data collection and preliminary analysis, ongoing analysis involved scanning transcriptions, typing field notes, and categorising data into themes. This iterative process of data collection and analysis contributed to a coherent interpretation of findings. Data management entailed organising the information into a narrative format, followed by the conversion of files into discrete text units for rigorous analysis. Key themes and recurrent ideas linking participants were identified, with the data being distilled into manageable thematic sets, culminating in a cohesive narrative. The coding process involved theme development and interpretation. The researchers engaged in extensive reading of each transcript to achieve a comprehensive understanding of the interviews, subsequently dissecting the data into various components. Researchers assessed the utility of the data in illuminating the key issues under investigation and its relevance to understanding the impact of human trafficking on female survivors.

This study received ethical clearance (Reference number: 27622275) from the Faculty of Humanities at the University of Pretoria, South Africa. The researchers facilitated potential participants to make informed decisions to participate in this study voluntarily. The researchers presented the goal of this research study, including possible advantages and disadvantages, to the participants. Emphasis was placed on giving accurate and complete information on the demands the research project would make upon participants in terms of time and disclosure of confidential information. Adequate opportunity was given to the participants to ask questions before this study’s commencement and during the investigation. Furthermore, written consent was obtained from the participants.

The researchers maintained the confidentiality and anonymity of the participants throughout the research process by not using their names during data collection, transcribing, and report writing. Strydom (2011a) refers to confidentiality as agreements between persons that limit access to private information. The researchers were aware that all people have the right to privacy and the right to decide how much of their attitudes, beliefs, and behaviour they want to reveal. Therefore, the researchers made every effort to safeguard the privacy and identity of participants and acted with the necessary sensitivity.

The interviews were conducted in the offices of the participating organisations. To prevent any harm to the participants, the interviewers ensured that the interview environment was safe, conducive, and relaxed. To minimise harm, the participants were informed in advance about the potential impact of this study, including the possibility of distress, trauma, and fatigue. The participants were informed of their right to withdraw from the interviews at any stage. The participants were allowed to take breaks during the interview as needed. Considering the sensitivity surrounding the issue of work, the researchers conducted a debriefing session with each participant immediately after the interviews. This was conducted to ensure that the interviewees felt okay and had the necessary support and services, including addressing the impact of vicarious traumatisation and re-traumatisation.

3. Findings

The social service providers (SSP) shared a developed understanding of the consequences faced by women survivors of human trafficking. The findings indicate that social service providers associate the consequences of human trafficking for the women survivors with psychological challenges, health issues, isolation and loneliness, involvement with drugs and sex work, dependency on the perpetrator and lack of self-esteem, self-blame and shame, financial struggles, and being disoriented. These understandings, developed by social service providers through their direct practice with trafficked women, are discussed below as themes.

3.1. Psychological Challenges

Participants stated that women survivors of human trafficking often experience a lot of psychological challenges and stress stemming from unfulfilled promises. Their views are recorded below:

They [Women survivors of trafficking] are affected emotionally; I think these women become psychologically stressed. They are torn apart due to the fact that they are not given what they were promised. They are depressed, they are frustrated, desperate, and miserable.

Trafficked women have psychological problems. It is like they do not know themselves. This trafficking thing destroys the mind of the survivor. We had one survivor who came to us completely finished.

Experiences of trauma were commonly shared by social service providers working with women survivors of trafficking, as reflected in the interview excerpts below.

They feel bad about themselves, they put their lives in danger, they feel useless, they lose power and feel and start feeling powerless. The experience is very traumatising for them.

They experience trauma, some of them come here being so traumatised, and depressed, so stressed, many of them do not want to talk about what happened to them.

This finding is congruent with the extant literature. Several authors (see Banović and Bjelajac 2012; National Sexual Violence Resource Center 2012; Tennessee Department of Human Services 2013) indicate that that survivors of human trafficking are likely to suffer from depression, anxiety, and PTSD. Hossain et al. (2010) similarly demonstrate a common comorbidity between PTSD, depression, and anxiety among trafficked girls and women. Zimmerman et al. (2011) add that women survivors of trafficking experience post-traumatic disorders, with the following signs being common: constant remembering of stressful events; dreams or nightmares; low sensitivity to external circumstances; and avoidance of actions and situations that remind the survivor of the trauma. In their systematic review of the extant literature published between 2011 and 2015, Ottisova et al. (2016) underscore that studies indicated that trafficked women, men, and children experience high levels of violence and report significant levels of physical health symptoms, including headaches, stomach pain, and back pain, and that the most reported mental health challenges included depression, anxiety, and post-traumatic stress disorder.

