Abstract
Commercial sex plays a critical role in the heterosexual transmission of HIV in China. This study reviews behavioral studies in English literature on female sex workers (FSWs) in China from 1990 to 2006. Existing studies indicate that FSWs in China are young, mobile, most of them have both commercial and non-commercial sex partners; they have low rates of consistent condom use and high rates of STD infection. Some FSWs are also engaged in drug abuse. There is a great variation of sexual practices and HIV risks among FSWs across different work settings. Limited numbers of intervention studies have reported positive effects on increasing condom use and/or decreasing STD infections. Literature gaps and lessons learned from existing studies are identified and future research needs are discussed. Future behavioral intervention programs need to be multi-faceted and incorporate environmental and structural factors for different groups of FSWs.
Similar content being viewed by others
References
*: Articles reviewed
Abrams, H. K. (2001). The resurgence of sexually transmitted diseases in China. Journal of Public Health Policy, 22, 429–440.
Anonymous (2005). AIDS in China: Anatomy of an epidemic. Economis, July 28, 2005. http://www.economist.com/world/asia/displayStory.cfm?story_id=4223578 Accessed September 28, 2005.
Basuki, E., Wolffers, I., Deville, W., Erlaini, N., Luhpuri, D., Hargono, R., et al. (2002). Reasons for not using condoms among female sex workers in Indonesia. AIDS Education & Prevention, 14, 102–116.
Buckingham, R. W., Moraros, J., Bird, Y., Meister, E., & Webb, N. C. (2005). Factors associated with condom use among brothel-based female sex workers in Thailand. AIDS Care, 17, 640–647.
*Chen, X. S., Yin, Y. P., Liang, G. J., Gong, X. D., Li, H. S., Poumerol, G., et al. (2005). Sexually transmitted infections among female sex workers in Yunnan, China. AIDS Patient Care & STDS, 19, 853–860.
*Chen, X. S., Yin, Y. P., Liang, G. J., Gong, X. D., Li, H. S., Shi, M. Q., et al. (2006). Co-infection with genital gonorrhoea and genital chlamydia in female sex workers in Yunnan, China. International Journal of STD & AIDS, 17, 329–332.
China Ministry of Health, UN Theme Group on HIV/AIDS in China (2004). A joint assessment of HIV/AIDS prevention, treatment, and care in China. Beijing: China Ministry of Health.
China Ministry of Health, UNAIDS, WHO (2006). Update on the HIV/STD epidemic and response in China 2005. Beijing: China Ministry of Health.
Cohen, M. S., Henderson, G. E., Aiello, P., & Zheng, H. (1996). Successful eradication of sexually transmitted diseases in the People’s Republic of China: Implications for the 21st century. Journal of Infectious Diseases, 174, S223–S229.
Cohen, M. S., Ping, G., Fox, K., & Henderson, G. E. (2000). Sexually transmitted diseases in the People’s Republic of China in Y2K: Back to the future. Sexually Transmitted Diseases, 27, 143–145.
*Ding, Y., Detels, R., Zhao, Z., Zhu, Y., Zhu, G., Zhang, B., et al. (2005). HIV infection and sexually transmitted diseases in female commercial sex workers in China. Journal of AIDS, 38, 314–319.
Ford, K., Wirawan, D. N., & Fajans, P. (1998). Factors related to condom use among four groups of female sex workers in Bali, Indonesia. AIDS Education & Prevention, 10, 34–45.
Gil, V. E. (1991). An ethnography of HIV/AIDS and sexuality in the People’s Republic of China. Journal of Sex Research, 28, 521–537.
*Gil, V. E. (1994). Sinic conundrum: A history of HIV/AIDS in the People’s Republic of China. Journal of Sex Research, 31, 211–217.
*Gil, V. E., Wang, M. S., Anderson, A. F., Lin, G. M., & Wu, Z. O. (1996). Prostitutes, prostitution and STD/HIV transmission in Mainland China. Social Science & Medicine, 42, 141–152.
Gill, B., Chang, J., & Palmer, S. (2002). China’s HIV crisis. Foreign Affairs, 81, 96–111.
Grusky, O., Liu, H., & Johnston, M. (2002). HIV/AIDS in China: 1990–2001. AIDS & Behavior, 6, 381–393.
Hershatter, G. (1993). Regulating sex in Shanghai: The reform of prostitution in 1920 and 1951. In F. Wakeman & W. H. Weh (Eds.), Shanghai sojourners (pp. 106–137). Berkeley, CA: Center for Chinese Studies, University of California at Berkeley.
Hershatter, G. (1996). Sexing modern China. In G. Hershatter, E. Honig, & J. Lipman (Eds.), Remapping China-fissures in historical terrain (pp. 77–96). California: Stanford University Press.
