Kimberly Vrudny


In HIV/AIDS, Structural Drivers of the Pandemic, Trafficking on August 11, 2010 at 1:15 am

The fastest growing criminal industry in the world today is the illegal sale and circulation of drugs, which is estimated to generate more than $320 billion annually. Two similar industries vie for the second position in terms of fastest growing criminal industries worldwide: the illegal sale of weapons (gunrunning), and the trafficking of humans (the modern-day slave trade). All three are contributing in their unique ways to the HIV/AIDS pandemic. The first, the trafficking of drugs, supplies the demand for illegal drugs that are injected into the bloodstream, often through shared needles contaminated by the virus. The second, gunrunning, arms and empowers people whose intentions are rarely for the common good, very often forcing the mass migration of people as cartels, militias and armed soldiers, sometimes children, destabilize societies and overthrow sometimes legitimate governments. In situations of social unrest, rape and survival sex are common, exposing people to sexually transmitted diseases. The third, the modern-day slave trade, exploits human beings for their labor in garment factories, agricultural fields, and sex brothels. Given these realities, any attempt to understand the structural drivers of the HIV/AIDS pandemic must take into account the unlawful trafficking of drugs, weapons, and humans, for all three are contributing to the spread of the virus in the human population.

Because the sale of drugs, weapons, and humans is lucrative, these industries are growing rapidly. Though public awareness about their activities is growing, prosecution of traffickers is difficult. Victims are often too fearful to further endanger their lives by testifying against individuals who abused them or who are involved with much larger networks against which there is little protection. And, too often, law enforcement is corrupted. Officials are paid with financial bribes or sexual services not to make arrests when drug dealers, weapons traders, and human traffickers are identified. The more information the public has about trafficking, however, the easier it is to identify illegal activities that are often occurring quite openly, and the harder it becomes for those who are the masterminds behind the trafficking of drugs, weapons, and humans to line their pockets by the sale of cocaine, guns, and slaves.

Drug Trafficking

The headlines are rarely front-page news in the United States, but they’re posted nevertheless: “Drug war death toll in Mexico since 2006 exceeds 28000, official says” (August 3, 2010; cnn); “UN: Drugs linked to Kenya’s Alarming HIV spread” (December 14, 2009; Nation); “Re-organized crime: Shifting battle lines bring violence to new parts of Mexico” (June 3, 2010; The Economist). Because the first and last of these deals with death on the far side of the Rio Grande, and the central one deals with a set of problems on a continent apparently rife with them, most Americans are simply not paying attention.

Nevertheless, Charles Bowden, an award-winning non-fiction author, journalist, and essayist, has covered the drug violence between Mexico and the United States for the last decade. In his most recent book, Murder City: Ciudad Juárez and the Global Economy’s New Killing Fields (Nation Books, 2010), Bowden attempts to track the causes of the disintegration of Mexican society, pointing specifically to failed international policies around trade. He is especially critical of the United States, and its role in the unfolding bloodbath along the border (interactive map 1; interactive map 2; interactive map 3). He writes of the illicit trade in drugs within this larger context, pointing to illegal immigration into the United States as the natural consequence of policies that drive the working poor of Mexico northward, from their families, from their land, and from previous means of income.

The migration of the Mexican poor is the largest human movement across a border on the planet. It was triggered by the destruction of peasant agriculture at the hands of the North American Free Trade Agreement, by the corruption of the Mexican state, by the growing violence in Mexico, and exacerbated by the millions of Mexicans working illegally in the U.S. who send money home to finance their families’ trips north. It should be seen as a natural shift of a species (Bowden, March 1, 2010,

For much of the last two decades, Bowden’s work has been focused on the disintegration of Ciudad Juárez. In his recent novel, Dreamland (University of Texas, 2010), Bowden poetically yet convincingly describes the deterioration of this Mexican city just south of El Paso, Texas, from the perspective of an astute fictional observer, who likens the violence in the city itself to a factory production line—the inevitable product of failed policies that favor the market over its minions.

The city thinks of itself as a bustling place with foreign-owned factories where over two hundred thousand people toil. This is a small part of the real work here. The city itself is the factory. It produces the human beings in quantities far greater than the market can absorb. The giant machines cut the babies from templates of mud, then malnourish them so that their minds and bodies never get too large or free-ranging. By age ten, at the latest, they are fed a diet of paint, glue, drugs, and alcohol. Training in guns and prostitution begins around age fourteen, also tattoos are added to the flesh as adornment. Like the foreign-owned factories, the giant plant of the city works three shifts, a ceaseless production line belching out little humans at the loading dock. There is very little quality control, but even so, some of the production is slaughtered for ill manners or for no reason at all. Schooling is limited since the factory managers believe the product is fully equipped once it leaves the plant. Every year, production quotas are raised and more redundant human beings are fabricated and cast out into the streets. / The noise of all this work is so great that no one ever hears it. They do not hear the screams, the gunshots, the knives sliding into flesh. They do not even notice the work. Instead, everyone says the city is about producing various objects for export—car parts, vacuum cleaners, things like that. Of course, such products are tiny compared to the real production line, the one nobody speaks of, the one slamming out human beings, a factory line of drill presses and lathes and huge stamping devices and intricate wiring and instant delivery. No one on the line gets a bathroom break or any other time off from this conveyor belt of flesh. (Bowden, Dreamland, 25).

