“Prostitution isn’t people deferring entrance to Yale while they prostitute to raise money for tuition—that’s not the reality of what it looks like,” said Nicole Bell, who worked as a prostitute after being trafficked as a teen. “We’re looking at people in poverty, people of color, people coming out of the foster care system.”

Bell, who spoke alongside a panel of activists at the Women in the World Summit in Manhattan Friday, is now the founder and CEO of Living in Freedom Together (LIFT), a survivor-led organization that helps individuals exit the world of commercial sexual exploitation.

“We look at prostitution and trafficking as two different things, but most people in prostitution have experienced trafficking in some form,” Bell said. “Most were brought into this before they were old enough to consent to have sex—never mind to being sold for sex.”

Human trafficking is estimated to bring in global profits of about $150 billion a year—$99 billion from sexual exploitation, according to the International Labor Organization. Nearly 9,000 cases in the U.S. were reported to the National Human Trafficking Hotline and BeFree Textline in 2017—a 13% increase from the prior year, according to the Polaris Project. But this data is incomplete, as cases are severely underreported.

“This is not only a dominant issue, it’s an epidemic issue,” Cindy McCain, who chairs the McCain Institute’s Human Trafficking Advisory Council said. “It’s also something that is hiding in plain sight. It’s everywhere—it’s absolutely everywhere.”

President Donald Trump has said his proposed wall at the Southern border would have a huge effect on ending human trafficking, but McCain said the problem is within our own borders.

“He’s living in Disneyland,” McCain said. “These kids that are being trafficked are domestic. They are within the United States and they’re going from state to state.”

A Pipeline of Vulnerability

Some of the biggest factors that lead vulnerable children to become vulnerable adults are poverty, homelessness, abuse at home, the foster system, and glamorization of the sex industry, what is essentially a “pipeline of vulnerability,” said Dr. Sharon Cooper, founder and CEO of Developmental and Forensic Pediatrics.

“What we see is that children are at great risk to be brought into what’s referred to as ‘the life’,” said Cooper. “They are really groomed, sometimes by society, by the advertisements, by what they see on social media, and therefore we have to be very proactive to make this stop.”

Through LIFT, Bell works with incarcerated women, another group hugely vulnerable to sex trafficking.

“When you’re looking at our prison system, it’s literally a fish pool of vulnerabilities,” said Bell. “Women with substance abuse disorder, people who don’t have any family support, homelessness—if you want to find a victim, all you have to do is go through the court transcripts … and offer them a way out.”

And don’t think your state is immune. Of the 5,147 human trafficking cases reported in 2018 through the National Human Trafficking Hotline, not one state was excluded.

“The general public thinks that trafficking of girls occurs in inner cities,” said Cooper. “We’ve seen cases where girls were taken to farms and sold to migrant farmers, drugged in order to become compliant. We’ve seen girls who have been living in homeless shelters, and who come out of the homeless shelter just to walk down the street, but that homeless shelter has been cased by traffickers who will then drive down the street and say, ‘Hey I have a job for you and you can get the tips.’ This is the kind of thing if you offered to a homeless child they would will absolutely believe is authentic and is an okay thing to do.”

Prostitution vs. Sex Trafficking

Dr. Cooper often treats sexually traumatized children and testifies in court to help prosecute those who victimized them.

“When I’m testifying in a trafficking case, which is fairly common these days, it’s really clear that judges and juries do not really understand the difference between prostitution and sex trafficking,” said Cooper.

While prostitution is defined as the exchange of sex for money, drugs, or influence between two consenting adults—where consent can be given—human trafficking means there is third-party control.

“Whenever someone else is getting that money on the backs of those individuals—often children who are having to perform 10, 12, 15 sexual acts, and actually being sexually assaulted, at a time—that constitutes sex trafficking,” she said.

And these children often end up the adult prostitutes, who many assume are just making a job choice, said Bell.

“The difference between a child victim of sex trafficking and an adult victim of sex trafficking is 60 seconds,” she said. “Nothing changed as I turned 18 years old. I was still being victimized. It still was not something I wanted to be doing. I spent the majority of my adult life involved in prostitution, sometimes with a third-party exploiting me and sometimes because I didn’t feel like I had any other options or any other worth in this world.”

Bell is working to decriminalize the act of prostitution, and advocates instead for harsher penalties for those who purchase sex, because while female sex workers often face jail time, johns are often given educational intervention.

But things are starting to change.

“We take their cars away from them now,” said McCain, referring to the state of Arizona. “So these guys have to go home and explain to their wife, their significant other, to their boss, whatever it may be, why they don’t have a car anymore. And it’s working beautifully.”

In other cities, like Los Angeles, those who get arrested for buying sex might find their names printed on billboards. And Bell said her organization, LIFT, sends bright yellow postcards to the homes of those caught buying sex.

But the best way to end sex trafficking, activists say, is preventing it.

Making sure our prosecutors, judges, schools, doctors, first responders, are trained on what to look for and what to do when they see human trafficking, is the most important piece of combatting it, said McCain—but that can be harder than it sounds.

Schools aren’t always welcoming when it comes to speaking to children about sex, even when it is a safety issue.

“I’ve run into this everywhere I go,” said McCain. “This is not sex ed, this is saving lives.”

The McCain Institute is supporting research to get more complete and reliable data on human trafficking in the U.S., in order to better target awareness and prevention training. McCain also encourages people, especially women, to be proactive in their communities and see what resources are available to both prevent sex trafficking and help victims.

“This is very much a man’s issue,” said McCain. “Women, we need to take hold of this.”