A profile of HIV risk factors in the context of sex work environments among migrant female sex workers in Beijing, China

Abstract

Migrant female sex workers (FSWs) are one of the most at-risk populations for HIV in China. This study demonstrates how multiple risk factors are situated and vary by types of sex work environments in a sample of 348 migrant FSWs in Beijing. Participants reported high rates of clients' refusal to use condoms (76%), unsafe sex with both clients (32%), non-paid regular partners (e.g., boyfriend or husband) (76%), and a STI symptom (79%) last year. Only 22% of FSWs had been tested for HIV. Risk factors were compared by three types of sex work environments: (1) entertainment establishments, (2) personal services sectors, and (3) street-based venues, including roadside brothels. Street-based FSWs, compared to the other FSWs, were more likely to be older, married with children, migrate from rural areas, and be arrested by police, and less likely to be educated, have contact with prevention services, be knowledgeable about HIV, and be tested for HIV. The FSWs in entertainment establishments were more likely than streetbased FSWs to have reported being physically, verbally, and/or sexually abused by clients. Multiple discriminant analysis distinguished a profile of two different groups of risk factors: (1) police arrest, lack of protection from violence, access to prevention and health care, and HIV knowledge, and (2) verbal and physical abuse and clients' refusal of condom use. In the massive internal migration in China, disadvantages in economic sectors drive women to become involved in sex work. HIV prevention strategies must target socio-structural factors embedded in sex work environments. Keywordsmigrants; female sex workers; sex work environment; China; HIV preventionChina's open door policy in 1978 toward market-driven economic development led to massive migration from rural to urban areas. In Beijing, an estimated 5.4 million of the 17.4 million city residents in 2007 were migrants (Juan, 2007). Large-scale urbanization also resulted in the reemergence of the sex work industry and a resurgence of sexually transmitted infections (STIs) (Chen et al., 2007;Gil et al, 1996). There are an estimated 10 million FSWs in China (Yang et al., 2005c) As sexual transmission is currently the primary driver of the HIV epidemic in China, the potential spread of HIV via the expanded sexual networks among migrant "floating" populations along with urbanization is of particular concern (Anderson et al., 2003;Yang et al., 2005c). In Li and colleagues' study (2004) of migrants in Beijing, mobility, assessed by the total years of migration and the number of migratory cities, was highly correlated with sexual risk. There have been consistent findings that female migrants reported higher STI rates than male migrants in China (Detels et al., 2003;Liu et al., 2005;Mao & Sun, 1999;Sun, 1997). One of the reasons for this disparity may be women's relative disadvantage to men in socio-economic status, facilitating women's entry into the sex work industry and exposure to other health risks (Huang, 2001;Ren, 1999;Yang & Xia, 2006). Whi...

Realigning government action with public health evidence: the legal and policy environment affecting sex work and HIV in Asia

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Alcohol Consumption in Relation to Work Environment and Key Sociodemographic Characteristics Among Female Sex Workers in China

“…For the purpose of data analysis, these venues were categorized into three main types: entertainment (e.g., KTV and nightclubs), personal service (e.g., hair salons, sauna, and massage parlors) and street-based (e.g., streets and mini-hotels), following a similar classification system in previous studies (Yi et al, 2010).…”

HIV risk and sexual health among female migrants in China

“…Consequently, female migrants in China are frequently undereducated and underprepared for the increased opportunities to engage in sexual behavior that are available to them in urban settings (Huang et al, 2014). In the absence of skills, knowledge and services to promote sexual health, female migrants who relocate to large urban centers may experience risk for a range of health consequences, including unwanted pregnancy, unsafe termination of pregnancy and sexually transmitted infections (STIs) Yi et al, 2010;He et al, 2012). Some research has contrasted the more permissive norms related to premarital sex in large urban contexts versus norms in rural settings, which might also contribute to health risk behaviors among rural-to-urban migrants .…”