Chinese Female Sex Workers Research Articles

Predictors of Consistent Condom Use Among Chinese Female Sex Workers: An Application of the Protection Motivation Theory

We utilized Protection Motivation Theory to assess predictors of intention and behavior of consistent condom use among Chinese female sex workers (FSWs). A self-administered questionnaire was used in a cross-sectional survey among 700 FSWs in Guangxi, China. Multivariate logistic regression analysis indicated that extrinsic and intrinsic rewards, self-efficacy, and response costs predicted consistent condom use intention and behavior among FSWs. Sexually transmitted infection/ HIV prevention programs need to reduce FSWs’ perceptions of positive extrinsic rewards and intrinsic rewards for engaging in consistent condom use, reduce FSWs’ perception of response costs for using a condom, and increase condom use self-efficacy among FSWs.

Stickiness of respondent-driven sampling recruitment chains.

Respondent-driven sampling (RDS) is an increasingly popular chain-referral sampling method. Although it has proved effective at generating samples of hard to reach populations—meaning populations for which sampling frames are not available because they are hidden or socially stigmatized like sex workers or injecting drug users—quickly and cost-effectively, the ease of collecting the sample comes with a cost: bias or inefficiency in the estimates of population parameters (Gile & Handcock, 2010; Goel & Salganik, 2010). One way that RDS can produce inefficient estimates is if one or more of the recruitment chains gets stuck among members of a cohesive subpopulation, preventing the RDS sampling process from exploring other areas of the network. If that happens, members of the population subgroup recruit one another repeatedly, leading to an increase in sample size without increasing the diversity of the sample. This type of stickiness is particularly likely when hidden populations are stratified, and the stratified groups are organized into venues that provide opportunities to recruit other members of the same stratum. Female sex workers (FSW) in China, who are stratified into tiers of sex work that are correlated with marital status, age, and risk behaviors, are a prime example (Merli et al., 2014; Yamanis et al., 2013). Chinese FSW recruit clients from venues such as karaoke bars, massage parlors, or street corners. At larger venues, sex workers who participate in an RDS study might recruit other members of the same venue into the study at a higher rate than expected, leading to inefficient estimates. In short, the chain could get stuck in a venue.

HIV pre-exposure prophylaxis interest among female sex workers in Guangxi, China.

ObjectivesAcceptability of pre-exposure prophylaxis (PrEP) and willingness to participate in a clinical trial for both safety and efficacy of PrEP were investigated among female sex workers (FSWs) in Guangxi, China.MethodsA cross-sectional study was performed in three cities in Guangxi. Structured, self-administered questionnaires were used to assess the acceptability of PrEP and the willingness to participate in a clinical trial. Multivariable logistic regression models were fitted to identify predictors.ResultsAmong 405 participants, 15.1% had heard of PrEP. If PrEP was deemed to be effective, safe and provided for free, 85.9% reported that they would accept it, and 54.3% of those who accepted PrEP said that they would participate in a clinical trial. The increased acceptability of PrEP was associated with working in male dominated venues, higher income, a poor family relationship, better HIV/AIDS knowledge, not realizing HIV risk from unfamiliar clients, not being forced to use condoms by the gatekeepers, consistent use of condoms, and use of drugs to prevent STD infection. The increased willingness to participate in a clinical trial was associated with a poor family relationship, better HIV/AIDS knowledge, not realizing HIV risk from unfamiliar clients, a willingness to adhere to daily PreP use, and not being concerned about discrimination by others. The main reason for rejecting PrEP or participating in a clinical trial was the concern about the side effects of PrEP.ConclusionsAcceptability of PrEP among Guangxi FSWs is relatively high, indicating that PrEP intervention programs may be feasible for Chinese FSWs. Given the fact that most of the participants had never heard of PrEP before, and that family, gatekeepers, and social discrimination could significantly affect its acceptability, a comprehensive mix of multiple interventions is necessary for the successful implementation of a PrEP program among this population in Guangxi.

