Health and Human Trafficking

Health-care reform has dominated policy debates. While human trafficking has not been at the front of these debates, human trafficking something. Though there are serious health consequences from trafficking itself - including STDs and STIs, broken bones, burns, malnourishment, and psychological trauma -, victims often do not have access to proper medical care until their situation becomes serious. At the same time, medical professionals may be the only person a victim does come in contact with. Service providers also need to be aware of their own mental health needs when working with victims and survivors; secondary trauma is an issue often ignored. The relationship between health issues, health-care, and human trafficking is complex and multifaceted.


Meg: Sexually transmitted diseases are drastically high among women who have been prostituted. For example, in one study done in 1994 with 68 females who had been prostituted in Minnesota for at least six months, only 15% had never contacted one of the study's focus STDs (chlamydia, syphilis, gonorrhea, and herpes). However, women in the sex trade can be less likely to seek out treatment for a number of reasons, including inability or suspicion of outsiders and authorities. How can governments increase treatment/decrease STDs among these populations? Should a policy of decriminalizing prostitution for the prostitute, while criminalizing it for the purchaser (similar to Sweden's policy), be adopted in order to encourage more women caught in the sex trade to seek treatment? In 2009, the sheriff of Cook County, Illinois, initiated a similar policy to Sweden's by shifting resources away from arresting prostituted females (instead referring them to social services), to arresting sex purchasers. It will be interesting to see if this is a model that will be useful for the rest of the country.

Shreya: In 2003, Global AIDS Act, i.e. United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 is signed into law. This ACT requires organizations to sign a "Prostitution Pledge" to receive U.S. funding. This pledge prohibits funding to organizations that do not have a policy explicitly opposing prostitution and sex trafficking.
The Act seems to merge the terms "prostitution" and "sex trafficking". As a PLoS Medicine article points out this is not acceptable: "One of our key findings was that the merging of the terms “prostitution” and “sex trafficking” in the Global AIDS Act is not accepted as standard language or practice by the scientific literature on HIV/AIDS or by international agencies with HIV prevention programs. Trafficking in persons for any purpose is consistently seen as a criminal and human rights offense, and the subset of human trafficking related specifically to the sex industry is universally seen as among the most grievous of trafficking-related crimes. While the law calls for opposing sex trafficking, we could find no entity that did not already oppose it. The same holds true for any form of prostitution involving children or minors—this was universally acknowledged as a crime and a human rights violation before the policy. However, many organizations disagree with the Act's equation of all forms of prostitution with sex trafficking. The term prostitution itself is controversial—most groups working with persons who sell or trade sex for money use the terms “sex work” and “sex worker,” rather than “prostitute,” which is widely held to be stigmatizing and pejorative".

The goal of the pledge was to control HIV transmission by decreasing or ending prostitution, but according to most studies the pledge has had no measurable impact. Most people believe this pledge only hurts the already vulnerable population of sex workers.

Youngbee: When one thinks about health and human trafficking, the first thing that comes to his or her mind is HIV/AIDS infection. Though HIV/AIDS is a commonly known byproduct of human trafficking, especially, sex trafficking, the victims often suffer more than sexually transmitted disease. Along with sexually transmitted disease, they suffer mentally or psychologically as a result of forced prostitution or even labor exploitation. According to a research, child victims suffer depression, guilty&shame, cultural shock, Post Traumatic Stress Disorder(PTSD), and traumatic bonding with the traffickers. In a case of forced prostitution or prostitution alone, both child as well as adult victims suffer from PTSD, guilt and shame, difficulty in establishing a healthy relationship, and low self-esteem. Many times, victims are re-victimized in the brothels or sex industry after the rescue, if they fail to receive proper counseling treatment to recover from the trauma.

Jenn: Medical professionals and health-care workers may be the first or only people to come in contact with a trafficking victim. Doctors, nurses, emergency medical responders, and other medical professionals need to receive training on recognizing potential trafficking indicators and should be part of coordinating anti-trafficking efforts. The London School of Hygiene and Tropical Medicine provides a report on the causes of health issues in trafficking victims and the consequences of these issues, including physical, psychological, and sexual/reproductive health issues.

