It appears that TIP is NOT getting better, if anything the situation is worsening. With the Congressional appropriation being only $50 million worldwide annually which translates into $11 million worldwide for actually programs, its not hard too imagine why we are unable to make an impact. G/TIP says: We do not know for sure if TIP is getting worse or not, because as there has been increased attention to the issue, there have been more reports of TIP. This is the problem, we don’t know, in some places, anti-TIP prevention campaigns may be working, while in others, depressed economies may be making the situation worse. Also, I can’t confirm the appropriation figure above, so I would just note orally that the demand for anti-TIP resources has increased while funding has not.
Perhaps the world’s (i.e. USG, UN other donor countries) attempt to address labor trafficking has help to make an impact on lessening labor trafficking but the off-setting increase in sexual exploitation is greater which points to the need to address this side of the problem to a greater extent.
EXPLANATION This figure on the stages of the trafficking process highlights the cumulative nature of the health problems that may occur during the trafficking process. A trafficked woman’s health complications may result not only from the abuse and exploitation she experiences at the destination point, but also from the various dangers and abuses she faces before, during and after she is exploited. For example, prior to leaving home, a woman may have been sexually abused by her step-father, as many women in our study were, raped by an acquaintance or beaten by her husband. During the travel and transport stage, while travelling to a destination location, traffickers may have forced her to swim through freezing river currents to evade border controls, or survive in an airtight cargo hold of a lorry. After escaping the exploitative situation, she may be re-traumatised during a police or immigration interrogation or while providing court testimony. She may have been held in detention or forcefully deported. In other words, the multiplicity of symptoms women display are likely to be a result of numerous dangers and cumulative physical and psychological harm. This conceptual model also highlights the points at which it is possible to intervene.
EXPLANATION The traditional explanation for recruitment generally includes push and pull factors. Push factors being those things that make a woman want to leave home. For example, poverty, unemployment, violence, political instability, gender inequalities, etc. Pull factors being those things that draw a woman to another place. For example, safety, job opportunities, ease of travel, media images of a better life elsewhere, greater freedoms, greater equality. However, based on women’s accounts, it seems that among the most decisive factors influencing a woman’s decision to leave, is the credibility of the offer. That is, is the offer made by someone the woman trusts, or a friend or acquaintance of someone she trusts. The timing of the offer is also important. Offers to leave may come at a time when women are particularly in need of escaping a dangerous situation, financially desperate, etc. And whether the offer seems good to her, e.g., money, type of work, etc. When considering push factors, there are also individual, character level factors that may have even greater influence than the structural factors, such as women’s vulnerabilities (distress, loneliness, etc.), their strengths (e.g., courage to take action to remedy her situation) and her hopes (for a better future for herself or her family). It is important to recall that for every woman who is offered a job and ends up trafficked, there are many more women who are offered a job and who are not trafficked. There is little reason for a woman to believe she will be the unlucky one, when other friends and acquaintances recount good experiences with jobs elsewhere (even ones who may have been trafficked and do not wish to disclose this).
EXPLANATION Women were asked about their experiences of violence prior to being trafficked. Before leaving home, 60% reported that they had been physically and/or sexually abused. 50% were physically abused, 32% were sexually abused, and 22% reported both physical and sexual abuse, and one in seven said that they had been sexually abused before the age of 15, one-quarter of whom said they had been abused by more than one perpetrator. Often the perpetrator was a father of step-father. 60% is a high level of abuse, as national prevalence levels of intimate partner violence are generally between 23% and 49%. 39% of the women in the study had children, and 82% of these women were single mothers. INTERPRETATION These figures illustrate several key issues: these numbers suggest factors that may have contributed to women’s vulnerability to accepting dubious offers promising a better, safer life elsewhere. a history of violence has implications for women’s physical and psychological health, because multiple or chronic experiences of abuse are generally believed to cause greater health damage than single events. the prevalence of violence in women’s past suggests that security assessments must be carried out before returning women to their home.
