Affilia: Journal of Women

and Social Work

Volume 22 Number 2
Summer 2007 163174
The International Sexual 2007 Sage Publications
10.1177/0886109907299055
Trafficking of Women http://aff.sagepub.com
hosted at

and Children http://online.sagepub.com

A Review of the Literature

David R. Hodge
Cynthia A. Lietz
Arizona State University

The contemporary international slave trade has received little attention in the social work lit-
erature. In keeping with the professions commitment to social justice and human rights, this
article reviews perhaps the most prominent and fastest-growing component of the tradethe
trafficking of young women and children for prostitution and other forms of sexual exploita-
tion. The role of criminal networks in the globalization of sexual trafficking is discussed, along
with the recruitment strategies used by the networks. Suggestions are offered for advocating
on behalf of women and children, and information is provided to assist social workers in the
provision of services to victims of trafficking.

Keywords: prostitution; sex trade; sex trafficking; social justice

H uman trafficking is the term that is commonly used to describe the present-day slave
trade. Although slavery is often thought of as a relic of a bygone era, human traf-
ficking is widely perceived to be a growing problem. According to the United Nations
Office on Drugs and Crime (2005), the trafficking of human beings has reached epidemic
proportions over the past decade. Furthermore, trafficking is a problem in essentially every
country; no nation is exempt.
Since human trafficking is part of the shadow economy, determining the number of indi-
viduals who are trafficked is difficult (Curtol, Decarli, Di Nicola, & Savona, 2004). Traffickers
seek to evade notice and victims are often hesitant to relate their experiences due to fear of
reprisals. Consequently, estimates of the prevalence of trafficking have varied considerably
(Flowers, 2001; McDonald, 2004; Monzini, 2004). It is important to emphasize that
although questions exist about the magnitude of the problem no one questions its existence
(McDonald, 2004).
Among the more conservative estimates may be those the U.S. government provides.
According to the U.S. Department of State (2004), 600,000 to 800,000 persons are trafficked
across international borders annually. International trafficking tends to be easier to estimate
than domestic trafficking. With this caveat in mind, on the basis of U.S. estimates, approxi-
mately 2 million to 4 million persons are trafficked within their home nations.
Trafficking is highly gendered. Among those who are trafficked internationally, 70% to
80% are female (U.S. Department of State, 2004), and approximately 50% are children.
Among all females, approximately 70% are trafficked for prostitution and other forms of
sexual exploitation. Put differently, the largest subset of human trafficking is the sexual
trafficking of young women and children (Curtol et al., 2004). It is widely agreed that this

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164 Affilia: Journal of Women and Social Work

subset of human trafficking has grown dramatically over the past decade (Flowers, 2001;
Kelly, 2004; Monzini, 2004).
Given the growing prevalence of sexual trafficking around the globe, the secretary-
general of the United Nations called for urgent action (Annan, 1999). Although social work
is characterized by a strong commitment to social justice and advocacy for vulnerable
groups, little has appeared in the social work literature on this topic (Struhsaker Schatz &
Furman, 2002). Accordingly, this article addresses the issue of sexual trafficking, beginning
with how the term is defined.

Definitions

Many definitions of human trafficking exist (Aronowitz, 2004). Perhaps the most promi-
nent, however, stems from the United Nations 2000 trafficking protocol, sometimes
referred to as the Palermo Protocol (Erez, Ibarra, & McDonald, 2004; Zimmerman, et al.,
2003). Article 3(a) of the United Nations (2000) Protocol to Prevent, Suppress and Punish
Trafficking in Persons, Especially Women and Children states,

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.

