Saving 'Face' and 'Othering': Getting to the Root of Barriers to Condom Use Among Chinese Female Sex Workers

Sexual transmission of HIV between female sex workers (FSW) and clients accounts for a growing proportion of new infections in China, whose HIV epidemic is among the world's most rapidly expanding. "Successful HIV prevention relies on the delivery of relevant, culturally appropriate messages to influence behavior change," the authors noted, but "the cultural systems that give rise to barriers to condom use among Chinese FSW have been poorly examined." Improved understanding of these barriers is key to the global fight against HIV, "particularly considering increasing international migration of Chinese women who go on to engage in sex work in their migrant country."

The researchers conducted semistructured interviews with 23 FSW incarcerated in a "re-education and detention center" in Shenzhen, China, from July to August 2004.

All the women were internal economic migrants who had become sex workers to pursue greater financial rewards. If they returned home penniless, the women explained, they would "lose face." The women made very subtle distinctions between their commercial and non-commercial sex partners: The nature of their "boyfriend" relationships was diverse and often transactional. Factors influencing whether condoms were used included gender norms, familiarity, a desire to "save" and "give" face, and whether money was offered in transactional relationships. Only two women felt personally at risk of HIV infection; most viewed HIV/AIDS as a disease of "others."

"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," the authors concluded.

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