Infectious Disease Unit, Massachusetts General Hospital, Boston, Massachusetts, United States of America.
PLoS One. 2011;6(9):e24816. doi: 10.1371/journal.pone.0024816. Epub 2011 Sep 13.
Reducing harm associated with selling and purchasing sex is an important public health priority in China, yet there are few examples of sustainable, successful programs to promote sexual health among female sex workers. The limited civil society and scope of nongovernmental organizations circumscribe the local capacity of female sex workers to collectively organize, advocate for their rights, and implement STI/HIV prevention programs. The purpose of this study was to examine social networks among low-income female sex workers in South China to determine their potential for sexual health promotion.
METHODS/PRINCIPAL FINDINGS: Semi-structured interviews with 34 low-income female sex workers and 28 health outreach members were used to examine how social relationships affected condom use and negotiation, STI/HIV testing and health-seeking behaviors, and dealing with violent clients. These data suggested that sex worker's laoxiang (hometown social connections) were more powerful than relationships between women selling sex at the same venue in establishing the terms and risk of commercial sex. Female sex workers from the same hometown often migrated to the city with their laoxiang and these social connections fulfilled many of the functions of nongovernmental organizations, including collective mobilization, condom promotion, violence mitigation, and promotion of health-seeking behaviors. Outreach members observed that sex workers accompanied by their laoxiang were often more willing to accept STI/HIV testing and trust local sexual health services.
CONCLUSIONS/SIGNIFICANCE: Organizing STI/HIV prevention services around an explicitly defined laoxiang social network may provide a strong foundation for sex worker health programs. Further research on dyadic interpersonal relationships between female sex workers, group dynamics and norm establishment, and the social network characteristics are needed.
减少与卖淫嫖娼相关的危害是中国的一项重要公共卫生重点，但很少有成功的可持续方案能够促进性工作者的性健康。有限的公民社会和非政府组织的范围限制了性工作者集体组织、倡导自身权利以及实施性传播感染/艾滋病预防计划的能力。本研究的目的是调查中国南方低收入性工作者的社会网络，以确定其促进性健康的潜力。
方法/主要发现：对 34 名低收入性工作者和 28 名健康外展成员进行半结构式访谈，以调查社会关系如何影响 condom 的使用和协商、性传播感染/艾滋病检测和健康寻求行为，以及应对暴力客户。这些数据表明，性工作者的老乡（家乡的社会关系）比在同一场所卖淫的女性之间的关系更能确定商业性行为的条件和风险。来自同一家乡的性工作者通常会与老乡一起迁移到城市，这些社会关系履行了许多非政府组织的职能，包括集体动员、 condom 的推广、减少暴力和促进健康寻求行为。外展成员观察到，有老乡陪伴的性工作者往往更愿意接受性传播感染/艾滋病检测，并信任当地的性健康服务。
结论/意义：围绕明确界定的老乡社会网络组织性传播感染/艾滋病预防服务，可能为性工作者健康计划提供坚实的基础。需要进一步研究性工作者之间的人际关系、群体动态和规范建立，以及社会网络特征。