As the foregoing implies, sexual trafficking refers to a specific subset of the wider phe-
nomena of human trafficking. In other words, it can be understood as the component of
human trafficking that deals with the use of personsalmost exclusively young women
and childrenin prostitution and other forms of sexual exploitation (Goodey, 2004).
Furthermore, as subsection (b) of the protocol clarifies, the issue of whether a victim
consents shall be irrelevant (United Nations, 2000). In essence, the protocol holds that
consent cannot truly be given when acts, such as fraud and deception, are employed.
Exploitation, rather than consent, is the central feature of the Palermo Protocols definition
(Aronowitz, 2004). This construction has a number of important ramifications for women
and children. Perhaps what is most important is that no deserving or undeserving victims
of trafficking exist when the issue of consent is taken off the table (Zimmerman et al.,
2003). Rather than attempt to discern innocence and guilt, the state is responsible for aid-
ing all victims of trafficking. Important legal consequences also exist. Convictions are more
difficult to obtain if the lack of consent must be proved, even when it is clear that traffick-
ing has occurred (Kelly, 2004).
In essence, the Palermo Protocols definition shifts the focus from victims to traffickers
and their exploitation of women and children. The emphasis on traffickers is also evident
in the fact that the Palermo Protocol is a supplement to the United Nations convention
against transnational organized crime. It is these organized criminal networks that have
played an instrumental role in the globalization of sexual trafficking (Curtol et al., 2004;
Monzini, 2004; United Nations Office on Drugs and Crime, 2005).

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 Hodge, Lietz / International Sexual Trafficking 165

The Globalization of Sexual Trafficking

Prior to the 1990s, most authorities believed that sex trafficking was largely concen-
trated in Asia (Erez et al., 2004). More recently, however, sex trafficking has globalized. In
other words, trafficking is no longer primarily localized in one geographic region but has
become increasingly transnational and fluid in character. A young girl may be recruited in
Nigeria and sold and trained in Italy, with the Netherlands being the ultimate destination.
The United Nations mapped the emerging patterns in flows of international trafficking
(Monzini, 2004). The nations of origin, transit, and destination were assessed and classified
into the following regions: Africa, Asia, the Commonwealth of Independent States (CIS
the countries of the former Soviet Union), Eastern Europe, Latin America, and the indus-
trialized nations. Although every region functions as a place of origin, transit, and
destination to some degree, it is possible to estimate broad patterns of movement. Most
commonly, trafficking victims originate in Asia; the CIS; Africa; Eastern Europe; and, to a
lesser extent, Latin America. The main transit regions are Eastern Europe, the industrial-
ized nations, Asia, Africa, and, to a lesser extent, the CIS. The primary destinations are the
industrialized nations. In descending order, the most prominent destination countries are
Italy, the United States, Germany, the Netherlands, Japan, Greece, Turkey, and Thailand
(Monzini, 2004).
Destination countries tend to be wealthy nations in which large sex industries exist or
where prostitution is legalized or broadly tolerated (Hughes, 2000a). For instance, the child
pornography industry in the United States is one of the largest in the world (Flowers, 2001),
and prostitution is legal in Germany and the Netherlands (Hughes, 2000a). Conversely,
originating countries tend to be poor. Similarly, at the microlevel, within regions and indi-
vidual nations, it is often the most vulnerable who are victimized (Flowers, 2001).

Sexual Trafficking: High RewardLow Risk

Many factors contribute to the sexual trafficking of young women and children. Some
observers have categorized them into push-and-pull factors (Curtol et al., 2004). Poverty,
war, and the lack of a promising future help to foster discontent, pushing individuals away
from their originating countries. Conversely, media-constructed images of glamorous
industrialized nations seem to offer the possibility of a better life, pulling individuals
toward these countries.
While these factors help create an environment conducive to trafficking, Hughes (2000a)
argued that the most critical element is criminal networks. Many areas are poor and chaotic,
but not every area becomes a major supplier of women for the sex industry. It is the orga-
nized crime networks that manipulate these push-and-pull factors to recruit and traffic
women. Criminal organizations have an interest in manipulating these factors because of
the substantial profits that are involved in trafficking (Curtol et al., 2004; Monzini, 2004;
Zhao, 2003). After narcotics and arms sales, trafficking is the largest source of revenue for
organized crime (U.S. Department of State, 2004). The sale of trafficked young women and
girls is profitable, although prices can vary significantly (Zimmerman et al., 2003). In Italy,
which serves as a major transit point for entry into the European Union, authorities uncov-
ered a ring auctioning young women who were abducted from the former Soviet Union.
These women were sold for an average price of approximately U.S.$1,000 a piece

