Saving ‘face’ and ‘othering’: getting to the root of barriers to condom use among Chinese female sex workers
Jenifer Chapman A B E , Claudia S. Estcourt A C and Zhou Hua DA Centre for Infectious Disease, Institute of Cell and Molecular Science, Queen Mary, University of London, London E1 2AT, UK.
B Present address: Constella Futures, One Thomas Circle, Washington DC 20005, USA.
C Infection and Immunity, Bart’s and The London NHS Trust, Whitechapel Road, London E1 1BB, UK.
D Shenzhen Institute of Dermato-venereology, Shenzhen, 2021 Buxin Road, Shenzhen 518020, China.
E Corresponding author. Email: jchapman@constellagroup.com
Sexual Health 5(3) 291-298 https://doi.org/10.1071/SH07057
Submitted: 20 July 2007 Accepted: 14 February 2008 Published: 6 August 2008
Abstract
Background: 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. Methods: We conducted semistructured interviews with 23 FSW incarcerated in a re-education and detention centre in Shenzhen, China in July to August 2004. Results: 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. Conclusions: 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.
Additional keywords: migration, prostitution, risk.
Acknowledgements
The present study was funded jointly by the Shenzhen Institute of Dermato-Venereology and Infection and Immunity, Bart’s and The London Trust and the University of London Central Research Fund. The views expressed are those of the authors and should not be taken to represent the opinions of the funding body. We are very grateful to the women interviewed and the co-operation of the re-education centres and the community health clinics from which the women were sampled is gratefully acknowledged. Authors wish to acknowledge the role of the wider management team in both China and the UK in progressing all phases of the study and particularly Adrian Mindel for his helpful comments early in the study.
[1]
[2] Rogers SJ, Ying L, Xing YT, Fung K, Kaufman J. Reaching and identifying the STD/HIV risk of sex workers in Beijing. AIDS Educ Prev 2002; 14 217–27.
| Crossref | GoogleScholarGoogle Scholar | PubMed | [verified 29 May 2008].
[44]
[45] Zhang SX. A survey on condom use among sex workers and their clients. Chin J STDs HIV/AIDS Prev 2000; 6 9–11.
![](../../media/share/OpenURL_Image.gif)
[46] Adu-Oppong A, Grimes RM, Ross MW, Riser J, Kessie G. Social and behavioural determinants of consistent condom use among female commercial sex workers in Ghana. AIDS Educ Prev 2007; 19 160–72.
| Crossref | GoogleScholarGoogle Scholar |
![](../../media/share/OpenURL_Image.gif)
[47]
[48]
[49] Liao SS, Schensul J, Wolffers I. Sex-related health risks and implications for interventions with hospitality women in Hainan, China. AIDS Educ Prev 2003; 15 109–21.
| Crossref | GoogleScholarGoogle Scholar |
![](../../media/share/OpenURL_Image.gif)
[50]