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

Abstract

Background 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. 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. Methods Semi-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. Results The 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. Conclusion The 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.

Ways of HIV transmission in China: The effect of age, period, and cohort

“…On the other hand, social context has a significant influence on the ways of HIV transmission, as HIV is transmitted through human behaviors, such as sexual intercourse and intravenous drug injection, which are significantly influenced by local socio-cultural and political contexts ( 7 ). In China, the southwestern border area has the highest HIV/AIDS prevalence and is thus considered to be the epicenter of HIV in China ( 8 ). The spatial difference in HIV prevalence might be related to local economic development, culture, and population mobility.…”

Understanding Women’s Knowledge, Awareness, and Perceptions of STIs/STDs in Asia: A Scoping Review

“…Based on the data, Southeast Asia recorded the highest number of studies conducted, with Indonesia (n = 8), Malaysia (n = 4), Vietnam (n = 3), and Thailand (n = 3) emerging as the top four countries, followed by Cambodia (n = 2) and one study in Myanmar [19]. China (n = 11) produced the highest number in East Asia, which included one multi-country study [20]. Iran (n = 11) published the most papers in the western Asian region, with one paper published from Lebanon [7].…”

“…Men tend to play more dominant roles in sexual interactions in most Asian cultures, which includes making decisions about when and how sexual activities will take place, as well as whether condoms will be used [4,25,37]. Married men who engage in risky sexual behaviour with female sex workers [20,47] and transgender women [26,42] also put their spouses in jeopardy of contracting STIs/STDs or HIV as a result of their extramarital affairs or high-risk sexual behaviours outside the marriage. In a single study on unmarried women in Lebanon [7], they were aware of the risk of STI/STD and undesired pregnancy but knew little about contraception, which could lead to the likelihood of unsafe abortions.…”

“…In the sexual entertainment industry in Asia, it is a common practice for female employees to refer to their male sexual partners as "lovers" [20,47,48]. This mentality contributes to the non-use or inconsistent use of condoms as a demonstration of mutual trust between the couple, and it shows the need for a tailored approach for policy interventions amongst female sex workers.…”