EXPLANATION The study documented a wide range of physical health symptoms, including neurological, gastro-intestinal, sexual and reproductive health symptoms, mental health symptoms, and injuries and infections. The most prevalent health symptoms were headaches, fatigue, dizzy spells, back pain, sexual and reproductive health problems, and memory problems. Over 80% of the women reported headaches and fatigue. Of the eight in ten women stating they had headaches, three-quarters of these women described the headaches as very, very painful. For many, they were excruciating beyond explanation. Approximately 70% reported dizzy spells and back pain, Between 60 and 70% reported sexual health problems, 63% reported memory problems. INTERPRETATION Look to see how many of these are neurological problems or those that potentially affect cognitive functioning. These findings are important for law enforcement personnel and immigration services who often evaluate a woman’s credibility based on the clarity and consistency of her story—which is likely to be affected by this pain and discomfort. Impaired cognitive functioning can significantly hinder a woman’s ability to recall and recount what happened to her, which may mistakenly be interpreted as a woman being uncooperative or untruthful. It is essential that police and immigration services begin to understand that trauma leads to dissociation and significant memory problems. Again, I ask you to try to imagine how you would feel with a massive headache, feeling exhausted, dizzy, with back pain, pelvic pain, and fearing that you have acquired infections that might mean that you could never hope to have a family. You can imagine that your thinking might be clouded, your interest in answering questions might be slim and your disposition would not be cheerful. You might not even have the energy to seem grateful. As you can see, the majority of these symptoms affect cognitive functioning—or women’s memory and thought processes. These findings on women’s physical health are important for health service providers assisting women who may have difficulty explaining each and every one of their symptoms, and speculating what may be the source of their problems. Although sexual and reproductive health problems are the most common health problem associated with trafficking, while they were prevalent, other symptoms were equally or more often reported.
EXPLANATION This slide shows the changes in the number of poor MENTAL health symptoms that women reported over the course of the study. Within the first fourteen days, 71% of the women reported more than 12 symptoms of mental distress This did not reduce significantly even after 28 to 56 days, as over half were still reporting these symptom levels, with 52% reporting that they experienced more than 12 symptoms of psychological distress. It is not until approximately 90+ days in care, that a real reduction in symptom prevalence can be seen. Yet, even at this point, nearly one in five women (19%) were burdened with a long list of symptoms. IMPLICATIONS Mental health consequences appeared to be the most consistently problematic and enduring for the women in this study. Mental health symptoms take longer than physical health symptoms before a reduction can be observed. Psychological support is key to women feeling better. For some women, a professional psychiatric assessment may be necessary in order to provide them with appropriate medication, when needed. A period of reflection and recovery should be at least 90 days in order to give women time to regain a significant level of psychological functioning. Even at this point, however, many women are likely still be suffering numerous and severe trauma symptoms.
EXPLANATION Here we have compared women’s depression, anxiety and hostility levels with the symptom levels of an average female population. The red line represents the norm for an average female population. The “norms” came from a sample of women in the U.S. What we see is that even at 90+ days, women who have been trafficked show symptom levels well above population norms. For example, trafficked women’s depression levels, the black line, still fall near the 90 th percentile. Further analysis is required to see if it is possible to understand what main factors may have contributed to these symptom levels, for example, history of abuse, level of abuse and intimidation during trafficking, physical health status, or even site-specific factors.
HRW on women and children in Africa: children are often double victims of AIDS. First orphaned, then trafficked for sex, put at risk of HIV
SCRIPT: So what can TSA do? Using existing programs as a base TSA can do outreach to prostituted and trafficked persons. It is very important though that outreach be coupled with serious offers of transitional assistance. Outreach to these populations without giving them the hope of a new life borders on the unethical. Report and Rescue simply means that cases of trafficked persons are reported and that rescue is attempted. (Some harm-reduction, health-based programs run by other NGOs only focus on certain health issues of people caught in obviously terribly exploitive and slavery conditions) Advocacy – contrary to popular belief TSA has and can engage in legal reform –the campaign to raise the legal age of consent in the UK in the 1880s is a perfect and dramatic example how powerful our voice (on behalf of others) can be.
SCRIPT: Some more ideas of what can be done Foster parenting – potential parents would need extensive training Shelters – the problem is sustainability and “institutionalizing” the victims Job skills training – most job skills training (in foreign countries) involves handicrafts, sewing, hair dressing – more advanced skills training should be developed and provided to those with the capacity to develop Sally Ann − a program run by TSA Bangladesh. Sexually trafficked women learn skills to make handicrafts. A catalog of goods is available by writing the Bangladesh command. Special marketing initiatives – purchasing to support micro-credit programs – conference bags and ornaments are examples – NHQ purchased ornaments from Sally Ann to give to all NHQ employees at Christmas time. People could make special purchases for advisory board members, women’s auxiliaries, Home League projects, etc. NHQ has also purchased conference bags from a company that employees formerly prostituted/trafficked women. Working cross-borders/cross-territorially is important. For example lots of trafficking from Mexico and Canada to the U.S. – thus it would be great for the territories there to collaborate
Empower most vulnerable through income generation projects and access to adequate health care Train clinic outreach workers and service providers on both HIV/AIDS and TIP so that they can properly recognize affected persons, treat them appropriately and refer them to appropriate services
EXPLANATION While exploited, most women have been given few options, little to no control over their bodies or their movements, etc. It is important to begin to restore some control for her, to let her know that she is “free” and has a right to be informed, to make choices, to refuse. While trafficked a great deal of what happens to women on a moment to moment basis is unpredictable, beyond their control To restore a sense of control and predictability, one should offer clear explanations of what will happen, the purpose for questions, and a step-by-step explanation of what will take place. These are good first steps in letting women know that they are being treated with respect, and in allowing women to have a sense of their immediate future. Describe general subjects she will be asked about, warn her about subjects that may bring up bad memories, may be embarrassing or difficult. Explain clearly who will and will not have access to the information she describes. Offer that she may return to difficult questions later Tell her that if she does not understand something she should say so, then repeat slowly and clearly
EXPLANATION As it turns out, that which benefits the victim, allays her symptoms, making her more physically comfortable, pain medication, sleep, psychologically comforted, security, sympathy, and time is likely to result in her being able to give more reliable information. I am going to try to offer some hints that may help creating a good environment and a more productive and trusting rapport.