3.2. Health Issues

Several participants stated that they perceive women survivors of human trafficking as experiencing a lot of health challenges. They narrated their views on the health consequences experienced by the survivors as follows:

I think there are a lot of consequences, it could be psychological, physical, even medical conditions may arise. In such cases, basic medical assessment and attention is needed.

Reproductive health problems, particularly sexually transmitted diseases, were identified among women survivors of trafficking by the social service providers, as evidenced in the interview excerpt below.

The survivors’ bodies become weak, and they easily catch diseases like HIV and AIDS, TB, and pneumonia. This requires specialised medical attention.

The interviews also illuminated multiple illnesses and, therefore, the need for multiple services for women survivors of trafficking, as pronounced in the following interview excerpt:

They suffer from several sicknesses. Since when they are trafficked, they do not have control over what happens to them. They suffer from different diseases that may require multiple services.

These findings are consistent with the extant literature, which discusses several health issues that trafficked women suffer, including physical, sexual, and psychological challenges (see García-Vázquez and Meneses-Falcón 2024; Krushas and Kulig 2023; Zimmerman et al. 2011). The Center for Social Justice (2013) states that human trafficking frequently involves sustained levels of abuse and violence, with many women suffering serious health issues for a long time after their experience.

3.3. Isolation and Loneliness

The participants stated that another consequence of human trafficking on the women survivors is isolation and loneliness. Participants shared the following sentiments:

Survivors experience isolation and loneliness […] The survivors feel the world outside is closed and they become isolated.

The survivors feel like black sheep in the middle of other women; they prefer being alone.

Banović and Bjelajac (2012) reiterate that women survivors of trafficking experience isolation and detachment. The Center for Social Justice (2013) also illuminates that these women can often feel degraded, isolated, and unreachable. Palmiotto (2015) indicates that survivors of human trafficking often isolate themselves due to PTSD, which leads to extreme anxiety and fear, profound shame and guilt, despair, loneliness, and hopelessness. The absence of emotional and social support has enormous implications for women’s ability to withstand and cope with the stress of their situation, since social support has been deemed a critical component of coping with trauma and for adaptation among survivors (Hossain et al. 2010; Jobson et al. 2023; Kowalchyk et al. 2023), and trafficking usually involves prolonged and repeated trauma (Dixon 2008; Hossain et al. 2010).

3.4. Involvement in Drugs and Sex Work

The participants highlighted that a major consequence of human trafficking faced by women survivors is their involvement in drug abuse and sex work. They stated that most of the survivors were forced into the use of drugs until they became addicted, and they were then introduced to sex work to feed the addiction. The effect of the latter puts the woman survivor in a precarious situation. The participants explained this issue as follows:

The survivors are given drugs, their body no longer functions properly. Their mind is on drugs because they are used to them, they go through withdrawals, as a result they run away from the shelter.

Survivors have been exposed to drugs for a long time on the streets, they struggle with cravings and withdrawal symptoms especially the first three months.

This study also highlighted the precarious situation where trafficked women are forced into drug use and unsafe sex work, as evidenced by the following interview excerpt:

The survivors are used for prostitution and drugs […]. They will be having sex with them [clients] without using protection. Some of them were sexual slaves—they were forced into abusing and selling drugs.

Banović and Bjelajac (2012) also found that it was common among women victims to use drugs, alcohol, or cigarettes as a coping mechanism that subsequently developed into an addiction.

3.5. Dependency on the Perpetrator and Lack of Self-Esteem

Some of the participants verbalised that women survivors of trafficking are dependent on the perpetrator and experience a lack of self-esteem. The following excerpt provides a testimony:

The victim has been away from family for a long time, and they have been doing things they didn’t want or by force. They lack self-esteem; they start depending on the perpetrator.

Dependency on the perpetrator, often described in the literature as identification with the aggressor, also formed a part of the work experience of social service providers. Participants shared the following:

They [trafficked women] become friends with trafficker, even though it was a traumatic experience, they become used to the lifestyle.

We had one survivor who came to us in a really bad shape—I think she was left to die. After she stayed in the house [shelter for trafficked women] for about a year, she was fine and she was giving testimonies how she got healed and on how trafficking affected her, but she later went back to the traffickers. It is very difficult to work with the survivor’s mind.

The Tennessee Department of Human Services (2013) confirms these research findings by stating that survivors experienced Stockholm Syndrome or, at least, trauma bonding with the perpetrator. Ricard-Guay and Hanley (2014) reveal that, due to numerous and lengthy psychological consequences, the survivors experience mental health problems like borderline personality disorder, bipolarity, drug addiction, and crushed self-esteem.

