title: HIV vulnerabilities of sex-trafficked Indian women and girls.
abstract: OBJECTIVE
  To qualitatively explore potential mechanisms that may confer heightened risk for HIV infection among survivors of sex trafficking in India.
  
  
  METHODS
  Case narratives of 61 repatriated women and girls who reported being trafficked into sex work and were receiving services at an NGO in Mysore, India, were reviewed. Narratives were analyzed to examine potential sources of HIV risk related to sex trafficking.
  
  
  RESULTS
  Participants were aged 14-30 years. Among the 48 women and girls tested for HIV, 45.8% were HIV positive. Narratives described very low levels of autonomy, with control exacted by brothel managers and traffickers. Lack of control appeared to heighten trafficked women and girls' vulnerability to HIV infection in the following ways: use of violent rape as a means of coercing initiation into sex work, inability to refuse sex, inability to use condoms or negotiate use, substance use as a coping strategy, and inadequate access to health care.
  
  
  CONCLUSIONS
  Sex trafficked women and girls lack autonomy and are rendered vulnerable to HIV infection through several means. Development of HIV prevention strategies specifically designed to deal with lack of autonomy and reach sex-trafficked women and girls is imperative.
authors.affiliation: Yale School of Public Health and Yale University Center for Interdisciplinary Research on AIDS, 60 College Street, New Haven, CT 06520, USA. Jhumka.gupta@yale.edu
authors.forename: Jhumka
authors.initials: J
authors.lastname: Gupta
authors.forename: Anita
authors.initials: A
authors.lastname: Raj
authors.forename: Michele R
authors.initials: MR
authors.lastname: Decker
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Reed
authors.forename: Jay G
authors.initials: JG
authors.lastname: Silverman
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D017280:Condoms / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000635:transmission; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D007194:India / Q000453:epidemiology; D026684:Personal Autonomy; D011902:Rape / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012306:Risk; D012742:Sex Offenses / Q000706:statistics & numerical data*; D011477:Sex Work / Q000706:statistics & numerical data*; D019966:Substance-Related Disorders / Q000453:epidemiology; D017741:Survivors / Q000706:statistics & numerical data; D055815:Young Adult