The “way out of Juarez,” according to Bowden, is the legalization of drugs. Likening it to the battle over prohibition of alcohol in the early twentieth century, Bowden argues that legalizing drugs would do to traffickers what the legalizing of alcohol did to rum-runners and bootleggers when alcohol was legalized in 1933—they rather disappeared. As such, he boldly disagrees with a statement from U.S. Secretary of State Hillary Clinton who spoke of the interrelated nature of drug trafficking and gunrunning. She said upon arrival to Mexico City in March of 2009, using language the New York Times considered “unusually blunt”: “Our insatiable demand for illegal drugs fuels the drug trade. Our inability to prevent weapons from being illegally smuggled across the border to arm these criminals causes the deaths of police officers, soldiers and civilians” (New York Times). Without mincing words, Bowden responded to Clinton’s statement directly, “The official line of the U.S. government, one most recently voiced by Secretary of State Hillary Clinton, is that drug consumers in the United States are responsible for drug murders in Mexico. Only someone who is drugged could believe this claim. The sole source of the enormous amount of money in the drug business and the accompanying violence is the U.S. prohibition of drug use by its citizens” (

Clinton and Bowden voice two very different approaches to the situation: one defends the position that drugs ought to remain illegal and that resources ought to be allocated to prevent their entry into the United States; the other supports the view that drugs ought to be made legal so that the issue rather dissipates, enabling the resources applied to fighting the “war on drugs” to be reallocated to other causes—ones less prone to failure.

The extent of the problem is well known. The Centers for Disease Control and Prevention reported that in one month in 2007, the prevalence rate of illicit drug use among individuals in the United States aged twelve and over was as high as 8% (faststats). This was an increase from 7.1% in 2001 (fact sheet). “Illicit drug use” includes use of marijuana, cocaine, hallucinogens, inhalants, heroin, or nonmedical use of sedatives, tranquilizers, stimulants, or analgesics. A survey conducted in 2001, however, found that 41.7% of the population confessed to using one or more of these substances ever in their lifetimes (fact sheet). The demand for illegal drugs in the United States is undeniably high.

As the debate about how to handle the situation wages on, drugs continue to flow over the border—in ever more clever ways that are killing tens of thousands of people while lining the pockets of people who are ruthless, driven by little else than the power and riches that come with the acquisition of the large quantities of cash flowing in from sales in the U.S. While marijuana is, by far, the most illegally used drug in the United States, it is smoked, not injected. So here the focus will remain on the problem of the drug trade in relation to the HIV/AIDS pandemic, and as such will look at the transfer of drugs that can be injected: cocaine and heroine.

Tracing the movement of cocaine and heroine through Mexico from Colombia and Afghanistan, respectively, into the United States, helps to express the scope of the problem. Colombia, for example, is the world’s major producer of the coca plant, the source from which cocaine is made. It is legal to grow the coca plant in Colombia, but only in small amounts and only for personal use—not for large-scale trade or sale. However, as the producer of three-quarters of the cocaine that is sold worldwide, Colombia produces only a small amount of its coca for legal purposes, including traditional uses by indigenous communities; the rest is sold to traffickers, whose job is to get the powder from South America into the United States, the world’s largest market for cocaine consumption ( Approximately 65% of the cocaine entering the United States comes by land through Mexico, at points in Arizona, California, and Texas. The rest comes by sea or by air, predominantly into Florida (map). Some is dropped by air, while some arrives on hard to detect sea vessels. CNN reported in April 2009 that the U.S. Coast Guard “captured six hard-to-detect boats that travel at night and seized 30,000 pounds of pure cocaine,” noting that drug traffickers “have become much more aggressive in their smuggling tactics.” The article references “go-fast boats that travel at night” as well as “new self-propelled semi-submersible vessels” that can be sunk by the trafficker upon detection ( Even so, most of the drugs continue to come by land. Authorities have discovered about 100 tunnels along the 1,950 mile border between the United States and Mexico ( Moreover, officials have uncovered cocaine in tables, lollipops, toys, candles, tires, furniture, and shoes. There are also so-called “mules,” or humans who carry the drugs on their bodies across the border.

