Sex workers are 12 times more likely to be diagnosed with HIV.
Sex workers are at a very high risk of contracting HIV due to multiple sexual partners and their inconsistent condom use. Due to the marginalization and criminalization of sex workers, access to healthcare and social services is limited and often unavailable. Sex workers also do not always have control over their working conditions, making it even more difficult to ensure safe sex practices.
Sex workers are also likely to be victims of extreme sexual violence such as gang rape and forced unprotected sex, increasing their risk of HIV infection even more.
Evidence shows that HIV prevalence among sex workers is 12 times greater than among the general population. Even in very high prevalence countries, HIV prevalence among sex workers is much higher than among the general population. Around the world, approximately 1 in 10 sex workers is estimated to be living with HIV. An analysis of 16 countries in sub-Saharan Africa in 2012 showed a pooled prevalence of more than 37% among sex workers. Stigma and discrimination, violence and punitive legal and social environments are key determinants of this increased HIV vulnerability. Punitive environments have been shown to limit the availability, access and uptake of HIV prevention, treatment, care and support for sex workers and their clients.
Trafficking women and children for sexual exploitation is the fastest growing criminal enterprise in the world.
Globally, there are an estimated 4.5 million people trapped in forced sexual exploitation.
Women and girls make up 98% of victims of trafficking for sexual exploitation.
About 2 million children are exploited every year in the global commercial sex trade.
From Polaris Project
Survival sex is not a financial transaction, but rather the exchange of one’s body for goods that fulfill basic human needs such as clothing, food, and shelter. Close to 1/3 of homeless youth end up engaging in survival sex for many purposes, shelter and protection being the primary ones.
One reason that homeless and runaway youth turn to survival sex is past abuse, as a background of past abuse often trains children to see dysfunctional relationships as part of the norm. Another reason, aside from necessity, is that homeless and runaway youth often lack knowledge about alternatives that are available to them, such as shelter and housing options.
“To the extent that [survival sex] can be considered a choice, it is born out of the fact that there are no other choices.”
-Meredith Dank, Senior Research Associate at the Urban Institute
Survival Sex and LGBTQ Youth
A 2015 study of LGBTQ teens who engaged in survival sex found that homelessness is the primary reason that these teens turn to survival sex at high rates. A previous study of LGBTQ teens in New York also showed that LGBTQ youth were seven times more likely to engage in survival sex than heterosexual teens, and that transgender teens were eight times more likely.
The reasons for these startling statistics are numerous, and include care systems that fail in specific ways to meet the needs of LGBTQ youth. For example, the homeless shelter system is often difficult for queer or transgender teens to maneuver, as gender segregation is a key characteristic and can result in feelings of alienation.
Survival Sex and Sex Trafficking
Sex trafficking is treated differently than survival sex, as sex trafficking involves force, fraud, coercion, or underage commercial sex. However, survival sex and sex trafficking overlap in important ways, and unfortunately, survival sex can serve as a segue into sex trafficking. Frequently, pimps and other exploiters are able to seek out youths who are already engaging in survival sex, and force or coerce them into sex trafficking. The relationship between survival sex and sex trafficking also flows in the other direction, with victims of sex trafficking escaping their situations only to find that survival sex was their best and sometimes only option.
Impact on Women
The nexus of the global epidemics of sex trafficking and HIV/AIDS primarily manifests in the lives of women and girls. This intersection exists in sex trafficking victims’ increased vulnerability to HIV infection, the proliferation of HIV infection through sex trafficking, and the perceived and actual clashes between HIV and sex trafficking prevention efforts. Holistically addressing these intersecting issues entails framing the elimination of sex trafficking as a tool to reduce HIV transmission. This article explores this deadly junction for women and girls and proposes tools to address it.
The direct and individual impact of sex trafficking and HIV on girls and women is illustrated by the experience of “Gita” (not her real name). Gita grew up in India, and was sold into sexual slavery by a family member when she was twelve years old. When she arrived at the brothel in Mumbai, she was locked in a room, raped, tortured, and abused until she was deemed sufficiently obedient. When the brothel owners began selling Gita, she was threatened with death if she refused to have sex with a customer. Most days she was forced to have sex with ten to twenty men. The brothel did not provide condoms, and she was not able to control which of her customers chose to practice safer sex. During her early teens, Gita contracted HIV from a customer. However, she was not allowed to seek testing or treatment and was forced to continue having unprotected sex with several men per day for several more years. Finally, Gita managed to escape to a local anti-trafficking organization and is now living in a shelter and receiving HIV treatment and counseling.