3.6. Self-Blame and Shame

The participants indicated that survivors blame themselves for the human trafficking ordeal they experienced. Their views regarding the matter are as follows:

They keep on asking why this thing happened to me…They blame themselves.

Some survivors blame themselves; they think that the reason why they were trafficked was their fault, but it was not their fault.

Research on human trafficking regarding self-blame and shame is in harmony with the empirical findings of this study and indicates that many women survivors of human trafficking often do not initially self-identify as victims (Morrison et al. 2014; Sambo and Spies 2020).

3.7. Financial Struggles

The participants mentioned that women survivors of human trafficking experience financial struggles. They observed the following:

They lose track of their world; they become stuck financially.

Having no job and no money puts the survivor in a vulnerable situation.

The National Sexual Violence Resource Centre (2012) support these findings by stating that women survivors, in general, face immense financial challenges. Many trafficking survivors do not have money or medical aid to pay for medical visits. The Tennessee Department of Human Services (2013) states that survivors are not in control of their own money and suggests that it is due to the underground nature of human trafficking, as the women are used as commodities, not worthy of owning anything.

3.8. Disorientation

Participants indicated that they often found women survivors of women trafficking to be disoriented. They explained this issue as follows:

The survivors become disoriented because of the trafficking experience. They look blank, confused, and disillusioned.

They are disoriented due to the experience, and it also delays their progress in terms of livelihood. They lose track of their world; they are like lost sheep.

Disorientation is often associated with survivors in the extant literature (see Dixon 2008; The Tennessee Department of Human Services 2013) along with other psychological challenges.

4. Discussion

This section discusses the findings presented in the earlier section, considering the extant literature. The key themes that came up through the findings relate to psychological and physical challenges, involvement in drug use and sex work, and the financial struggles that women survivors of trafficking experience.

The responses from the social service providers that women survivors of human trafficking often experience a lot of psychological challenges and stress stemming from unfulfilled promises align with the extant literature in the field. Women survivors are oversensitive and distressed due to trauma (Banović and Bjelajac 2012) and some of them exhibit mental symptoms consistent with the psychological effects of trauma, such as relentlessness, anxiety, insecurity, fear, depression, alienation, and disorientation (Dixon 2008); insomnia, irritability, depression, and sleeping and eating disorders (Zimmerman et al. 2011); and symptoms of hypervigilance and irritability (Palmiotto 2015). Banović and Bjelajac (2012) underscore that women survivors share minimisation of the experience in their own minds; feelings of helplessness and loss of control; lack of a sense of order or justice in the world; and fear of the future (Banović and Bjelajac 2012). The Tennessee Department of Human Services (2013) further states that survivors are fearful, anxious, depressed, submissive, tense, nervous, paranoid, and disoriented. They exhibit unusually fearful or anxious behaviour, especially whenever law enforcement is mentioned, and they avoid eye contact (Tennessee Department of Human Services 2013). Disorientation of women survivors of trafficking has also been discussed in a social and cultural context where they do not know the rules and have limited or no access to resources. The Ohio Human Trafficking Task Force (2013) also alludes to the fact that the woman survivor might be confused, scared, and distracted. As such, engaging in casual conversation before therapeutic interventions might help them to build trust and set the tone for effective, non-defensive communication. Zimmerman et al. (2011) highlight that many survivors of trafficking are overwhelmed at the thought of navigating the logistics of a place they do not know.

The findings indicate that another consequence of human trafficking on the women survivors is isolation and loneliness, and that many of the survivors preferred being alone. These findings resonate with United Nations Office on Drugs and Crime (2025), which flags that most trafficked women are often socially isolated by the trafficker using various forms and mechanisms of coercion; some women have been reported to be confined and shackled, while other women have existed under surveillance or in a hostile setting that effectively imprisons them. Disallowing privacy is another strategy used by traffickers on women (Zimmerman et al. 2011), augmenting social isolation. Under regular surveillance, women do not have an opportunity to discuss personal matters or establish supportive relationships. Traffickers often dictate the terms and nature of a woman’s contact with others; they create situations that ensure she does not form bonds that decrease her feelings of isolation or her dependency on them (Puidokiene et al. 2008). Further hindering the development of supportive relationships, traffickers frequently relocate women to avoid detection (Abdulkadir 2011).

