THE CONDOM QUANDARY

Chapter 4: HIV, Condoms, and Public Policy
4.1 HIV programs for sex workers
In 2004, China identified people who inject drugs, sex workers, and men who have sex
with men as “high risk” groups for HIV transmission. 59 The government adopted specific
measures to reduce the HIV vulnerability of these key populations, which included
outreach and peer education* to provide information on STIs/HIV and to increase access
to condoms and promote correct condom usage. 60 Since then, CDC working groups have
been conducting outreach and providing services in entertainment venues. But these
interventions have limited reach with street-based, low-income sex workers, who are
characterized by high mobility, low education, and low HIV/STI awareness and infrequent
health seeking behavior. 61 There are an estimated 1-3 million female sex workers in China,
with a 4-8% prevalence of lifetime active syphilis; about 30% are street-based sex workers,
with a 25-40% prevalence of active syphilis in this group. 62
Because of the illegal status of sex work and the frequent crackdowns by police, sex
workers are usually hidden, scattered, and mobile, and are thus described as a “hard
to reach” population. Since 2011, UNFPA China has supported HIV prevention among
street-based female sex workers in four project sites across China. In recent years, when
the Chinese government initiated mass crackdowns on sex, the number of sex workers
who accessed HIV prevention services in those four project sites decreased dramatically.
In 2012, at one project site, 1,528 sex workers received HIV testing; in 2013, the number
dropped to 1,247; in 2014, only 749 sex workers received HIV testing; and in 2015, the
number decreased even further to 457. The number of sex workers who received free
condoms and HIV counseling also declined. 63
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