chevron-down Created with Sketch Beta.
April 01, 2010

Sex Trafficking and HIV/AIDS: A Deadly Junction for Women and Girls

by Amanda Kloer

“A way out of no way, it’s flesh out of flesh, it’s courage that cries out at night; A way out of no way, it’s flesh out of flesh, it’s bravery kept out of sight; A way out of no way, it’s too much to ask, it’s too much of a task for any one woman.”

-- “Oughta Be A Woman,” by Sweet Honey in the Rock


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.

Sex Trafficking Victims’ Increased Vulnerability

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. See The Human Trafficking Data Collection and Reporting Project (2010).

It is important to note, however, that women and girls also are trafficked into industries other than the commercial sex industry, including agricultural work, factory work, domestic servitude, and the service industry. They may be at increased risk of HIV transmission as well, because trafficked women in all industries become more vulnerable to sexual assault and rape and may not be able to access testing and treatment for HIV during their enslavement.

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.

It is difficult to determine how many sexual partners an “average” trafficking victim might have over the course of her captivity. Reports from nongovernmental organizations vary greatly, with some reporting only a handful of customers per day, others up to forty or fifty per day. However, between five and ten customers per day is often considered a conservative figure. If a victim is forced to have sex with only five customers per day, six days per week for one year, she will have had sexual contact with 1,560 men that year. Without the ability to enforce safer sex practices or screen potential partners for STDs, this much sexual contact clearly puts the victim at a heightened risk for contracting HIV.

Another risk factor for trafficked females is their age. According to the U.S. Department of Justice, the average age of entry into prostitution is twelve to fourteen years old, and every child under eighteen in prostitution in the United States and many other countries is considered by law a sex trafficking victim. Children and young teens sold into prostitution are at a greater risk for contracting HIV because their smaller, still-developing bodies are more susceptible to the genital tearing that often leads to HIV transmission during sexual intercourse. Because trafficked children in prostitution are even less likely to be in control of choices than adults, they may have less opportunity to insist on safer sex practices. Worse still, some men seek ever younger children for sex, based on the warped belief that there is less risk of HIV transmission with a younger partner. In turn, younger children are being recruited into prostitution, which provides a longer period during which they can become HIV-infected.

Sex Trafficking as a Facilitator of Global HIV Transmission

While trafficked women and girls are individually at an increased risk for contracting HIV, sex trafficking as an international phenomenon is also a catalyst and facilitator of large-scale HIV transmission. According to AIDS prevention organization AVERT, in some parts of the world, such as West Africa, the AIDS epidemic appears to be driven in part by the commercial sex industry, including the abuse of those trafficked into it. AVERT found that 27.1 percent of people in the commercial sex industry in Dakar, Senegal, were infected with HIV in 2005. See AVERT, “Aids and Prostitution” (2010). Other studies have found commercial sex to be a significant factor in the AIDS epidemics in Ghana, Togo, and Burkina Faso. Id. Similarly, a 2008 study out of the Harvard School of Public Health found that 38 percent of women trafficked from Nepal to India for sex were returned to Nepal HIV-positive. See Harvard Public Heath Review, Trafficked (2007). In the United States, there are both high rates of sexual exploitation of African American teen girls within the commercial sex industry and by family members and high rates of HIV infection among African American females. In addition to the sexual risk factors, high rates of injection drug use within the commercial sex industry also increase the risk of infection and transmission on a global scale.

Human trafficking within the commercial sex industry, however, greatly exacerbates the spread of HIV infections. Traffickers frequently transport victims between cities or countries to both disorient the victims and provide “fresh faces” for the men who buy sexual services from them. For example, “Corina” was trafficked in her home country of Moldova, where she likely contracted HIV. Her trafficker then sold her in London, Prague, New York, and Miami for a month each to have sex with ten to twenty men per night. As a trafficking victim, Corina was unable to seek testing or treatment for her HIV, and may have unknowingly and unwillingly spread the disease. Corina also began using drugs to mask the pain of sexual slavery. Women and girls trafficked for sex may turn to drugs and alcohol, including injection drugs, thus increasing their risk of infection and widespread transmission.

Another example of how sex trafficking can spread HIV is the cultural belief in some parts of the world that sex with a virgin can cure HIV or AIDS. HIV-positive men who believe this myth will seek out traffickers to procure a virgin for them, often a child. They then have unprotected sex with that virgin, and in the process will sometimes transmit the disease. However, the transmission factor of this encounter is multiplied exponentially, because after this sexual contact, the man, thinking himself cured, may have unprotected sex with other partners. The child he used, now possibly infected, will often continue to be trafficked for sex. In these cases, HIV transmission is not merely a byproduct of sex with a trafficking victim, but is the impetus for the trafficking and the sexual contact. It is also an action that can spread the disease exponentially.

Human trafficking has also been implicated as a possible catalyst for the mutation of HIV into multiple subtypes. Dr. Chris Beyer of Johns Hopkins University has linked sex trafficking to both the spread and mutation of HIV, stating that the commercial sex industry in general, and sex trafficking in particular, are facilitating the global dispersion of various (and possibly drug-resistant) HIV subtypes. Another factor in the creation of mutations is inconsistent treatment for people infected with HIV. Even those few trafficking victims who are able to seek testing and treatment for their HIV may suffer repeated interruptions in care because of lack of access, lack of education, or re-trafficking. The role of sex trafficking in the mutation of HIV is extremely dangerous and must be recognized in the global fight against AIDS.

