Chinese AIDS prevention practitioners struggle to reach sex workers

By moonlight, Ma Yuanqiong, a grassroots AIDS prevention practitioner, and her colleagues slipped into a large community of migrant workers in the city of Jinghong in southwest Yunnan province. As usual, they were greeted tepidly. A dozen sex workers living in the community came to obtain free condoms and brochures on AIDS prevention and quickly dispersed. "We visit these women every week. They are familiar with us, but rarely talk about themselves," said Ma, who is in charge of an AIDS prevention program targeting sex workers in Jinghong. The program was initiated by Fuhua International, a local NGO. Sex workers are highly sensitive and vigilant due to safety concerns, since sexual services are illegal in China, Ma said. They have become harder to find since local police started a persistent crackdown on prostitution two years ago and drove many sex workers underground, she said. INACCESSIBILITY IMPEDES EFFORTS Jinghong is located in Xishuangbannan Dai autonomous prefecture. Bordering Laos and Myanmar, it's a famous tourist city where the underground sex industry thrives. The AIDS prevention program, which began in 2006, is aimed at improving sex workers' awareness of the epidemic -- which is primarily sexually transmitted -- and prompting them to change risky behavior. In the beginning, program workers quickly realized they faced a significant challenge. "We were often rejected, or even threatened when trying to get in touch with the sex workers at first," Ma said. But the practitioners persisted, approaching nonjudgmentally and treating them as friends, and eventually their efforts began to pay off.During the past five years, the program has provided free condoms and AIDS consulting services to more than 400 sex workers aged 14 to 58 and from many parts of the country, according to Ma. The program has even helped several sex workers give up the business and pursue legitimate careers. However, the organization currently only keeps in touch with about 100 sex workers and has found it more difficult to reach more. The police crackdown has made the sex workers, especially low-paid street hookers, more mobile and less visible, and Ma pointed out that low-paid sex workers are in greater need for outreach as they are more vulnerable to HIV infection than their their higher-paid counterparts. "Low-level sex workers are at a heightened risk, as they and their clients, mainly migrant workers and the elderly, all have insufficient knowledge of the disease," she said. According to statistics provided by the provincial disease control and prevention center (CDC) of Yunnan, about 1.6 percent of sex workers in Yunnan have contracted HIV, while the ratio among the low-level group is 3 percent. By the end of October, Yunnan reported 93,567 HIV carriers and AIDS patients, the most among all provinces, autonomous regions and municipalities. "We conducted a survey in Jinghong and neighboring Menghai County at the end of 2008 and found that low-level sex workers almost never used condoms then," said Kang Jun, head of the HIV/AIDS prevention and treatment office in Xishuangbanna. The survey also found that the low-level sex workers only charged about 20 yuan (3.2 U.S. dollars) for each service, and every day they received 16 clients on average, according to Kang. Ahead of the police crackdown, Kang and his colleagues had provided HIV testing services for more than 30 low-level sex workers, and the results showed that two of them had been infected by the virus. "The testing work was forced to halt as the crackdown began soon and we could hardly find them," Kang said. The good news, he said, was that the local CDC will launch a four-year investigation on sex workers in Xishuangbanna next January as part of a massive state-funded research project.