Hong finds working with gatekeepers of Chinese female sex workers key to HIV/STI prevention

Within the global HIV/AIDS epidemic, female sex workers constitute a key population with respect to HIV infection and transmission because of their vulnerability and the potential role they play in transmission to the general public. Yan Hong, Ph.D., associate professor at the Texas A&M Health Science Center School of Public Health, recently published research on female sex workers in China calling for structural interventions to protect their occupational health and safety.

The study published in Qualitative Health Research titled, “‘Misses’ and ‘Mommies’: Relationship of Female Sex Workers and their Gatekeepers and its Implications for HIV/STI Prevention,” focuses on the relationships between women in the sex industry and their “managers” or gatekeepers, and how those relationships affect preventative measures and health among female sex workers. To gather data, Hong and other researchers conducted individual in-depth interviews with both gatekeepers and female sex workers in Guangxi, a region in southeastern China with an alarming increase of HIV cases in the past decade.

The study examined different types of gatekeeper-worker relationships and concluded that their relationship is reciprocal because female sex workers bring business and money to gatekeepers, who in turn serve as recruiters, space providers, business mediators, and protectors of female sex workers. However, the relationship is imbalanced, with the gatekeepers holding most of the power and making most of the decisions.

Gatekeepers not only decide the condom use policies in the venue, but they are also the crucial agent in the communication of HIV prevention in the venue. Their motivation to engage in HIV prevention for female sex workers is driven by financial interest; maintaining a healthy workforce in the venue is often secondary to the desire to reduce interruption of their business and stay out of legal trouble.

These findings prompted Hong and her fellow researchers to conclude that when designing HIV interventions, it is important to recognize “financial interests of the gatekeepers and design strategies compatible with their needs.” Additionally, they recognize that gatekeepers provide a safe space for women in the sex industry, so it is important to include gatekeepers in the strategies, promoting a trusting relationship between them and the workers.

“Working closely with gatekeepers is a promising way to reduce structural health risk factors and promote occupational safety among female sex workers in China,” said Hong.

This study received funding from an NIH Research Grant by the National Institute for Alcohol Abuse and Alcoholism and Research Development Award from Texas A&M University. Additional researchers include Chen Zhang, M.P.H., Vanderbilt University, Nashville, Tennessee; Xiaoming Li, Ph.D., Wayne State University School of Medicine, Detroit, Michigan; Yuejial Zhou, M.D., Guangxi Center for Disease Control and Prevention, Nanning, China; and Weigui Guo, M.D., Beihai Center for Disease Control and Prevention, Beihai, China.