*Hesketh, T., Zhang, J., & Qiang, D. J. (2005). HIV knowledge and risk behavior of female sex workers in Yunnan Province, China: potential as bridging groups to the general population. AIDS Care, 17, 958–966.
Hong, Y., Stanton, B., Li, X., Yang, H., Lin, D., Fang, X., et al. (2006). Rural-to-urban migrants and the HIV epidemic in China. AIDS & Behavior, 10, 421–430.
*Huang, Y., Henderson, G. E., Pan, S., & Cohen, M. S. (2004). HIV/AIDS risk among brothel-based female sex workers in China: Assessing the terms, content, and knowledge of sex work. Sexually Transmitted Diseases, 31, 695–700.
*Hyde, S. T. (2000). Selling sex and sidestepping the state: Prostitutes, condoms, and HIV/AIDS prevention in southwest China. East Asia, 18, 108–136.
Jana, S., Basu, I., Rotheram-Borus, M. J., & Newman, P. A. (2004). The Sonagachi Project: A sustainable community intervention program. AIDS Education & Prevention, 16, 405–414.
Joesoef, M. R., Kio, D., Linnan, M., Kamboji, A., Barakbah, Y., & Idajadi, A. (2000). Determinants of condom use in female sex workers in Surabaya, Indonesia. International Journal of STD & AIDS, 11, 262–265.
*Lau, J. T. F., Tsui, H. Y., Siah, P. C., & Zhang, K. L. (2002). A study on female sex workers in southern China (Shenzhen): HIV-related knowledge, condom use and STD history. AIDS Care, 14, 219–233.
*Li, X., Wang, B., Fang, X., Zhao, R., Stanton, B., Hong, Y., et al. (2006). Short term effect of a cultural adaptation of voluntary counseling and testing among female sex workers in China: A quasi-experimental trial. AIDS Education & Prevention, 18, 406–419.
Li, X., Zhang, B., & Zhang, N. (2002). Sex-related entertainment service: Investigation on female sex workers on a coastal city in China. http://www.sexstudy.org/article.php?id=646 Assessed December 10, 2005.
*Liao, S. S., He, Q., Choi, K., Hudes, E. S., Liao, J., Wang, X., et al. (2006). Working to prevent HIV/STIs among women in the sex industry in a rural town of Hainan, China. AIDS & Behavior, 10, S35–S45.
*Liao, S. S., Schensul, J., & Wolffers, I. (2003). Sex-related health risks and implications for interventions with hospitality women in Hainan, China. AIDS Education & Prevention, 15, 109–121.
Lin, C. C., Gao, X., Chen, X. S., Chen, Q., & Cohen, M. S. (2006). China’s syphilis epidemic: A systematic review of seroprevalence studies. Sexually Transmitted Diseases, 33, 726–736.
*Ma, S., Dukers, N. H., van den Hoek, A., Yuliang, F., Zhiheng, C., Jiangting, F., et al. (2002). Decreasing STD incidence and increasing condom use among Chinese sex workers following a short term intervention: A prospective cohort study. Sexually Transmitted Infection, 78, 110–114.
Monitor AIDS Pandemic (MAP) (2005). Sex Work and HIV/AIDS in Asia. http://www.mapnetwork.org/docs/MAP_SW%20in%20Asia%20Final%2004July05_en.pdf h Accessed September 28, 2005.
Minh, T. T., Nhan, D. T., West, G. R., Durant, T. M., Jenkins, R. A., Huong, P. T., et al. (2004). Sex workers in Vietnam: How many, how risky? AIDS Education & Prevention, 16, 389–404.
Pan, S. M., Parilsh, W. L., Wang, A. L., & Lao, M. (2004). Chinese people’s sexual relationships and sexual behaviors (1999–2000). Beijing: Social Science Document Publishing House.
*Pingmin, W., Yuepu, P., & Jiwen, Z. (2005). Prevalence survey on condom use and infection of urogenital mycoplasmas in female sex workers in China. Contraception, 72, 217–220.
Qian, H. Z., Vermund, S. H., & Wang, N. (2005). Risk of HIV/AIDS in China: Subpopulations of special importance. Sexually Transmitted Infection, 81, 442–447.
*Qu, S., Liu, W., Choi, K. H., Li, R., Jiang, D., Zhou, Y., et al. (2002). The potential for rapid sexual transmission of HIV in China: Sexually transmitted diseases and condom failure highly prevalent among female sex workers. AIDS & Behavior, 6, 267–275.
*Rogers, S. J., Ying, L., Xin, Y. T., Fung, K., & Kaufman, J. (2002). Reaching and identifying the STD/HIV risk of sex workers in Beijing. AIDS Education & Prevention, 14, 217–227.
Rojanapithayakorn, W. (2006). The 100% condom use programme in Asia. Reproductive Health Matters, 14, 41–52.
