The Dark Side of Travel: The Sex Trade

Gary Podolsky, MD

Not all consequences of travel are good.

A prime example: travelers using their positions as rich visitors manipulatively to engage sexually with locals. In many cultures and countries this is acceptable, morally and legally. Usually travel health care professionals label this as high-risk activity and counsel abstinence, use of condoms and awareness of STDs. This is a politically safe stance allowing the professional to care for their patients without allowing transference or counter-transference to interfere with treatment. However, it ignores the issue of whether exploitation is taking place.

Many countries, mostly developing ones, have acquired reputations as "hot spots" for both sexual adventurers and sources of disease. In fact, and contrary to public perception, STDs often originate from "first world" countries. Haiti and Thailand, for example, originally had HIV and other STDs imported into their countries by sexual tourists. These countries are now viewed as exporters of STDs. The original native culture was not excessively promiscuous or heavily wrought with disease, but as sex-seeking travelers frequented these countries, an environment was created that allowed for the development of high concentrations of HIV.

On the individual level, counseling travelers on how not to get STDs may be helpful for individuals, but this must be considered in a global arena. Effective measures must reduce diseases imported into the developing countries. In Haiti and Thailand this approach is much too late.

The Exploitive Nature of Prostitution

Economic pressure and disparity between relatively rich travelers and relatively poor women creates a driving force for an ongoing problem of exploitative prostitution. The degree of exploitation becomes difficult to define since different societal norms are involved. Many countries make prostitution clearly illegal yet widely tolerate it. Exploitative prostitution includes the exploitation of women (or men and children), nonconsensual sex, the influence of dire poverty, the trafficking and deception of sex workers, or the involvement of children. The age of consent may be as low as 14 (Mexico) or to 18 yrs. As client and sex worker are likely to come from different cultures, age of consent becomes difficult to determine.

On a cruise in international waters a 16-year-old Mexican girl engaged in consensual sex with a 21-year-old traveler. The girl's parents wanted to initiate a charge of statutory rape against the man, and asked the ship's doctor to perform a forensic rape examination to establish evidence. The physician was conflicted. Although he agreed with the parents on moral grounds, nothing illegal had occurred.

Various permutations of ages and relationships may occur in sexual relationships. Guidelines that may help determine if an abuse of authority has occurred include:

• The minor's age, mental development, and maturity, and the age of consent in the minor's country. Emancipated minors may be permitted to marry younger in some cultures. Likewise, 16-year-olds living independently and working to support themselves may be significantly more mature than 25-year-old university students living in their parents' basements.
• Age of adulthood.
• Situation where influence (teacher, doctor, counselor) may be abused. Depending on the degree of authority a more significant degree of exploitation may exist.

The issue of the exploitativeness of a specific relationship may be difficult. But when there is a strong suspicion it should be reported. It may be best to seek local advice from the appropriate authority, local Social Services, police, a college of physicians and surgeons, or the teachers association, for example. In many countries, laws are being developed which will imprison those guilty in their home country. But such laws are difficult and there are few convictions.

One strategy to end or minimize exploitation of sex workers is to eliminate some of the driving push and pull factors.

Push factors include: economic disparity, breakdown of the family unit, and lack of supports that may drive people towards exploitation.

Pull factors include the allure of easy money, `heroine chic', and the glamour of the streets ("The Pretty Woman (Julia Roberts) Effect").

Child Prostitution

This represents the most extreme form of abuse and exploitation. The widespread belief that sex with a virgin will "cleanse" one of HIV has contributed to an increased uptake in child prostitution as ever younger children are brought into the sex trade, many acquiring HIV infections. These children are exposed to diseases and trauma. The psychological damage may permanently scar them. Counseling and support are needed for these victims. In some programs, previous victims of the trade help out in counseling.

Public Perception and Sexual Tourism

Public awareness has focused on specific countries, Thailand and Cuba, for example, as countries where such tourism is well established. Due to recent crackdowns in Thailand, much of the activity has migrated to Cambodia.

But it may occur anywhere.

One Doctor involved in fighting child sex trafficking revisited a Thai village well known for such activities. He observed tourism was dead with shops or businesses doing poorly. One villager ruefully explained that the abuse was still occurring but a few miles away from the eyes of observers. While the village was now politically sanitized very little actual improvement had taken place.