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166 Affilia: Journal of Women and Social Work

(Bertone, 2000; Hughes, 2000a). Conversely, Asian women who are sold in the United
States and Japan sell for up to U.S.$20,000 each (United Nations Office on Drugs and
Crime, 2004).
Unlike narcotics, which are sold and used once, women who are sold into prostitution
earn profits continually, year after year, for their exploiters or pimps. The overhead is
minimal and is typically paid for by the women. Russian women who are prostituted in
Germany reportedly earn approximately U.S.$7,500 per month, of which $7,000 goes to
the pimp (United Nations Office on Drugs and Crime, 2004). Many trafficked women retain
little or none of the money they earn (Zimmerman et al., 2003). Interpol reportedly esti-
mated that sexually exploited women in Europe earn approximately U.S.$124,000 annually
for their pimps (Monzini, 2004).
In addition to high profits, the risks associated with trafficking are comparatively mini-
mal (Bertone, 2000). Prostitution is legal or semilegal in many places, complicating efforts
to incarcerate traffickers. Even in settings where prostitution is clearly illegal, punishment
is usually light. Furthermore, enforcement efforts typically focus on the women instead of
the exploiters. In such settings, women often attempt to remain unnoticed for fear of being
charged, particularly if they are trafficked internationally. The risk of incarceration is fur-
ther reduced by the fact that many women are afraid of retaliation by their exploiters. Many
traffickers use extreme violence to intimidate and control women. In Turkey, for instance,
two trafficked women were reportedly murderedthrown off a balconywhile six others
were forced to watch (Hughes, 2000a).
According to estimates, human trafficking is the fastest-growing area of organized crime
(United Nations, 2002). In some cases, the high profit and low risk have led existing crime
syndicates to become involved in trafficking. In other instances, the favorable riskreward
ratio has spawned new criminal organizations that specialize in trafficking. Over the past
decade, in particular, decentralized groups have evolved into complex organized networks
of recruiters, transporters, and pimps (Monzini, 2004). Some groups have become verti-
cally integrated, engaged in the recruitment, transportation, and pimping of women.
Others have sought to specialize in a particular area, such as recruitment.

Recruitment Strategies
Researchers have explored various aspects of trafficking in numerous locations, includ-
ing Asia (Aronowitz, 2004) and Southeast Asia (Beyrer, 2001), China (Zhao, 2003),
Nigeria (Aghatise, 2004; Okonofua, Ogbomwan, Alutu, Kufre, & Eghosa, 2004), North
America (Estes & Weiner, 2001; Raymond & Hughes, 2001), the Ukraine (Hughes, 2000a),
the former Soviet Union (Hughes, 2004a, 2004b), and Western Europe (Zimmerman et al.,
2003). These and other studies have suggested that traffickers use a number of strategies
to recruit women into the sex industry. Although specific modes of recruitment vary from
location to location, it is possible to identify four general modalities under which most
strategies can be subsumed (Curtol et al., 2004).
In the first strategy, seemingly legitimate organizations are frequently used to recruit
young women and children. Employment, modeling, and marriage agencies purport to offer
access to a better life in another, typically richer, nation. Those who are recruited usually
have no idea of the fate that awaits them once they arrive at their destination. The second
strategy is to approach healthy, non-drug-addicted women who are already engaged in pros-
titution in their country of origin. Women who work in nightclubs, for instance, may be

