High rates of HIV infection documented among young Nepalese girls sex-trafficked to India

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Infection rate exceeded 60 percent in girls forced into prostitution prior to age 15

A study by Harvard School of Public Health (HSPH) researchers of girls
and women who were sex-trafficked from Nepal to India and then
repatriated has found that 38 percent were HIV positive. The infection
rate exceeded 60 percent among girls forced into prostitution prior to
age 15 years. One in seven of the study’s participants had been
trafficked into sexual servitude prior to this young age.  

Approximately 600,000 to 800,000 people are trafficked across the globe
every year, and 80 percent of these individuals are estimated to be
women and girls, according to the U.S. Department of State. The State
Department further reports that the majority of transnational victims
are females trafficked into commercial sexual exploitation. An
estimated 150,000 women and girls are trafficked annually within and
across South Asia, with the majority destined for major Indian cities,
according to a report by the Congressional Research Service.

“The high rates of HIV we have documented support concerns that sex
trafficking may be a significant factor in both maintaining the HIV
epidemic in India and in the expansion of this epidemic to its
lower-prevalence neighbors,” said Jay Silverman, Associate Professor of Society, Human Development, and Health at HSPH. 

India has the third largest HIV/AIDS population in the world, with
approximately 2.5 million infected individuals, according to the
country’s National AIDS Control Organization, supported by UNAIDS and
the World Health Organization. Neighboring Nepal has far lower but
increasing numbers of HIV/AIDS cases. 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.

Silverman is the lead author of the study published in the August 1, 2007, issue of the Journal of the American Medical Association (JAMA).
He led a research team in reviewing the medical documentation and case
records of 287 girls and women who had been sex-trafficked from Nepal
to India between the years 1997 and 2005. All had been repatriated back
to Nepal and had received rehabilitative services from Maiti Nepal, a
non-governmental organization that works to assist trafficking victims.
The word “Maiti” means “mother’s home” in Nepali.

The researchers found that among the 287 girls and women, 38 percent
tested positive for HIV. Among those with complete documentation of
trafficking experiences (225 girls and women), the median age at time
of trafficking was 17 years, with 33 girls (14.7 percent) trafficked
prior to age 15 years. Compared to those trafficked at 18 years or
older, girls trafficked prior to age 15 years had an increased risk for
HIV, with 60.6 percent infected among this youngest age group. Risk was
also associated with being trafficked specifically to Mumbai, India,
and with longer durations in brothels.

“HIV infection has been seen as perhaps the most critical health
consequence of sex trafficking, but sex-trafficked girls and women are
rarely studied — leaving the prevalence of HIV and other health issues
among this highly vulnerable population little understood,” said
Silverman. “This study sheds new light on infection rates among a
sex-trafficked population and exposes both the tragic existence of the
youngest victims and the dire health consequences of this crime.”

Silverman and his team suggest several likely explanations for the
observed high risk for HIV infection among the youngest trafficked
girls. Previous research on male brothel clients in India suggests that
these men prefer very young girls, often presented as virgins, due to
fear of HIV and other infection, as well as to the widespread myth that
sex with a virgin will cure such illnesses. As a result of client
demand and of the relatively high profits earned from prostituting
these very young girls, brothel owners take steps to keep them in
captivity for longer periods of time. The HSPH team found that girls
trafficked under age 15 were more likely than older girls to be held in
brothels for a year or longer, and that the risk of HIV infection
increased by two percent for every additional month of brothel

“Historically, there has been little recognition of these young girls
in brothels because they are typically hidden from both legal
authorities and those working to help and study prostituted women,”
said co-author and former HSPH doctoral student Jhumka Gupta.

Added co-author and HSPH doctoral student Michele Decker, “Now, we are
learning that these youngest girls not only exist, but are actually the
most vulnerable to HIV, highlighting the need for improved prevention
of trafficking and greater efforts to identify and rescue
sex-trafficked girls.”

Silverman and his team suggest that the prevention of sex trafficking
and the intervention into the practice should be seen as a critical
aspect of preventing both the spread of HIV/AIDS and reducing a
widespread and violent human rights violation. The authors assert that
few resources have been devoted to the prevention of sex trafficking,
particularly in relation to the large estimated numbers of affected
individuals and to the public health consequences. In particular, the
authors specify that approaches oriented to male clientele that reduce
the demand for sex from young prostituted girls must be emphasized.

“Just as in other areas of HIV prevention, we can no longer afford to
ignore the behavior of men and boys,” said Silverman. “Addressing the
widely accepted male demand for commercial sex is critical to ending
this modern day form of female slavery.”  

The study was supported by grants to J. Silverman and B. Willis from
the Office of Trafficking in Persons, U.S. Department of State; J.
Silverman and A. Raj from the Harvard University Center for AIDS
Research; A. Raj from the Center for International Health at the Boston
University School of Public Health; and J. Silverman and J. Gupta from
the Harvard University South Asia Initiative.