A groundbreaking study of Native American women in prostitution reveals astronomical levels of assault, homelessness, substance abuse, and related problems among one of the most vulnerable populations in the United States.

Conducted by the nonprofit Minnesota Indian Women’s Sexual Assault Coalition and the San Francisco–based Prostitution Research & Education, the study is based on interviews with more than 100 Native women. “Before this, nobody had ever done research speaking with Native American women used in prostitution and trafficking,” says Nicole Matthews, executive director of the coalition.

The report, released today, found that 92 percent of the women had been raped, 84 percent were physically assaulted, and 72 percent suffered traumatic brain injuries in prostitution. Almost all the women—98 percent—were either currently or previously homeless. Seventy-nine percent of the women interviewed said they had been sexually abused as children by an average of four perpetrators.

Nearly half the women in the study had been used by more than 200 sex buyers, and 16 percent had been used by at least 900 sex buyers. At the time of their interviews, 52 percent of the women had posttraumatic-stress syndrome, a rate comparable to that of combat veterans. Seventy-one percent manifested symptoms of dissociation. “There’s times I’d walk around in a space-out because when I stop and think about reality, I break down and can’t handle it,” one woman said.

Most of the prostitutes had sought help for their problems, with 80 percent using outpatient substance-abuse services, 77 percent using homeless shelters, 65 using domestic-violence services, and 33 percent using sexual-assault services.

Although 92 percent of the women said they wanted to escape prostitution, the study reported that “there are currently few or no available services especially designed for Native women in prostitution.”

According to Sarah Deer, coauthor of the study and an assistant law professor at the William Mitchell College of Law in St. Paul, Minn., Native people compose 1 to 2 percent of the American population today, with about half living on reservations at any given time. And yet “the rates of sexual violence against Native women are two and a half times higher than those in the mainstream population,” says Deer, a leading expert on violence against Native women.

The study identified such problems as a long-term consequence of the organized practices of extermination and cultural annihilation imposed by European settlers on indigenous peoples in America. “Over hundreds of years, Indian people were systematically stripped of their land, their language, their spirituality, and their safety,” Deer explains. “Colonization accounts for the vulnerability of Native women, because even though a lot of these policies happened a long time ago, they still have present-day effects. It’s intergenerational trauma; if your mother and grandmother and great-grandmother were all victims of sexual assault, there’s a normalization of that crime in your culture, where it seems as if everyone is a victim. ”

Despite the historical depiction of Native people as “savages,” crimes against women were rare in indigenous cultures prior to colonization. “Native people had strong laws that prevented the epidemic levels of violence you see today,” Deer reports. “A lot of tribal communities were matrilineal or matriarchal, and many tribal laws would have imposed the death penalty for mistreating a woman or child. When it started happening in tribal communities, the perpetrators were military- or missionary-based, and the Native people were unprepared to deal with the consequences. Even today, most of the perpetrators of these crimes against Native women are non-Native, which is unusual. Most violent crime in the United States happens intraracially; the victims and the perpetrators are almost always the same race. The only exception to that is Native women.”

As the victims of crime, Indian women also experience “more extreme violence” than other women, Deer says. “One of the reasons is the idea that Native women are less valuable. You see that play out in places like Anchorage, the rape capital of the United States, where Native women are targeted in bars. A crime mapping of sexual assaults reported in Anchorage showed a clear pattern of predatory behavior that was targeted against Native women.”

Interviews in the new study showed that Indian women often encounter racism among sex buyers. “When a man looks at a prostitute and a Native woman, he looks at them the same: ‘Dirty,’” one woman said.

“A john said to me, ‘I thought we killed all of you,’” reported another prostitute.

The study was sparked by ongoing reports of Native women being trafficked and used in prostitution in cities and on ships in the port city of Duluth, Minn., and elsewhere on the Great Lakes. “Numerous women had friends who were taken to Detroit or Chicago or wherever for the purposes of prostitution, and who were never seen or heard from again,” Matthews says.

Download the full report on the Prostitution and Trafficking of Native women in Minnesota here.