Polaris Project points out that health-care workers have unique opportunities to recognize the signs of trafficking, and advises that human trafficking assessment protocols should be "adapted to fit existing organizational protocols for interacting with potential victims of child abuse, violence, sexual assault and other related crimes. Health practitioners should familiarize themselves with social service providers in their area working on the issue of human trafficking and work with these agencies to create a protocol for responding to victims of trafficking." Polaris Project also provides several lists of health indicators that should be trafficking red flags and information about short and long-term effects of trafficking on health.

Elise: Over the last year, as I have worked for a service provider for survivors of human trafficking, I have come to better understand the important role of health care workers in the fight against human trafficking, both as sources for identification of victims and support for survivors. Low-income clinic workers and emergency personnel are particularly important because traffickers often withhold medical care from the victims until it becomes absolutely necessary. DHHS created an identification card as well as other training materials for health care workers.

In addition, I would submit that survivors would be better served if hospitals and medical personnel were trained not only on identification, but also on an understanding of the support system set up to assist survivors through the TVPA. I mention this specifically because even when survivors are linked with NGOs, he/she may still be considered undocumented until the service provider or law enforcement agency has been able to adjust their status as their case proceeds. Outside of emergency assistance, this time of limbo complicates the survivor's ability to receive health care services because this individual may have limited identification documents, no insurance and a limited cap on medical expenses depending on the funding or grant source of the organization. Even with the existence of MOUs or SOPs that a service provider may set up with a medical provider, staff turnover and gaps between cases may lead to unnecessary complications. Perhaps the solution lies in training mandates or curriculum in medical schools or stronger cooperation between service providers and health care facilities, but this is an extremely important service to survivors of any type of trafficking.

Sex Trade of Minors in India

Child Trafficking in Malawi

Child Prostitution in Sri Lanka

Sex Slaves: A Darker Side Of The Russian Economic Boom

Nigeria: Porous Border Aids Human Trafficking

From allAfrica:

Nigeria's porous border with its northern neighbour Niger is being exploited by traffickers smuggling teenage girls to Europe where they will work as prostitutes, immigration officials told IRIN."Our 910 kilometre boundary with Niger is too much for us to police which provides human traffickers an advantage to conduct their trade of smuggling young girls to Europe for prostitution," Oemi Bio Ockiya, head of the Nigerian immigration department in Kano told IRIN.

Ockiya said girls are transported from the southern part of Nigeria to Kano from where they are driven to Libya through Niger and then shipped to Europe, their final destination, for prostitution.

The traffickers convince the girls and their parents that lucrative jobs await their victims, but force them into prostitution once in Europe by holding on to their passports.The trafficking of young women to Europe through Kano has been a common occurrence.

Hitherto the traffickers would smuggle their victims through Kano airport using fake and stolen passports.

However the introduction of state-of-the-art passport reading machines and a run of high-profile arrests meant the traffickers resorted to driving the victims overland to Niger then Libya from where they are shipped to Europe, Ockiya said.

Ahmed Bello, head of the federally-funded National Agency for the Prohibition of Traffic in Persons [NAPTIP] in charge of 18 northern states said trafficking is also spreading HIV/AIDS."Our investigation shows that 40 percent of trafficked girls repatriated to Nigeria test positive to HIV and this has serious social and economic implications," he said.

Read the full article

Under Wraps, Prostitution Rife In North Afghanistan

*This article sheds light on the connection between prostitution and the spread of HIV and AIDS. Although prostitution is not by any means always connected to sex trafficking, the societal health risks posed by the respective issues remain the same.

From the New York Times:

MAZAR-I-SHARIF, Afghanistan (Reuters) - When 19-year-old Fatima returned to her home in northern Afghanistan after years as a refugee in Iran, she struggled desperately to earn a living.

She briefly found work with an NGO, before being let go, and then spent two months learning how to weave carpets, before the factory shut down and she was again out on the streets of Mazar-i-Sharif.

Determined to support her mother, two sisters and young brother, she turned to a profession that has long been practiced the world over but remains deeply suppressed in conservative Afghanistan -- prostitution.

"I had no other way but prostitution," says the pretty teenager, dressed in tight blue jeans with a black veil pulled loosely over her head.

"I get up early in the morning and wander around the city," she said, at first reluctant to discuss her work. "My customers stop me and give me a lift and then we talk about the price," she explains, her face coated in make-up.

