1. The Health Burden of Trafficking in Persons Presentation by Derek Ellerman Co-Executive Director Polaris Project Forum 7 Global Forum for Health Research Special Thanks to Louis Currant Dr. Sameera Al-Tuwaijri Trafficking in Persons Trafficking in persons, or ‘human trafficking’, is a form of modern-day slavery, and is the fastest growing criminal industry in the world.

2. Scope and Severity of Trafficking in Persons Human trafficking is the third largest criminal industry in the world, after the illegal trade in drugs and arms. An estimated 2 million victims are trafficked across borders each year. Worldwide estimates that include victims of internal trafficking are 27 million. The US spent approximately $15 million to combat human trafficking over 2002- 2003. It is estimated that the US spends approximately $40-50 billion combating drug trafficking each year.

3. Definitions (UN Protocol to Prevent, Suppress and Punish Trafficking in Persons) “'Trafficking in persons' shall mean the recruitment, transportation, transfer, harboring or receipt of persons, by means of the threat or use of force or other forms of coercion, of abduction, of fraud, of deception, of the abuse of power or of a position of vulnerability or of the giving or receiving of payments or benefits to achieve the consent of a person having control over another person, for the purpose of exploitation. Exploitation shall include, at a minimum, the exploitation of the prostitution of others or other forms of sexual exploitation, forced labor or services, slavery or practices similar to slavery, servitude or the removal or organs.” In Plain English Trafficking in persons is defined by use of force, fraud, coercion, or abuse of power for the purpose of commercial sexual exploitation, slavery-like labor exploitation, or organ removal.

4. Health Burden of Trafficking in Persons Severe physical injury from violence Psychological trauma Sexually transmitted (STD) and other infectious diseases, including HIV/AIDS Substance abuse Lack of medical care, infertility, cervical cancer, and other conditions Sex trafficking and the sex industry has been documented as a major contributor to the worldwide HIV/AIDS epidemic Comparatively little research has been conducted on the severe physical and psychological consequences of the violence experienced by victims

5. Physical Violence: Physical assault (Beating, slapping, assault with a weapon, etc), sexual assault, murder, and physical confinement and isolation Psychological Violence: Threats to life, safety, to family members or other parties. Systematic breakdown of self- esteem and encouragement of dependence through emotional abuse. Debt bondage: manipulation of debt to control the victim. The Burden of Violence Data from Five Country Study on Women in the Sex Industry 73 percent reported physical assault in prostitution 62 percent reported having been raped since entering prostitution; In S. Africa, Zambia, and the US, approximately 50% had been raped more than 5 times 67 percent met criteria for a diagnosis of PTSD

6. Multiple sex acts with strangers each day combined with violence and lack of negotiation power is a death sentence to many sex trafficking victims. Additional risk factors include presence of other STD’s, which can raise the risk by up to 10 times. ~70% of women in the sex industry in Mumbai, India and Freetown, Sierra Leone were found to be HIV positive. The role of the sex industry has long been recognized in contributing to the worldwide HIV/AIDS epidemic. At one of the worst periods in Thailand’s AIDS crisis, up to 80% of cases were attributed to the sex industry. HIV/AIDS contributes to sex trafficking – 12 million children in Africa have lost one or both parents. Many are forced into commercial sex industry for survival. Harm reduction strategies are limited in effectiveness because of lack of freedom of victim and difficulty in service providers locating and accessing victims. HIV/AIDS and Trafficking in Persons

7. The traditional victim-blaming paradigm is slowly changing as experts recognize the central role of males as demand agents and in disease transmission from high risk to lower risk groups. Commercial sex buyers transmit the disease to victims, usually by paying extra for or forcing unprotected sex. The unequal power dynamic undermines the effectiveness of safe sex programs that have been successful in reducing HIV in other commercial sex sectors. Efforts to reduce demand include public awareness campaigns stressing the health risks and human rights implications of commercial sex buying and aggressive enforcement of anti-‘John’ laws. Sweden has enacted a model law that targets demand for prosecution while decriminalizing prostituted persons. The law has led to a significant drop in sex trafficking since its passage. HIV/AIDS and the Role of Demand

8. Conclusions Additional Research: Further research is required to fill in the substantial gaps in our understanding of the many impacts on health for trafficking victims, including the effects of violence, and the costs associated with these health impacts. Target Demand for Reduction of Sex Trafficking: Focus on aggressive enforcement against demand in sectors with high trafficking rates. Aggressive enforcement against traffickers should also be present, with decriminalization for the trafficking victims. Eradication of Sex Trafficking as a Best Practice Against HIV/AIDS: Supplementing other proven best practices like safe sex and condom promotion, voluntary testing and counseling, and needle exchanges. Recognize that Harm Reduction Approaches to the Sex Industry are Insufficient with Sex Trafficking: Safe sex and condom promotion strategies fail to protect victims from the severe violence and from forced unprotected sex. Eradication of sex trafficking must be the central goal rather than harm reduction that fails to reduce the size of the trafficking industry.

10. Polaris Project is named after the North Star, which helped guide slaves to the relative freedom of the North during the centuries of slavery in the US. For More Information: www.PolarisProject.org www.HumanTrafficking.com Contact Information: Derek Ellerman Tel: +1-202-547-7909 E-mail: DEllerman@PolarisProject.org