Trafficking of women

Forcing young women into prostitution represents a modern form of true slavery. Away from their home country and faced with a different language and culture, these women are more easily managed, particularly if given street drugs. In Europe alone, officials estimate that more than 200,000 women and girls — one-quarter of all women trafficked globally — are smuggled out of Central and Eastern Europe and the former Soviet Republics each year, the bulk of whom end up working as enslaved prostitutes. Almost half are transported to Western Europe. Roughly a quarter of them end up in the U.S. The numbers may be larger; most women remain silent rather than turn to frequently corrupt authorities for help.

Often women are approached by locals to emigrate for legitimate purposes: marriage proposals from suitors they believed they knew, jobs such as babysitters or secretarial or data entry work, for example. They are then forced/coerced into prostitution. Certain situations encourage a growing market for prostitution, UN peacekeepers in the Balkans, for example.

Natasha, a Moldovan woman was abducted by a false suitor and transferred as a slave to Macedonia to service UN peacekeepers: "Besides the Albanians and Macedonians, there were men from France, Germany and the U.S. "They were as bad as the rest. They did anything they wanted to us. If I asked for help I would have been killed."

Human rights groups try to rescue these women but only a few hundred make their way home with the groups' help.

Various organizations have begun to set objectives and goals to find effective strategies. But this is often complicated by corruption and bribery among law enforcement officials. Not all countries agree that trafficked women are victims. Some of these countries place blame on the women - for illegally entering to work, using false documents, being prostitutes. Current efforts shift the focus from criminalizing the behavior of the trafficked person to punishing the trafficker. And distinctions must be made in the law between women forced into involuntary prostitution and women who voluntarily travel from one country to another for the purpose of prostitution. Only the former are truly trafficked.

These women are also vulnerable to revictimization. Once "rescued" and sent home they may be resold. Revictimization often occurs due to the lack of employment opportunities at home and the difficulties faced in reintegrating into their communities.

To preventing trafficking, countries must educate potential victims to the dangers of trafficking. Inaction in preventing trafficking constitutes a violation of international law.

In March 1999, the United Nations Office of the High Commissioner for Human Rights (OHCHR) initiated an anti-trafficking program based on two fundamental principles: that human rights must be at the core of any credible anti-trafficking strategy; and that such strategies must be developed and implemented from the perspective of those who most need to have their human rights protected and promoted. The emphasis is on legal and policy development.

The European Union (EU) has also launched programs, both within the EU and in third-party countries. These programs address discrimination and gender inequality, unemployment and poverty, and the development of judicial and law enforcement cooperation to criminalize trafficking and to protect victims.

In the United States, the Protect Act was signed in 2003. This Act allows law enforcement agencies to prosecute Americans who travel abroad and engage in sex with minors (without having to prove prior intent), expands the statute of limitations for such crimes, and imposes strict new penalties. There is a nationwide, toll-free, 24-hour hotline to report incidents of trafficking: 1-888-373-7888.

In the Ukraine, in 2005, the government has made the trafficking of Ukrainian girls a top priority. In Canada, Romania has been in the news recently because of fast track immigration status for Romanian exotic dancers into Toronto, with subsequent diversion into prostitution. Widespread criticism has stopped this trafficking. Meanwhile Romanian television has an educational program addressing human trafficking from within its borders. In Bucharest, there is a human trafficking center to help victims. And most of the Balkan countries now belong to several regional organizations that fight trafficking in humans, drugs and guns. Many non-governmental agencies are also dealing with human trafficking^.

What Travel Medicine Practitioners Can Do about Sexual Tourism

Counseling prospective travelers on the harmful effects they may cause by their presence and behaviors abroad may be less effective than hoped for. Travel medicine clinics may be a relatively non-threatening environment to introduce new ideas to people who at the time of this encounter may be especially receptive to new ideas. Passive non-time consuming media like leaflets, poster displays or guest speakers may become effective tools to further raise awareness of this problem.

References: Please contact Gary at gary_podolsky@yahoo.com for the references for this article.

Gary Podolsky lives in Winnipeg, Manitoba, Canada where he operates a travel clinic. He has worked as a physician aboard cruise ships and on medical air evacuations with the Canadian Air Force, and has volunteered in Nepal, the Canadian North, and Ukraine. He is especially interested in cruise medicine and Arctic medicine and is planning conferences on both subjects. Presently he is organizing volunteers and collecting donations for a medical relief mission to the western Ukraine in July 2006. For more information, check his website at www.skylarkmedicalclinic.com.