The trafficking of heroine is more complicated. According to a 2004 UN survey, Afghanistan is the producer of 87% of the opium or poppy plant, the organic source from which heroine is made (unodc). While the Taliban banned opium production in 2000 as “un-Islamic,” bringing its production down to only 30 square miles of land by 2001, one year later, after the U.S. and British forces had installed an interim government, farmers returned to the cultivation of opium as their most lucrative crop. By 2002, 285 square miles of land were dedicated to the production of opium, positioning Afghanistan to surpass Burma as the world’s greatest supplier of the plant (orwell). In 2009, the UN reported that opium production fell from 157,000 hectares of land, to 123,000 hectares. At the same time, each plant yielded a greater amount of opium (unodc). From Afghanistan, the opium is smuggled into Pakistan and India, through which it enters the United States (map). “According to a Drug Enforcement Administration report obtained by the Los Angeles Times, Afghanistan’s poppy fields have become the fastest-growing source of heroin in the United States. Its share of the U.S. market doubled from 7 percent in 2001, the year U.S. forces overthrew the Taliban, to 14 percent in 2004, the latest year studied” ( The same article reported that another DEA report said the share could be “significantly higher” than 14 percent, because “not only is more heroin being produced from Afghan poppies coming into the United States, it is also the purest in the world, according to the DEA’s National Drug Intelligence Center” (

Obviously, the legalization of these substances is unlikely in the current political climate in the United States. Recognizing the crisis that is unfolding south of the border, however, other theoreticians are struggling to identify how to decrease this country’s demand for these illegal substances. One approach has been adopted elsewhere throughout the world, and is based on a philosophy of harm reduction. Harm reduction is a philosophy that attempts to keep drug users safe in their use of injected drugs until they are prepared to address their addiction. Free access to clean needles through needle exchange programs is at the heart of the philosophy ( Bowden, however, continues to advocate for the legalization of drugs and attention to the policies of the United States on the people of Mexico as the single most effective means by which to address the problem.

The planet is being skinned by my kind and this means people leave ancient ground and push out into some void called the future. The Mexican line is simply a detail in this movement and the Mexican war is simply one response, that of government, to a reality that is past denying or changing. Where I sit is the ground from which the lessons have entered my life. I first saw this patch of high-desert grassland and mesquite as a boy and then it was a lonely ground seldom visited and barely noted by mapmakers. Now it is the center of a war room where all kinds of marks on various plans see it as a stream of drugs, blood, and human beings heading north. The little village to the south averages a thousand people a day marching north and remains unknown except to the various forces seeking to control the border. Juárez, to the east, with its noise and slaughter, is simply another glimpse of this same vista, a vista where all can see that the land has failed people due to global trade and destruction of soil and water, a vista where human numbers have exceeded the ability of the earth to sustain them, a vista where criminal activities such as drugs or sex trafficking offer entrepreneurs the chance for success even though they begin with limited capital. / What commentators and politicians call problems are no more than how these facts manifest themselves. There is no drug problem, there is a drug appetite. There is no immigration problem, there is a flight from poverty and a demand for cheap and docile labor. There is no violence problem, there is simply an economic engine running without lubricant and without much hope of lubricant unless you count blood as a possible source, something our ancestors would simply see as a typical unregulated market. And the Mexican war is actual and it is fought by Americans against Mexicans because such a war is preferable to Americans. The only alternative is to recognize the implications of our appetites and policies and no one wishes to do this” (Bowden, Dreamland, 138).

Weapons Trafficking

Despite Bowden’s disagreement with Hillary Clinton’s statement in front of the press, he never disproved a relationship between the illicit drug trade and the trafficking of weapons; instead, he shifted the conversation to one about making it legal to consume cocaine and heroine in the United States. Clinton’s assessment, however, drew a legitimate connection between the violence in Mexico, and the illicit trade in weaponry originating in the United States. According to the findings of a June 2009 report of the U.S. Government Accountability Office:

Available evidence indicates many of the firearms fueling Mexican drug violence originated in the United States, including a growing number of increasingly lethal weapons. While it is impossible to know how many firearms are illegally smuggled into Mexico in a given year, about 87 percent of firearms seized by Mexican authorities and traced in the last 5 years originated in the United States, according to data from Department of Justice’s Bureau of Alcohol, Tobacco, Firearms and Explosives (ATF). According to U.S. and Mexican government officials, these firearms have been increasingly more powerful and lethal in recent years. Many of these firearms come from gun shops and gun shows in Southwest border states. U.S. and Mexican government and law enforcement officials stated most firearms are intended to support operations of Mexican DTOs, which are also responsible for trafficking arms to Mexico (

The ready availability of weapons is not only further empowering the drug cartels that are increasingly controlling Mexico. Whereas Mexico’s disintegration and its attending vulnerability to high prevalence rates of HIV/AIDS is attributable in part to the drug trade, and to the social unrest that is occurring in the overtaking of Mexico by the drug cartels, Africa’s is due in part to the trafficking of weapons, which is inextricably related, again in part, to the looting of that continent’s natural resources—most centrally its gold and diamonds. The link between “conflict diamonds” and armed conflict was addressed by resolution A/RES/55/56, adopted by the UN on December 1, 2000.