*Ruan, Y., Cao, X., Qian, H., Zhang, L., Qin, G., Jiang, Z., et al. (2006). Syphilis among female sex workers in southwestern China: Potential for HIV transmission. Sexually Transmitted Diseases, 33, 719–723.
Ruxrungtham, K., Brown, T., & Phanuphak, P. (2004). HIV/AIDS in Asia. Lancet, 364, 69–82.
Schafer, S. (2003). Not just another pretty face. Newsweek October 13, 2003. http://www.aegis.com/news/ads/2003/AD032119/html Accessed August 25, 2005.
Tucker, J. D., Henderson, G. E., Wang, T. F., Huang, Y. Y., Parish, W., Pan, S. M., et al. (2005). Surplus men, sex work, and the spread of HIV in China. AIDS, 19, 539–547.
UNAIDS (2005). AIDS epidemic update: December 2005: Special section on HIV Prevention. http://www.unaids.org/Epi2005/ Accessed December 2, 2005.
*van den Hoek, A., Yuliang, F., Dukers, N. H., Zhiheng, C., Jiangting, F., Lina, Z., et al. (2001). High prevalence of syphilis and other sexually transmitted diseases among sex workers in China: Potential for fast spread of HIV. AIDS, 15, 753–759.
Vanwesenbeeck, I. (2001). Another decade of social scientific work on sex work: A review of research 1990–2000. Annual Review of Sex Research, 12, 242–289.
*Wang, B., Li, X., Stanton, B., Yang, H., Fang, X., Zhao, R., et al. (2005). Virginal douching, condom use and sexually transmitted infections among Chinese female sex workers. Sexually Transmitted Diseases, 32, 696–702.
*Wei, S. B., Chen, Z. D., Zhou, W., Wu, F. B., Li, S. P., Shan, J. G. (2004). A study of commercial sex and HIV/STI-related risk factors among hospitality girls in entertainment establishments in Wuhan, China. Sexual Health, 1, 141–144.
WHO (2001). Sex Work in Asia. http://www.wpro.who.int/themes_focuses/theme1/focus4/pub_doc. asp Accessed September 28, 2005.
WHO (2005). Toolkit for targeted HIV/AIDS prevention and care in sex work settings. http://www.who.int/hiv/pub/prev_care/en/sexworktoolkit.pdf Accessed September 28, 2005.
*Wong, W. C. (2003). Acceptability study of sex workers attending the HIV/ AIDS clinic in Ruili, China. Asia Pacific Journal of Public Health, 15, 57–61.
*Wong, W. C., & Wang, Y. (2003). A qualitative study on HIV risk behaviors and medical needs of sex workers in a China/Myanmar border town. AIDS Patient Care & STDs, 17, 417–422.
*Xia, G., & Yang, X. (2005). Risky sexual behavior among female entertainment workers in China: Implications for HIV/STD prevention intervention. AIDS Education & Prevention, 17, 143–156.
*Yang, H., Li, X., Stanton, B., Liu, H., Liu, H., Wang, N., et al. (2005a). Heterosexual transmission of HIV in China: A systematic review of behavioral studies in the past two decades. Sexually Transmitted Diseases, 32, 270–280.
*Yang, H., Li, X., Stanton, B., Chen, X., Liu, H., Fang, X., et al. (2005b). HIV-related risk factors associated with commercial sex among female migrants in China. Health Care Women Intentional, 26, 134–148.
*Yang, H., Li, X., Stanton, B., Fang, X., Zhao, R., Dong, B., et al. (2005c). Condom use among female sex workers in China: Role of gatekeepers. Sexually Transmitted Diseases, 32, 572–580.
Yu, E. S., Xie, Q., Zhang, K., Lu, P., & Chan, L. L. (1996). HIV infection and AIDS in China, 1985 through 1994. American Journal of Public Health, 86, 1116–1122.
Zhang , B. (1997). Pros and cons of China’s policies on prostitutes in era of AIDS (article in Chinese). Paper Collection of China HIV/AIDS Intervention Forum. Beijing.
Zhang, K., Li, D., Li, H., & Beck, E. J. (1999). Changing sexual attitudes and behavior in China: Implications for the spread of HIV and other sexually transmitted diseases. AIDS Care, 11, 581–589.
Acknowledgement
This study is supported in part by a grant from the NIH Office of AIDS Research (R01MH064878-3S1). The authors wish to thank Dr. Ambika Mathur and Ms. Joanne Zwemer for assistance in preparing the manuscript.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Hong, Y., Li, X. Behavioral Studies of Female Sex Workers in China: A Literature Review and Recommendation for Future Research. AIDS Behav 12, 623–636 (2008). https://doi.org/10.1007/s10461-007-9287-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10461-007-9287-7