Sometimes charging $50 a time, her work is illegal and would bring shame on her family if discovered, but it provides a lifeline she otherwise could not have imagined.

And there is anecdotal evidence, supported by doctors concerned about the potential for the spread of HIV and AIDS, that more and more young women across northern regions of Afghanistan are turning to sex work to escape grinding poverty.

Mohammad Khalid, a doctor who runs an AIDS awareness clinic in Mazar-i-Sharif, says he has seen a rise in infections, although from a very low base, and fears that women working in prostitution are reluctant to come forward to be tested.

"Unfortunately the public is not aware of the risk of HIV infection," he says. "It is very dangerous and these prostitutes will be a major factor in spreading it."

Read the full article

From Nepal to India: Trafficking and the HIV/AIDS Crisis

From the American Chronicle:

Nepal is certainly an important country globally for urgent HIV/AIDS interventions? UNAIDS predicted two years back that Russia and India were going to be the two largest centers for the future AIDS epidemics, though both countries are able to expertly handle any kind of pandemic when push comes to shove. In fact India's projected rate of 50 million next to South Africa's 56 million, is now hugely diminished re-totaling to only 21 million, but still a large figure nonetheless. China too has nearly 27 million known HIV infections. Both countries are capable of intensive AIDS patient care and produce their own anti-retroviral treatment based total health care packages.

Where would that leave Nepal, which is the only country that India shares an open border with? Has anyone thought about it seriously? The alarming fact appearing to both Indian and Nepali media these days is that a large number of Nepalese girls and women are trafficked to India and known to be engaging in the commercial sex trade in Indian brothels substantiating a decade old ILO estimate. There are only a handful of NGOs that work in this sector among the 6,500 registered at the national level.

Just imagine this likely scenario. A quarter of Nepal's female commercial sex workers numbering around 100,000 of a total 200,000 were infected with HIV or had full blown AIDS (a 2005 estimate that is quoted in You and AIDS, UNDP web portal), came back and got married into Nepalese communities, gave birth to Nepalese children, and infected their Nepalese spouses.

According to the UN website, "a major challenge therefore is to control HIV in the country is the trafficking of Nepali girls and women into commercial sex work in India, and their return to practice in Nepal. About 50 percent of Nepal's FSWs previously worked in Mumbai, India and some 100,000 Nepali women continue to engage in the practice there. The National Network against Girls' Trafficking, an Indian coalition of approximately 40 NGOs initially established to tackle the problem of girl trafficking, has also begun to address the issue of HIV/AIDS".

But many of the remaining have got married to Indians in Indian cities and stayed back. What kind of crises would Nepal and India jointly face in the future? Certainly, on of the most staggering geo-strategic cross-border security and human development challenges facing any two countries in the world requiring 'quick brew' interventions, availability of an international pool of knowledge bank experts, vast quantity of ART drugs, hospitals and hospices, 'stand-by' financial resources and workable intervention strategies comparable to a hidden, springing math formula.

It would be a major diversion from the two countries' development budgets and a loss of human lives as more people died of AIDS related illnesses. Are we capable of handling such a scenario in Nepal? The answer again is NO!"

The author of this stark and alarming article is Surya B. Prasai, a Nepali national who has written extensively on issues of the environment, HIV/AIDS, the United Nations, and migration, often with inclusion of Nepal's issues. The scenarios and figures Mr. Prasai discusses, however, are not only concerns he has. The Journal of the American Medical Association produced a report in August 2007 entitled "HIV Prevalence and Predictors of Infection in Sex-Trafficked Nepalese Girls and Women," which produced the following results among 287 repatriated Nepalese victims:

• 38% tested positive for HIV,
  
• Girls who were trafficked prior to the age of 15 were at increased risk for HIV with over 60% of this group testing positive for infection,
  
• Girls who were trafficked prior to the age of 15 were also at greater risk of being detained in multiple brothels with longer periods at each one,
  
• Additional factors associated with HIV positivity included being trafficked to Mumbai and longer duration of forced prostitution

In a New York Times article, written at the time of the release of the report, Dr. Jay G. Silverman, professor of human development at Harvard's School of Public Health as well as the lead author of the AMA report had this to say:

Girls from China's Yunnan Province sold to Southeast Asian brothels, Iraqi girls from refugee camps in Syria and Jordan, and Afghan girls driven into Iran or Pakistan all appear to be victims of the same pattern, he said, and are presumably contributing to the H.I.V. outbreaks in southern China, Afghanistan and elsewhere.