In taking up this agenda item, the General Assembly recognized that conflict diamonds are a crucial factor in prolonging brutal wars in parts of Africa, and underscored that legitimate diamonds contribute to prosperity and development elsewhere on the continent. In Angola and Sierra Leone, conflict diamonds continue to fund the rebel groups, the National Union for the Total Independence of Angola (UNITA) and the Revolutionary United Front (RUF), both of which are acting in contravention of the international community’s objectives of restoring peace in the two countries (

It is impossible to quantify the impact of the illegal trade in weaponry and ammunition. Perhaps it is sufficient to consider the role of guns on one life—the life of a child, Ishmael Beah—in a single region of social unrest, Sierra Leone. Then, by multiplying his story by 300,000—the number of child soldiers Amnesty International estimates to be active throughout the world, it might prod Americans to pay attention to what is happening in the rest of the world, and to weigh their own policy positions against the potential impact of that policy on a child living on another continent, desiring the same access to food, shelter, clothing, education, and security that so many on this continent are privileged to possess.

Sierra Leone was engaged in a war for eleven years. Rebels crossed the border from Liberia to Sierra Leone in 1991, and were supported for a time by civilians who were dissatisfied by the corruption of the government that had virtually dissolved the functioning of a peaceful society. But soon the guns were turned on the civilians. “By the time the war was declared over, tens of thousands had been killed out of a population of five million, thousands had been mutilated or raped, and an estimated 10,000 children had been abducted to be child soldiers. Up to two-thirds of the population had been displaced from their homes, and another 600,000 had fled the country” ( Since Sierra Leone did not manufacture any of its own weapons, and since international laws were in place to prevent the entry of weapons into the region given its instability, every rifle shot, grenade detonated, and bullet fired after 1997 was supplied illegally.

In his memoir, A Long Way Gone, Ishmael Beah writes about having a new life in New York after having been a child soldier in Sierra Leone. “These days,” he writes, “I live in three worlds: my dreams, and the experiences of my new life, which trigger memories from the past” (Beah, 20). After capturing in vivid detail a nightmare he had experienced, in which he saw his own face on the body of a victim he pushed in a wheelbarrow through a blood-soaked field, Beah writes of awakening from his dream state and his subsequent struggle to disentangle one world he occupies from the others:

I lay sweating for a few minutes on the cool wooden floor where I had fallen, before turning on the light so that I could completely free myself from the dreamworld. . . . A shudder racked my body, and I tried to think about my new life in New York City, where I had been for over a month. But my mind wandered across the Atlantic Ocean back to Sierra Leone. I saw myself holding an AK-47 and walking through a coffee farm with a squad that consisted of many boys and a few adults. . . . As soon as we left the coffee farm, we unexpectedly ran into another armed group at a soccer field adjoining the ruins of what had once been a village. We opened fire until the last living being in the other group fell to the ground. . . . [Now awake,] I got up from the floor, soaked a white towel with a glass of water, and tied it around my head. I was afraid to fall asleep, [so] I stayed awake all night, anxiously waiting for daylight. (Beah, 19-20)

In his memoir, Ishmael Beah records his memories of how war first touched his life when he was twelve. He had travelled with friends on foot to a neighboring town to participate in a talent show when word came through that rebels had attacked his village. The next eighty pages recount how Ishmael struggles for weeks to find his family, sneaking into villages avoiding rebel fire to steal food, freezing in forested areas through the nights, only to rummage again the next day. Finally Ishmael met someone who recognized him, and insisted that she knew that his family was in the next village, about a two days’ walk from where they were. They headed for their destination and, on their way, Beah recalls meeting Gasemu, a former neighbor, who shared, “‘Your parents and brothers will be happy to see you. They have been talking about you every day and praying for your safety. Your mother cries every day, begging the gods and ancestors to return you to her” (Beah, 92). He guided them to the village where they all were staying. As they approached, Ishmael recalls:

I heard gunshots. And dogs barking. And people screaming and crying. We dropped the bananas and began running in order to avoid the open hillside. A thick smoke started rising from the village. At the top of it, sparks of flames leapt into the air. / We hid in the nearby bushes and listened to gunshots and the screams of men, women, and children. . . . The gunshots finally ceased, and the world was very quiet, as if listening. I told Gasemu that I wanted to go to the village. He held me back, but I shoved him into the bushes and ran down the path as fast as I could. I didn’t feel my legs. When I got to the village, it was completely on fire and bullet shells covered the ground like mango leaves in the morning. I did not know where to begin looking for my family. . . . / “They stayed in that house,” Gasemu said to me as he pointed toward one of the charred houses. The fire had consumed all the door and window frames, and the mud that had been pushed in between the sticks was falling off, revealing the ropes through which the remaining fire was making its way. / My entire body went into shock. Only my eyes moved, slowly opening and closing. I tried to shake my legs to get my blood flowing, but I fell to the ground, holding my face. On the ground I felt as if my eyes were growing too big for their sockets. I could feel them expanding, and the pain released my body from the shock. I ran toward the house. Without any fear I went inside and looked around the smoke-filled rooms. The floors were filled with heaps of ashes; no solid form of a body was inside. I screamed at the top of my lungs and began to cry as loudly as I could, punching and kicking with all my might into the weak walls that continued to burn. (Beah, 93-95)