This study shared the experiences of women survivors of trafficking, who frequently exhibited dependence on the perpetrator, which is often described in the literature as identification with the aggressor, Stockholm Syndrome, or trauma bonding. Stockholm Syndrome was coined after the incident in Stockholm, Sweden, where two criminals and four hostages formed such a bond that the captives developed a legal defence fund to assist their captors who abused and threatened them in captivity for over six days (Ram and Goldin 2022). Karan and Hansen (2018) found the presence of the four main criteria for Stockholm Syndrome (perceived threat to survival; showing of kindness from a captor; isolation from other perspectives; and perceived inability to escape) among female sex workers and propose that Stockholm Syndrome be considered in developing interventions relating to the psychological challenges they face. This finding is relevant for this study due to the significant presence of trafficked women in sex work. The Tennessee Department of Human Services (2013) explains it as the emotional bond a survivor feels towards an abuser, as a means of coping to increase her own safety and decrease pain during victimisation. Turner et al. (2014) state that loyalty to their trafficker presents as a barrier to these women survivors’ ability to seek services. Solis (2015) further reveals that trafficked women often do not recognise that they are victims of a crime until they are rescued from their trafficker. Therefore, it is imperative for law enforcement and social service professionals who initially encounter these women to identify them as victims.

This study illuminated that survivors blame themselves for the human trafficking ordeal they experienced. Self-blame and shame are related to social behavioural norms regarding the women survivors’ departure from their villages, the sexual nature of the work they were involved in, and whether they made a positive or negative contribution to their family (Sambo and Spies 2020). If the woman survivor returns home with an illness, her family sees her as having disgraced them (Morrison et al. 2014). The women survivors’ perceptions of sex work, even when they were forced into it, involve shame; therefore, they do not easily discuss or disclose their experience with their families after they return to the family system (Morrison et al. 2014). Although women survivors of human trafficking often blame themselves initially for being trafficked, they tend to develop different ideas about it when they know more about the phenomenon (Morrison et al. 2014). As such, the social service provider should approach the experiences and perceptions of women survivors as unique realities, as they perceive their world, including themselves and their interaction with others, in a uniquely individual way. The service provider, thus, should not pass any judgment but should show unconditional positive regard for the survivor of human trafficking.

Most survivors of human trafficking often suffer from at least one health problem, such as unhealthy weight loss due to food deprivation and poor nutrition, memory loss, chronic pain, head and neck trauma, loss of consciousness, infectious diseases, HIV and other sexually transmitted infections, and oral problems (Office for Victims of Crime Training and Technical Assistance Center 2012). Due to multiple health-related problems that affect the survivors of human trafficking, there is a need to provide them with access to integrated health and psychosocial services, to identify and establish the various needs of the survivors, and then refer them to the appropriate professional services.

The trafficked women also suffer reproductive health problems, for example, urinary tract infections, pelvic pain, sexual-assault injuries, and forced abortions, as well as STDs such as syphilis and gonorrhoea (Michigan Commission on Human Trafficking 2013). The interview excerpt presented in the Findings Section provides anecdotal evidence for this report. The Michigan Commission on Human Trafficking (2013) states that an increased likelihood of HIV infection is often cited as a risk among women trafficked for sexual exploitation, owing notably to a lack of bargaining power concerning condom use and other potentially dangerous sexual practices. Trafficked women are also less likely to be beneficiaries of medical services made available to non-trafficked women engaged in sex work. In line with these findings, Ricard-Guay and Hanley (2014) suggest that immediate healthcare, pregnancy tests, and screening for STDs of women survivors rescued from trafficking is paramount. Access to healthcare and proper medical assessment is important because survivors who have been subjected to physical and sexual abuse or who engaged in sex work are at a higher risk of STDs and unwanted pregnancy.

Another key theme that came up through the findings is the involvement of women survivors of trafficking in drugs and sex work. Interviewees shared that the majority of the survivors were forced into drug use until they became addicted and forced into sex work to enable continuing substance use. The association between trafficked women and substance use is frequently found in the literature. Dixon (2008) contemplates that trafficked persons may turn to substance abuse to alleviate the pain of their situation, and finds that this often results in addiction, organ damage, malnutrition, needle-induced infections, overdose, and death. Dixon (2008) presented the shared experiences of trafficked women who were forced to use drugs or alcohol to ensure their compliance and to enable them to take on more clients, work longer hours, or perform objectionable or risky acts. The interview excerpt presented in the Findings Section succinctly captures Dixon’s contention. Zimmerman et al. (2011) contended that traffickers force women to use drugs and alcohol as another tool of power and control. Whatever leads to substance dependency in trafficked women, they face a significant risk of being further tied to their trafficker and working to support their addiction.