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 Hodge, Lietz / International Sexual Trafficking 167

approached and promised much higher earnings for doing similar work in wealthier nations.
Women in this category are cognizant of the general type of work they will be required to per-
form but are unaware of the slavelike conditions in which they will be forced to work. The
third strategy, which is less common, is kidnapping. Those who are approached to work
in the sex industry but are unwilling to leave their country of origin may be kidnapped,
along with completely unsuspecting individuals. To transport these victims to destination
countries, traffickers often bribe officials to procure passports and/or safe passage
(Aronowitz, 2004). Finally, in some comparatively rare situations, recruiters may approach
families or guardians who are living in poverty and seek to purchase girls or young women.
The recruiters may point out how the money may be used to help the family and promise
that the daughter will have access to a better life in a richer nation.
Traffickers often target the most vulnerable individuals, since these individuals tend to
be easier to control (Flamm, 2003; Kelly, 2004). In Russia, for example, young women and
girls with disabilities are recruited by some marriage and adoption agencies (Hughes,
2004a). While the victims presume that they will wind up in stable, loving relationships,
traffickers market them to individuals with sexual fetishes involving various disabilities.
Similarly, in Nigeria, traffickers target individuals who are illiterate and have no experience
with urban life (Aghatise, 2004). Thus, when they are transported to large metropolitan
areas with which they have little familiarity, the victims are particularly dependent on their
exploiters.

Transportation and Enslavement

The costs that are involved in traveling to another country are typically borne by the
women through the mechanism of debt-bondage. The traffickers pay the costs associated
with transportation, and the women incur the costs as debt, which they repay out of future
earnings. A woman may be passed from organization to organization as she makes her way
to her destination country, incurring further debt with each exchange.
When they arrive at their destination countries, the victims are commonly told what they
are expected to do and how much money they must repay to regain their freedom. For many
individuals, this is the first time they realize that they are in some type of bondage
(Aghatise, 2004). Their options, however, are limited. By this point, they must cope with a
new setting, country, language, and culture without the assistance of family members,
friends, or other supportive social support networks. In this context, they are largely depen-
dent on the traffickers for their psychological and physical survival.
The traffickers use various strategies to increase the victims isolation and dependence.
Passports may be held (Zimmerman et al., 2003). Psychological techniques may be used
(Aghatise, 2004). Women may be involved in fraud or some other type of illegal activity
during transportation. In such cases, the victims are often hesitant to consult with local offi-
cials out of concern about possible legal consequences.
In spite of the procedures, many women resist induction into the sex industry. To procure
compliance, traffickers often use threats and violence. Women may be told that they have
committed crimes and are threatened with arrest or that family members in their country of
origin will be harmed. If the victim has any children, the children may be seized or threat-
ened with harm. In addition to threats, violence may be used, particularly if law enforcement
is ineffective (United Nations Office on Drugs and Crime, 2004). Rapevaginal, anal, and
gangis common. Young women and girls may be beaten; burned with hot irons, cigarettes,

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168 Affilia: Journal of Women and Social Work

or other objects; or cut and salt poured into the wounds. The violent acts tend to be perpe-
trated upon nonvisible areas of womens and girls bodies, however, so as to not reduce the
marketability of the product. Murder is not uncommon, although it is often used as a last
resort, since future profits are lost (Hughes, 2000a; Zimmerman et al., 2003). Consequently,
murders are typically staged in a manner that helps to establish control over others.
In short, traffickers seek to break victims psychologicallyto bring them to the point
where they feel they no longer have control over their own safety. Rather, the traffickers do.
Consequently, to survive, the women must become subservient to the traffickers wishes.
As one young respondent who was trafficked from Laos to Thailand put it, After eight
days of torture, I thought I will accept the job to save my life (quoted in Zimmerman et al.
2003, p. 46).

