Risky sexual behavior among female entertainment workers in China: implications for HIV/STD prevention intervention

Using qualitative information from in-depth interviews of 40 female entertainment workers (FEWs) in Shanghai, this article explores factors associated with unprotected sex and barriers to consistent condom use among FEWs. Results suggest that not all FEWs were at high risk, nor did they all engage in unprotected sex for the same reasons. Prevalence of unprotected sex varied by individual characteristics, across different settings where commercial sex took place, and by the FEWs' relationship to pimps or establishment owners. Factors contributing to unprotected sex included lack of HIV transmission knowledge, economic hardship, client refusal/coercion, and control by pimps/establishment owners. Incorrect beliefs also contributed to use of methods that offered no protection. Study participants endorsed the need for HIV/sexually transmitted disease prevention, but were suspicious about government programs. Prevention interventions need to target simultaneously clients of commercial sex and pimps/business owners and to promote a social environment supportive of 100% condom use in commercial sex.