A thematic analysis of experiences of HIV risks among female sex workers in the Yunnan-Vietnam Chinese border region

Amanda Wilson,Shiyue Li,Runsen Chen,Tang Wang,Xing Yao,Hong Yan,Ping Cen,Yuehui Wang,Yuan Yuan Wang

doi:10.1186/s12905-020-01143-x

Abstract

BackgroundThe Yunnan province is located near the “Golden Triangle” border region between China, Myanmar and Thailand, which has the highest HIV/AIDS prevalence in China. Female sex workers (FSWs) in the Yunnan province are highly vulnerable to HIV infection. The objective of this study was to examine the experiences of FSWs in the Yunnan to better understand the risk of infection and the potential for transmission of HIV.MethodsSemi-structured interviews were conducted between May 2018 and June 2018 with 20 FSWs recruited in Hekou County, Yunnan Province, China. Thematic analysis was conducted to identify themes that highlighted increased exposure of FSWs to the risk of HIV infection and transmission.ResultsThe findings showed that FSWs’ primary source for HIV information was gynecologists, with few visiting the local HIV charity Red Ribbon. FSWs reported infrequent visits for check-ups with some seeing a gynecologist once a year. FSWs felt that the onus was on them to prevent STI/HIV infection by using a condom during sex, regardless of their ability to negotiate use. FSWs were also reluctant to see a gynecologists for treatment. Instead, they resorted to douching as a way of preventing HIV/STIs and treating vaginal health problems, such as leucorrhea. Most FSWs worked without the influence of alcohol and drugs. A small number of FSWs reported heroin addiction and injecting drug use.ConclusionThe findings suggest a need for innovative HIV prevention strategies among FSWs and their clients in the Chinese border region. Governmental agencies should continue to implement practical strategies in terms of HIV prevention education and condom use through tailored interventions that are localized. Such strategies should include localized tailored interventions that dispel myths about douching as a method of HIV/STI prevention and incorporate a mobile outreach approach, similar to the ‘roadside restaurant’ outreach that has been successful in rural China.

Highlights

The Yunnan province is located near the “Golden Triangle” border region between China, Myanmar and Thailand, which has the highest human immunodeficiency virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS) prevalence in China
Infrequent access to informational support for HIV/AIDS The narratives showed that the Female sex workers (FSWs) had limited access to informational support for HIV/AIDS because of inability to attend regular check-ups by gynecologists who were their primary source of information, and limited engagement with the HIV/AIDS charity operating in the study setting, the Red Ribbon
The workers did not know much about AIDS despite the presence of Red Ribbon, a non-profit that provides integrated care and support for those living with HIV, which was an indication of limited contact with the program

Summary

Introduction

The Yunnan province is located near the “Golden Triangle” border region between China, Myanmar and Thailand, which has the highest HIV/AIDS prevalence in China. Female sex workers (FSWs) in the Yunnan province are highly vulnerable to HIV infection. Introduction Globally, female sex workers (FSWs) are a highly vulnerable population to the human immunodeficiency virus (HIV). Prevention initiatives in China promote male condoms; studies among FSWs show that condom use varies across settings, which suggests a need for further research to understand trends in HIV risk to manage and prevent transmission through condom use [3]. Research on FSWs’ male clients show conflicting findings and the prevalence of sexually transmitted infections (STIs) / HIV remains high (6, 7), providing little insight into how male clients’ use of condoms mediate risk of HIV and STIs. There have been some reports in China of FSWs contracting HIV, through the selling of blood/plasma; the majority of risks come from condom less heterosexual behavior and injecting drug use (IDU) [8]. Effective HIV prevention for sex workers should be tailored according to the environment where FSWs work (11, 12)

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