Exploitation in the Sex Industry

Once control has been established, the victims are exploited in the sex industry, with
prostitution being perhaps the most common venue. The victims frequently have little con-
trol over the type of clients they will serve, the number of clients they will be required to
see, or the hours they will be forced to work. Some trafficked women reported serving as
many as 40 to 50 clients on any given night (Zimmerman et al., 2003), and 18-hour days
are common (United Nations Office on Drugs and Crime, 2004). In many cases, their free-
dom of movement is monitored, and the victims are essentially imprisoned in brothels
(Farley, 2004).
Similarly, victims often have little control over the acts they will be required to perform.
Young women and girls may be forced to engage in abusive, degrading, and violent sexual
acts (Raymond, 2004). Examples include urinating or defecating on women, tying women
to bedposts and whipping them until they bleed, and cutting their breasts and genital areas.
It is not uncommon for it to take a thousand sex acts to pay off the accumulated debt
(Beyrer, 2001). However, since many victims are innumeratethey have never been taught
to countthey have no way to keep track of their wages and debts. When those who are
able to count come close to achieving their freedom, they may be trafficked to another
country, incurring new debts that must be worked off (Zimmerman et al., 2003).
Many victims are prostituted in pornography (Flowers, 2001). Videotapes depict chil-
dren being raped, tortured, and even murdered on film. Pornography is also used to control
victims. Traffickers may take shots in which the victims are clearly identified and then
threaten to reveal particularly degrading portrayals to family members in the victims coun-
try of origin.
The Internet has opened up new opportunities for traffickers to prostitute women (Long,
2004). Young women and girls can be exploited in areas where law enforcement can be
bribed or where prostitution is legalized or tolerated. One Cambodian-based pornographic
Web site, the rape camp, featured trafficked Asian sex slaves who were gagged, bound,
and blindfolded while they were used in various sex acts (Hughes, 2000b). Viewers could
relay requests for sexual torture that would be fulfilled in real time, from anywhere in the
world. Although this particular site was shut down by governmental authorities after it
received widespread attention, many similar sites exist. One Russian-based Web site adver-
tises itself as the most violent rape site on earth, while a Denmark-registered Web site,
the slave farm, features images of needle torture, hanging bondage, tits nailed to
board, and drunk from the toilet, with a live chat option where viewers can command

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 Hodge, Lietz / International Sexual Trafficking 169

the bitches (Hughes, 2002). Some sites use encryption technology so that the various ways
in which young women and girls are exploited can be hidden (Hughes, 2000b).

A Multilevel Ecological Response to Sexual Trafficking

In seeking to assist victims of trafficking, social workers face a number of challenges.

As has been implied, these challenges include the victims invisibility as part of the shadow
economy, potential criminalization by law enforcement officials, and reluctance to cooper-
ate because of a fear of reprisals from traffickers. The victims have often lacked access to
educational, economic, political, and social resources throughout their lives (Perkins,
2005). Against the most vulnerable individuals, the traffickers use tactics of power and con-
trol, similar to those seen in domestic violence, to prevent the victims from seeking assis-
tance. Given the complex nature of the challenges that social workers face in addressing the
problem, an ecological perspective that targets interventions at multiple levels should be
implemented.

