title: Alcohol use and client-perpetrated sexual violence against female sex workers in China.
abstract: The global literature suggests that female sex workers (FSWs) experience high rates of sexual violence perpetrated by their clients, especially when FSWs are under the influence of alcohol. However, such data are limited in China. The current study is aimed to fill in the literature gap by examining the association between alcohol use by FSWs and client-perpetrated sexual violence against FSWs in China. A total of 1022 FSWs were recruited through community outreach in Guangxi, China. Female sex workers completed a self-administered survey on their demographic information, alcohol use, and sexual violence perpetrated by clients. Multivariable regression was employed to assess the relationship between alcohol use and client-perpetrated sexual violence among FSWs while controlling for possible confounders. Results indicated that alcohol use was positively associated with the experience of sexual violence in both bivariate and multivariable analyses. Women who were at a higher risk level of alcohol use were more likely to experience sexual violence perpetrated by clients even after controlling confounders (e.g., demographics and alcohol-serving practice). Given the association between alcohol use and client-perpetrated sexual violence, preventing or reducing alcohol use among FSWs could be an effective strategy to protect these women from sexual violence perpetrated by their clients. Alternatively, psychological counseling and other support should be available to these women so they can reduce their alcohol use as a maladaptive coping strategy. We call for culturally appropriate alcohol use reduction components, incorporated with sexual violence reduction strategies including adaptive coping skills training as well as empowerment, and targeting both FSWs and their clients.
authors.affiliation: Global Health Institute, Rollins School of Public Health, Emory University, Atlanta 30322, USA. chen.zhang2@emory.edu
authors.forename: Chen
authors.initials: C
authors.lastname: Zhang
authors.forename: Xiaoming
authors.initials: X
authors.lastname: Li
authors.forename: Bonita
authors.initials: B
authors.lastname: Stanton
authors.forename: Yan
authors.initials: Y
authors.lastname: Hong
authors.forename: Yiyun
authors.initials: Y
authors.lastname: Chen
authors.forename: Qiao
authors.initials: Q
authors.lastname: Shan
authors.forename: Wei
authors.initials: W
authors.lastname: Liu
authors.forename: Yuejiao
authors.initials: Y
authors.lastname: Zhou
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000428:Alcohol Drinking / Q000009:adverse effects / Q000453:epidemiology* / Q000517:prevention & control; D002681:China / Q000453:epidemiology; D015986:Confounding Factors, Epidemiologic; D003376:Counseling; D003710:Demography; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D015995:Prevalence; D012044:Regression Analysis; D012307:Risk Factors; D012720:Severity of Illness Index; D012742:Sex Offenses / Q000208:ethnology / Q000517:prevention & control / Q000706:statistics & numerical data*; D060386:Sex Workers / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014754:Violence / Q000208:ethnology / Q000517:prevention & control / Q000706:statistics & numerical data*; D055815:Young Adult