Unmet Needs of STDs and HIV/AIDS among Sex Workers in Shanghai: Lessons from a Baseline Survey of an Intervention Study

Junqing Wu, Shanghai Institute of Planned Parenthood Research
Xikuan Chen, Shanghai Institute of Planned Parenthood Research
Ying Yang, Shanghai Institute of Planned Parenthood Research
Hong Yu, Shanghai Institute of Planned Parenthood Research
Pengfei Zhao, Shanghai Institute of Planned Parenthood Research

Unmet needs of STDs and HIV/AIDS among Sex workers in Shanghai: Lessons from a baseline survey of an intervention study Wu Junqing1 Chen Xikuan2 Yang Ying3 Yu Hong4 Zhao Pengfei5 ABSTRACT: In recent years, the rates of STDs and HIV/AIDS have been increased in china. The purpose of this study is to understand the unmet needs of the STDs and HIV/AIDS among sex workers in Shanghai and to evaluate the feasibility of developing STDs and HIV/AIDS counseling among female sex workers by in-depth interview in Shanghai. In the baseline study, 63 sex workers in entertainment business during 1999 to 2001 had been conducted the in-depth interview, which is expected to provide useful information to the future intervention study, such as hotline and face to face counseling and good quality service in model-counseling clinics. 63 sex workers were recruited from 38 places, of which, 38 from beauty parlors, 13 from pubs/bars and sauna settings, 10 from KTV and 2 from freelance. The average age was 25(17-45) years old. 73% of them were not permanent residents. The results showed that there were misconceptions about STDs and HIV/AIDS among them. The knowledge related to STDs and HIV/AIDS was very poor and only 37 (58.7%) of them had heard of STDs, but most of them did not really know what they were. The results indicated that 37 (58.7%) respondents admitted that they had multiple sexual partners, and only 4 of them had ever used male condoms for STDs protection. And 20 respondents reported having had a STDs, and 2 respondents reported more than one episode. But the ratio of correct health seeking behavior was considerable low. Women in entertainment settings, especially those who had migrated to Shanghai, often resorted to sex work as a last resort to support themselves and their families. Women working in entertainment settings were vulnerable to infection because their knowledge level of STDs/ HIV was either non-existent or low and inaccurate. The migrant women from outside Shanghai were particularly vulnerable. Women engaging in sex work in entertainment settings often used a family planning method only after an induced abortion. Condom use was, except for contraception, almost non-existent for STDs and HIV/AIDS intervention. Women in entertainment settings were usually engaging in high-risk behaviors, such as unprotected sex with multiple partners and employing unsafe weekly injections of penicillin, using vaginal cleansing or visual inspection of partners. STDs infections were common although not readily admitted among women in the entertainment settings. When treatment was sought for a STDs, it was often inappropriate, such as self-medication or to quacks. Many women with symptoms did neither recognize their symptoms, nor know where to go to seek treatment. Injecting drug use among sex workers in the entertainment settings was increasing,especially among those from Shanghai. This trend is likely to continue because of targeting of sex workers by dealers. Women in entertainment settings were a mobile population, migrating from one setting to another to avoid security and to find new sex work opportunities. The major barriers to service were the providers¡¯ attitudes and discrimination, lack of privacy, poor accessibility, long waiting time, the high cost in the clinic and same gender physicians. These escort girls were risky in unwanted pregnancy and contracting STI infection. The ages of most escort girls were at their early 20yrs, and the youngest was only 17-year old. Some new enrollees knew nothing about contraception and STDs and HIV/AIDS prevention. Specific and effective intervention, particularly the implementation of 100% condom use program and good quality service at all entertainment establishments are necessary to prevent the spread of STDs and HIV/AIDS. Lessons we learned from the baseline study: (1) Value of collaboration between social science and medicine and value of qualitative interviews in providing detailed accurate information. (2) Sex workers in entertainment settings are more difficult to access than those in detention centers because of mobility, pressures not to interfere with work and fear of punishment for the sex work. (3) Importance of establishing trust and rapport with the sex workers by good counseling and personal communications. Introducing major activities and objectives of the project particularly is helpful for managers of entertainment establishment to dispel scruple of escort girls who think themselves are stigmatized. In conclusion, it deems that the most effective and practical measures should be taken in women working in the entertainment settings who have higher risk of contracting STDs and HIV/AIDS in China and in Shanghai as well. And the privacy and acceptable of hotline counseling and model counseling clinic seems better. KEY WORDS Unmet needs STDs and HIV/AIDS Sex worker 1. Shanghai Institute of Planned Parenthood Research (SIPPR), National Laboratory of Contraceptives and Devices Research, 2140 Xietu RD. Shanghai, P.R.China, 200032 Tel: 86-21-64171430 Fax: 86-21-64046128 E-mail: wujq@sippr.stc.sh.cn 2. SIPPR. Tel: 86-21-64171430 Fax: 86-21-64046128 E¨Cmail:chenxikuan@yahoo.com 3. SIPPR. Tel: 86-21-64171430 Fax: 86-21-64046128 E¨Cmail:yangyingsh@yahoo.com 4. SIPPR. Tel: 86-21-64171430 Fax: 86-21-64046128 E¨Cmail:yuhong@sippr.stc.sh.cn 5. World Health Organization, 401, Dongwai Diplomatic Office Bldg. 23, Dongzhimenwai Dajie Chaoyang District Beijing 100600, China Tel: 86-10-65327189 to 92 Fax: 86-10-65322359 E-mail: zhaopf@chn.wpro.who.int *WHO supported the project.