Drug use, coupled with forced sex work, impacts the lives of survivors of human trafficking in multiple ways, including seeking services. Solis (2015) underscores that the survivor’s background, often resulting from forced sex work or drug use, makes it difficult for them to access social services or to obtain legal support. Solis’s findings resonate with Sambo and Spies (2020), who contend that trafficked persons are more likely to be treated as criminals rather than victims of a crime, either because they may have entered the country illegally, have irregular employment status, or because of their involvement in sex work.

Another key theme that was highlighted through the findings relates to the financial struggle of women survivors of human trafficking. Financial struggles of women survivors of trafficking in South Africa could be viewed in light of the structural and systemic socio-economic conditions in South Africa that exacerbate their vulnerability (United Nations Women 2025). High unemployment rates in South Africa, along with other socioeconomic challenges, contribute to the vulnerability of women survivors of trafficking, making them more susceptible to exploitation (Sambo and Sibanda 2025). The combination of poverty, unemployment, gender inequality, inadequate legislation, and insufficient support mechanisms compounds the financial vulnerability of trafficked women in Southern Africa (US Department of State 2024).

5. Conclusions

In conclusion, women survivors of human trafficking are a vulnerable group that should be protected. The experiences shared by the social service providers were largely reflective of the wider literature on the consequences of human trafficking on the survivors. They perceive the consequences to be around involvement in drugs and sex work; dependency on the perpetrator; lack of self-esteem; self-blame and shame; disorientation; psychological challenges; financial struggles; health issues; isolation; and loneliness. These findings were able to provide an in-depth insight into the experiences of the women survivors of human trafficking through the understanding developed by frontline workers in the field of human trafficking work in South Africa.

This study brings together these insights to illuminate that the sharing of the understanding by the social service providers in Gauteng Province in South Africa is not isolated and merely individual but aligns with the extant literature in the field and collectively contributes to a deeper understanding of the issues facing women survivors of trafficking in the nation and, in turn, to strengthening the services provided to these women. The insights, therefore, are useful to social work practitioners and other social service providers in the field of human trafficking in South Africa and in similar contexts. Understanding the consequences of human trafficking on women survivors is essential in shaping and framing the nature of interventions and services that should be provided to them.

The findings loudly and clearly underscore that for services to be relevant and effective, they should be packaged in a manner that addresses all the biological, psychological, and social consequences faced by women survivors of human trafficking. Future research could focus on exploring how to develop holistic intervention policies and programs for forced migrants and women survivors of human trafficking.

6. Recommendations

The addressing of the consequences of human trafficking experienced by women survivors requires proper institutional and infrastructural arrangements. As such, the following recommendations are made. 1. The Department of Social Development, as the custodian of welfare services in South Africa, should play a leading role in facilitating the establishment of programmes and interventions that holistically address the bio-psycho-social needs of women survivors of human trafficking. 2. Continued professional development and in-service training should be provided to social service providers. Such a training should focus on building their knowledge base on the bio-psycho-social, economic, legal, and spiritual consequences and needs of the women survivors of human trafficking. 3. Social workers, by virtue of their training, should be the coordinators of multi-disciplinary and multi-sectoral teams that render services to women survivors of human trafficking. Social workers often work from a trauma-informed practice; as such, they will be better placed in guiding other stakeholders to protect the survivors against further trauma. 4. Academic institutions involved in the training of social workers should conduct research studies to design interventions aimed at addressing the consequences of human trafficking on women survivors. 5. Future studies to further explore how the findings of this study contribute to shaping migration, trauma, and social work theories.

Author Contributions

Conceptualization, S.S. and J.S.; methodology, S.S., J.S. and S.D; software, J.S.; validation, S.S., J.S. and S.D.; formal analysis, S.S., J.S. and S.D.; investigation, J.S.; resources, J.S.; data curation, S.S. and J.S; writing—original draft preparation, S.S.; writing—review and editing, S.S., J.S. and S.D.; visualization, S.S. and J.S; supervision, S.S.; project administration, S.S. All authors have read and agreed to the published version of the manuscript.

Institutional Review Board Statement

The study was conducted in accordance with the Declaration of Helsinki, and approved by the Faculty of Humanities at the University of Pretoria (protocol code 27622275(GW20160715HS), 28 July 2016).

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

The datasets presented in this article are not readily available because of ethical restrictions.

Conflicts of Interest

The authors declare no conflict of interest.

Footnotes

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References

Abdulkadir, Mohammed Sanni. The history and socio-economic implications of trafficking in persons for developing nations. Centre-Point Humanities Edition; 2011; 14, pp. 209-22.

Advocates for Human Rights. Trafficking in Women, Stop Violence Against Women. 2010; Available online: http://www.stopvaw.org/ (accessed on 4 February 2025).