EXPLANATION Women have many reasons why they may not wish to disclose various aspects of the trafficking experience, or personal details. The most obvious barrier to disclosure is a woman’s fear of retaliation by traffickers. This may be exacerbated by their mistrust of authorities. She may feel guilty over any level of participation she had in the trafficking—perceived and actual. She may feel guilt over other criminal activities that occurred in conjunction with the trafficking, e.g., crossing borders illegally, taking money earned illegally. Sexual activities are of particular embarrassment for many women, and therefore it is important to recognise the difficulty women may have in discussing these and the possibility that they may not explain exactly what happened and how, if it is shameful or stigmatising to them.
EXPLANATION Interpreters are not a ‘tool’ like a pencil or scissors. They are people with opinions, personalities, and backgrounds. It cannot be assumed that all interpreters are fit to translate for a trafficked person. Rule 1: do not use persons on the site where a person suspected of having been trafficked has been identified. For example, if a sex worker at the club ‘volunteers’ to interpret for the woman you want to speak with, this is not a good idea. She may be part of the trafficking network, or may report conversation to traffickers. Woman is unlikely to be certain that what she says will be held in confidence. Case in California: Police went into a brothel where they wanted to speak with a young Indian woman. Man says he is her uncle and volunteers to interpret. Two months later, police went back to venue with a real interpreter and found out he had trafficked her and was selling her. Rule 2: Interpreters have opinions and they may feel that, for example, sex workers are dirty, migrants are unacceptable, etc. and this impression is likely to affect their interpreting and is likely to be perceived by the women. Rule 3: ‘No Neighbours’: take the time to find out if the interpreter comes from the same area/village as the woman. She is likely to be very unwilling to discuss events if she thinks they will get back to her community and she will be ashamed and stigmatised. Rule 4: Some women may prefer talking to a woman, some to a man. Whenever possible, as a woman her preference. Rule 5: Warn interpreters against telling anyone about what they hear—no matter how interesting the information/experiences may seem. Communities are very small, and information travels very quickly and one never knows the tenuous connections individuals may have to those who are traffickers. Try to come up with a way to check the acceptability of an interpreter with the person who is being interviewed after about 10-20 minutes into the interview. It may be possible to have a paper prepared in the person’s language that asks them to circle yes and no questions about their impression and trust of the interpreter. It is of NO USE to employ interpreters that will not have the confidence of the person who has been trafficked. She will not share the important information. Be suspicious of interpreters who give very very short interpretations of long sentences, or vice versa.
EXPLANATION: Purpose of presentation: to describe some of the findings from a multi-country study on the health of women who have been trafficked. This study was a collaborative project carried out by London School of Hygiene and Tropical Medicine, the Rehabilitation Centres of International Organization for Migration in Moldova and Ukraine, La Strada, Czech Republic and Bulgaria, the Poppy Project in London, On the Road in Italy, and Pag-Asa in Belgium. This research was funded by the European Commission’s Daphne programme, which specifically focuses on violence against women. The study was carried out between 2003 and 2006. INTERPRETATION Can be used for: training of law enforcement Social support workers Health professionals Policy advocacy-government Other
Trafficking in Persons September 2007
Acknowledgements <ul><li>Lisa Thompson – Salvation Army </li></ul><ul><li>Kristin Wiebe – World Hope International </li></ul><ul><li>Jeff Barrows – CMDA </li></ul><ul><li>Lynn Sauls – USAID </li></ul><ul><li>Anna Stormzand – USAID </li></ul><ul><li>Ruth Pojman – USAID </li></ul><ul><li>Laura Lederer – Department of State </li></ul>
Educational Objectives <ul><li>Increased awareness of the phenomenon of trafficking in persons (TIP) </li></ul><ul><li>Information on research about the health effects of TIP </li></ul><ul><li>Ability to identify TIP victims </li></ul><ul><li>Steps to take to help the TIP victim </li></ul><ul><li>Further sources of information </li></ul>
Why talk about it? <ul><li>A Biblical Framework for Christian Engagement </li></ul><ul><ul><li>The dignity of all human life </li></ul></ul><ul><ul><li>Jesus’ commanded care and concern for the marginalized, and modeled this in life </li></ul></ul><ul><ul><li>The heart of Christ’s message on earth: hope for new life </li></ul></ul><ul><ul><li>God will judge the violent and the and deliver the oppressed who cry out to Him </li></ul></ul>
And also… <ul><li>Intersecting Program Areas: </li></ul><ul><ul><li>TIP and HIV/AIDS </li></ul></ul><ul><ul><li>TIP and Displaced People </li></ul></ul>
Sexual Trafficking War New Technologies Cultural Attitudes And Values Poverty Ethnic Minority Orphaned Abandonment/ Runaways Legal and Tolerated Sex Industries Corruption Prior Sexual Abuse Gender Demand for Commercial Sex Government Policies
Two Broad Categories of Human Trafficking Labor Trafficking: Domestic Service Sweat Shops/Factories Begging Agricultural Work Mining Brick Kilns Military Conscription Sexual Trafficking: Prostitution Pornography Stripping Lap Dancing Live-Sex Shows Mail-order Brides Child Brides (Sex is Not Labor/Work!)
