Health Needs of Human Trafficking Victims
Ambassador Mark P. Lagon, Director of the Office to Monitor and Combat Trafficking in Persons
Keynote Address at the National Symposium on the Health Needs of Human Trafficking Victims at the Department of Health
and Human Services
September 22, 2008
Tina Frundt, thank you so much for your introduction. Tina is one of the extraordinary people who have worked on the
front lines of the anti-slavery movement, forging the best ways to do street outreach, for example, in downtown DC. I am
so happy to know that you are working on a shelter project, Courtney’s House, because providing models for excellent
protection services is essential. I have great confidence that your new work will advance the movement’s knowledge and
capability—while helping individuals recover their lives.
As Ambassador-at-Large to Combat Human Trafficking, I travel a lot. And while the primary purpose of most official
travel is to meet with foreign government officials, I always meet with survivors, together with the brave NGOs who are
implementing anti-trafficking programs.
I have realized, as many of you know, that a defining aspect of the human trafficking experience is PAIN— physical,
emotional, and psychological pain. In every account, in every personal tale of suffering I hear, the story includes
adverse health impacts ranging from extremely painful experiences to grotesque examples of brutality.
Now, this should be self-evident, considering that force, fraud, and coercion, part ofthe defining legal criteria of
human trafficking, typically include confinement and physical or psychological abuse which harm the health of the
victim. But the implications of this fact have not been fully absorbed, I’m afraid.
The more I travel, and think about the people I’ve met, and worry about how we are working on this issue—the more we
learn through the very fact of compiling the annual Trafficking in Persons Report—the more I’ve realized that two
simplistic assumptions, shared by many, undermine general acknowledgement that human trafficking must be prioritized as
a health pandemic as well as a human rights travesty. One assumption pertains to forced labor, the other to sex
Migrant workers who leave home communities for economic opportunity are vulnerable to conditions of forced slavery. They
are vulnerable to conditions that impair their health, typically with minimal recourse to medical assistance. Yet, there
is a common assumption that migrant workers assume all risk—and are not owed fundamental protection—as soon as they
Those who are trafficked for labor suffer a terrifying range of physical and mental health problems.
Last week, I was talking to a Congressional staffer just back from a field investigation. In describing the situation of
a group of labor trafficking victims, in one breath, he mentioned that the group suffered from malaria, renal failure,
gastritis, and malnutrition. Victims of forced labor are routinely beaten and assaulted. Their injuries are rarely
treated, so infection is a common risk. They suffer depression and post-traumatic stress disorder, which elevate the
risk of suicide.
Last year, my office dedicated the 2007 Trafficking in Persons Report to a group of Burmese fishermen who were
trafficked on fishing boats. The men were forced to remain at sea for years, denied pay, and fed only fish and rice.
They suffered vitamin deficiencies, and then, starvation. One by one, they began to die. So the traffickers tossed them
off the boat, into the sea. Death is the ultimate adverse health impact of trafficking. And note, in this case, because
there were no bodies remaining, the fishing fleet’s owner claimed not to owe families death benefits.
Research has demonstrated that violence and abuse are at the core of trafficking for prostitution. A 2006 study of women
trafficked for prostitution into the European Union found that 95% of victims had been violently assaulted or coerced
into a sexual act, including extreme violence that resulted in broken bones, loss of consciousness, and gang rape. Over
60% of victims reported fatigue, neurological symptoms, gastrointestinal problems, back pain, and gynecological
infections. Complications related to forced abortions, unhealthy weight loss, lice, suicidal depression, alcoholism, and
drug addiction are also reported in accounts of the health impacts of commercial sex and trafficking for prostitution.
Less obvious health consequences of sex trafficking can include cervical cancer, caused by the human papillomavirus,
which is more common among women who have sexual encounters with many men.
A study in 2001 by Janice Raymond, Donna Hughes, and Carol Gomez revealed that 86% of women trafficked within their
countries and 85% of women trafficked across international borders suffer from severe depression.
Studies of the health impacts of sex trafficking and of prostitution describe similar pathologies. Dr. Melissa Farley
led a team investigating the physical and psychological damage of prostitution. First published in the Journal of Trauma
Practice in 2003, the study found that 73% of women used in prostitution were physically assaulted, 89% wanted to escape
but had no other means of survival, 63% were raped, and 68% met the criteria for post-traumatic stress disorder. I am
very happy that Dr. Farley will be able to discuss her research at this symposium.