Aransiola, Joshua; Zarowsky, Christina. Human trafficking and human rights violations in South Africa: Stakeholders’ perceptions and the critical role of legislation. African Human Rights Law Journal; 2014; 14, pp. 509-25.

Banović, Božidar; Bjelajac, Željko. Traumatic experiences, psychophysical consequences and needs of human trafficking victims. Vojnosanitetski Pregled; 2012; 69, pp. 94-97. [DOI: https://dx.doi.org/10.2298/VSP1201094B] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/22397304]

Bello, Paul Oluwatosin; Olutola, Adewale A. The enforcement of anti-human trafficking law in South Africa: A case of an aircraft without a pilot. Police Practice and Research; 2018; 19, pp. 270-83. [DOI: https://dx.doi.org/10.1080/15614263.2017.1387783]

Bello, Paul Oluwatosin; Olutola, Adewale A. Effective response to human trafficking in South Africa: Law as a toothless bulldog. Sage Open; 2022; 12, 21582440211069379. [DOI: https://dx.doi.org/10.1177/21582440211069379]

Botha, Renee; Warria, Ajwang’. Social Service Provision to Adult Victims of Trafficking at Shelters in South Africa. Practice; 2019; 32, pp. 3-20. [DOI: https://dx.doi.org/10.1080/09503153.2019.1567702]

Botha, Renee; Warria, Ajwang’. Challenges of social workers providing social services to adult victims of human trafficking in shelters in South Africa. Social Work/Maatskaplike Werk; 2021; 57, pp. 57-69. Available online: https://socialwork.journals.ac.za/pub/article/view/906 (accessed on 4 February 2025). [DOI: https://dx.doi.org/10.15270/57-1-906]

Buthelezi, Silindile. Human trafficking and the new legal framework in South Africa: Intervention needed for the law to reach vulnerable girls and women. Agenda; 2015; 29, pp. 155-64. [DOI: https://dx.doi.org/10.1080/10130950.2015.1045338]

Creswell, John W. Research Design: Qualitative, Quantitative, and Mixed methods Approaches; 4th ed. SAGE: London, 2014.

de Haas, Hein. A theory of migration: The aspirations-capabilities framework. Comparative Migration Studies; 2021; 9, 8. [DOI: https://dx.doi.org/10.1186/s40878-020-00210-4]

Dixon, Judith. The impact of trafficking in persons. An Introduction to Human Trafficking: Vulnerability, Impact, and Action; 2008; Available online: https://www.unodc.org/documents/human-trafficking/An_Introduction_to_Human_Trafficking_-_Background_Paper.pdf (accessed on 15 February 2025).

ECPAT. The Trafficking of Children for Sexual Purposes: One of the Worst Manifestations of This Crime. Retrieved from Human trafficking: The third largest crime industry in the world 2018; Available online: https://ecpat.org/trafficking-the-third-largest-crime-industry-in-the-world/ (accessed on 7 May 2025).

Fouché, Christa; Schurink, Willem. Qualitative research designs. Research at Grass Roots: For the Social Sciences and Human Service Professions; 4th ed. Vos, Allucia Shokane De; Strydom, Herman; Fouché, Christa; Delport, Catharina. Van Schaik: Pretoria, 2011.

García-Vázquez, Olaya; Meneses-Falcón, Carmen. What is the Impact of Human Trafficking on the Biopsychosocial Health of Victims: A Systematic Review. Journal of Immigrant and Minority Health; 2024; 26, pp. 148-62. [DOI: https://dx.doi.org/10.1007/s10903-023-01496-z]

Hossain, Mazeda; Zimmerman, Cathy; Abas, Melanie; Light, Miriam; Watts, Charlotte. The relationship of trauma to mental disorders among trafficked and sexually exploited girls and women. American Journal of Public Health; 2010; 100, pp. 2442-49. [DOI: https://dx.doi.org/10.2105/AJPH.2009.173229] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/20966379]

International Labour Organization (ILO)Walk FreeInternational Organization for Migration (IOM). Global Estimates of Modern Slavery: Forced Labour and Forced Marriage. 2022; Available online: https://www.ilo.org/publications/major-publications/global-estimates-modern-slavery-forced-labour-and-forced-marriage (accessed on 7 April 2024).

International Organization for Migration (IOM). Glossary on Migration. 2019; Available online: https://publications.iom.int/system/files/pdf/iml_34_glossary.pdf (accessed on 15 January 2025).

