A Qualitative Exploration of Barriers to Condom Use among Female Sex Workers in China

Abstract

BackgroundSex workers in China continue to engage in unprotected sex acts that put them at risk for contracting HIV (Human Immunodeficiency Virus) and other STIs (Sexually Transmitted Infections). The purpose of this study was to explore women’s work history, the context of sex work, condom use, HIV testing services, and potential barriers to condom use in a sample of FSWs (female sex workers) in Guangzhou, China.Methodology/Principal FindingsIn-depth, semi-structured, face-to-face interviews were conducted with 24 FSWs in Guangzhou, China. Informants were recruited using a purposive sampling technique. Qualitative data were coded and analyzed using NVivo 8.0. The majority of respondents were internal economic migrants who had entered the sex industry in pursuit of greater financial reward. Most women in the study were married or had steady boyfriends, and were young, with secondary education and limited knowledge about HIV and STIs. Most were not satisfied with their current living conditions and expressed a desire to leave the sex industry. Women reported that they were more likely to use condoms during sex acts with commercial partners than with non-commercial partners. The potential stigma of being seen as a sex worker prevented many from accessing HIV testing. Three key factors put these FSWs at risk for HIV and STIs: unreasonable trust toward clients, stereotypes and assumptions about customers, and financial incentives.Conclusions/SignificanceThese findings suggest that social and economic factors play an important role in shaping sexual decision-making among female sex workers in Guangzhou. We argue that greater insight into and attention to these factors could enhance the success of HIV prevention efforts.

What’s technology got to do with it? Exploring the impact of mobile phones on female sex workers’ lives and livelihood in India

“…Past studies (Mahapatra et al, 2012;Navani-Vazirani et al, 2015) show how solicitation patterns enabled by mobile phones may be associated with high-risk sexual behaviours among sex workers indicated by lower levels of condom use. While condom use behaviours were not explored in the current study, results from the current study revealed that mobile phones facilitated closer bonds between FSWs and some clients, which may place them at risk for non-condom use with such trusted partners, an issue that has been repeatedly highlighted in past studies (Deering et al, 2011;Jie et al, 2012;Murray et al, 2007;Panchanadeswaran et al 2008Panchanadeswaran et al , 2010Voeten, Egesah, Varkevissesr, & Habberma, 2007).…”

Lessons Learned From a Review of Interventions for Adolescent and Young Key Populations in Asia Pacific and Opportunities for Programming

“…Low perceptions of risk, including trusting the partner, were the most often cited individual factors impacting condom use for both MSM 10 and female sex workers (FSW) including migrant FSW. 11 Lower condom use was associated with FSW desiring to be seen as trustworthy or build trust with clients who may become potential partners, 11,12 deciding a client "looked clean" or if regular and client partners claimed, they were uninfected. 13 Similar subjective risk reduction strategies were found in 2 studies with young clients (aged 15-24 years) of FSW in 9 hotels in Dhaka, Bangladesh, including perception of trust (inconsistent condom use with frequently visited FSW), general cleanliness (clean perceived as uninfected), perceived social status (dark skin equated with lower class and therefore fewer clients), and anal sex (perceived low risk of infection).…”

“…16 As with FSW and MSM, people who inject drugs also were found to have a low perceived sense of risk. 17,18 Structural level factors associated with condom negotiation and use in articles reviewed included economic hardship, 10,11,16 knowledge of HIV 10,19 (closely related to individual factors of risk perception and self-risk assessments), violence and trafficking, peer education and peer influence, availability of condoms and support of the brothel or entertainment venue managers, and cultural norms.…”

“…11 In the report of the above-mentioned regional YMSM consultation in Bangkok in October 2012, it was mentioned that "within the context of a relationship, that is, allowing unprotected penetration as a sign of trust or desire for love, relationship, and connectedness. Some may see condoms as undermining intimacy during the sex act.…”

Correlates of selling sex among male injection drug users in New York City

“…Exchange sex has previously been found to be associated with HIV infection among high-risk heterosexual men in NYC (Jenness et al, 2011). Those who sell sex may be incentivized to not use condoms (Jie et al, 2012) may have greater numbers of sex partners (Edwards et al, 2006), and may have more risky sex partners (Weber et al, 2002). Exchange sex has been found to be common among female IDUs (Astemborski et al, 1994;Davey-Rothwell and Latkin, 2008) and the majority of research concerning exchange sex has focused on females selling sex.…”