Monday, December 28, 2015

Typology of Older Female Sex Workers & Sexual Risks for HIV Infection in China

The HIV epidemic continues to develop among older adults in China, including older female sex workers. Yet, few studies have been conducted among this relatively hidden population. 

The objectives of this study were to investigate the reasons for women's entry into sex work during their thirties and to develop typology of older women sex workers. Semi-structured in-depth interviews with sixty-three older women sex workers and six focus groups interviews with stakeholders were conducted in three cities in China in 2012. Data were analysed inductively using constant comparative method. 

The mean age of participants was 43 years old and the mean age of entry into sex work was 39 years old. The primary reasons for entry into sex work include heavy economic burdens, limited employment opportunities, and the appealing nature of sex work. 

Street-based and venue-based older sex workers were identified based on where they solicited clients. Street-based older sex workers were more likely to engage in unsafe commercial sex due to financial incentives, whereas those in entertainment venues were unlikely to use condoms with regular clients. 

The development of effective HIV interventions needs to consider older women sex workers unique characteristics and target factors that impede safer sex practices.

Table 1

Socio-demographic characteristics of study respondents (N = 63)
Street-based older sex workers(n = 28)Venue-based older sex workers (n = 35)

Massage or saunaEntertainments

n (%) or Mean (SD)n (%) or Mean (SD)n (%) or Mean (SD)
Age47.3 (6.8)39.4 (3.9)38.3 (4.4)
Age at first sex work42.8 (6.0)35.9 (4.3)34.5 (5.8)
 Han22 (78.6)11 (55.0)15 (100.0)
 Other6 (21.4)9 (45.0)0 (0.0)
 Rural21 (75.0)19 (95.0)15 (100.0)
 Urban7 (25.0)1 (5.0)0 (0.0)
Length of stay in study city
 Less than 1 year0 (0.0)2 (10.0)4 (26.7)
 1- 3 years5 (17.9)7 (35.0)1 (6.6)
 4- 9 years7 (25.0)8 (40.0)4 (26.7)
 10 or more years16 (57.1)3 (15.0)6 (40.0)
 Primary school or less13 (46.4)12 (60.0)8 (53.3)
 Middle school10 (35.7)7 (35.0)7 (46.7)
 High school5 (17.9)1 (5.0)0 (0.0)
Marital status
 Unmarried0 (0.0)0 (0.0)0 (0.0)
 Married11 (39.2)12 (60.0)4 (26.7)
 Divorced12 (42.9)8 (40.0)10 (66.7)
 Widow5 (17.9)0 (0.0)1 (6.6)
Number of children
 None0 (0.0)0 (0.0)1 (6.6)
 One13 (46.4)14 (70.0)10 (66.7)
 Two or more15 (53.6)6 (30.0)4 (26.7)
Children in school or pre-school
 No13 (46.4)1 (5.0)3 (20.0)
 Yes15 (53.6)19 (95.0)12 (80.0)
Previous occupation
 Office workers1 (3.6)0 (0.0)0 (0.0)
 Low-paid services*22 (78.6)13 (65.0)10 (66.7)
 Selling food or fruit in small carts5 (17.8)3 (15.0)2 (13.3)
 Farmers0 (0.0)4 (20.0)3 (20.0)
Study sites
 Qingdao18 (64.3)3 (15.0)1 (6.7)
 Hefei0 (0.0)7 (35.0)14 (93.3)
 Nanning10 (35.7)10 (50.0)0 (0.0)
*Waitress, cleaner, housekeeping, and shop assistant.

Table 2

Typology of older female sex workers
Street-based (n = 28)Venue-based (n = 35)

Massage or saunaEntertainment
Place of solicitationStreets, parks or other public placesRoadside massage parlours Saunas, beauty salonsKaraoke bars Dance halls
Place of having sexPublic: behind streets or in parksInside venuesInside venues
Indoor: older FSWs' or clients' apartments, rented room in off-street buildings, roadside hotelsOutside venue: roadside hotelsOutside veneue: roadside hotels
OrganizersNo or quasi “leaders” of older sex workersVenue ownersVenue owners
Rules of commercial sex service*Pay a referral fee (10 RMB per client) to the leaders or the owners of the off-street premisesShare profits with owners (10 to 20 RMB per client)Share profits with owners (10% to 50% of income per client)
Forbidden to sell sex outside venues without permission
Types of clientsLow-paid manual workers and older menLow-paid manual workers and older menLow-paid manual workers and older men, officers, and private business men
Service charge*Less than 50 RMB50-100 RMB100 RMB or more
Common reason for unsafe sexFinancial incentives/erectile dysfunctionFinancial incentives or regular clientsRegular clients
*$1 USD = 6.28 RMB

Full article at:

aDepartment of Epidemiology and Biostatistics, School of Public Health, University of Maryland College Park, College Park, Maryland, USA
bDepartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
cDepartment of Epidemiology, Shandong University School of Public Health, Jinan, China
dDepartment of HIV/AIDS Control and Prevention, Hefei Center for Disease Control and Prevention, Hefei, China
eDepartment of HIV/AIDS Control and Prevention, Nanning Center for Disease Control and Prevention, Nanning, China
fDepartment of HIV/AIDS Control and Prevention, Qingdao Center for Disease Control and Prevention, Qingdao, China
corresponding authorCorresponding author.
Hongjie Liu: ude.dmu@0121uilh

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