Jobson, Laura; Matharu, Taranpreet Kaur; Kulendran, Shiromie; Sivakumar, Vishaal D.; Lee, Qian Yi; Li, Haoxiang; Haque, Shamsul. Exploring the associations between social support and symptoms of posttraumatic stress disorder among Malaysian and Australian trauma survivors. European Journal of Psychotraumatology; 2023; 14, 2192962. [DOI: https://dx.doi.org/10.1080/20008066.2023.2192962]

Karan, Abraar; Hansen, Nathan. Does the Stockholm Syndrome affect female sex workers? The case for a Sonagachi Syndrome. BMC International Health and Human Rights; 2018; 18, 10. [DOI: https://dx.doi.org/10.1186/s12914-018-0148-4] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/29409491]

Kowalchyk, Mary; Chernoff, Eva; Brinkman, Hannah R.; Brown, Adam D.; Pietrzak, Robert H.; Feder, Adriana. Perceived social support moderates the relation between forward-focused coping and PTSD symptoms in World Trade Center trauma survivors. Journal of Psychiatric Research; 2023; 159, pp. 130-34. [DOI: https://dx.doi.org/10.1016/j.jpsychires.2023.01.018] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/36708637]

Krushas, Amber E.; Kulig, Teresa. C. Exploring the physical, mental, and social health issues of sex trafficking victims by stage of exploitation. Victims & Offenders; 2023; 18, pp. 447-72. [DOI: https://dx.doi.org/10.1080/15564886.2022.2128128]

Levine, James A. Mental health issues in survivors of sex trafficking. Cogent Medicine; 2017; 4, 1278841. [DOI: https://dx.doi.org/10.1080/2331205X.2017.1278841]

Martin, Susan. n.d. Internal Trafficking; Forced Migration Review: Retrieved on 2025, January 23 from Internal Trafficking—Forced Migration Review Available online: https://www.fmreview.org/martin-2/ (accessed on 18 January 2025).

Michigan Commission on Human Trafficking. 2013 Report on Human Trafficking. 2013; Available online: https://www.michigan.gov/-/media/Project/Websites/AG/publications/2013/2013_Human_Trafficking_Annual_Report.pdf?rev=b3844645b07d4fe2a6e98347a704ed44 (accessed on 9 November 2024).

Morrison, Todd; Miles, Siobhan; Schafer, Priscilla; Sophal, Heang; Vanntheary, Lim; Phally, Sreang; Channtha, Nhanh. Resilience: Survivor Experiences and Expressions. 2014; Available online: https://humantraffickingsearch.org/resource/resilience-survivor-experiences-and-expressions/ (accessed on 18 January 2025).

Motseki, Moses Morero; Mofokeng, Jacob Tseko. An analysis of the causes and contributing factors to human trafficking: A South African perspective. Cogent Social Sciences; 2022; 8, 2047259. [DOI: https://dx.doi.org/10.1080/23311886.2022.2047259]

National Sexual Violence Resource Centre. Assisting Trafficking Victims: A Guide for Victim Advocates. 2012; Available online: https://www.nsvrc.org/sites/default/files/2012-10/publications_nsvrc_guides_human-trafficking-victim-advocates.pdf (accessed on 2 October 2024).

Office for Victims of Crime Training and Technical Assistance Center. Human Trafficking. 2012; Available online: https://www.academia.edu/35145614/Office_for_Victims_of_Crime_Training_and_Technical_Assistance_Center_Human_Trafficking (accessed on 18 October 2024).

Ohio Human Trafficking Task Force. Human Trafficking Screening Tool. 2013; Available online: https://humantrafficking.ohio.gov/links/Screening-Tool.pdf (accessed on 6 February 2025).

Oram, Siân; Stöckl, Heidi; Busza, Joanna; Howard, Louise M.; Zimmerman, Cathy. Prevalence and risk of violence and the physical, mental, and sexual health problems associated with human trafficking: Systematic review. PLoS Medicine; 2012; 9, e1001224. [DOI: https://dx.doi.org/10.1371/journal.pmed.1001224]

Ottisova, Livia; Smith, Patrick; Oram, Sian. Psychological consequences of human trafficking: Complex posttraumatic stress disorder in trafficked children. Behavioral Medicine; 2018; 44, pp. 234-41. [DOI: https://dx.doi.org/10.1080/08964289.2018.1432555]

Ottisova, Livia; Hemmings, Stacey; Howard, Louise M.; Zimmerman, Cathy; Oram, Sian. Prevalence and risk of violence and the mental, physical and sexual health problems associated with human trafficking: An updated systematic review. Epidemiology and Psychiatric Sciences; 2016; 25, pp. 317-41. [DOI: https://dx.doi.org/10.1017/S2045796016000135]

Palmiotto, Michael J. Combating Human Trafficking a Multidisciplinary Approach; CRC Press: New York, 2015.