A Decline in HIV and Syphilis Epidemics in Chinese Female Sex Workers (2000–2011): A Systematic Review and Meta-Analysis

BackgroundFemale sex workers (FSWs) play an important role in transmitting HIV and syphilis from high-risk groups to the general population. However, the trends in HIV and syphilis epidemics in Chinese FSWs in the period after 2000 are unclear to date.MethodsThe Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement was followed. Seven databases were searched for published peer-reviewed articles. The incidence of HIV and syphilis in FSWs in different time periods, provinces and workplaces in China were separately pooled by meta-analysis. Correlation analysis was conducted between HIV and syphilis incidence and study time, respectively.ResultsAfter 1,662 articles were screened, 190 published papers were included in the final analysis. Estimated HIV prevalence was 0.284% (95% CI: 0.080–0.488%) in the period 2000–2002, 0.211% (95% CI: 0.149–0.273%) in 2003–2005, 0.242% (95% CI: 0.190–0.294%) in 2006–2008 and 0.041% (95% CI: 0.024–0.058%) in 2009–2011. The corresponding syphilis prevalence was 9.669% (95% CI: 7.810–11.529%), 4.970% (95% CI: 4.384–5.556%), 4.404% (95% CI: 4.032–4.775%) and 3.169% (95% CI: 2.738–3.600%), respectively. Spearman rank correlation coefficients were −0.165 (p = 0.002) between HIV prevalence and study time, and −0.209 (p = 0.000) between syphilis prevalence and study time. The combined HIV prevalence was 0.318% (95% CI: 0.156–0.479%) in medium and high-tier workplaces and 0.393% (95% CI: 0.176–0.610%) in low-tier workplaces. The corresponding syphilis prevalence was 3.216% (95% CI: 2.192–4.240%) and 13.817% (95% CI: 10.589–17.044%), respectively.ConclusionsOur data suggested a decline in HIV and syphilis epidemics in FSWs in China on a national level during the study period (2000–2011). FSWs in low-tier workplaces should be given more attention in the future to ensure they are included in prevention programs for HIV and sexually transmitted diseases.

Violence Against Chinese Female Sex Workers in Hong Kong

Violence against sex workers is considered a global phenomenon. Despite this, very little is known about the patterns and nature of this form of violence. This article is concerned with violence against Chinese female sex workers in Hong Kong. Based on a systematic analysis of 75 police case files, it was found that violent attacks on sex workers display clear temporal and spatial patterns, and that perpetrators share certain characteristics. The article concludes that violence against female sex workers in the Chinese context is largely opportunity driven and goes on to argue that situational measures offer the greatest potential for preventive gains. Barriers to effective implementation such as the inappropriate or unfavourable responses of the government, the police, community leaders, and local residents toward commercial sexual activity are also discussed.

Sex and Emotion: Change of the Related Discourses among Some Chinese Female Sex Workers and their Representations in the Cosmopolitan Context

Sex and Emotion: Change of the Related Discourses among Some Chinese Female Sex Workers and their Representations in the Cosmopolitan Context

Prevalence of psychological problems and relationships with condom use and HIV prevention behaviors among Chinese female sex workers in Hong Kong

The present study investigated the prevalence of psychological problems and their relationships with relevant HIV prevention behaviors among female sex workers (FSWs). An anonymous cross-sectional survey was conducted. With a mapping exercise, 293 Chinese FSWs were recruited from a red-light district in Hong Kong. Results showed high prevalence of psychological problems among FSWs: substance use (40.4%), probable depression (53.9%), self-harm tendencies (34–38%), poor self-esteem (48–52%), and pessimistic future outlook (46–47%). Inconsistent condom use was common (51% with clients, 23% with one-night-stand sex partner, and 73% with boyfriends). Over 70% had not used HIV-related prevention services in the last 6 months. Multivariate analyses indicated that psychological problems were significantly associated with inconsistent condom use and non-use of prevention services. The poor psychological well-beings of FSWs have important public health implications. Relevant professional services should be provided and integrated with HIV prevention efforts.

Saving 'face' and 'othering': getting to the root of barriers to condom use among Chinese female sex workers

China has one of the most rapidly expanding HIV epidemics in the world with sexual transmission between female sex workers (FSW) and clients accounting for a rising fraction of new infections. Successful HIV prevention relies on the delivery of relevant, culturally appropriate messages to influence behaviour change. However, the cultural systems that give rise to barriers to condom use among Chinese FSW have been poorly examined. A better understanding of these barriers is fundamental to global HIV prevention efforts particularly considering increasing international migration of Chinese women who go on to engage in sex work in their migrant country. We conducted semistructured interviews with 23 FSW incarcerated in a re-education and detention centre in Shenzhen, China in July to August 2004. All respondents were internal economic migrants who had entered the sex industry in pursuit of greater financial reward. Respondents explained that they would 'lose face' if they returned from their migration penniless. Women's distinction between commercial and non-commercial partners was very subtle; the nature of 'boyfriend' relationships was diverse and these were often transactional. Condom use was influenced by gender norms, familiarity, a desire to 'save' and 'give' face and, in transactional relationships, whether more money was offered. Women felt HIV was a disease of 'others'; only two women felt personally at risk. The present study has highlighted the importance of unique cultural structures in Chinese FSW sexual decision-making, an understanding of which will enhance the success of HIV-prevention efforts globally.

