This article focuses on the rights violations and public health harm caused by the conflation of sex work with trafficking. The UN definition of trafficking requires coercion and movement or harbouring of people for the aims of exploitation, and estimates of its prevalence vary widely. An operational definition of trafficking in sex work settings identifies two clear situations - minors being exploited or adults being coerced against their will. Surveillance data from peer-based interventions using such criteria identified trafficking in only 4-10% of women entering sex work in Mysore and West Bengal, India. The affected people, mostly women and girls, deserve appropriate interventions and services that are carefully designed to mitigate rather than exacerbate harm. Yet, for most adult sex workers who choose their profession without coercion, it is the official response to trafficking, particularly police actions, which is most likely to increase vulnerability to violence or HIV. Common so-called raid and rescue actions and related police responses destabilise sex worker communities and drive sex workers underground, increasing vulnerability and risk for all sex workers, disrupting HIV and STI prevention efforts, impeding access to services, and severing relations with service providers. Intergovernmental and donor policies on sex work, HIV and human trafficking often clash substantially, leading to situations in which activities in one area set back efforts in another, for example in the case of forced large-scale brothel closures carried out as anti-trafficking measures. Experience shows that it is feasible to address both HIV and human trafficking positively in sex work settings if prevention efforts are aligned with and committed to sex worker participation. The dominant anti-trafficking theory and methods must be rethought at local level, together with coherent policies among governments and donors that guide and support efforts in both HIV and human trafficking. The article illustrates the success of a self-regulating board, the Durbar Mahila Samanwaya Committee in West Bengal, which builds on sex workers' commitment to improve their living and working conditions and has led to positive results by building an anti-trafficking response on a strong community platform with developed peer networks. The board assists almost three times as many trafficked women and girls in West Bengal as all other agencies combined.1
1. Steen R, Jana S, Reza-Paul S, et al. Trafficking, sex work, and HIV: efforts to resolve conflicts. Lancet 2015;385(9963):94-6. http://dx.doi.org/10.1016/S0140-6736(14)60966-1. http://dx.doi.org/10.1016/S0140-6736(14)60966-1