"Most authorities fighting human trafficking don't see it as having anything to do with H.I.V.," Dr. Silverman said. "It is just not being documented."

Brothel owners pay twice as much for young girls, Dr. Silverman said, and charge more for sex with them, sometimes presenting them as virgins, because men think young girls have fewer diseases or believe the myth - common in some countries - that sex with a virgin cures AIDS.

"It's absolutely heartbreaking, "Dr. Silverman said. "Some of them are just shells - and shells of very young human beings. It's every father of a daughter's worst nightmare."

"About half of those tested had been lured to India by promises of jobs as maids or in restaurants. Some were invited on family visits or pilgrimages and then sold - sometimes by relatives. Some were falsely promised marriage. Some were simply drugged and kidnapped, often by older women offering a up of tea or a soft drink in a public market or train station," Dr. Silverman said.

Sex Workers Fight HIV in Bengal

The Sonagachi Project

From Thaindian News:

Kolkata, Bengal: Sex workers of Sonagchi, the largest brothel in India, are working to prevent HIV infection and human trafficking by organizing camps for sex workers of West Bengal and asking them to fight for their rights.

Under the banner of Durbar Mahila Samanwaya Committee (DSMC), 65,000 sex workers in West Bengal, India organize to advocate for sex workers rights and discuss major issues such as HIV infection and human trafficking.

West Bengal is the state with the highest number of HIV infected patients (150,000).

Rajeev Shukla, Project Director, West Bengal State AIDS Prevention and Control Society said that Bengal's open borders with Bangladesh, Nepal and Bhutan are the biggest challenge for HIV infection. Migrants from these countries carry the virus and further spread the disease.

Earlier, police raids were so frequent that the number of clients was very low. Additionally, the fear of losing customers used to stop [sex workers] from demanding condom use. "Police used to think sex workers encourage human trafficking which was an absolutely wrong notion," said Bharati Dey, who has been a sex worker for the last 30 years. "To stop human trafficking in sex trade, a self-regulatory board has been established by the sex workers."

The board works as a filter and checks whether the new girl joining the trade is an adult or a minor. This board also tries to find out if any new girl joining the profession is under any pressure to do so. "This has been very successful way to check human trafficking, police raids have also reduced considerably," said Swapna Gayen, a sex worker in Sonagachi for over two decades. During the seminars, sex workers also discussed new amendments proposed in the existing laws, which they feel would criminalize sex work.

There have already been protests against the new amendments, which criminalize clients of sex workers. Sex workers feel that such amendments would make the entire trade a crime. "The new amendments will force the sex trade underground," said a legal expert Tripti Tandon.

*The last paragraph brings up an interesting point: by cracking down on the demand side of prostitution, does this simply drive the industry underground and thus create more opportunities for trafficking? Or by focusing on demand, does this stymie the profits made by prostitution and trafficking and force the traffickers to move onto other more profitable enterprises (such as drug trafficking)?

As tends to be the case with trafficking, there is no Achilles heel, no single solution that will effectively address the issue on its own. The organizing of sex workers to monitor for trafficking. raise awareness of HIV and advocate for their rights is an innovative and seemingly effective approach for those in the flesh trade to protect themselves. But this needs to be combined with a coordinated effort from all other sectors of society (public, private, civil) to truly make an impact.

My two cents, what do you think?

Trafficking Spreads HIV/AIDS in Asia

Source: Corbis

From Reuters:

About 300,000 women and children are trafficked across Asia each year, accelerating the spread of HIV/AIDS, the United Nations said on Wednesday.

"Trafficking ... contributes to the spread of HIV by significantly increasing the vulnerability of trafficked persons to infection," said Caitlin Wiesen-Antin, HIV/AIDS regional coordinator, Asia and Pacific, for the United Nations Development Programme (UNDP). "Both human trafficking and HIV greatly threaten human development and security."

UNAIDS estimates 5.4 million people were living with HIV in the Asia Pacific region in 2006, with anywhere between 140,000 and 610,000 people dying from AIDS-related illnesses.

That makes it the world's second largest number of people living with HIV after sub-Saharan Africa, where 25.8 million people are infected with the virus.

Read the full article here