Macrolevel Interventions
To address the growing problem of sexual slavery, social work must be engaged in the
formation of state, national, and international policies (Linhorst, 2002). As the Palermo
Protocol suggests, the prosecution of those who enslave young women and children is
instrumental to ending the practice of sexual slavery. At the macrolevel, social workers can
organize efforts to create tougher statutes against traffickers, as well as enforce existing
laws (Raymond & Hughes, 2001). In many jurisdictions, legal sanctions against sexual traf-
ficking are inconsequential compared to the penalties that are used to address drug traf-
ficking (Bertone, 2000). In settings in which sufficient legal penalties exist, officials can be
encouraged to make the prosecution of traffickers a priority. Similarly, the enforcement of
obscenity laws against Internet pornographers who use women and girls in bestiality and
torture is critical (Hughes, 2003). As Queiro-Tajalli, McNutt, and Campbell (2003)
observed, much of this type of advocacy can be conducted by social workers online, from
anywhere in the world.
Online forums can also be used to engage the legislative debate over legalizing prosti-
tution. Proponents of this controversial policy have argued that it will end child prostitution
and protect women by regulating the sex industry and subjecting it to governmental scrutiny.
To date, however, no research has demonstrated that legal prostitution decreases illegal
prostitution. Rather, legalization seems to increase the amount of both legal and illegal pros-
titution (Farley, 2004; Raymond, 2004). Nations that have legalized prostitution, such as the
Netherlands and Germany, appear to have become magnets for traffickers (Raymond, 2003;
Sullivan & Jeffreys, 2001). Similarly, child prostitution seems to have increased dramati-
cally in the Netherlands and some other nations since prostitution was legalized (Raymond,
2003).
An alternative legislative approach has been developed by Sweden (Ekberg, 2004).
Under Swedish law, prostitution is viewed as a form of male sexual violence against women
and children. Consequently, the men who buy sexual services from women are criminal-
ized, rather than the women, who are provided with services that are designed to enable
them to leave the prostitution industry. Since the implementation of this law, prostitution
and trafficking appear to have either declined or remained stable (Ekberg, 2004). In contrast,

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170 Affilia: Journal of Women and Social Work

neighboring Scandinavian countries with more lenient legislation, such as Denmark, have
seen dramatic increases in both prostitution and trafficking.
The Swedish law has significant ramifications for sex tourism and United Nations aid
and peacekeeping operations. Sex tourism typically involves rich men traveling to poorer
nations to exploit young women and children. In an effort to offer newer and more exotic
sexual experiences, the traffickers are providing an increasing variety of women and
younger and younger children (Hughes, 2000b; Monzini, 2004). In Cambodia, for instance,
the average age of those in prostitution fell during the 1990s (Hughes, 2000b); roughly a
third of all women and girls in prostitution in Cambodia are estimated to be under age 17,
with some under 12 years old (Hughes, 2000b). United Nations aid and peacekeeping
efforts have been associated with the use of prostitution and trafficked females (Long,
2004). In addition, many aid workers trade critical emergency supplies for sex with girls
(Hynes, 2004), and some peacekeeping forces have been involved in prostituting and traf-
ficking the local women and girls they were sent to protect (Ekberg, 2004).
The Swedish law may provide a model for curtailing such abuses, since Swedish citi-
zens are subject to prosecution for attempting to procure sexual services anywhere in the
world. A number of nations are considering legislation that is modeled after the Swedish
law (Ekberg, 2004). Social workers may wish to encourage other authorities to implement
the Swedish model in their respective spheres of influence.

Mezzolevel Interventions
In addition to macrolevel interventions, social work should also consider community
interventions to identify, educate, and respond to sexual trafficking. Given the invisibility
of the issue, public education campaigns can be helpful (Yoshihama, 2005). Social work-
ers may partner with organizations, such as the Coalition Against Trafficking in Women,
the Salvation Army, Vital Voices, and others that are dedicated to raising public awareness
about sexual trafficking.
In originating nations, information campaigns to expose traffickers misinformation can
be an effective intervention (Beyrer, 2001). Explaining the realities that are associated with
the sex trade can help inoculate potential victims against traffickers efforts to enslave them.
Similarly, Christian and Muslim leaders who have spoken out against sex trafficking in
Nigeria have had some success in turning public opinion against the practice (Okonofua
et al., 2004).
Attention should also be directed at push factors in poorer countries. As Flamm (2003,
p. 36) stated, Poverty will always remain one of the root causes for women and children
to be lured into prostitution. Microenterprise efforts may be developed and targeted toward
young women who are especially vulnerable of being trafficked (Bertone, 2000).
In cities with a high prevalence of trafficked victims, social workers may consider orga-
nizing multidisciplinary teams to address the multifaceted challenges associated with sex-
ual trafficking. Such teams may include area representatives of social service agencies,
local and federal law enforcement officials, immigration lawyers, clergy, and other com-
munity leaders with standing among various ethnic and immigrant populations. Such col-
laborations help coordinate responses among the various relevant actors. Police officers, for
instance, may either fail to identify victims who are working in the sex trade or criminalize
them. To address the former concern, social workers may organize training sessions simi-
lar to those used in the United States to sensitize police officers to the crime of domestic
violence (Toon & Hart, 2005). While police officers previously viewed domestic violence