Female Sex Workers in China: Vectors of Disease?

To analyze the extent by which Chinese female sex workers (FSWs) serve as vectors of HIV/AIDS to an otherwise spared general population and to describe the implications of centering efforts solely on this high-risk group. By using the example of FSWs in China, we intend to demonstrate the role that structural factors can have on HIV transmission above and beyond individual high-risk behaviors. Literature review of years 1980-2006. Analysis of the literature suggests that major determinants of HIV transmission amongst FSWs in China include sociopolitical context, gender, work environment and finally, risky sexual behaviors. Chinese FSWs live in a specific sociopolitical context that shapes their capacities to engage in safe-sex practices. Focusing on FSWs as vectors of HIV/AIDS epidemic in China neglects the larger context that endangers all members of society and blames an already vulnerable population.

Variations in Condom Use by Locale: A Comparison of Mobile Chinese Female Sex Workers in Hong Kong and Mainland China

The present study investigated the prevalence of HIV and HIV-related behaviors and perceptions among 336 female sex workers (FSW) traveling from mainland China to work in Hong Kong. None of the participants tested HIV positive. Of the participants, 13.2% and 26.8%, respectively, would have unprotected sex with a client in Hong Kong or in mainland China if they liked the client; 16.7% and 21.7%, respectively, would have unprotected sex with a client in Hong Kong and in mainland China if he paid more. Of the participants, 98.5% used condoms in the last episode of sex work in Hong Kong and 78.1% were consistent condom users in Hong Kong in the last month. Yet, among those who previously worked as FSW in mainland China (n = 141), only 28.6% used condoms consistently in mainland China in the last year; 60% of those who used condoms inconsistently while in mainland China became consistent condom users in Hong Kong. Among those who did not use condoms in mainland China, willingness to have unprotected sex with a client who was liked by the FSW was a strong predictor for consistent condom use in Hong Kong (OR = 18.67, p < .001). Among those who were consistent condom users in Hong Kong, the same variable predicted inconsistent condom use while in mainland China (OR = 14.02, p < .05). Condom use behaviors change when FSW are working in different social contexts and behavioral changes are possible. Education programs should take socio-contextual factors into account.

Prevalence of HIV and factors associated with risk behaviours among Chinese female sex workers in Hong Kong

The study examined the HIV prevalence and factors associated with risk behaviours among Chinese female sex workers (FSW) in Hong Kong. Unlinked anonymous HIV antibody testing and interviews, using structured questionnaires, were conducted for 293 FSW. None was tested HIV positive. In the last 6 months, 13.7% self-reported having contracted STD, 50.7% were not using condoms with their male clients consistently; 73.3% and 22.6% respectively had had unprotected sex with boyfriends and one-night-stand partners. Believing that condom use with a boyfriend is a mistrust and the perception that one did not have full control over condom use decisions, would agree not to use condoms if being paid more, and could not refuse to have unprotected sex with clients were significantly associated with condom use with various types of sex partners (OR =1.95 to 4.83). FSW has low HIV prevalence but high prevalence of risk behaviours. Bridging effects exist. Empowerment of FSW is warranted.

Environmental health and safety of Chinese sex workers: A cross-sectional study

Aim This paper presents a Hong Kong (HK) data on the effect that sex work has on women's environmental health and safety. An outreach role that highlights safety and human rights is suggested for nurses working with female sex workers (FSWs) as clients. Background In HK it was estimated that there were at least 200,000 FSWs in 2002 and the total population involved as workers, support staff, clients and partners of the clients exceeded half a million in a city of 6.8 million people. Despite these numbers, both locally and internationally there are very limited outreach nursing services that address the FSW's occupational health needs. Method A cross-sectional survey, was undertaken over a 5 month period commencing in October 2003. A validated Chinese version of the World Health Organisation Quality of Life Measure was administered to a convenience sample of 89 female street sex workers. A focus group interview was later conducted to gain contextual information. Results The predominantly mainland Chinese FSWs had a mean age of 36.1 years. These women tended to be less educated and older than the general population of FSWs. They worked long hours with most of their income sent back home to China. Many lived in sub-optimal conditions and risked being abused while at work. The women scored significantly lower in the environmental domains when compared to the general female population. Conclusion Highlighted is the critical importance of developing a new role, both international and within the Asian region, for community nurses working in an outreach capacity. This role should be visible, affordable and accessible, for at risk populations such as FSWs. The primary focus of the new role would be to establish a close working relationship between sex workers, sex industry owner/operators, health agencies and local authorities. Risk awareness programs developed and conducted by community nurses should embrace the complexity of occupational health issues. Such programs would also have the benefit of affirming the health rights of sex workers and public health.

