Nearly 40 percent of repatriated Nepalese sex-trafficked girls and women tested were positive for HIV infection, with girls trafficked before age 15 having higher rates of infection, according to a study in the August 1 issue of JAMA, a theme issue on violence and human rights.

“Trafficking across or within national borders for purposes of sexual exploitation including forced prostitution, i.e., sex trafficking, is recognized as a major gender-based human rights violation with significant individual and public health consequences and is increasingly discussed as a potentially critical mechanism in the spread of human immunodeficiency virus (HIV) across developing nations,” the authors write.

There are an estimated 150,000 girls and women trafficked each year within and across the countries of South Asia, with approximately 5,000 to 7,000 Nepalese girls and women trafficked to India’s commercial sex industry each year, according to background information in the article. Data on HIV prevalence among survivors of sex trafficking and roles of trafficking-related exposures in HIV infection have been limited.

Jay G. Silverman, Ph.D., of the Harvard School of Public Health, Boston, and colleagues examined the prevalence and risk factors for HIV infection among 287 repatriated Nepalese girls and women sex trafficked to brothels in India. Medical and case records were reviewed of the girls and women, who received rehabilitative services between January 1997 and December 2005.

The researchers found that among the 287 girls and women, 38.0 percent tested positive for HIV. Among those with complete documentation of trafficking experiences (n = 225), median (midpoint) age at time of trafficking was 17.0 years, with 33 girls (14.7 percent) trafficked prior to age 15 years. Compared with those trafficked at 18 years or older, girls trafficked prior to age 15 years had an increased risk for HIV, with 20 of 33 (60.6 percent) infected among this youngest age group.

Additional factors associated with being HIV positive included being trafficked to Mumbai (India’s second largest city) and longer duration of forced prostitution (indicating increased risk per additional month in a brothel). Additional analyses indicated that girls trafficked prior to age 15 years had five times the increased odds of having been detained in multiple brothels and more likely to be in brothels for a duration of 1 year or more vs. those trafficked at age 18 years or older.

The authors write, “Findings of the present study emphasize the critical need to strengthen efforts to prevent sex trafficking and to intervene to protect trafficking survivors so as to shield young girls and women, both from this form of sexual violence and from the high risk of HIV infection. Currently, relatively few such efforts exist, and organizations that do engage in this work often lack adequate political or financial support. Furthermore, the high rates of HIV documented herein support concerns that sex trafficking may be a significant factor in the expansion of the South Asian HIV epidemic, both within higher-prevalence nations such as India and also from such nations to their lower-prevalence neighbors (e.g., Nepal). Moreover, the current demonstration of the very young age of many of those trafficked and sexually exploited, and the further harm to these young lives through high rates of HIV infection, requires attention from public health researchers and strategists to better understand and reduce the demand for sexual services from prostituted girls and women.”

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(JAMA. 20017;298(5):536-542. Available pre-embargo to the media at http://www.jamamedia.org)

Contact: Christina Roache
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