Involuntary Servitude <ul><li>Involuntary servitude: a condition of servitude induced by means of: </li></ul><ul><li>Any scheme, plan, or pattern intended to cause a person to believe that, if the person did not enter into or continue in such condition, that person or another person would suffer serious harm or physical restraint; or </li></ul><ul><li>The abuse or threatened abuse of the legal process. </li></ul>Image: USDOJ Report on Activities to Combat Human Trafficking 2001-2005
Trafficking and Armed Conflict <ul><li>Child Soldiers </li></ul><ul><li>Refugees and IDPs </li></ul><ul><li>Sexual and Other Violence </li></ul><ul><li>Drug Use </li></ul>
International Scope of the Problem <ul><li>According to the International Labor Organization there are 12.3 million people in forced labor, bonded labor, forced child labor, and sexual servitude at any given time; other estimates range from 4 to 27 million.* </li></ul><ul><li>500,000 women from all over the world are trafficked each year into Western Europe alone.** </li></ul><ul><li>The last 3 years have seen a 20 percent increase in the number of prostituted children in Thailand.** </li></ul><ul><li>One million children enter the sex trade each year.** </li></ul><ul><li>(* US Department of State, 2007, TIP Report. ** End Child Exploitation , UNICEF/UK July 2003.) </li></ul>
Magnitude of Human Trafficking / USG estimates Numbers are for cross border trafficking and do NOT include internal trafficking in persons
International Scope of the Problem <ul><li>According to the FBI, human trafficking generates $9.5 billion in annual revenue. </li></ul><ul><li>(U.S. State Department, Trafficking in Persons Report, June 2006) </li></ul>
International, Trans-border Trafficking <ul><li>800,000 persons are trafficked across international borders annually.* </li></ul><ul><li>(*U.S. Department of State, Trafficking in Persons Report , 2007. Not disaggregated by age or gender. Estimate excludes internal trafficking.) </li></ul>
Trafficking in the U.S. <ul><li>From fiscal year 2001 through fiscal year 2005, the Civil Rights Division and United States Attorneys' Offices filed 91 trafficking cases, a 405% increase over the number of trafficking cases filed from fiscal years 1996 through 2000. </li></ul><ul><li>U.S. Department of Justice, Civil Rights Division. (2006, February). Report on Activities to Combat Human Trafficking Fiscal Years 2001-2005 . </li></ul>United States v. Cadena . Photo: U.S. Department of Justice, Report on Activities to Combat Human Trafficking Fiscal Years 2001-2005 .
Trafficking in the U.S. <ul><li>In these cases, Department attorneys charged 248 trafficking defendants, a 210% increase over the previous five fiscal years. In addition, 140 defendants of trafficking related crimes were convicted, a 109% increase over the previous five years. </li></ul>Kil Soo Lee, a former owner of Daewoosa factory in American Samoa, was sentenced in June 2005 to 40 years of incarceration for trafficking more than 200 victims. Photo: USDOJ Report on Activities to Combat Human Trafficking 2001-2005.
