Unpacking the ‘structural’ in a structural approach for HIV prevention among female sex workers: A case study from China

Abstract

Interventions for HIV prevention among female sex workers (FSWs) in China focus on HIV/sexually transmitted infection (STI) and individual behaviour change. An occupational health framework facilitates intervention across an array of health issues FSWs face including HIV/STI, violence, reproductive health, stigma and substance use. Through a case study of a community-based Jiaozhou (JZ) FSW programme, we developed a conceptual framework incorporating global discussions of structural approaches to HIV prevention with the specific social and structural contexts identified among FSWs in China. Based on ethnographic fieldwork between August 2010 and May 2013, we describe the evolution of this programme to its current occupational health focus and unpack the intervention strategies. We describe the critical features of the programme that have fostered success among FSWs including high-quality clinical services provided within a welcoming setting, responsive outreach work through staff and trained FSW peers, interpersonal and community-level engagement aimed at changing the local social and structural environments of sex work and tailored health education materials. This intervention differs from other projects in China by adopting a more holistic approach to FSW health that incorporates social issues. It also demonstrates the feasibility of structural interventions among FSWs even within an environment that has strong anti-prostitution policies.

Keywords:

• structural approach
• female sex workers
• China
• HIV
• STI

Acknowledgement

The draft paper was presented in the 2nd International HIV Social Science and Humanities Conference, Paris, July 2013.

Disclosure statement

No potential conflict of interest was reported by the authors.

Funding

We acknowledge financial support from the Fundamental Research Funds for the Central Universities, the Research Funds of Renmin University of China [grant number 10XNJ059] and writing support from Partnership for Social Science Research on HIV/AIDS in China [grant number NICHD R24 HD056670]. We especially appreciate support from Oxfam Beijing office, staff and FSW peer educators from JZ FSW programme to assist the fieldwork.