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 Hodge, Lietz / International Sexual Trafficking 171

as a private family matter, after the training, they tended to view domestic violence as a
real crime that warrants police intervention (Toon & Hart, 2005). Similar educational ses-
sions may be held to ensure that enslavement in the sex trade is not viewed as a victimless
exchange but as a criminal offense.
To prevent the criminalization of victims, police officers and other key personnel should
be informed about the pertinent legal issues that are involved in sexual trafficking. For
example, in addition to prosecuting traffickers, the Palermo Protocol was designed to pro-
tect victims (United Nations Office on Drugs and Crime, 2004). Toward this end, some
nations, including the United States, issue special visas designed to protect the victims of
severe forms of trafficking (Aronowitz, 2004). In the United States, these visas allow the
victims to remain in the country to assist federal authorities in the prosecution and investi-
gation of trafficking offenses. After three years, permanent residence may be granted.
To ensure that undocumented victims benefit from such provisions, coordinated advo-
cacy is often needed (Hertzke, 2004). Cross-disciplinary training can help to inform offi-
cials about these visas and to advocate for their use, since some officials may be reluctant
to hand them out. In nations that lack similar protections for undocumented victims, social
workers may work for the adoption of such statutes (Linhorst, 2002).
Interventions with social work agencies may be necessary to ensure that identified victims
are provided with services, rather than overlooked because of misplaced priorities or the lack
of awareness. In India, social workers contracted with pimps to hand out condoms. In return,
the workers agreed to ignore the prostituted children and agreed not to inform the women
about services that would enable them to escape prostitution (Farley, 2004). Similar inci-
dences have occurred in the United States, where public officials ignored 9- and 10-year-old
trafficked girls, who were forced to service up to 35 men an hour, so officials could provide
protection against HIV and other sexually transmitted diseases (Farley, 2004). To prevent such
situations in the future, training is needed to ensure that social workers stand on the side of
vulnerable young women and children by helping them to obtain their freedom and alerting
them to available services, not to mention complying with mandatory reporting laws.
Alternatively, social workers may seek to remove the children and address their safety
without considering the possibility that the childrens mothers may also be victims of sex-
ual trafficking. This problem is similar to the one that occurs in child welfare when battered
mothers are charged with neglect because of their failure to protect their children. It can
occur despite situations in which battered women and their children may face increased
levels of harm when they stand up against the abusers (Kohl, Edleson, English, & Barth,
2005). Training could help social workers better identify situations in which children are
not the only people who are vulnerable or oppressed in the situation of sexual trafficking.

Microlevel Interventions
Finally, social workers at the microlevel must also be prepared to respond to cases of
sexual trafficking as these cases are identified. Perhaps most important, research is needed
on various strategies that are successful in assisting women and children who are victim-
ized by sexual trafficking. Currently, empirical work on this issue is almost nonexistent
(Struhsaker & Furman, 2002).
Some insights, however, may be drawn from work in related areas. Victims of sexual traf-
ficking deal with issues that are similar to those encountered by victims of child sexual abuse
and domestic violence (Lundy & Grossman, 2005). The exercise of what is referred to as
dependence or punitive powercreating dependence on an abusive partner and/or the use of