Gita contracted HIV as a direct result of her status as a victim of sex trafficking. She also, unknowingly and unintentionally, may have spread HIV to customers who bought her after she became infected. If Gita were never trafficked, she may not have ever become infected with HIV and, in turn, transmitted it to the men who bought her and their future sex partners. Preventing this multiplier effect of HIV transmission catalyzed by sex trafficking involves fighting two global phenomena—a deadly disease and a highly complex and lucrative criminal industry, both of which disproportionately affect girls and women around the world.
According to U.S. law, sex trafficking is a form of modern-day slavery in which a commercial sex act is induced by force, fraud, or coercion, or in which the person induced to perform such an act is under eighteen years of age. Precise statistics for the number of women and girls trafficked in the commercial sex industry are difficult to obtain. However, the U.S. Department of State estimates that up to 900,000 people are trafficked across international borders each year, the majority of whom are women and girls forced into commercial sex industries. See U.S. Department of State Trafficking in Persons Report (June 2003). International Labor Organization data indicates that 1.39 million girls and women are victims of sex trafficking at any given time. See U.S. Department of State Trafficking in Person Report (June 2009).
Sex trafficking is a global epidemic, and cases of forced prostitution and sex trafficking have been identified in almost every country in the world. The United Nations Children’s Fund estimates that in the past thirty years, more than 30 million women and children in Asia have been victimized in the commercial sex industry. See United Nations Children’s Fund press release (2006). In Latin America, the International Organization for Migration estimates that the sex trafficking of women and girls is a $16 million-a-year business. See Association for Women’s Rights in Development, “Sex Trafficking Now a $16 Billion Business in Latin America” (2008). The scourge of sex trafficking also plagues Europe, Africa, and Australia. Even in the United States, the National Center for Missing and Exploited Children estimates that up to 100,000 American children are at risk for sex trafficking each year, and 83 percent of the 1,200 human trafficking allegations made to the U.S. Department of Justice in 2007 were sex trafficking cases.
Sex trafficking victims, however, are at significantly increased risk for contracting HIV for a number of reasons directly related to the nature of their forced servitude. Sex trafficking victims are modern-day slaves, and thus are unable to make choices about or control some aspects of their lives, including their sexual activity. They are forced to sell sex acts on the street, in hotels, through escort agencies, at brothels, and many other places where they don’t have access to safer sex tools. Even when trafficking victims are held in brothels or other places where condoms are made available, they may not be able to enforce condom usage and other safer sex practices. Women and girls enslaved in commercial sex also are forced to endure sex with multiple partners, many of whom may also have had unprotected sex with multiple partners, which increases victims’ risk of contracting HIV. They further must endure the riskiest types of unprotected sex, such as anal sex, injurious sadomasochism, and violently abusive sex, which increases their risk of transmission. Often injuries inflicted during violent sex are not allowed to heal properly, as traffickers force victims to continue to serve men without seeking medical attention. As a result, trafficked women may have high-risk, unprotected sex with multiple partners despite having open genital cuts and abrasions.
Studies have documented the substantial risk of human immunodeficiency virus (HIV) infection endured by sex-trafficked women, but it remains unclear how exposure to trafficking puts its victims at risk. We assessed whether the association between sex trafficking and HIV could be explained by self-reported forced prostitution or young age at entry into prostitution using cross-sectional data collected from 1,814 adult female sex workers in Karnataka, India, between August 2005 and August 2006. Marginal structural logistic regression was used to estimate adjusted odds ratios for HIV infection. Overall, 372 (21%) women met 1 or both criteria used to define sex trafficking: 278 (16%) began sex work before age 18 years, and 107 (5%) reported being forcibly prostituted. Thirteen (0.7%) met both criteria. Forcibly prostituted women were more likely to be HIV-infected than were women who joined the industry voluntarily, independent of age at entering prostitution (odds ratio = 2.30, 95% confidence interval: 1.08, 4.90). Conversely, after adjustment for forced prostitution and other confounders, no association between age at entry into prostitution and HIV was observed. The association between forced prostitution and HIV infection became stronger in the presence of sexual violence (odds ratio = 11.13, 95% confidence interval: 2.41, 51.40). These findings indicate that forced prostitution coupled with sexual violence probably explains the association between sex trafficking and HIV.
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All graphics by Jaclyn Saik