Trafficking in the U.S. <ul><li>Despite the an estimated prevalence of 100,000 to 150,000  slaves in the U.S., fewer than 1,000 victims have been assisted through the efforts of federal, state, and local law enforcement since 2001, when services for trafficking victims were first made available.  </li></ul><ul><li> Bales, K. (n.d.). International Labor Standards: Quality of Information and Measures of Progress in Combating Forced Labor . </li></ul><ul><li> U.S. Department of Justice, Civil Rights Division. (2006, February). Report on Activities to Combat Human Trafficking Fiscal Years 2001-2005 . </li></ul>
Teenage Prostitution… The most common form of human trafficking in the US today
Trafficking in Persons is Not <ul><li>Not exclusively movement of persons </li></ul><ul><li>(Remember: recruitment, harboring, transportation, provisioning, and obtaining) </li></ul><ul><li>Not carried out by exclusively violent means of force </li></ul><ul><li>Not the same as smuggling of migrants </li></ul>
Differences between TIP and smuggling of migrants <ul><li>Consent </li></ul><ul><li>Exploitation </li></ul><ul><li>Trans-nationality </li></ul><ul><li>Profits </li></ul>Trafficking in Persons Global Patterns. UNODC. 2006.
US Laws and UN Conventions <ul><li>USA: Trafficking Victims Protect Act of 2000 (TVPA) and Trafficking Victims Protection Reauthorization of Acts of 2003 and 2005. </li></ul><ul><li>UN: 1949 Convention for the Suppression of the Traffic in Persons and the Exploitation of the Prostitution of Others </li></ul><ul><li>UN: Protocol to Prevent, Suppress, and Punish Trafficking in Persons, Especially Women and Children of the UN Convention Against Transnational Organized Crime </li></ul>
Health risks and opportunities Destination Travel and transit Pre-departure Detention, deportation, criminal evidence Integration and reintegration STAGES OF THE TRAFFICKING PROCESS
ACCEPTS OFFER Vulnerabilities Hopes Strengths + = CREDIBILITY OF THE OFFER Timing of the offer Quality of the offer PUSH & PULL FACTORS DECIDING FACTORS Recruitment Equation
Sexual Trafficking <ul><li>“ The majority of victims of human trafficking are women and children, who are mostly destined for sexual exploitation.” </li></ul><ul><li>(Antonia Costa, UNODC) </li></ul>
The Prostitution Link <ul><li>The Netherlands is a major destination country in Western Europe, with 2000 brothels and numerous escort services, using an estimated 30,000 women. </li></ul><ul><li>Sixty to 70 percent of the women in prostitution in there are not citizens of the Netherlands or other EU countries. </li></ul><ul><li>In one study, 79 percent of women in prostitution gave an indication that they were in prostitution due to some degree of force. </li></ul>Source: Dr. Donna M. Hughes. The Corruption of Civil Society.
The Prostitution Link <ul><li>It is not possible to distinguish between men’s demand for victims of sexual trafficking as separate from men’s demand for commercial sex acts. </li></ul><ul><li>(Dr. Donna M. Hughes, San Diego, 4 th Annual Bi-Lateral Safety Corridor Conference, Sept 2004.) </li></ul>This sign, outside a Hong Kong club, reads: "Young, fresh Hong Kong girls; white, clean Malaysian girls; Beijing women; luxurious ghost girls from Russia." Photo: Kay Chernush for the U.S. Department of State. 2005
Methods of Recruitment and Trafficking <ul><li>Kidnapping </li></ul><ul><li>Deception/Fraud </li></ul><ul><ul><li>Newspaper ads promising career opportunities in foreign countries </li></ul></ul><ul><ul><li>Recruitment by other victims </li></ul></ul><ul><ul><li>Falsified travel document </li></ul></ul><ul><ul><li>Visa overstays </li></ul></ul><ul><li>Debt bondage </li></ul><ul><li>Parents, family, boyfriends, husbands selling children/wives/relatives </li></ul>
The Path to Exploitation <ul><li>Vulnerability Factors: </li></ul><ul><ul><li>Gender </li></ul></ul><ul><ul><li>Orphans/refugees </li></ul></ul><ul><ul><li>Street children/runaways </li></ul></ul><ul><ul><li>Poverty </li></ul></ul><ul><ul><li>Prior sexual abuse </li></ul></ul><ul><ul><li>Widows/abandoned wives & children </li></ul></ul><ul><ul><li>Ethnic minorities </li></ul></ul>
Primary Demand <ul><li>Men who purchase sex acts are all ages and come from all socioeconomic levels, all occupation categories, and ethnic/racial groups. Their behavior to buy a sex act is a choice. </li></ul>Donna Hughes. Best Practices to End Demand . 2004.
The Path to Exploitation <ul><li>Tertiary Demand (culture): </li></ul><ul><ul><li>Media promotion of a culture of prostitution </li></ul></ul><ul><ul><li>Male privilege/flattery of men’s sexual promiscuity </li></ul></ul><ul><ul><li>Other cultural attitudes, religious practices and values: e.g. value of girl children/familial duty/temple prostitution/dowry systems/virgin myths (virgin cure/sexual virility) and rape stigma </li></ul></ul>Image source: Internet.