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172 Affilia: Journal of Women and Social Work

punishment to controlresults in interpersonal abuses (Solomon & Samp, 1998). As is the

case in sexual trafficking, perpetrators use tactics of power and control to maintain compli-
ance in the face of unhealthy and unsafe practices (Afifi, Olson, & Armstrong, 2005; Pence
& Paymar, 1993; Yoshihama, 2005). Children who are abused physically or sexually often do
not tell because of fear, attachment to the abuser, or even a belief that the abuse is their fault.
In a similar way, women who are victims of domestic violence may remain in unsafe situa-
tions. They often cover up physical symptoms of abuse because of threats of physical harm,
threats of harm to their children or pets, or the lack of financial freedom (Yoshihama, 2005).
Afifi et al. (2005) described this dynamic as the chilling effect. Victims avoid sharing
what they perceive as negative information with people whom they perceive as powerful.
This effect occurs for a number of reasons, including attempts to avoid negative conse-
quences that are imposed by a partner or authority figure, to minimize the reality of what
is occurring and concerns about reactions from those whom they may tell.
When victims of sexual trafficking are encountered in hospitals, child welfare agencies,
schools, and other community agencies, the provision of services is often predicated upon
understanding the complex nature of these social patterns. Practitioners should be aware
that engaging such clients can be difficult and that building trust takes additional care and
effort. Victims may be hesitant to discuss the injustices they have suffered. They may cover
up their injuries, both physical and emotional, because of shame and fear.
Just as women return to abusive spouses or children lie about the maltreatment they suf-
fered by the hands of a parent or relative, sexually trafficked women and children may make
choices that seem contrary to their best interests. For example, they may choose to return
to an unsafe environment, seeing it as their only alternative. In such situations, social work-
ers should avoid passing judgment. Rather, dialogue and reflective questioning can be used
to expand the victims understanding of the options that are open to them. In a process sim-
ilar to Frieres (1970) model of reflecting on oppressive social structures and their inherent
contradictions, women who have been told that they have no choice can be helped to find
their own voice.
Direct practitioners can also benefit from understanding the physical and psychological
effects of being trafficked. The victims of sexual trafficking often need medical attention to
respond to injuries as well as to check for HIV and other sexually transmitted diseases
(Perkins, 2005). In addition, they often experience severe psychological trauma (Flowers,
2001; Perkins, 2005; Zimmerman et al., 2003). Posttraumatic stress syndrome, dissocia-
tion, depression, and low self-esteem are common. Social workers should be prepared to
assess and treat such problems. As is the case with victims of other types of severe abuse,
the recovery process is often extended (Lundy & Grossman, 2005). During this process, it
is important to ensure that immediate needs are addressed, such as housing, vocational
training, and legal assistance (Perkins, 2005).

Conclusion

As Annan (1999) noted, women and children are not property to be bought and sold,
used and discarded. Rather, they are human beings with certain fundamental human rights
that preclude being sold into slavery. The social work profession is unique in its commit-
ment to social justice on behalf of the vulnerable and oppressed. The young women and
children who are enslaved in the sex trade represent some of the most oppressed individu-
als in the world. Social work must not ignore these victims. Rather, the profession can play

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 Hodge, Lietz / International Sexual Trafficking 173

an active role in ending sexual slavery and assisting victims by using a multilevel ecologi-
cal approach that emphasizes interventions in the areas of policy, community, and direct
practice.

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David R. Hodge, PhD, is an assistant professor at the Department of Social Work, Arizona State University and
a senior nonresident fellow at the University of Pennsylvanias Program for Research on Religion and Urban Civil
Society. Address correspondence to him at the Department of Social Work, Arizona State University, P.O. Box
37100, Phoenix, AZ 85069-7100.

Cynthia A. Lietz, PhD, LCSW, is an assistant professor at the Department of Social Work, Arizona State
University, P.O. Box 37100, Phoenix, AZ 85069-7100; e-mail: clietz@asu.edu.

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