Puidokiene, Dalia; Peciuriene, Jurgita; Juneviciene, Daiva. The Model of Assistance for Women Victims of Human Trafficking in Lithuania; Ministry of Social Security and Labour: Lithuania, 2008.

Ram, Sharda; Goldin, Deana. Primary care clinician’s knowledge of trafficking in persons: A systematic review. Journal of Transcultural Nursing; 2022; 33, pp. 388-97. [DOI: https://dx.doi.org/10.1177/10436596211070285] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/35075928]

Ricard-Guay, Alexandra; Hanley, Jill. Frontline Responses to Human Trafficking in Canada: Coordinating Services for Victims. 2014; Available online: http://www.cathii.org/sites/www.cathii.org/files/CATHII_english.pdf (accessed on 14 January 2025).

Sambo, Juliet; Spies, Gloudien. Consequences experienced by women survivors of human trafficking in South Africa. Social Work; 2020; 56, pp. 78-87. [DOI: https://dx.doi.org/10.15270/56-1-791]

Sambo, Juliet; Sibanda, Sipho. Multi-disciplinary initiatives to rendering services to women survivors of human trafficking in South Africa. Journal of Social Service Research; 2025; pp. 1-11. [DOI: https://dx.doi.org/10.1080/01488376.2025.2468949]

Solis, Cristina. Addressing the Needs of Overlooked Victims: Providing Child Support for Children of Human Trafficking Victims; Western Michigan University: Kalamazoo, 2015.

Strydom, Herman. Ethical aspects of research in social sciences and human service professions. Research at Grass Roots: For the Social Sciences and Human Service Professions; 4th ed. De Vos, Allucia Shokane; Strydom, Herman; Fouché, Christa; Delport, Catharina. Van Schaik: Pretoria, 2011a.

Strydom, Herman. Sampling in the quantitative paradigm. Research at Grass Roots: For the Social Sciences and Human Service Professions; 4th ed. De Vos, Allucia Shokane; Strydom, Herman; Fouché, Christa; Delport, Catharina. Van Schaik: Pretoria, 2011b.

Tennessee Department of Human Services. Human Trafficking Services Coordination and Service Delivery Plan. 2013; Available online: http://www.tn.gov/humanserv/adfam/TDHS-2013-HT-Plan.pdf (accessed on 17 October 2024).

Tessitore, Francesca; Gallo, Marica; Cozzolino, Mauro; Margherita, Giorgia. The frame of Nigerian sex trafficking between internal and external usurpers: A qualitative research through the gaze of the female Nigerian cultural mediators. International Journal of Applied Psychoanalytic Studies; 2022; 19, pp. 499-513. [DOI: https://dx.doi.org/10.1002/aps.1759]

The Center for Social Justice. It Happens Here, equipping the United Kingdom to fight Modern Slavery; Centre for Social Justice: Britain, 2013.

Turner, Kathleen; Anderson, Michelle; Lopez-Howard, Stefanie. Assessing the Scope and Availability of Services for Human Trafficking Victims Among Georgia’s Victims’ Services Providers. 2014; Available online: https://cjcc.georgia.gov/sites/cjcc.georgia.gov/files/CJCC_HTReport_FINAL.pdf (accessed on 12 January 2025).

United Nations Office on Drugs and Crime. Human Trafficking. 2025; Available online: https://www.unodc.org/unodc/en/human-Trafficking/Human-Trafficking.html (accessed on 18 January 2025).

United Nations Women. South Africa’s Report on the Progress Made on the Implementation of the Beijing Platform for Action 2019–2024. 2025; Available online: https://www.unwomen.org/sites/default/files/2025-01/south_africa_b30_report_en.pdf (accessed on 6 February 2025).

US Department of State. Trafficking in Persons Report. 2024; Available online: https://www.state.gov/reports/2024-trafficking-in-persons-report (accessed on 14 December 2024).

Van der Watt, Marcel. The Nature and Future of Human Trafficking in South Africa; GIBS Business School: Johannesburg, 2018.

Yusufu, Shaka. Human Trafficking: A South African Perspective. Journal of Social Sciences and Humanities; 2020; 17, pp. 103-20.

Zimmerman, Cathy; Hossain, Mazeda; Watts, Charlotte. Human trafficking and health: A conceptual model to inform policy, intervention and research. Social Science and Medicine; 2011; 73, pp. 327-35. [DOI: https://dx.doi.org/10.1016/j.socscimed.2011.05.028]