Methods of Conditioning <ul><li>Starvation </li></ul><ul><li>Confinement </li></ul><ul><li>Beatings </li></ul><ul><li>Torture </li></ul><ul><li>Rape and gang rape </li></ul><ul><li>Threats of violence to victims and victim’s family members </li></ul><ul><li>Forced drug usage </li></ul><ul><li>Cultural beliefs (e.g. Karma) </li></ul>
Understanding Traumatic Bonding <ul><li>Captivity, which brings the victim into prolonged contact with the perpetrator, creates a special type of relationship, one of coercive control.* </li></ul><ul><li>The goal of the perpetrator is to instill in his victim not only fear of death but also gratitude for being allowed to live. * </li></ul><ul><li>Attachment between hostage and captor is the rule rather than the exception.* </li></ul><ul><li>(*Dr. Judith Herman, Trauma and Recovery, 1992.) </li></ul>
Understanding Survival Strategies <ul><li>“ As people find the best way to survive, some of their behaviors may raise questions if viewed out of context. For example, the woman’s and adolescent girl’s flirtatiousness, seeking out clients, and getting clients to feel pity or love for them may represent strategies aimed at enhancing their survival.” </li></ul><ul><li>(Wendy Freed, “From Duty to Despair: Brothel Prostitution in Cambodia.” Prostitution, Trafficking and Traumatic Stress . 2003. </li></ul>
Harms of Commercial Sexual Exploitation <ul><li>Physical Health: </li></ul><ul><ul><li>Drug and alcohol addiction </li></ul></ul><ul><ul><li>Bodily injuries: broken bones, concussions, burns, vaginal/anal tearing from violence including assault, stabbings, rape, and torture </li></ul></ul><ul><ul><li>Traumatic brain injury (TBI): resulting in memory loss, dizziness, headaches, numbness, etc. </li></ul></ul><ul><ul><li>STDs (e.g. HIV/AIDS, gonorrhea, syphilis, UTIs, pubic lice) </li></ul></ul><ul><ul><li>Sterility, miscarriages, menstrual problems </li></ul></ul><ul><ul><li>Disease (e.g. TB, hepatitis, malaria, pneumonia) </li></ul></ul><ul><ul><li>Forced abortions </li></ul></ul>
Harms of Commercial Sexual Exploitation <ul><li>Psychological: </li></ul><ul><ul><li>Post Traumatic Stress Disorder (PTSD): acute anxiety, depression, insomnia, physical hyper-alertness, self-loathing that is long-lasting and resistant to change (complex-PTSD) </li></ul></ul>
PTSD Among Prostituted Women <ul><li>In a study of prostituted women from 9 countries, PTSD was 68%, which is in the same range as that of treatment-seeking combat veterans. </li></ul><ul><li>(Farley et al. (2003). Prostitution and Trafficking in Nine Countries: An Update on Violence and Posttraumatic Stress Disorder. Prostitution, Trafficking, and Traumatic Stress. ) </li></ul>
Harms of Commercial Sexual Exploitation <ul><li>Psychological: </li></ul><ul><ul><li>Mind/body separation/disassociated ego states </li></ul></ul><ul><ul><li>Shame </li></ul></ul><ul><ul><li>Grief </li></ul></ul><ul><ul><li>Fear </li></ul></ul><ul><ul><li>Distrust </li></ul></ul><ul><ul><li>Hatred of men </li></ul></ul><ul><ul><li>Self-hatred, suicide and suicidal thoughts </li></ul></ul>
Understanding the Impact <ul><li>“ Sexual trauma is unique from other forms of trauma. It is a violation of the most intimate and personal aspects of the self. One’s own body becomes the setting in which the atrocities are perpetrated . . . .” </li></ul><ul><li>(Wendy Freed. Commercial Sexual Exploitation of Women and Children in Cambodia − Personal Narratives − A Psychological Perspective. Physicians for Human Rights. 1997) </li></ul>
The Faces of Prostitution Courtney. The Denver Post . 2005. Melissa. Photos -Pinellas County Police Dept, Florida.