Prevalence of Induced Abortion and Associated Factors among Chinese Female Sex Workers in Hong Kong

In this study, we interviewed 293 Chinese female sex workers (FSW) in Hong Kong of them, 55.6% of had experienced induced abortion 52.0% of which were accomplished in registered clinics. Those who were older, married, with frequent insomnia, did not use condom in the last episode of serving a client, and would agree not to use condom if paid more, were more likely than others to have had induced abortion (multivariate OR = 2.34 to 3.64). Those who were younger, had harmed herself, and drank at least 5 cans of beer per day (OR = 0.36 to 3.02) were more likely than others to have the induced abortion performed via improper means.

Recruiting young women to a trial of chlamydia screening

Xiang-Sheng Chen et al. recruited 505 young Chinese female sex workers to a prevalence study and found that 59% had Chlamydia trachomatis infection. Although unclear from the paper it is likely that the response rate of those asked to take part in this study was high. By contrast in the UK recruitment of healthy volunteers to trials can be difficult. Recruitment problems may also be exacerbated by reports of adverse effects of trials. We describe our experience of recruiting young women to a trial of chlamydia screening before and shortly after the negative publicity surrounding the TGN1412 commercial drug trial. (excerpt)

The Cost-Effectiveness of an Outreach Clinical Model in the Management and Prevention of Gonorrhea and Chlamydia Among Chinese Female Sex Workers in Hong Kong

Social marginalization and stigmatization in usual medical care setting may refrain female sex workers (FSWs) from seeking usual medical care for sexually transmitted infections in Hong Kong. To evaluate the cost-effectiveness of using an outreach approach for treatment and prevention of gonorrhea and chlamydia among FSWs. A decision tree was designed to simulate the outcomes of 2 alternatives: (1) outreach service providing treatment of gonorrhea and chlamydia and counseling to FSWs (outreach arm) and (2) no outreach service (control arm). Five tiers of outcomes were estimated for each study arm: (1) total direct medical cost, (2) number of FSWs infected with gonorrhea, (3) number of new cases of gonorrhea in clients transmitted by FSWs, (4) number of FSWs infected with chlamydia, and (5) number of new cases of chlamydia in clients transmitted by FSWs. Clinical inputs were estimated from literature, and cost analysis was conducted from the perspective of a public health organization. Compared to the control group, the marginal savings per new case of infection averted (marginal cost divided by marginal cases of infection) of the outreach group were $10,988 (US dollars) per case of gonorrhea averted in FSWs, $685 per case of gonorrhea averted in clients, $9643 per case of chlamydia averted in FSWs, and $220 per case of chlamydia averted in clients ($1=7.8 Hong Kong dollars). An outreach clinic is potentially less costly and more effective in preventing transmission of gonorrhea and chlamydia between FSWs and their clients in Hong Kong.

Vaginal Douching, Condom Use, and Sexually Transmitted Infections Among Chinese Female Sex Workers

Vaginal douching has been hypothesized to increase a woman's risk for human immunodeficiency virus (HIV) infection. However, data on the prevalence of this practice and its association with condom use and sexually transmitted infections (STIs) are limited. A cross-sectional survey among 454 female sex workers (FSWs) in a Chinese county. Vaginal douching was reported by 64.7% of the women. The prevalence of self-reported history of STI and that of current STI was 19.4% and 41.5%, respectively. Fifteen percent of the women reported consistent use of condoms with their clients and 8.4% with their regular partners. Vaginal douching was significantly associated with decreased use of condoms (with clients: OR = 0.31; with regular partner(s): OR = 0.22) and increased rate of self-reported STI history (OR = 1.95). However, there was no direct relation between douching and current STI. Over one third of the women believed that douching can prevent STI/HIV. Vaginal douching exposes FSWs to a high risk of STI/HIV. Medical professional and public health workers should correct women's misconception about the effectiveness of douching and discourage women from douching through educational activities.