J Epidemiol Community Health 65:334-339 doi:10.1136/jech.2009.096834
  • Research report

Sex trafficking, sexual risk, sexually transmitted infection and reproductive health among female sex workers in Thailand

  1. Jay G Silverman1
  1. 1Department of Society, Human Development and Health, Harvard School of Public Health, Boston, Massachusetts, USA
  2. 2Institute for Population and Social Research, Mahidol University, Bangkok, Thailand
  3. 3SWING, Bangkok, Thailand
  1. Correspondence toMichele R Decker, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St., E4142, Baltimore MD 21205, USA; mdecker{at}
  1. Contributors All authors were involved in developing the current analyses and drafting and revising the article and have approved this version to be submitted for publication.

  • Accepted 7 December 2009
  • Published Online First 1 June 2010


Background The trafficking of women and girls for sexual exploitation is an internationally recognised form of gender-based violence, and is thought to confer unique sexual and reproductive health vulnerabilities. To date, little research has compared sexual risk or health outcomes among female sex workers (FSWs) on the basis of experiences of sex trafficking.

Aim To compare experiences of sexual risk and sexual and reproductive health outcomes among FSWs on the basis of experiences of trafficking as an entry mechanism to sex work.

Methods Data from a national sample of FSWs in Thailand (n=815) was used to assess (a) the prevalence of sex trafficking as an entry mechanism into sex work and (b) associations of sex trafficking with sexual risk and health outcomes.

Results Approximately 10% of FSWs met criteria for trafficking as an entry mechanism to sex work. Compared with their non-trafficked counterparts, sex-trafficked FSWs were more likely to have experienced sexual violence at initiation to sex work (adjusted risk ratio (ARR) 2.29, 95% CI 1.11 to 4.72), recent workplace violence or mistreatment (ARR 1.38, 95% CI 1.13 to 1.67), recent condom failure (ARR 1.80, 95% CI 1.15 to 2.80), condom non-use (ARR 3.35, 95% CI 1.49 to 7.52) and abortion (ARR 2.83, 95% CI 1.48 to 5.39).

Discussion Both the prevalence of sex trafficking as an entry mechanism to sex work and the threats to sexual and reproductive health observed on the basis of trafficking status show the need for comprehensive efforts to identify and support this vulnerable population. Moreover, existing STI/HIV-prevention programming may be stymied by the limited condom-use capacity and high levels of violence observed among those trafficked into sex work.


  • Funding Support was provided to JGS and MRD via the Office to Monitor and Combat Trafficking in Persons, US Department of State (S-GTIP-08-GR-0009) and to MRD via the Harvard University Center for AIDS Research (HU CFAR NIH/NIAID fund P30-AI060354). Collection of the original survey data was initiated and funded by United Nations Population Fund Thailand.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the IPSR.

  • Provenance and peer review Not commissioned; externally peer reviewed.