Violence women experienced prior to being trafficked
81% headaches 71% dizzy spells 69% back pain 60-70% various sexual health problems 63% memory problems 82% fatigue The most common physical health symptoms reported by women at 0-14 days
Levels of psychological distress are high, with multiple presenting symptoms 0-14 days 28-56 days 90+ days
Trafficked women’s mental health compared to a general female population 0-14 days 28-56 days 90+ days
Examples of the HIV/TIP Intersection Soweto, South Africa Disaster / Armed Conflict Displaced People Vulnerability Conflict Rape/Sex Slavery HIV Tourism Prostitution/Sex Industry (Corruption) Vulnerability Poverty Gender Inequality (Apathy) Vulnerability Children Orphaned by AIDS Poverty Vulnerability
Risk Factors <ul><li>High Risk Sex </li></ul><ul><ul><li>Lack of Control / Choice over activity </li></ul></ul><ul><ul><li>Inability to insist on condom use </li></ul></ul><ul><ul><li>Link to intravenous drug use </li></ul></ul><ul><ul><li>Violent sex </li></ul></ul><ul><ul><li>Youth (myths, preference) </li></ul></ul>
Indicators <ul><li>HIV prevalence among women in prostitution* </li></ul><ul><ul><li>70.4% South Africa </li></ul></ul><ul><ul><li>31% Zambia (prevalence in red light areas) </li></ul></ul><ul><ul><li>28.8% Cambodia </li></ul></ul><ul><ul><li>20% Nepal </li></ul></ul><ul><ul><li>Major factor: clients spreading HIV to others </li></ul></ul><ul><ul><li>(WHO Africa 2005) </li></ul></ul><ul><li>HIV prevalence post-conflict </li></ul><ul><ul><li>Nigerian peacekeepers leaving Sierra Leone 2x higher </li></ul></ul><ul><ul><li>Sierra Leone post conflict: Women 6x more likely to be infected than men </li></ul></ul><ul><ul><ul><li>* 2005 Trafficking in Persons Report, US Dept. of State </li></ul></ul></ul>
So… what to do? <ul><li>Pray </li></ul><ul><li>Listen </li></ul><ul><li>Watch </li></ul><ul><li>Think </li></ul><ul><li>Act </li></ul>
Victim Identification <ul><li>Evidence of being controlled (rarely alone, seems to be under constant surveillance, isolated or cut off from family and friends, fear of speaking for themselves, and bruises. </li></ul><ul><li>Evidence of inability to move or leave job. </li></ul><ul><li>No passport or other identifying documents. </li></ul><ul><li>Excessive work hours – not free to take time off. </li></ul>Chain link fence with barbed wire surrounds the Bunny Ranch, a “legal” brothel outside Nevada. Photo: Lisa Thompson. 2005
Victim Identification <ul><li>Lives with co-workers and “employer” – no privacy </li></ul><ul><li>Untreated illnesses and infections </li></ul><ul><li>Unpaid for work completed or paid very little (money is managed by a third party) </li></ul><ul><li>Brands or scarring indicating ownership </li></ul><ul><li>Cannot speak local language and shows no knowledge of local community </li></ul>
Key Questions to Ask Potential Victims <ul><li>What type of work do you do? </li></ul><ul><li>Are you being paid? </li></ul><ul><li>Can you leave your job? </li></ul><ul><li>Can you come and go as you please? </li></ul><ul><li>Have you or your family been threatened? </li></ul><ul><li>What are your working and living conditions like? </li></ul>
Key Questions to Ask Potential Victims <ul><li>Where do you sleep and eat? </li></ul><ul><li>Do you have to ask permission to eat, sleep, or to go to the bathroom? </li></ul><ul><li>Are there locks on your doors or windows so you cannot get out? </li></ul><ul><li>Have your documents of identification been taken from you? </li></ul>
Ideas for Action <ul><li>Address Demand: </li></ul><ul><li>Advocate laws that criminalize demand </li></ul><ul><ul><li>Billboards with pictures of men arrested for soliciting </li></ul></ul><ul><ul><li>Impounding cars of men arrested for soliciting </li></ul></ul><ul><ul><li>Johns schools </li></ul></ul><ul><li>Sex addiction treatment programs (e.g. Avenue) </li></ul><ul><li>Oppose legalization of prostitution </li></ul><ul><li>Street outreach to potential “johns” passing out literature </li></ul>
Ideas for Action <ul><li>Survivor Programs: </li></ul><ul><ul><li>Outreach: Jail and Street (must be coupled with transitional assistance and referrals for services) </li></ul></ul><ul><ul><li>“ Report and Rescue” (modeled after mandatory reporting laws) </li></ul></ul><ul><ul><li>Transitional reintegration programs (using merit/reward type programs drawing from prerelease prison programs; micro-enterprise programs) </li></ul></ul>