The Clash of HIV and Trafficking Prevention Efforts

One reason the intersection of sex trafficking and HIV may be under-examined is the tension between those groups conducting HIV prevention and treatment initiatives, and those groups conducting human trafficking prevention or rescue operations. Historically, HIV prevention programs have focused on harm-reduction models, which involve supplying brothels and women in prostitution with condoms, access to HIV tests, and other tools to prevent infection and transmission of the virus. This model of prevention sometimes entails allowing illegal commercial sex enterprises to operate without involving the local authorities, based on the philosophy that cooperation with the commercial sex industry is the best technique for preserving the safety of those in it. Human trafficking raids and prevention activities, however, have historically focused on identifying human trafficking within the commercial sex industry as a criminal activity and arresting the perpetrators and facilitators of that crime. HIV prevention organizations have sometimes seen anti-trafficking raids in brothels or red-light districts as disrupting HIV outreach and prevention or harming local relationships. Anti-trafficking organizations have sometimes seen HIV prevention as ineffective in assisting trafficking victims, and seen relationship-building within the commercial sex industry as neglecting to address the criminal components of sex trafficking within it.

Another issue that has caused tension between HIV prevention and anti-trafficking initiatives was the Bush administration’s policy of denying federal funding to any organization found to be “promoting prostitution.” For the better part of the last decade, “promoting prostitution” was interpreted broadly to include everything from making condoms readily accessible to offering English classes for women trying to leave the sex industry. One way this debate played out was over the effectiveness of a 2008 anti-trafficking law in Cambodia. Some anti-trafficking organizations have claimed the law has led to better identification of victims, but some HIV prevention groups have argued that it has instead increased fear and stigmatization of condom use in the commercial sex industry. However, in July 2009, the U.S. Department of Justice dropped its appeal of a 2006 court injunction prohibiting enforcement of the “anti-prostitution pledge” under U.S. global AIDS policy. This move suggests strongly that the Obama administration will not continue the Bush policy in this regard.

As the Obama era moves forward, HIV and trafficking prevention groups will need to develop new strategies—collaboratively, one hopes—for addressing their concerns in and with the commercial sex industry. Overall, HIV/AIDS heretofore has received minimal attention in the context of addressing sex trafficking, and few HIV/AIDS-focused services exist for trafficking victims. Similarly, while some HIV/AIDS plans address the role of the commercial sex industry in HIV transmission, what often are not addressed are the trafficking, forced prostitution, and sexual violence against women and girls. Despite the historical tension between anti-trafficking and HIV organizations, more common ground than not exists between them and should be pursued by both.

Ending Sex Trafficking as a Tool for Curbing the Spread of HIV

One promising practice to reduce the global epidemics of HIV and sex trafficking, as proposed by Holly Burkhalter, former U.S. Policy Director of Physicians for Human Rights, during testimony before the U.S. House of Representatives International Relations Committee, is to frame the ending of sex trafficking as a tool for preventing HIV/AIDS. This approach would be effective for a number of reasons. First, it would provide an immediate road map for anti-trafficking and HIV prevention organizations to work together. Once the positive correlation between the reduction of sex trafficking and new HIV infections is identified, groups with formerly disparate goals will have a common goal around which to unite. HIV/AIDS prevention and trafficking prevention organizations working together to find common ground is crucial to effectively addressing both of these epidemics.

Second, the Trafficking Victims Protection Act (TVPA) can be used as a tool to convince foreign countries to address the dual epidemics of HIV and sex trafficking. When the TVPA was initially passed in 2000, it authorized the U.S. Department of State to issue an annual Trafficking in Persons Report, which places countries on “tiers” appropriate to their efforts to combat human trafficking. Countries placed on Tier 3 do not fully comply with the minimum standards of the TVPA and are not making significant efforts to do so. Pursuant to the TVPA, governments of countries on Tier 3 may be subject to certain sanctions, whereby the U.S. government may withhold non-humanitarian, non-trade-related foreign assistance. These sanctions provide additional leverage with which to convince foreign nations that eliminating sex trafficking and reducing HIV is in their national best interest—in economic, diplomatic, humanitarian, and public health terms.

Finally, the TVPA provides a framework for the collection of data on the intersection of HIV and human trafficking, including a list of countries with limited resources and significant need for human trafficking prevention; the opportunity to collect epidemiological data on the relationship between HIV transmission and sex trafficking; tools to facilitate collaboration between HIV and trafficking prevention programs; and resources to assist victims of sex trafficking and HIV. However, the ability to fully utilize the framework provided by the TVPA to address the intersection of HIV and sex trafficking rests in the identification of common goals by advocates for both issues.

In conclusion, women and girls are the primary victims of the nexus of the global epidemics of sex trafficking and HIV/AIDS. As sex trafficking victims, women and girls are more vulnerable to HIV infection because of their lack of choice with regard to high-risk sexual activities. Similarly, HIV infection is spread through international and local sex trafficking. This intersection has not been the subject of significant scholarship, possibly in part because of the perceived and actual clashes between HIV and sex trafficking prevention efforts. However, the TVPA provides some tools for both HIV and sex trafficking advocacy groups to move forward collaboratively and identify promising practices for addressing this deadly junction, which has destroyed the lives of so many women and girls.

Amanda Kloer

Amanda Kloer is program associate of the American Bar Association’s AIDS Coordination Project in Washington, D.C., and writer for the End Human Trafficking cause at