During a diplomatic visit to Calcutta, India, in May, US Secretary of State Hillary Rodham Clinton stopped at a shelter for young women and girls. It was not an ordinary shelter, but one with a specific mission – a mission Ms. Clinton wanted reporters to broadcast to Americans back home. It was a shelter established to help victims of human trafficking, an international crime that Clinton and other international players have called one of the world's largest and most pressing human rights concerns. It was also, primarily, helping girls who'd been trafficked for sex.

This is a key cause for Clinton. In recent years, she and other international figures – from United Nations Secretary-General Ban Ki-moon to British Prime Minister David Cameron – have raised the alarm about human trafficking, a practice involving forced labor, from mining to domestic work to prostitution.

"These victims of modern slavery ... their stories remind us of what kind of inhumane treatment we are still capable of as human beings,"

Clinton said in June upon the release of the annual State Department report on global human trafficking. "Traffickers prey on the hopes and dreams of those seeking a better life, and our goal should be to put those hopes and dreams back within reach."

Moreover, Clinton and others have said regularly, human trafficking is also an American problem. It doesn't just take place in the sweatshops of impoverished Indian villages or in Thai brothels, but on US streets from San Francisco to New York. The federal government has estimated the number of domestic trafficking victims to be in the tens of thousands annually. Victims range from Southeast Asian indentured nail salon manicurists to Mexican agricultural workers to underage American prostitutes.

Many advocates say this last group, made up of American girls – and a relatively small number of boys – victimized in America, is the primary trafficking problem in the United States. "Sex trafficking," as this particular strain of human trafficking is called, has become a national human rights crisis, they say, and deserves a huge public outcry.

Indeed, domestic sex trafficking has become a high-profile cause. Celebrities from Jada Pinkett Smith and Salma Hayek to former couple Ashton Kutcher and Demi Moore have picked up the bullhorn of the anti-trafficking movement, with a focus on sex trafficking.

New York Times columnist Nicholas Kristof's crusade last spring against domestic sex trafficking and the online marketer Backpage.com, which he accused of helping sell underage girls into sex slavery, prompted a widespread movement against the website and its owner, Village Voice Media. Many advertisers in Village Voice Media – including Starbucks, AT&T, and Best Buy – cut ties with the company.

There have been local benefit concerts against sex trafficking and, recently, even a Tennessee church rodeo to raise awareness about the issue.

Federal prosecutors have also increased their efforts against human trafficking – with a primary focus on sex trafficking. The Department of Justice prosecuted only two human trafficking cases in 1998; in 2011 it charged 120 defendants with human-trafficking crimes. The bulk of cases were related to sex trafficking.

"For years, whenever we talked about sex trafficking in America the reaction was surprise," says Andrea Powell, executive director and cofounder of FAIR Girls, an anti-trafficking organization based in Washington, D.C. "The perception was that it happened to girls in foreign countries.... We've seen the beginning of a shift in the attitudes in the US, and that has to do with public awareness."

On one level, the new and growing focus on domestic human trafficking seems straightforward. Clearly, enslavement of individuals, and sexual exploitation of children, is cause for concern. But when the international issue becomes a domestic one, and when forced labor starts to involve sex, there also comes an emotional debate about where the real problem ends and where hype and sensationalism begin.

As with anything that involves the letters S, E, and X, academics, advocates, and the general public are emotional and divided. Dig beneath the surface of the anti-sex-trafficking movement and there are ambiguities and confusions and facts and fictions.

Are all prostitutes really sex-trafficking victims? Does Internet porn or sex tourism encourage trafficking? Are underage prostitutes always exploited by pimps?

Rather than being a black-and-white, good-and-bad issue, trafficking touches on some of the most uncomfortable and conflicted areas of American public discourse. The resulting debate is about sex and abuse and human rights, for sure. But it's also about prostitution and attitudes toward commercial sex overall. It is a conversation about the sexualization of teens and social responsibility for troubled youth, even the tenuous relationship with cheap labor.

Understanding these interrelated issues, say many who have long worked against human trafficking in all its forms, is necessary for coming up with the most effective solutions. They contend that celebrity videos and sloganeering – even from the highest-ranking policymakers – oversimplify the problem.