In her report for the UN copyrighted by Unicef under the title The Impact of War on Children, Graça Machel begins her chapter on child soldiers with the words, “The increasingly widespread exploitation of children as soldiers is one of the most vicious characteristics of recent armed conflicts” (Machel, 7). With the UN, she defines “[a] child soldier [as] any child—boy or girl—under the age of 18, who is compulsorily, forcibly or voluntarily recruited or used in hostilities by armed forces, paramilitaries, civil defense units or other armed groups,” and reports that “most are adolescents, though many are 10 years of age and younger. The majority are boys, but a significant proportion overall are girls” (Machel, 7).

Ishmael Beah becomes a child soldier in chapter twelve of his memoir. Losing hope of finding his family, exhausted from weeks of hiding in the cold without food or shelter, he and his companions are captured. His report is succinct: “Suddenly two men put us at gunpoint and motioned with their guns for us to come closer” (Beah, 100). They took Ishmael and his companions to a village occupied by the military, and gave them sanctuary for several weeks. However, as the rebels came closer to the village, the lieutenant informed the orphans, Ishmael among them, that “‘[W]e need strong men and boys to help us fight these guys, so that we can keep this village safe. If you do not want to fight or help, that is fine. . . . You are free to leave, because we only want people here who can help . . . . [W]e need the help of able boys and men to fight these rebels. This is your time to revenge the deaths of your families and to make sure more children do not lose their families'” (Beah, 106).

Some of the boys, though not Ishmael’s companions, tried to leave the village. The lieutenant used them in his speech to help the boys make their “decision.”

‘The rebels shot them in the clearing. My men brought them back, and I decided to show you, so that you can fully understand the situation we are in.’ The lieutenant went on for almost an hour, describing how rebels had cut off the heads of some people’s family members and made them watch, burned entire villages along with their inhabitants, forced sons to have intercourse with their mothers, hacked newly born babies in half because they cried too much, cut open pregnant women’s stomachs, took the babies out, and killed them. . . . [The Lieutenant said of the enemy:] They have lost everything that makes them human. They do not deserve to live. That is why we must kill every single one of them. Think of it as destroying a great evil. It is the highest service you can perform for your country.’ (Beah, 107-108)

The lieutenant’s speech, and its manipulation of the children’s desire to avenge the pain inflicted upon them, is a telling entry to the minds of adults who place semiautomatic rifles into the hands of children, often after shooting them up with methamphetamines. But because of the lucrative nature of the business, the industry thrives.

The International Action Network on Small Arms reports that “Some 25,000 small arms, 1,000 light weapons, and almost a million rounds of ammunition were handed in during the various disarmament processes for rebel forces and pro-government militias between September 1998 and January 2002” ( AK-47 weapons were traced to China, the Soviet Union, and Eastern Europe; G3 rifles were traced to Germany; FN-FAL rifles came from Belgium; and machine guns came from China. “Of the minority of transfers that are known about, weapons came from Ukraine, Bulgaria, and Slovakia. Supply lines went through Burkina Faso, Niger, and Liberia. Libya, Côte d’Ivoire, and Guinea are also reported to have helped in providing weapons to the RUF. Other countries were also complicit: air cargo companies from the UK, Senegal, and Belgium carried weapons to Sierra Leone” ( Today, actually quite a lot is known about how the weapons were trafficked into Sierra Leone—especially pertaining to Leonid Minin’s involvement (frontlineworld).

The illegal sale or smuggling of contraband weapons is undeniably destabilizing entire regions of the world, and is often placing automatic and semi-automatic rifles into the hands of children, who are then forced to fight in guerilla style wars. The activity of these units forces the migration of people. HIV thrives in situations where encounters with drug use, rape, and sex work are high. War fuels all of these—so stemming the flow of weapons will inevitably contribute to the reduction of HIV/AIDS infection rates throughout the world.

In 2001, the United Nations adopted a “Protocol Against the Illicit Manufacturing of and Trafficking in Firearms, Their Parts and Components and Ammunition,” as a supplement to that body’s earlier “Convention Against Transnational Organized Crime” (UN General Assembly, Protocol Against the Illicit Manufacturing of and Trafficking in Firearms, Their Parts and Components and Ammunition, Supplementing the United Nations Convention against Transnational Organized Crime , 31 May 2001, A/RES/55/255). Moreover, members of the United States Congress requested a report from the Government Accountability Office examining the types, sources, and users of the firearms, as well as key challenges facing efforts to stem the flow of firearms, and an outline of strategies going forward. The complete report is available online ( Together, these documents indicate that the trafficking of firearms is on the radar of national and international authorities. Lobbying for their enforcement would enable legislators and senators to hear that constituents are aware and concerned about these issues. It would be especially beneficial for informed constituents to educate their legislators and senators that the nature of trafficking in drugs and weapons is interrelated and, thus, to address the one is to address the other. Moreover, given the relationship between intravenous drug use and HIV/AIDS, to address drug- and gun-running is also to address public health.

