Saving 'face' and 'othering': getting to the root of barriers to condom use among Chinese female sex workers.
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.
Chapman
Jenifer
J
Centre for Infectious Disease, Institute of Cell and Molecular Science, Queen Mary, University of London, London E1 2AT, UK. jchapman@constellagroup.com
Estcourt
Claudia S
CS
Hua
Zhou
Z
D000328:Adult; D002681:China / Q000453:epidemiology; D017280:Condoms / Q000706:statistics & numerical data*; D003268:Contraception Behavior / Q000523:psychology / Q000706:statistics & numerical data; D003466:Cultural Characteristics; D005260:Female; D015658:HIV Infections / Q000453:epidemiology; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D012309:Risk-Taking; D011477:Sex Work / Q000523:psychology / Q000706:statistics & numerical data*; D012747:Sexual Partners / Q000523:psychology; D012749:Sexually Transmitted Diseases / Q000453:epidemiology; D011795:Surveys and Questionnaires; D047568:Unsafe Sex / Q000523:psychology / Q000706:statistics & numerical data*; D016387:Women's Health