Responding to reality or hype?

One of the most public campaigns against domestic trafficking was launched last year by the philanthropic foundation of Ms. Moore and Mr. Kutcher. It was called "Real Men Don't Buy Girls," and used a campy, interactive video format that enlisted other celebrities, such as Justin Timberlake and Eva Longoria, to raise awareness about "child sex slavery in the US."

Moore and Kutcher gave interviews, made T-shirts, and rallied the Twitterverse to the cause. One of the most troubling statistics they shared was that there are 100,000 to 300,000 sex slaves in the US – figures repeated by interviewers, blogs, TV hosts and other movie stars.

The problem: The statistics are wrong.

Those figures came from a 2001 University of Pennsylvania study ("The Commercial Sexual Exploitation of Children in the U.S., Canada and Mexico") that estimated that there might be 100,000 to 300,000 children at risk of becoming trafficked prostitutes because of an array of negative circumstances, from homelessness to drug addiction. The number of actual sex-trafficking victims has been estimated by the US government to be in the tens of thousands, but even those numbers have been criticized as unfounded and far too high; between 2008 and 2010, federally funded human-trafficking task forces opened 2,515 suspected incidents of human trafficking for investigation. Among those cases, only 248 suspected sex-trafficking victims under the age of 18 were identified.

Anti-trafficking advocates acknowledge the goof but say the celebrities' point is still accurate: Far too many young girls are sold for sex in the US. The Department of Justice numbers, they say, reflect a fraction of the real victims.

But the misstep, say critics, is a prime example of the problem with how American activists have started to tackle the real problem of trafficking. Hype over such high and inaccurate numbers of "child sex slaves" leads to a misguided response at best, they say. At worst, it siphons financial resources away from preventing other sorts of human trafficking. These critics worry that the growing – alarmist – focus on sex trafficking in America, bolstered by this sort of sensationalism, undermines solutions to problems, such as poverty and homelessness, that lead to exploited youth in the first place.

One such critic – Ann Jordan, director of the program on trafficking and forced labor at American University's law school in Washington, D.C. – has watched the US anti-sex-trafficking campaign with dismay.

A longtime advocate against human rights violations associated with various types of forced labor globally – such as indentured servitude, debt bondage, and slavery – Ms. Jordan says the anti-domestic-sex-trafficking movement "just took off and created its own industry," in part because it touched upon a conservative social nerve.

"Everybody wants to save the virgins, right?" she states. The hype, she says, ends up sidelining other concerns – such as the broader categories of human trafficking or even forced labor, which do not have to involve sex. "You need to tailor your response to the reality. You should not tailor your response to the hype."

What exactly is 'sex trafficking'?

When nonprofits and celebrities and even sex-worker advocates throw around the term "sex trafficking," what do they mean?

Some are referring to girls and women who are enslaved, transported from country to country, and forced to work in brothels. Others mean girls who are essentially kidnapped, shuttled from motel to motel, sold for sex and subject to violence from pimps and johns.

But federal law defines sex trafficking broadly to include all children involved in prostitution with a pimp. Some even interpret the law as covering all minors involved in prostitution at all. This includes girls who seek out a pimp for work, who are engaged in prostitution in their hometowns, whose families know about their prostitution, and even those who turn down opportunities to leave their "traffickers." In some ways, sex-trafficking laws are similar to statutory rape laws – the government has determined that a minor simply cannot consent to being involved in this sort of commercial sex.

The law upon which much of the US anti-trafficking work is based, and to which many advocates trace the start of the domestic anti-trafficking movement, is the Trafficking Victims Protection Act 2000. The UN adopted its own anti-trafficking protocol the same year.

At first, the US law focused primarily on problems abroad. This made sense, according to those who worked on the legislation. The international numbers for human-trafficking victims were – and are – high: The UN has estimated human trafficking to be a $32 billion global industry; in 2008 it estimated that 2.5 million people from 127 countries were trafficked – 79 percent for sex, the rest for other forms of labor, from farm work to sweatshops. Many are children.