Human Trafficking

Epidemiologists have long known that HIV/AIDS follows the routes of traffickers in drugs and arms. This is on top of a third practice in the category of sale of illicit substances and services: the trafficking of human beings. So, from the coca fields of Colombia and the diamond mines of Sierra Leone, to the brothels of Cambodia and India where pimps and madams hold modern-day slaves in bondage, the virus thrives.

Although technically human trafficking pertains to all trade of human beings for exploitation, because of the nature of HIV/AIDS as a sexually transmitted disease, the focus here will be on sex trafficking. The trade in humans to supply the sex industry is more widespread than news services have successfully conveyed. Each story is slightly different, sharing the common element that money is exchanged for the services of, typically, a young woman, who has been forced or coerced to perform sexually, with the profit from the exchange going to a pimp or a madam who holds the victim hostage in some way. Consider, just for a few examples, the following stories.

A twelve-year-old girl born to a tribal minority in one of Cambodia’s provinces is orphaned when her parents die of AIDS. Her extended family is too poor to take in another mouth to feed, so she follows the road through the countryside until she reaches a motel on the outskirts of the nearest town. The manager attempts to strike up a conversation with the girl, but recognizes she does not speak Cham. Through gestures, he communicates that he will provide her food and shelter in exchange for her doing the cleaning and the laundry for the business. She is relieved to have found a way to secure food, and a modicum of comfort. One day, a customer offers the manager a few extra riel for an hour with the girl. Soon, she is receiving several customers a day. The businessman is pleased to build an addition to his inn.

In India, a family receives a visitor who shares with them a flyer announcing the opening of a garment factory several hours to the north of where they live. Struggling to pull together the dowry for his third daughter’s upcoming marriage, the father agrees that his fourth daughter can travel with their guest to contribute to the economic well-being of the family. He is troubled when he loses touch with her, never receiving from her the wages she promised to send home. He is never able to confirm that the visitor was a human trafficker who made a profit when he exchanged the girl for cash to the brothel owners in Mumbai where she was brutally tortured and raped, seeing as many as ten clients a day, and never seeing herself any of the rupees exchanged for her services.

A teenager from an American suburb goes to her boyfriend’s house. After she drinks a Diet Coke that has been spiked with a sedative and she goes to sleep, an assistant videotapes and takes photographs of the rape, manipulating the girl to appear that they are having consensual sex. When she awakens, the boys show her the pictures, where she was staged to make it appear that she consented, and enjoyed, having intercourse. They threaten to post the photos on the internet, or to send them to her parents and priest, unless she does whatever they ask her to do. For the next several years, she is driven to various homes and hotels to have sex with clients who pay the boyfriend $50 per hour for the service she provides. Her parents are never suspicious, even when her boyfriend arrives in the driveway with a brand new car that he says his parents bought him for graduation.

The situations in each of these stories are adapted from true accounts. The first is derived from Nicholas Kristof’s reporting from Cambodia for The New York Times; the second is drawn from an account shared by Paul Farmer in his book, Women, Poverty, and AIDS: Sex, Drugs, and Structural Violence (Common Courage Press, 1996); the third is derived from Theresa Flores’ autobiographical account, The Slave Across the Street. Each story touches on ways that young women, especially, become vulnerable to those who seek to profit from the sex industry, either through deception (as in the cases of the suburban American girl as well as the Indian father of four daughters), or through desperate economic conditions (as in the cases of the Cambodian and Indian girls). Regardless of the scenario that has bound them to a pimp or madam, each is a victim of human trafficking, even though none of these stories has the girl being smuggled across a border.

Although the word “traffic” conjures the idea of movement, oftentimes in this context across a border, the term actually refers simply to the trade of a good or a service. In other words, “traffic” means only that there is a transaction—the buying and selling of illicit substances (as in the case of drugs and weapons), and/or of illegal services (as in the case of prostitution and underage or underpaid or unpaid labor). This definitional point is important to raise because often the term elicits the false assumption that drugs, weapons, and humans are only being trafficked internationally, across the borders of countries, through smuggling rings, cartels, and the like, and most stereotypically from impoverished countries to rich ones, most likely in cities closest to the borders. In reality, however, the illegal trade of drugs, weapons, and humans is occurring within countries, as well as across borders, affecting every socio-economic bracket in virtually every city in every country throughout the world. While those living in poverty are undeniably vulnerable to traffickers, boys and girls from the “’hood” and the “’burbs” alike are susceptible to the trafficker’s methods, capturing them in webs of violence from which they cannot readily disentangle themselves. Victims of traffickers can be tricked and then exploited under threat of injury or death, depending on the industry, into dealing drugs, running weapons, plowing fields, sewing clothes, pimping girls, or turning tricks.

