Objectives: To identify key factors affecting condom use among male sex workers (MSW) who serve men in China.
Method: In-depth semi-structured face-to-face interviews in Beijing and Shanghai, China. Informants were recruited through referral from a non-governmental organisation with a strong men who have sex with men (MSM) network and the snowball technique.
Results: Between 2004 and 2005, 30 MSW were interviewed (Beijing n = 14; Shanghai n = 16). The MSW in this study were mainly single, young, homosexual, rural migrants with secondary education. None practised safer sex in their home towns. Until they migrated to big cities and entered the sex industry, they did not develop safer sex practices. They reported high condom use at work, but more than half of them (n = 17) had not been tested for HIV. Four factors, derived from the interviews and correlated to their rural background, sexual orientation and sex work identity, put MSW at risk of HIV/sexually transmitted infections (STI): incorrect AIDS knowledge; economic hardship; homosexual orientation and over-trusting in sexual relationships.
Conclusion: MSW, a distinctive but often neglected group in both studies and sentinel surveillance among the MSM population in China, deserve special attention. There is not only potential for HIV/STI infection among the MSM population but also for infecting the general public. Education and prevention programmes should take their three major interlocking identities: rural migrant, sex worker and homosexual into consideration in social, cultural and economic contexts in China.
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Funding: This project was funded by two sources: One was the author’s previous institute, the Department of Applied Social Sciences, the Hong Kong Polytechnic University, which funded the author to do research on male prostitution in China. The other was UNAIDS, which funded the non-governmental organisation involved to conduct an HIV prevention programme on male sex workers in China. The author was invited to be the research consultant of this programme and thus gained access to this population. Both funders provided only financial support (eg, flight tickets, accommodation, meals, etc) for the author’s field trips and were not involved with the study design, with the collection, analysis and interpretation of data, with the writing of the report or with the decision to submit the paper for publication.
Competing interests: None.
Ethics approval: Ethics approval was sought from the Hong Kong Polytechnic University before commencement of the study.
Patient consent: Obtained.
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