(These numbers vary tremendously from agency to agency and year to year; they are also far lower than the 21 million to 27 million global trafficking victims reported by the US State Department and, recently, the International Labor Organization. The discrepancy depends on whether "trafficked" involves all forms of forced labor or a subset of situations, usually in which a person is actually moved from place to place. Some UN groups say that it is impossible to calculate an accurate number of victims.)

The US law required the State Department to include an analysis of trafficking in its annual country human rights reports and ordered the US Agency for International Development to put together programs to combat trafficking abroad. The law also established a new form of visa for trafficking victims as a way to encourage them to cooperate with law enforcement without fear of deportation.

But the federal law also gave a new definition of sex trafficking: "the recruitment, harboring, transportation, provision, or obtaining a person for the purposes of a commercial sex act, in which the commercial sex act is induced by force, fraud, or coercion, or in which the person induced to perform such act has not attained 18 years of age." The law states that coercion includes threats of physical or psychological harm to children, and that any person under age 18 induced to participate in commercial sex is a sex-trafficking victim.

The all-encompassing definition of victimhood, say social workers and advocates, is important because it doesn't matter how or why young women first begin "working" in prostitution. Often, girls who end up in prostitution are already vulnerable – they are abuse victims, come from unstable homes, have run away, or suffer mental impairments. Others are simply naive, susceptible to manipulation of a pimp, who often pretends at first to be a boyfriend.

"Pimps are professional exploiters," says Ms. Powell of FAIR Girls. "They know how to find their product, i.e., a young girl, and they know how to sell [her]. And girls are very easily lured if they are at risk. They're looking for love and attention and pimps know that."

Once girls have started working with a pimp, advocates say, they often feel trapped. They can be beaten, raped, or threatened with violence if they try to leave; they can simply feel they have nowhere else to go. But never, advocates say, are they wanting to be sold for sex to dozens of clients a night.

"A lot of people are calling sex trafficking 'modern-day slavery,' " says Megan Fowler, director of communications for the Polaris Project, a US anti-trafficking organization that runs the National Human Trafficking Resource Center hot line. "But it's not that physical chained-in-the-basement coercion. It's psychological coercion."

A case in point is the federal prosecution of Jose Ciro Juarez-Santamaria, a Salvadoran MS-13 gang leader in the Virginia and Maryland suburbs of Washington, D.C., who became the pimp of a 12-year-old runaway. She had sought him out at a Halloween party for help.

He told her to see him the next day, and he began taking her to "customers." For the next three months, federal prosecutors say, Mr. Juarez-Santamaria plied the girl with alcohol and marijuana, sold her for sex multiple times a day, and offered her to other gang members for sex, free of charge. He also had sex with her himself.

During his trial in July 2011, Juarez-Santamaria offered the defense that the girl knew what she was doing – that she wanted to work as a prostitute for the money. Indeed, when US Immigration and Customs Enforcement officers entered the Oxon Hill, Md., apartment where the girl was staying with Juarez-Santamaria, she denied she'd been prostituted; and when agents took her to a shelter, she quickly ran away and back to Juarez-Santamaria.

But, of course, "as a legal matter, the law does not recognize the defense that [an underage girl] did this willingly," says Neil MacBride, the US Attorney for the Eastern District of Virginia whose office prosecuted Juarez-Santamaria and has brought 16 human-trafficking cases over the past year or so. "And when you look at the facts of these cases, no reasonable juror would conclude that these girls were doing it willingly and voluntarily. They were lured in with promises."

The jury agreed and convicted Juarez-Santamaria of conspiracy to commit sex trafficking of a child, transportation of a minor to engage in prostitution, and sex trafficking of a child.

He was sentenced to life in prison.

A former prostitute's perspective

But here is where the concept of sex trafficking gets more controversial: If psychological coercion is at the root of the "slavery" aspect of sex trafficking, then it is only logical, many advocates say, to apply the "trafficking" label to adult prostitution, as well.

A number of studies put the average age of entry into prostitution in the teenage years; 13 is a regularly repeated – though disputed – age. Many researchers also estimate that between 60 to 70 percent of prostituted women were sexually abused as children. And while studies about this are both few and hotly contested, a high percentage of prostituted women in many research projects say they're unable to change their situations. Even policymakers and academics who argue that adult prostitution is a choice acknowledge that many women in the commercial sex industry suffer regular violence from pimps, johns, and others.