According to article 3 of the 2004 United Nations Protocol to Prevent, Suppress and Punish Trafficking in Persons, especially Women and Children, supplementing the United Nations Convention against Transnational Organized Crime, “trafficking in persons”

shall mean the recruitment, transportation, transfer, harbouring 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 labour or services, slavery or practices similar to slavery, servitude or the removal of organs (pg. 42).

According to the 2007 U.S. Department of State Trafficking in Persons report, “there are 12.3 million people in forced labor, bonded labor, forced child labor, and sexual servitude at any given time,” though it admits that “other estimates range from 4 million to 27 million” (report). Annually, according to U.S. Government-sponsored research completed in 2006, approximately 800,000 people are trafficked across national borders, which does not include millions trafficked within their own countries. Approximately 80 percent of transnational victims are women and girls and up to 50 percent are minors. The majority of transnational victims are females trafficked into commercial sexual exploitation. These numbers do not include millions of female and male victims around the world who are trafficked within their own national borders—the majority for forced or bonded labor (report).

While it is difficult to know how widespread the practice of trading humans is in the United States, the Justice Department reports that there were 1,229 human trafficking incidents in the United States from January 2007- September 2008. Of these, 83 percent were cases of sex trafficking (report). The industry is believed to generate about $9.5 billion in annual revenue around the world. More statistics are available from the Polaris Project.

Unlike the industries of drug trafficking and arms trafficking, where the relationship to HIV/AIDS is more circuitous as the arms trafficker empowers the drug trafficker who supplies the end user who might, in turn, become infected, the relationship between human trafficking and HIV/AIDS is more direct. An August 1, 2007, an issue of the Journal of the American Medical Association published an article that puts the relationship between sex trafficking and HIV/AIDS into scientific terms. On Aug 22 of the same year, the UN Development Program (UNDP) released a report that likewise explored the connection between sex trafficking and HIV in six countries of south Asia: Afghanistan, Bangladesh, India, Nepal, Pakistan, and Sri Lanka. Silverman and Decker, researchers behind these studies at the Harvard School of Public Health, summarize their findings in this way:

[T]he Harvard School of Public Health collaborated with NGOs in Mumbai, India (Rescue Foundation) and Kathmandu, Nepal (Maiti Nepal) to conduct two small-scale studies assessing the prevalence and predictors of HIV infection among sex-trafficked South Asian women and girls. The first study reviewed case records and HIV-testing results of 175 women and girls trafficked to brothels in Mumbai; the second study examined medical and case records of 287 repatriated women and girls trafficked to India from Nepal. In both studies, we sought to determine HIV prevalence and risk based on demographics and trafficking/prostitution experiences. 

Approximately one-quarter (22.9 percent) of those in the first study, and more than one-third (38.0 percent) in the second study, tested positive for HIV. Across both studies, those trafficked at younger ages were more likely to be infected with HIV; in the second study, more than 60 percent of girls trafficked at ages 14 and under were infected with the virus. Girls trafficked at younger ages also reported a greater likelihood of servitude in multiple brothels and longer periods of brothel confinement associated with increased HIV infection risk of 2 to 4 percent for each additional month of captivity. 

Although the small scale and specific findings, represent only individuals served by particular anti-trafficking NGOs, this initial work clearly suggests that women and girls trafficked across India and Nepal face extreme levels of vulnerability to HIV infection and may constitute a priority population for HIV prevention efforts (Silverman and Decker).

While the interrelationship between sex trafficking and HIV/AIDS should have been obvious, prostitutes, like the gay men who were first diagnosed in the United States, were not, and are not, at the top of the priority lists for those managing huge national and international budgets in relation to public health. Even one who is a vocal advocate, like Nicholas Kristoff of the New York Times, does a disservice to advocates for funding when he writes that the nature of prostitution and the sex trade in the United States is substantively different than in Cambodia, India, and the other countries he has visited globally. For example, in his recent book Half the Sky: Turning Oppression into Opportunity for Women Worldwide (Vintage, 2009), he writes, “most prostitutes in America, China, and Japan aren’t truly enslaved” (9). In May of this year (2010), although he warns against making “the mistake of thinking that terrible abuses happen only on the other side of the world,” he nevertheless underscores the dangerous perception that, in his words, “the abuses tend to be worse in Asia” (Kristoff).

