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A Study of the Impact of Law Enforcement Practices on Effective HIV Prevention among Male, Female, and Transgender Sex Workers in China

 

New publication by Asia Catalyst

Here’s an excerpt from the Executive Summary (Read the full report here ‘China The-Condom-Quandary-Report_en’):

 

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 sex workers, by various levels of the Center for Disease Control and Prevention (CDC) and CBOs across the country.

It is therefore perplexing and problematic that, alongside these efforts, the Chinese government has taken a punitive approach to sex work, and the system of public security bureaus (PSB), China’s law enforcement departments, have been authorized to crack down on sex work. The conflicting policies and messages are undermining the government’s own efforts at an effective HIV response, and the crackdowns on the sex industry have been positively reaffirmed in several major HIV prevention policy documents. Chinese CBOs working on HIV prevention report that it is a longstanding practice for police to specifically focus on condoms and use possession of condoms as the main evidence of prostitution.

About this study

There is little public debate on the impact of law enforcement on the HIV response, in part because of a lack of substantiated data on the issue in China. Little is known about law enforcement operations in general; the extent to which the police are using condoms as “evidence” of sex work in practice; what impact, if any, this is having on the safety and health of sex workers; and how it is affecting China’s national HIV prevention strategy.

Between late 2014 and August 2015, Asia Catalyst and four community partners undertook this study in three major Chinese cities with the support of UNFPA. The purpose of this study is twofold: (1) to better understand how relevant laws and law enforcement practices in China affect the ability of sex workers to access and carry condoms and access HIV and SRH services and, (2) to provide recommendations to revise laws and policies and to change law enforcement practices to improve the health and rights of sex workers in China.

The study combined quantitative and qualitative methods, including 517 survey questionnaires and 74 in-depth interviews with male, female, and transgender sex workers, and 18 interviews with key informants. The report uses the terms “survey respondents” and “interview respondents,” respectively.

Read the full report here

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