Three years ago, Jay Silverman, HSPH Assistant Professor of Society, Human Development, and Health, happened to catch a documentary on PBS that transformed his thinking on a critically overlooked aspect of violence against women and children. The Day My God Died profiled victims of child sexual slavery and the people working to free them in Mumbai (formerly Bombay), India. One of the victims profiled had been sold into slavery at age seven. Another, aged 19 years, became an unwilling prostitute after traffickers held her infant as a guarantee of her sexual labor.
"It was a very provocative film that crystallized my thinking about trafficking and my determination to find a way to contribute to our understanding of this issue within public health," said Silverman. "Based on that film, I approached the U.S.-based representatives of the NGOs featured in the documentary and listened to how they thought public health research might play a constructive role. Those conversations led to our first studies on trafficking."
Silverman was in an exceptional position to conduct such studies. Over the past 10 years, he has amassed a research base focused on studying the epidemiology and prevention of violence against women and girls in the U.S. Silverman's research has included many studies of the prevalence and health correlates of adolescent and adult partner violence victimization and perpetration, particularly regarding reproductive and sexual health concerns such as HIV. He directs Violence Against Women Prevention Practice in the Division of Public Health Practice at HSPH. He has also studied factors such as the etiology of adult partner violence, cross-cultural societal factors related to violence against women, experiences of battered immigrant women in the U.S., responses of health care practitioners to battered women, and other behaviors. In 2002, he co-authored the first book to assess how abusive men fare as parents, the award-winning The Batterer as Parent: Addressing the Impact of Domestic Violence on Family Dynamics. Silverman's latest domestic work involves a study of the overlap and development of a broad range of violence-related behaviors among young adult men.
With the addition of his efforts to examine the public health implications and prevention of sex trafficking, Silverman has entered the international arena. Working with HSPH doctoral students Michele Decker, Jhumka Gupta, and others, Silverman is focused currently on South Asia, where hundreds of thousands of people are reported to be sold into sexual slavery each year.
A SNAPSHOT OF TRAFFICKING
This mother traveled from her village in Nepal to Mumbai, India, hoping to find and rescue her teenage daughter who was trafficked into an Indian brothel. Nepalese girls are prized for their fair skin and are lured with promises of a "good" job and the chance to improve their lives. (Text and photo from U.S. State Department, "Images of Human Trafficking")
Two of the countries on which Silverman's team is focused - Nepal and Bangladesh - are ranked by the State Department as "Tier 2" countries, meaning that these countries' governments do not fully comply with the minimum standards of the Trafficking Victims Protection Act, but, in the opinion of the State Department, are making significant efforts to become compliant.
India, another country of interest to Silverman, has been put on a "Tier 2 Watch List" because the State Department has determined that India has failed to "show evidence of increasing efforts to address trafficking in persons."
OVERLOOKED BY PUBLIC HEALTH
According to Silverman and Decker, the public health aspects of human trafficking typically are examined through the narrow lens of sex workers and HIV/AIDS transmission. Yet those studies do not capture the experiences of underaged sex "workers" - many of whom are trafficked - because they are not typically included in study samples. Younger girls, Silverman has learned, are typically moved or hidden within brothels to prevent detection and are almost never allowed to seek the types of services or participate in the types of programs from which public health studies are typically conducted. As a result, said Silverman, they have remained invisible to those reading the public health literature.
"And so this really does beg questions such as 'Where are these girls in our public health picture of prostitution and trafficking?' and 'How do experiences of trafficking and young age impact their vulnerability to HIV?'" added Decker.
In December 2006, Silverman and his team published a paper in the Journal of Acquired Immune Deficiency Syndrome on HIV prevalence and predictors among rescued sex-trafficked women and girls in Mumbai, India. The team examined the case records of 175 trafficked women and girls tested for HIV. The researchers found that approximately one-quarter of the women and girls were HIV positive and, of those, the average age at the time they were initially trafficked was just 15.9 years. The team calculated that a girl's risk for becoming HIV positive increased three to four percent for each additional month she was held captive.
Recent work has documented that more than half of Nepali girls who were trafficked under the age of 15 have contracted HIV. Silverman said that data only serve to amplify concerns for both trafficked and infected girls, including their potential role in the spread of HIV locally and internationally.
Now, the team is looking to expand its research beyond the HIV/AIDS framework to examine the larger picture of why sex trafficking occurs and how to prevent it - an area that Silverman and Decker feel has been largely overlooked in public health.
Observed Silverman, "The question has been 'How are sex workers a vector of disease in the HIV epidemic?' The focus has not been on understanding the context, mechanisms, and logistics of sex trafficking, factors relating to people's vulnerability, or on programs to prevent people from being trafficked in the first place."
Silverman, Decker, and others recently published a paper on the experiences of sex trafficking victims in Mumbai in the International Journal of Gynecology and Obstetrics. Working with the Rescue Foundation of Mumbai, an NGO that helps to free and then assist trafficking victims, the team reviewed the records of 160 women and girls who had been held against their will in brothels. The team spoke with dozens of individuals assisted by this NGO and other anti-trafficking agencies. The victims' stories were dismal and often chilling.
More than half had been trafficked as minors, and nearly 60 percent had been trafficked by people they knew, such as husbands. Many had been drugged and kidnapped, only to awaken within brothels. Others were simply taken by force. Some believed they had been betrothed to men, when they had actually been sold to traffickers. Some were escaping violent households. Those that went "willingly" were propelled in some part by promises of better economic opportunities. In these scenarios, the women and girls often left their impoverished homes believing that they were on their way to a well-paying job, only to realize later that they had been tricked and sold into a form of human slavery.
Once in captivity, many of the victims experienced a violent initiation into sex work, often through multiple rapes, beatings, and threats to their lives, said Silverman. This combination makes outreach to the victims by NGOs very difficult, he said. Rescuers typically go undercover as customers in brothels, attempting to identify women and children held against their wills and persuading the victims that they will be safe if they leave as part of a rescue operation.
"That's a very scary proposition for a trafficked individual," explained Silverman. "It's very hard for them to feel like they can trust anybody because if they try to get out and they're discovered by their captors, the consequences may be dire." Severe beatings and murders of prostituted girls were reported as common.
Rescue is made more difficult by the fact that the youngest victims "are often kept in the scariest conditions, where they're hidden and confined far in the back of a brothel, sometimes under floorboards, sometimes literally caged," said Silverman. "In many circumstances, they are kept on top floors and then shifted to other buildings upon discovery of a rescue operation below."
Minors, who fetch higher prices from male brothel customers based on their young age and supposed "purity," are also often moved around highly sophisticated networks of brothels, getting sold and resold repeatedly, making these youngest of victims very hard to track.
FUTURE DIRECTIONS
Silverman and his team are expanding their research and have recently returned from collecting additional data in South India and Bangladesh. Also, based on his initial publications, Silverman has been funded by the United Nations Development Programme to expand his work on sex trafficking and health to several countries in Southeast Asia. Work in southwest China is also planned.
"The United Nations has recognized sex trafficking as a major facet of an epidemic of violence against women worldwide," said Silverman. "I think it very important for those of us in public health who seek to end gender-based violence to consider understanding and preventing trafficking of women and girls as a critical part of our mission."
Copyright, 2007, President and Fellows of Harvard College
