THE CONDOM QUANDARY

Executive Summary
The State allows condoms to be brought into hotels, guest houses and
venues where high-risk sex occurs, and I feel that, in this respect, the State
has made progress. So then why do the police still use them [condoms] as
evidence of prostitution? I feel this runs counter to national policies and really
needs to change.
– Li Huixian, female sex worker
Sex work is illegal in China, and law enforcement practices that focus on condoms as
evidence of prostitution are having a negative impact on HIV prevention among sex workers.
When Lanlan, who runs a community based organization (CBO) and support group for sex
workers in northern China, introduced female condoms to the female sex workers she works
with as part of her CBO’s HIV and sexual and reproductive health (SRH) program, their
first reaction was: “The female condom is too big. We can’t swallow it if the police come!”
This story highlights the conundrum sex workers in China face when attempting to avoid
penalties by law enforcement and protect themselves from sexually transmitted diseases
and infections (STIs) and HIV.
Context
HIV and other STIs are one of the major public health concerns in China. Although the HIV
epidemic remains low prevalence in the general population, it is highly concentrated among
key populations, with increasing infections among men who have sex with men (MSM) and
sex workers. The primary mode for transmission of HIV is through sexual intercourse—both
heterosexual and male to male sex. Of the 104,000 new cases diagnosed in 2014, 92.2%
were through sexual contact. In addition, the expanding epidemics of STIs are increasing at
an alarming rate—in 2015, syphilis and gonorrhea were among the top five reported kinds of
transmitted infections in China.
In many ways, the Chinese government has adopted a pragmatic and often progressive
approach to HIV. China has strategically concentrated its efforts on key populations, such as
sex workers, people who inject drugs, and MSM.
Condoms play a crucial role in preventing the spread of HIV and other STIs. In 2004, led
by the Ministry of Health (MOH), six government departments in China jointly issued the
Views on the Promotion of Condom Use for HIV/AIDS Prevention, which makes explicit
the responsibilities of health, family planning, commercial and broadcasting departments
for the promotion of condom use. The government has devoted great efforts to promote
the use of condoms: in many provinces, entertainment venues are required to display
condoms publicly; and the central government allocates a specific amount of funds each
year to purchase condoms, which are then widely distributed to key populations, including
2