supervision, for example, using the wrong kind of medicine or the wrong dosage, and
without adequate general health monitoring.172 This can lead to other health problems
such as liver damage, glucose or lipid metabolic imbalances, or heart disease as a
result.173
Condom use
Sex workers and their clients are at heightened risk of HIV, in large measure as a
result of a larger number of sex partners. 174 The use of condoms is an effective way
to prevent HIV and STD infection. Most of the sex
workers interviewed for this report were aware of
the importance of using condoms, but not all of
them were using condoms during sex work under all
circumstances.
“Globally, where sex
work is illegal and sex
workers have barriers
to the negotiation of
Research has shown that the power asymmetry
consistent condom use,
between clients and sex workers has a pronounced
vulnerability to HIV and
effect on condom use negotiation. 175 Globally, where
other STD infection
sex work is illegal and sex workers have barriers to the
increases.” 172
negotiation of consistent condom use, vulnerability to
HIV and other STD infection increases. 176 Interviewees
reported the initiative for using condoms often rests with the client. Lili said she often
encounters clients who refuse to use condoms: “I often run into the kind [of client] who
demands that you not use condoms. Condoms are uncomfortable, and most men don’t
like to wear them.”177
In places like Beijing where recent crackdowns on sex work have made clients scarce,
dire economic circumstances mean sex workers may compromise the use of condoms
in order to keep the client. Xiao Zhou, who has been a sex worker for four years, says:
“Whether to use a condom depends on the circumstances. When I’m with a client, and
the client is paying less, we use a condom. If the client pays more, then we sometimes
172 Wu Jisuan, Guo Yanan. Hormone Use Recommendations for Safe Transformation of Sexual Characteristics. [安全改变性别特征激素使用建议]
http://www.aibai.com/ebook/library/ebook_aibai/download//2012/7/19/Transgender_Hormone_Guide(1).pdf (accessed October 13, 2014).
173 Ibid.
174 UNAIDS, “UNAIDS Guidance Note on HIV and Sex Work”. April 2012. http://www.unaids.org/sites/default/files/media_asset/JC2306_UNAIDSguidance-note-HIV-sex-work_en_0.pdf (accessed October 13, 2014).
175 Susanne Y.P. Choi and Eleanor Holroyd, The influence of power, poverty and agency in the negotiation of condom use for female sex workers in
mainland China. Culture, Health& Sexuality, September-October 2007, 9(5): 489-503.
176 WHO, UNFPA, UNAIDS, NSWP, “Prevention and Treatment of HIV and other Sexually Transmitted Infections for Sex Workers in Low- and Middleincome Countries,” December 2012. http://apps.who.int/iris/bitstream/10665/77745/1/9789241504744_eng.pdf (accessed October 13, 2014).
177 Interview with Lili, Shanghai, July 28, 2014.
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