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 sexually transmitted infection 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 street-based 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.

Keywords:

• migrants
• female sex workers
• sex work environment
• China
• HIV prevention

Acknowledgements

The authors thank the participants in this research for their time and the staff members and peer outreach volunteers, Fang Xuefei, Wang Hui, Chen Ying, and Zhang Zhiqiang, at the Aizhixing Institute of Health who worked to enhance the well-being of underserved populations, and the managers of sex work venues who helped us to conduct the interviews. This research was funded by the United Nations Population Fund (UNFPA). They especially thank Mr. Chen, Jianzhong and Ms. Kumiko Yoshida, AIDS Project Coordinators of UNFPA China office, and Drs. Wang Weidong and Zheng Tiantian for providing valuable suggestions as well as monitoring and evaluation of this project. This research was also supported by a training grant from the National Institute of Mental Health (T32 MH19139, Behavioral Sciences Research in HIV Infection; Principal Investigator: Anke A. Ehrhardt, Ph.D.) and a center grant from the National Institute of Mental Health to the HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University (P30 MH43520; Principal Investigator: Anke A. Ehrhardt, Ph.D.). The content is solely the responsibility of the authors and does not necessarily represent the official views of UNFPA, NIH or NIMH.