Ideas for Action <ul><ul><li>Survivor Programs: </li></ul></ul><ul><ul><li>Child Sponsorship </li></ul></ul><ul><ul><li>Foster Parenting </li></ul></ul><ul><ul><li>Shelters/Institutional care </li></ul></ul><ul><ul><li>Legal aid </li></ul></ul><ul><ul><li>Immigration assistance </li></ul></ul><ul><ul><li>Health/Medical </li></ul></ul><ul><ul><li>Job/Skills Training </li></ul></ul><ul><ul><li>PTSD & spiritual counseling </li></ul></ul>
Caring for Victims of TIP <ul><li>Immediate / Short Term Needs </li></ul><ul><ul><li>Shelter </li></ul></ul><ul><ul><li>Safety </li></ul></ul><ul><ul><li>Food, clothing </li></ul></ul><ul><ul><li>Transportation </li></ul></ul><ul><ul><li>Translation </li></ul></ul><ul><li>Long Term Needs </li></ul><ul><ul><li>Counseling </li></ul></ul><ul><ul><li>Job / Skills training </li></ul></ul>
Compatible anti-HIV/TIP Activities <ul><li>Address root causes </li></ul><ul><ul><li>gender inequality </li></ul></ul><ul><ul><li>sexual violence </li></ul></ul><ul><ul><li>poverty </li></ul></ul><ul><li>Educate communities </li></ul><ul><li>Empowerment </li></ul><ul><li>Network with service providers and community groups </li></ul><ul><li>Train clinic outreach workers and service providers on both HIV/AIDS and TIP </li></ul>
<ul><li>Explain and inform </li></ul><ul><li>Inquire about her </li></ul><ul><li>Be on her side </li></ul>Give Control and Establish Trust
Physical comfort Comforted, comfortable individual More thoughtful, more reliable, accurate information Psychological comfort + Time + Of benefit to the victim = benefit to the case
A Complex Victim Group <ul><li>Disclosure barriers </li></ul><ul><li>Fear of retaliation by traffickers </li></ul><ul><li>Guilt of her perceived complicity in what occurred </li></ul><ul><li>Guilt over any criminal activities in which she participated </li></ul><ul><li>Shame about what she has done, particularly sexual activities </li></ul><ul><li>Little trust in officials, e.g., police, immigration, health workers </li></ul>
Interpreters <ul><li>Security- DO NOT USE ‘VOLUNTEER’ INTERPRETERS </li></ul><ul><li>No discrimination - against sex work, migrants, women </li></ul><ul><li>No neighbours – no one from the same village or town, or local destination community </li></ul><ul><li>Gender – may prefer a female or male </li></ul><ul><li>Warn against any disclosure, with criminal sanctions, e.g., official secrets, data protection act </li></ul>CHECK ACCEPTABILITY OF INTERPRETER WITH THE WOMAN HERSELF
Hotlines <ul><li>Report trafficking crimes or get help by calling the toll-free hotlines: </li></ul><ul><li>DOJ: 1-888-428-7581 (voice and TTY). </li></ul><ul><li>HHS: 1-888-3737-888 </li></ul>
For Additional Information <ul><li>http://www.salvationarmyusa.org/trafficking </li></ul><ul><li>http://www.iast.net/ </li></ul><ul><li>http://www.uri.edu/artsci/wms/hughes/hughes.htm </li></ul><ul><li>http://www.prostitutionresearch.com/ </li></ul><ul><li>http://www.state.gov/g/tip/ </li></ul><ul><li>http://www.acf.hhs.gov/trafficking/ </li></ul><ul><li>http://www.usdoj.gov/whatwedo/whatwedo_ctip.html </li></ul><ul><li>http://www.fbi.gov/hq/cid/civilrights/slavery.htm </li></ul><ul><li>http://www.ice.gov/pi/news/factsheets/humantraffic_071404.htm </li></ul>
STOLEN SMILES Physical and mental health consequences of women and adolescents trafficked in Europe Funding from the European Commission’s Daphne Programme, Sigrid Rausing Trust, International Organization for Migration
<ul><li>Zimmerman, C. 2006. Presentation on the health consequences among women who have been trafficked and their implications for services and policy. London: London School of Hygiene & Tropical Medicine. </li></ul><ul><li>The full report, Stolen Smiles, is available at: </li></ul><ul><li>www.lshtm.ac.uk/genderviolence </li></ul>Suggested citation
<ul><li>Kristin Wiebe </li></ul><ul><li>Director of Anti-Trafficking Programs </li></ul><ul><li>[email_address] </li></ul>WORLD HOPE INTERNATIONAL 625 Slaters Lane, Suite 100 Alexandria, VA 22314 (703) 923-9414 x121 www.worldhope.org
Other contacts <ul><li>International Justice Mission (worldwide) </li></ul><ul><li>Nightlight (Bangkok) </li></ul><ul><li>Wonderfully Made (India) </li></ul><ul><li>Eden Ministries (China) </li></ul>
Be Encouraged <ul><li>“ But if God be for you, who can be against you? Are all of them stronger than God? O be not weary of well-doing! Go on, in the name of God and in the power of His might, till even American slavery (the vilest that ever saw the sun) shall vanish away.” </li></ul><ul><ul><li>- John Wesley, 1791 </li></ul></ul>