"Ultimately, pimp-controlled prostitution is trafficking," Ms. Fowler says.

This is what an activist who goes by the name of Stella Marr believes. Ms. Marr was 20 years old when she first entered, as people involved call it, "the life." Today she helps run a group called Survivors Connect, which encourages sex-trafficking survivors to take a leading voice in the anti-trafficking campaign, and writes a blog at "My Body The City: The Secret Life of a Manhattan Call Girl."

Although Marr says her profile was somewhat atypical, the way she entered prostitution was not. Impoverished and trying to find a place to live and work in New York City, she was disowned by her troubled family, who pulled her out of Barnard College. She found herself on the streets, sleeping in apartment and academic building lounges. She was so broke, she said, she would walk from 120th Street down to Midtown to save subway fare.

And pimps, she says, noticed: "I was a sitting duck."

One day a man came up to her and told her that one of his friends needed a roommate, and that another friend owned a restaurant and could get her a job there.

It was a ruse. The friendly man soon turned violent, Marr recalls. And eventually he told her she could not leave. For the next decade she worked as a call girl, living in an apartment-turned-brothel. But even when she moved into her own apartment, she didn't dare leave the business. Her pimps told her that she would suffer if she tried to escape. Having been beaten up regularly, and having witnessed violence against other prostitutes, she believed them.

Now, she says, living in the suburbs, with a husband and a dog, she realizes that her traffickers weren't, in fact, omniscient. But at the time it was impossible to find rationality through the trauma, she says. And she understands why others don't leave.

"It's Stockholm syndrome, traumatic bonding," she says. "You bond with people who are hurting you, to survive. Most women in prostitution have no other place to go. They don't have a safety net…. And after a while, it seems like it's the only thing you're good for.

"Anyone who has been in prostitution doesn't really see a distinction between trafficking and prostitution," she says. "In my lifetime – I'm in my 40s – I want there to be a time when a woman can say 'I was domestically trafficked' and it will be like saying 'I had breast cancer.' "

Evolution of the term 'trafficking'

Stories such as Marr's help improve the understanding of trafficking and the commercial sex industry, says Danielle Palmer of the Child Rescue Association of North America, a group that works to eliminate child trafficking in the US and Canada, with a focus on sex trafficking.

"A big part of the problem is that we've viewed women in a sexually exploitative way for so long," she says, adding that her organization hopes to mold a generation of young people who will understand that commercial sex is far from victimless.

But this is a highly contested point. Many groups that serve sex workers say that for many, prostitution is a choice, and that lumping the commercial sex industry with sex trafficking is inaccurate and adds to the hype.

It is such a contested issue that several academics with expertise on prostitution contacted for this article declined to speak with the Monitor, pointedly saying their studies are about sex work, not trafficking.

"To throw the net and label all prostitution as trafficking is too broad," says Sienna Baskin, codirector of the Sex Workers Project at the Urban Justice Center, a group that provides services to commercial sex workers – those who have been trafficked as well as those who say they were not manipulated into prostitution. "It doesn't recognize that people have a really wide array of experiences in commercial sex; it also means that you're trying to put the same solution on a bunch of different problems."

Equating commercial sex with trafficking, says Ms. Jordan, the American University law professor, is the most recent in a series of morally based antiprostitution campaigns in the past century and a half, starting with a campaign by educated British women during the 1800s protesting white prostitutes following men to the colonies. "The middle-class and upper-class women didn't like it," she says. "They called it the 'white slave trade.' "

More recently, she says, was a 1980s feminist effort to label pornography and prostitution as trafficking: "They were talking about prostitution and nobody was paying any attention. Then there were all these women flooding out of Eastern Europe, China opened up, women were migrating and ending up in debt bondage situations. They would escape, run away, and end up at women's organizations asking for help. People started calling it trafficking, and ... antiprostitution campaigns adopted the term."

Sometimes the portrayal of sex slavery was accurate, Jordan says, sometimes it wasn't. But the term stuck, and got even more attention under the George W. Bush administration.

