HIV Prevalence and Predictors of Infection in Sex-Trafficked Nepalese Girls and Women

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[Abstract of the paper follows the news paper review. Moderator]

Sex Slaves Returning Home Raise AIDS Risks, Study Says By DONALD G. McNEIL Jr.

Adding another bleak dimension to the sordid world of sex slavery, young girls

who have been trafficked abroad into prostitution are emerging as an AIDS risk

factor in their home countries, according to a study being released today.

Girls who were forced into prostitution before age 15 and girls traded between

brothels were particularly likely to be infected, the study found. Shunned by

their families and villages on their return, they sometimes end up selling

themselves again, increasing the risk.

The study, in the Journal of the American Medical Association, concerns girls

from Nepal trafficked into bordellos in India, but the problem is also emerging

elsewhere, said the lead author, Jay G. Silverman, a professor of human

development at Harvard’s School of Public Health.

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.”

Aurorita M. Mendoza, a former Nepal coordinator for Unaids, the United Nations

AIDS agency, called the study “very important.”

“It’s the first I know of that’s linked H.I.V. to sex-trafficked girls,” she

said.

Nepal — a poor, religiously conservative country in the Himalayas — has until

recently had relatively few AIDS cases. The government estimates that it has

only about 10,000. The official Unaids estimate is 75,000, but that may be too

high, given that some previous estimates for other countries have been wrong.

One month ago, for example, Unaids cut its official estimate for neighboring

India by 56 percent, to about 2.5 million infected, more than anywhere except

South Africa and Nigeria.

The study, which was paid for by the State Department’s Office of Trafficking in

Persons and by Harvard and Boston Universities, tested 287 girls and women being

helped by a charity called Maiti Nepal, or Nepali Mother’s Home, in the capital,

Katmandu. Most had been sent home by Indian anti-prostitution groups working

with the police.

Thirty-eight percent of the Nepali women tested by Dr. Silverman’s team were

infected with H.I.V., the virus that causes AIDS. But among the youngest — the

33 girls who had been sent into sex slavery before they were 15 years old — the

infection rate was 61 percent.

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 cup of tea or a

soft drink in a public market or train station, Dr. Silverman said.

Not all Nepali women are kidnapped or tricked, Miss Mendoza, the former Unaids

official, noted; poverty drives some into the profession knowingly.

“This heartless ‘trade’ has been popular for more than six decades in the

subcontinent,” said Romesh Bhattacharji, a former national law enforcement

official in India. “In some parts of northern Nepal, one can tell which house

has a girl working in an Indian brothel by its roof. If it’s tin, that’s brothel

money.”

Miss Mendoza said returning girls may be rejected by their families and villages

because of fear that they will either corrupt other girls or will so taint the

village’s reputation that no one will marry its young women.

As a result, these victims of kidnapping and rape may be forced to keep selling

themselves. One survey of Katmandu prostitutes, Dr. Silverman said, found that

half had worked in India. They may also become pregnant and, without treatment,

infect their children.

Working in a brothel in Mumbai — India’s financial capital and one of the

world’s largest cities — was a risk factor in itself, the study found. The

youngest also tended to have been in multiple brothels and in them for more than

a year, raising their risk.

India’s epidemic, concentrated among prostitutes, truckers, men who have sex

with men and people who inject drugs, is most common in its industrialized south

and in the heroin-smuggling areas near Pakistan and Myanmar, not in regions

bordering Nepal.

Worldwide, about 500,000 young women are trafficked each year, according to the

State Department. Most of the 150,000 trafficked in southern Asia end up working

as prostitutes in Indian cities, according to the United States Congressional

Research Service. Rights agencies said a decade ago that up to 7,000 women from

Nepal were trafficked to India each year; civil strife has presumably increased

that number.

http://www.nytimes.com/2007/08/01/world/asia/01hiv.html?ref=health#

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HIV Prevalence and Predictors of Infection in Sex-Trafficked Nepalese Girls and

Women

Jay G. Silverman; Michele R. Decker; Jhumka Gupta; Ayonija Maheshwari; M.

Willis; Anita Raj. JAMA. 2007;298:536-542.

Context Sex trafficking of girls and women is widespread across South Asia and

is recognized as both a violent gender-based crime and major human rights

violation. Inadequate empirical data exist to characterize this phenomenon and

its related health consequences, such as human immunodeficiency virus (HIV)

infection.

Objective To determine the prevalence of HIV infection among repatriated

sex-trafficked Nepalese girls and women and to identify trafficking-related

predictors of such infection.

Design Medical and case records of 287 repatriated girls and women reporting

being trafficked from Nepal for sexual exploitation and receiving rehabilitative

services between January 1997 and December 2005 at a major nongovernmental

organization were systematically reviewed in January 2006.

Setting Major Nepalese nongovernmental organization providing shelter and care

to repatriated survivors of sex trafficking.

Main Outcome Measures Prevalence of and risk for HIV based on demographic

characteristics and on trafficking- and prostitution-related experiences.

Results Among 287 repatriated Nepalese sex-trafficked girls and women, 109

(38.0%) tested positive for HIV. Among those with complete documentation of

trafficking experiences (n = 225), median age at time of trafficking was 17.0

years, with 33 (14.7%) trafficked prior to age 15 years. Compared with those

trafficked at 18 years or older, girls trafficked prior to age 15 years were at

increased risk for HIV (adjusted odds ratio [AOR], 3.70; 95% confidence interval

[CI], 1.32-10.34), with 20 of 33 (60.6%) infected among this youngest age group.

Additional factors associated with HIV positivity included being trafficked to

Mumbai (AOR, 4.85; 95% CI, 2.16-10.89) and longer duration of forced

prostitution (AOR, 1.02; 95% CI, 1.01-1.03; indicating increased risk per

additional month of brothel servitude).

In post hoc analyses, girls trafficked prior to age 15 years had increased odds

of having been detained in multiple brothels (odds ratio [OR], 5.03; 95% CI,

1.96-12.93) and in brothels for a duration of 1 year or more (OR, 2.67; 95% CI,

1.12-6.33) vs those trafficked at 18 years or older.

Conclusions In this study, repatriated Nepalese sex-trafficked girls and women

were found to have a high prevalence of HIV infection, with increased risk among

those trafficked prior to age 15 years. Present findings demonstrate the need

for greater attention to reducing and intervening in sex trafficking in South

Asia, particularly among the very young.

Author Affiliations: Department of Society, Human Development and Health,

Harvard School of Public Health, Boston, Massachusetts (Drs Silverman and Gupta

and Ms Decker); University of California, San Francisco School of Medicine (Dr

Maheshwari); ECPAT International, Washington, DC (Mr Willis); and Department of

Social and Behavioral Sciences, Boston University School of Public Health,

Boston (Dr Raj).

_________________________

Kumara Singaravelu, M.B.B.S., M.P.H

School of Public Health

State University of New York - Albany

Rensselaer, NY

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