Harvard Public Health Review Winter 2007
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Trafficked: Sold into sexual slaver, women and young girls are both victims and conduits of HIV/AIDS
trafficked: peter horvathSlight and soft-spoken, the dark-eyed girl called Gina looks into the camera and speaks of her ordeal in a flat, disembodied voice, chronicling a story relived a thousand times. “The first night, they forced me to have sex. When I refused, they held me down, beat me, and raped me. I was seven years old.”

From her village in Nepal, Gina was kidnapped and sold by her abductors to a brothel in Mumbai, India, 1,000 miles away. She was proffered repeatedly to men willing to pay a premium for sex with a child. Some brothel customers believe a virgin can thwart or cure an HIV infection; others equate youth with purity and freedom from disease. By the time Gina was rescued, at age 11, she was dying of HIV/AIDS. Immortalized in the PBS television documentary The Day My God Died, Gina still speaks for thousands of girls and women who, trafficked internationally, are unwitting conduits for a global epidemic.

Watching the Emmy-nominated film on PBS one night in 2004, Harvard School of Public Health (HSPH) Associate Professor Jay Silverman was struck by both the horror and the global health implications of sex trafficking. In the age of HIV/AIDS, he realized, forced prostitution is often tantamount to murder. Many victims, compelled to service dozens of men per week, were contracting HIV and radiating the infection. Upon rescue or escape, critically ill women and girls were returning to their homelands, bringing the virus with them.

SEX TRAFFICKING AND HIV/AIDS

Around the world, an estimated 600,000 to 800,000 people are trafficked for labor or sexual exploitation every year, according to the U.S. Department of State. About 80 percent of victims are women and girls.

Sex trafficking is a global phenomenon. About 150,000 women and girls are trafficked annually within and across South Asia each year; most are destined for Indian cities, according to the Congressional Research Service.

Trafficking of Nepalese women and girls to India has been cited by the World Bank as a risk factor for HIV transmission in the region.

The youngest Nepalese victims are also at highest risk for HIV/AIDS. In the August 2007 study they published in JAMA, HSPH researchers reported that:
Of 287 girls and women sex trafficked to India and later repatriated to Nepal: 38 percent were HIV-positive

Detailed medical records for 225 subjects showed that at the time of their trafficking:
14.7 percent were under age 15

33.8 percent were 15 to 17

44.4 percent were 18 years or older

Of girls under age 15:
60.6. percent were HIV-positive

Infection risk was 3.7 times greater compared to women aged 18+

For all victims, infection risk rose by 2 percent per month in captivity.

“This very provocative film crystallized my determination to contribute to our understanding of sex trafficking from the perspective of public health,” says Silverman, who for six years has directed the Violence Against Women Prevention Practice at HSPH. Silverman reached out to the U.S.-based Friends of Maiti Nepal, who in turn helped him contact the nongovernmental organization in Kathmandu featured in The Day My God Died, Maiti Nepal.

The NGO provides shelter, medical care, education, and job training for repatriated sex trafficking survivors. In Nepali, “maiti” means “mother’s home.”

‘VIRGINS’ WITH HIV/AIDS
On August 1, 2007, an HSPH-led team that included researchers from Boston University, University of California, and a child-oriented network of NGOs called ECPAT International (End Child Prostitution, Pornography, and Trafficking), published a study of Maiti Nepal’s survivors in the
Journal of the American Medical Association (JAMA). Of women and girls trafficked between 1997 and 2005, the researchers found that 38 percent had HIV. At greatest risk by far, they discovered, were children—those who fetched the highest prices, perhaps because of their presumed virginity. One in seven study subjects had been sold before her 15th birthday. More than 60 percent of these children were HIV-positive.

To conduct the study, Silverman received partial funding from the U.S. State Department’s Office to Monitor and Combat Trafficking in Persons. Among those who studied victims’ case records and medical documentation were two HSPH collaborators, doctoral student Michele Decker and postdoctoral fellow Jhumka Gupta. Says Decker, a former rape crisis counselor, “I had noticed in my work that women in prostitution were often marginalized and incredibly vulnerable before they were prostituted. The trafficking studies are an amazing opportunity to try to understand what’s going on: What factors are putting victims at greatest risk? What can we do to intervene?”

Gupta was at that time a doctoral candidate in HSPH’s Department of Society, Human Development, and Health. Earlier she had completed a six-month fellowship in Mumbai, working on HIV outreach and education with children and adolescents. “You’d hear about parents being scared about their kids getting kidnapped and being forced into child labor,” she says. “And if you’d push a little further, you’d hear about the danger of being sex-trafficked.”

Says Silverman, “We in public health have too often turned a blind eye to sex trafficking and those most vulnerable to its consequences—very young girls. As our study reveals, they may well be a key piece of the global HIV/AIDS puzzle.”

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Christina Roache is the editor of Harvard Public Health NOW. To access or subscribe to this newsletter, published every two weeks, visit www.hsph.harvard.edu/now.

Illustration, David Horvath: photos- Jay Silverman, Harvard News Office, Michele Decker and Gupta,Kent Dayton/HSPH

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