The semantic fine lines, say advocates such as Marr, miss the point. If it weren't for the growing awareness of domestic sex trafficking within the US – if not for the Ashton Kutchers and Nicholas Kristofs and the many organizations explaining the background behind young girls on street corners – Marr says that she'd still feel ashamed, and hundreds of young women wouldn't feel they deserve to seek help.

Without "this new recognition of sex trafficking, I don't know if I'd have the courage to be speaking to you today," she says.

Funding at stake

But equating prostitution with sex trafficking isn't the only trouble with the domestic anti-sex-trafficking movement, critics say.

The focus on domestic underage prostitution diverts attention – and funding – from equally exploitative, but less sensational, forms of forced labor and slavery. These forms of human trafficking can just as easily happen in the US as elsewhere – an immigrant housekeeper without a passport whose employers force her to work, for instance, or an illegal immigrant smuggled into the country to work in a nail salon or on a farm and who is neither paid nor allowed to leave. Although estimates for these sorts of victims in the US are also in the many thousands, federal anti-trafficking task forces opened investigations into cases involving only 63 suspected victims between 2008 and 2010, according to the Bureau of Justice Statistics.

"I think information is good," says Bridgette Carr, who directs the Human Trafficking Clinic at the University of Michigan Law School in Ann Arbor. "But I worry ... that sound bites are harmful. They don't portray everything. If we're only talking about sex trafficking of children, we're not talking about the adults. If we're talking about sex trafficking, we're not talking about forced labor."

She tries to use the attention on sex trafficking as a way to educate people about the wider array of human-trafficking crimes, but she recognizes that there is a long way to go.

Although the number of US human-trafficking prosecutions has increased, the majority of those cases are focused on underage sex trafficking. Only 1 in 10 incidents of suspected human trafficking is labor trafficking, according to the Department of Justice Bureau of Labor Statistics. And some critics have claimed that too few of the new visas designed as an incentive to get human-trafficking victims to work with law enforcement have been issued. The State Department reported that these "T visas" were granted to 557 victims in fiscal year 2011.

And funding is diverted, too. The US State Department distributed tens of millions of dollars to support nonprofits working with domestic sex-trafficking victims, but the federal government in 2010 suspended a federal program to reunify human-trafficking victims with their families abroad. And while there has been an increase in private and government funds to help sex-trafficking victims, advocacy groups say prevention gets short shrift: Children most at risk of becoming trafficked – runaways and homeless – have difficulty getting help.

"Another issue throwing trafficking protections off balance is the [US] policy which focuses government trafficking efforts on eradicating prostitution, which it conflates with sex trafficking," said the Women's Commission for Refugee Women and Children, a humanitarian group associated with the International Rescue Committee, in the 2007 report "The U.S. Response to Human Trafficking: An Unbalanced Approach." "Efforts at addressing contributing factors to trafficking are laudable but should not be pursued to the exclusion of other efforts. There is a need for immigration and labor reform that would yield dramatic results in protections for trafficked and exploited persons in the informal economy."

For Mr. MacBride, the prosecutor of the Virginia gang leader, though, the debate of which sort of harm is worse, and which deserves more attention, is beside the point. He sees both forms of trafficking as law enforcement priorities. "All crime is bad, but I think [human trafficking] is particularly heinous, with traumatic implications for victims."

Not all law enforcement officials have taken the same position. There has been a shift to federal prosecution of sex trafficking – with a focus on pimps as the main criminals rather than prostitutes or even johns. But many local law enforcement vice squads still approach commercial sex crimes with the long-standard approach of raids and sweeps, where everyone involved is arrested as a criminal.

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Advocates say substantial changes in the way underage prostitutes are treated in the US – whether they're called trafficking victims or not – will take more than celebrity campaigns. It will require getting closer to the source problems of poverty, vulnerability, and demand, and will require changing attitudes and behaviors.

"A lot of people are talking about it, and some states are passing good laws," Ms. Carr says. "But it's going to take more than that to overcome decades of criminalizing prostitutes. We're not seeing fundamental shifts in the way people who are being sold for sex are treated."