Susan Gaertner, the County Attorney for Ramsey County in the State of Minnesota, delivering remarks at a Criminal Justice Institute in Bloomington, Minnesota in August, 2006, approached the same issues that Nicholas Kristoff has been covering for some time, but she did so much differently. She pointed to the statistics in the United States, admitting that they vary widely, but reported that “the State Department says that about 15,000 people are trafficked each year [within our own borders], whether they are from another country or not. Their coerced labor has ranged from prostitution, exotic dancing and pornography, to field labor, factory sweatshops, street peddling and domestic service” (Gaertner). Showing a videotape about a case where a Mexican girl was promised a waitressing job in the United States, only to be abducted into a trailer upon her arrival where she was forced to have sex up to thirty times a day, Gaertner explained how the customers paid the girls’ captor even as he kept her trapped, ready for the next engagement. Gaertner went on to recount other cases on trial in Minnesota about men who approached girls where they hung out: at McDonalds and the Mall of America, for example. When they were promised wages for babysitting, the girls went to his home, where he held them against their will at gunpoint in order to make money from the services they would supply to customers (Gaertner). These were not isolated cases. According to Gaertner, “Between 2001 (when the TVPA legislation came into effect) and 2005 the U.S. Attorneys’ Offices filed 91 trafficking cases (a 405% increase over the number of trafficking cases filed between 1996 and 2000); in these 91 cases, 248 trafficking defendants were charged, and 140 were convicted” (Gaetner).

In other words, Gaertner points to cases occurring in Minnesota that are not substantively different than what Kristoff is reporting from Asia. The difference between America and Asia may be only in volume rather than in substance—though, given the nature of the enterprise, even this is debatable.

As with drug trafficking, another debate is unfolding in the public square in relationship to what can be done. On the one side are advocates for lifting the ban on prostitution, arguing that legalizing and regulating the industry can protect sex workers by empowering workers to require clients to wear condoms or to disclose their HIV/AIDS status prior to an exchange. On the other side are advocates for ramping up efforts to enforce the prohibition of prostitution in order to create a climate in which disincentives, such as fines and prison sentences, outnumber the financial rewards, such that the availability of prostitution naturally decreases. In this debate, Nicholas Kristoff and Sheryl WuDunn make a compelling case for a third option. Rather than making the act of prostitution itself criminal, they would like to see the johns who create a demand for prostitution face criminal charges. Such a law, they report, has been successful in Sweden:

In 1999, Sweden took the opposite approach [than the Netherlands, which legalized prostitution in 2000], criminalizing the purchase of sexual services, but not the sale of them by prostitutes; a man caught paying for sex is fined (in theory, he can be imprisoned for up to six months), but the prostitute is not punished. . . . / A decade later, Sweden’s crackdown seems to have been more successful in reducing trafficking and forced prostitution. The number of prostitutes in Sweden dropped by 41 percent in the first five years, according to one count, and the price of sex dropped, too—a pretty good indication that demand was down. / In the Netherlands, legalization has facilitated health checkups for women in the legal brothels, but there’s no evidence that sexually transmitted diseases (STDs) or HIV has declined. Pimps in the Netherlands still offer underage girls, and trafficking and forced prostitution continue. . . . The bottom line? Customers can easily find an underage Eastern European girl working as a prostitute in Amsterdam, but not in Stockholm (Half the Sky, 31-32).

When I was in Thailand working on “30/30,” I visited with three women who had received support from the New Life Center Foundation, an organization that “works with ethnic minority women throughout Thailand and its neighboring countries who are at risk for, or victims of, labor exploitation and sexual abuse” (from the organization’s mission statement). It was inspiring to be at a place that is responding to the nightmarish situation being experienced by young women in Thailand, even as it was difficult to process their stories, one after the other, as they shared their perspectives in their journals. Although they were from very different parts of Northern Thailand, and grew up in different villages with different beliefs and memories, they shared with me the common experience of being ethnic minorities, which made them vulnerable to human trafficking. They were vulnerable, too, because the adults in their lives were unavailable to them, for various reasons: disabilities of their own, struggles with addiction, the stresses of mixing families from previous marriages, or other things that caused them to abandon or otherwise neglect their children. They all became entangled in the traffickers’ web in very different ways—whether it was through a deal that was made without their knowledge or consent between a parent or an employer and a broker, or following a potential employer to the city in the hope of making a living wage only to be trapped in a situation from which it seemed their was no escape. Finally, however, they shared one commonality. They each emphasized in their journals that they were too trusting—and that if they could communicate only one thing to young women, it would be to be cautious, and not to trust people too readily.

If you are moved to respond to the issue of the modern-day slave trade, as well as to the related issues of drug and gun trafficking, and the contribution of trafficking to HIV/AIDS infection rates both nationally and internationally, after donating to organizations like the New Life Center Foundation that are making a difference in the lives of those who have experienced trafficking firsthand, and that are attempting to prevent the same from happening to anyone else, the single most effective thing you can do is to write a letter to your legislators and senators. By communicating your knowledge about and concern for these issues, not only can you educate those in power—you can also influence their opinion. In the United States, with only your zip code, you can access contact information for your President, Senators, Representatives, and Governor by clicking here. Information about active federal legislation is available here, as well as here. Advice about writing a letter is available from the Minnesota AIDS Project. Finally, to participate in the election to office of those of like mind, please get informed about candidates prior to voting day. The League of Women Voters makes ballots, information about candidates, and regional initiatives available from its website before elections.


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