Additional psychological consequences common among prostituted women include dissociative and personality disorders,
anxiety, and depression. Yet, the adverse health impacts of commercial sexual exploitation are almost universally
disregarded, except the risk of HIV/AIDs.
The categorical pain, violence, and health risk of prostitution is obscured by a covering myth that individual volition
is involved. Prostituted women are ensnared not just by brothel owners and pimps. They are ensnared by the camouflaging
assumption that prostitution is work. It’s always degrading and dehumanizing.
Importance of Research
I’m sure one of the conclusions from the symposium will be that we need more research, and we do. An important example
of the value of research, funded in part by the Office to Monitor and Combat Trafficking in Persons, is a groundbreaking
study by Dr. Jay Silverman on sex trafficking and HIV within south Asia published in the Journal of the American Medical
Association in 2007. It is tremendous and fitting that we have Dr. Silverman presenting later today.
It has been estimated that half of all female sex trafficking victims in South Asia are under age eighteen at the time
of exploitation. Yet, research on HIV and sexually-transmitted infections has rarely sought to identify minors or adult
Dr. Silverman and his team partnered with major NGOs across India, Nepal and Bangladesh involved in rescue and care of
sex trafficking victims to examine the process of sex trafficking, HIV prevalence, and trafficking-related risk factors.
Among Nepalese women and girls who were repatriated victims of sex trafficking, the Silverman study found that 38% were
HIV positive. The majority were trafficked prior to age 18. One in seven was trafficked before age 15, and among these
very young girls, 51% were infected with HIV. Why? Very young girls were more frequently trafficked to multiple brothels
and for longer periods of time.
Silverman concludes that the girls at greatest risk for being infected with HIV (and for transmitting HIV) are the least
likely to be reached by traditional HIV prevention models.
He proposes collaboration among HIV prevention and human trafficking experts to develop efforts that simultaneously
reduce HIV risk and identify and assist trafficking victims—a policy prescription supported by the U.S. Government’s
interagency working group, the Senior Policy Operating Group, which I chair. I deeply hope that this symposium will
discuss ways to operationalize this collaboration because we must fight HIV and trafficking at the same time.
In recent months, we have been following a situation in Cambodia directly related to this issue. And information is
still emerging. But some public health activists are saying that the implementation of a new anti-sex trafficking law in
Cambodia has impeded their efforts to get access to brothels where they distribute condoms. We must confront both the
risk of HIV/AIDs in brothels as well as the reality that brothels can hold sex trafficking victims.
U.S. Government Policy
The Administration has implemented strong policies to combat HIV/AIDS and human trafficking. The U.S. Government
promotes the rescue and care of victims and seeks to ameliorate the harm suffered by men, women, and children trafficked
in prostitution. U.S. law encourages appropriate treatment and care for those trafficked into prostitution as well as
those who escape servitude. We will continue to treat people infected and affected by HIV/AIDS—including people in
prostitution and victims of trafficking—with dignity and compassion. But we must do a much better job of bringing these
two commitments into sync.
Prioritize Attention to Health in Programming
It’s always essential to bring discussions of human trafficking back to the people who we are hoping to help. When I’m
thinking about the health impact of sex trafficking I think of two young women I met in Romania.
Last winter, in an urban shelter for sex trafficking survivors, I met two young Romanian women, Anca and Silvia, who had
been trafficked separately to Western Europe, wound up together in a shelter, and were repatriated back home. Both women
had the look of traumatized people. They clung to each other. Just a few days after we met in Romania, the NGO caring
for them discovered that Anca had advanced TB and Silvia had severe syphilis. Why weren’t these women given proper
medical attention before they were repatriated? The time lost made their conditions worse.
Despite increased attention by law enforcement to sex trafficking, we do not see significant improvement in victim
protection or services provided, and this includes medical attention. But unless this trend is reversed we will never be
able to help significant numbers of victims become survivors.
Thank you all for being here. I hope this symposium will stand as one of the most significant accomplishments of 2008
for the anti-slavery movement. Finally, I must thank Melissa Pardue, a valued colleague and friend who is an
extraordinary policymaker and organizer of research. We have her to thank for making this event happen.