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HIV Prevalence and Predictors of Infection in Sex-Trafficked Nepalese Girls and Women
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1 August 2007
The Journal of the American Medical Association
Jay G. Silverman, PhD; Michele R. Decker, MPH; Jhumka Gupta, ScD, MPH; Ayonija Maheshwari, MD, MPH; Brian M. Willis, JD, MPH; Anita Raj, PhD
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).