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 horvathINVISIBLE CRIMES

JAMA’s publication, Maiti Nepal’s founder and chair, Anuradha Koirala, wrote to the HSPH team by email. “[As a result of the paper], we have become more aware of the combination of factors placing the youngest girls in the highest risk category of medical consequences from trafficking. We better understand the risk to the general Nepalese population as victims return, becoming a potential source of infection to the country.”

Silverman offers possible explanations for the heightened risk faced by young girls. These children are least able to demand that clients use condoms. They may be ignorant of sexually transmitted diseases and their transmission. Their still-developing genital tracts, traumatized again and again, become torn and highly susceptible to infection.

But to the HSPH team, the most compelling reason for their exceptional vulnerability may be the high value placed on these children. From anecdotal reports, the researchers learned that traffickers sell younger girls at higher prices. For children, brothel owners can demand up to twice the usual fee from clients who prefer virgins, who are presumed to be disease-free. These most valuable of human commodities are forced to serve many more men than are mature women.

These children are virtually invisible, Silverman says. Hidden from police, they are sequestered under floorboards, even caged. Forbidden to visit medical clinics or participate in health promotion programs, they fall under the radar of public health studies. Says Decker: “This really does beg the question, ‘Where are these girls in our public health picture of prostitution and trafficking?’”

Silverman likens sex trafficking to organized crime, with one driving motivation: profit. Attempts to study or disrupt international trafficking networks must abide by this reality.

Early in 2007, Silverman, Decker, and Gupta published online a report in the International Journal of Gynecology and Obstetrics that illuminated the inner workings of this dark enterprise. With help from the Rescue Foundation of Mumbai, the team reviewed the case and medical records of 160 women and girls who had escaped or been rescued. More than half the victims had been trafficked as minors; nearly 60 percent were trafficked by people they knew, including husbands. Many had been drugged. Others were taken by force. Some went willingly, desperately poor and alone and lured by promises of a better life.

Many girls and women experience a violent initiation into sex work, the researchers learned. Victims who refuse risk being beaten and raped into submission.

Meanwhile, the researchers say, efforts to stop this abuse and find those enslaved remain few and underfunded. Police and other officials are often bribed to look the other way.

As shown in The Day My God Died, trafficking victims are so terrorized and traumatized that rescue is exceedingly difficult. Rescuers typically go undercover as customers, then try to persuade children and women who are trapped to leave with them when they return as part of a police-run raid. But leaving is “a very scary proposition,” explains Silverman. “It’s hard for victims to trust anybody. If they try to get out and they’re discovered, the consequences can be dire.”

Against a rising tide of disease, Silverman, Decker, and Gupta suggest social and economic solutions. Boost educational and economic opportunities for women and girls, they urge. Devise policies, laws, and interventions to stem the demand for child prostitutes by imposing harsh criminal penalties, shaming men within their communities, and educating the public about sexual slavery.

In addition, Silverman says, “We need to comprehend men’s motivations for seeking out child sex slaves in the first place.” On that subject, he notes, research has “shockingly little” to say.

Ambassador Mark Lagon, director of the State Department’s Office to Monitor and Combat Trafficking in Persons, echoed this stance in an interview with the Boston Globe concerning the JAMA study. “It’s important not only to look at the awful economic situation, and the political situation that makes people vulnerable, but also at the demand that creates this situation,” he said.

To fuel policy changes at the highest levels of government, Silverman, Decker, and Gupta will continue to document the harsh realities and public health consequences of sexual slavery. Silverman has received funding from the United Nations Development Programme to expand the work to several countries in Southeast Asia. Research in southwest China, too, is planned.

“The United Nations has recognized sex trafficking as a major facet of the global epidemic of violence against women and girls, as well as a horrendous violation of human rights that nations are legally bound to stop,” Silverman says. “But stopping this crime must also be seen as critical to stemming the international spread of HIV/AIDS.”

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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.

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