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The Practice Of Everyday Life

Diligence and a strong sense of mission have shaped how Paul Farmer, a well-published anthropologist physician, undertook the study of Do Kay, a small Haitian village struck by the acquired immunodeficiency syndrome (AIDS). His method of research goes beyond his being the participant observer who conducted interviews and recorded what he saw and heard over a period of almost a decade. Farmer evidently identified with the Do Kay community, winning the confidence of its people, becoming the trusted recipient of their intimate insights and disclosures. Casual discussions, rumors, complaints, spontaneous reactions to radio and TV broadcasts, political and religious opinions are all ably assimilated and interwoven into the narrative. Thus this work supersedes the limitations normally attached to the rigors of scientific objectivity. Even if this approach departs somewhat from the conventions of traditional anthropology and closes the door on the likelihood of its ever being replicated, the work is

AIDS and Accusation: Haiti and the Geography of Blame

Background Sex workers are at disproportionate risk of violence and sexual and emotional ill health, harms that have been linked to the criminalisation of sex work. We synthesised evidence on the extent to which sex work laws and policing practices affect sex workers’ safety, health, and access to services, and the pathways through which these effects occur. Methods and findings We searched bibliographic databases between 1 January 1990 and 9 May 2018 for qualitative and quantitative research involving sex workers of all genders and terms relating to legislation, police, and health. We operationalised categories of lawful and unlawful police repression of sex workers or their clients, including criminal and administrative penalties. We included quantitative studies that measured associations between policing and outcomes of violence, health, and access to services, and qualitative studies that explored related pathways. We conducted a meta-analysis to estimate the average effect of experiencing sexual/physical violence, HIV or sexually transmitted infections (STIs), and condomless sex, among individuals exposed to repressive policing compared to those unexposed. Qualitative studies were synthesised iteratively, inductively, and thematically. We reviewed 40 quantitative and 94 qualitative studies. Repressive policing of sex workers was associated with increased risk of sexual/physical violence from clients or other parties (odds ratio [OR] 2.99, 95% CI 1.96–4.57), HIV/STI (OR 1.87, 95% CI 1.60–2.19), and condomless sex (OR 1.42, 95% CI 1.03–1.94). The qualitative synthesis identified diverse forms of police violence and abuses of power, including arbitrary arrest, bribery and extortion, physical and sexual violence, failure to provide access to justice, and forced HIV testing. It showed that in contexts of criminalisation, the threat and enactment of police harassment and arrest of sex workers or their clients displaced sex workers into isolated work locations, disrupting peer support networks and service access, and limiting risk reduction opportunities. It discouraged sex workers from carrying condoms and exacerbated existing inequalities experienced by transgender, migrant, and drug-using sex workers. Evidence from decriminalised settings suggests that sex workers in these settings have greater negotiating power with clients and better access to justice. Quantitative findings were limited by high heterogeneity in the meta-analysis for some outcomes and insufficient data to conduct meta-analyses for others, as well as variable sample size and study quality. Few studies reported whether arrest was related to sex work or another offence, limiting our ability to assess the associations between sex work criminalisation and outcomes relative to other penalties or abuses of police power, and all studies were observational, prohibiting any causal inference. Few studies included trans- and cisgender male sex workers, and little evidence related to emotional health and access to healthcare beyond HIV/STI testing. Conclusions Together, the qualitative and quantitative evidence demonstrate the extensive harms associated with criminalisation of sex work, including laws and enforcement targeting the sale and purchase of sex, and activities relating to sex work organisation. There is an urgent need to reform sex-work-related laws and institutional practices so as to reduce harms and barriers to the realisation of health.

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Associations between sex work laws and sex workers’ health: A systematic review and meta-analysis of quantitative and qualitative studies

While 70% of HIV positive individuals live in sub-Saharan Africa it is widely believed that the future of the epidemic depends on the magnitude of HIV spread in India and China the world’s most populous countries. China’s 1.3 billion people are in the midst of significant social transformation which will impact future sexual disease transmission. Soon approximately 8.5 million ‘surplus men’ unmarried and disproportionately poor and migrant will come of age in China’s cities and rural areas. Meanwhile many millions of Chinese sex workers appear to represent a broad range of prices places and related HIV risk behaviors. Using demographic and behavioral data this paper describes the combined effect of sexual practices sex work and a true male surplus on HIV transmission. Alongside a rapid increase in sexually transmitted disease incidence across developed parts of urban China surplus men could become a significant new HIV risk group. The anticipated high sexual risk among many surplus men and injecting drug use use among a subgroup of surplus men may create bridging populations from high to low risk individuals. Prevention strategies that emphasize traditional measures – condom promotion sex education medical training – must be reinforced by strategies which acknowledge surplus men and sex workers. Reform within female sex worker mandatory re-education centers and site specific interventions at construction sites military areas or unemployment centers may hold promise in curbing HIV/sexually transmitted infections. From a sociological perspective we believe that surplus men and sex workers will have a profound effect on the future of HIV spread in China and on the success or failure of future interventions. (authors)

Surplus men, sex work, and the spread of HIV in China.

Aims: To review the patterns, contexts and impacts of alcohol use associated with commercial sex reported in the global literature. Methods: We identified peer-reviewed English-language articles from 1980 to 2008 reporting alcohol consumption among female sex workers (FSWs) or male clients. We retrieved 70 articles describing 76 studies, in which 64 were quantitative (52 for FSWs, 12 for male clients) and 12 qualitative. Results: Studies increased over the past three decades, with geographic concentration of the research in Asia and North America. Alcohol use was prevalent among FSWs and clients. Integrating quantitative and qualitative studies, multilevel contexts of alcohol use in the sex work environment were identified, including workplace and occupation-related use, the use of alcohol to facilitate the transition into and practice of commercial sex among both FSWs and male clients, and self-medication among FSWs. Alcohol use was associated with adverse physical health, illicit drug use, mental health problems, and victimization of sexual violence, although its associations with HIV/sexually transmitted infections and unprotected sex among FSWs were inconclusive. Conclusions: Alcohol use in the context of commercial sex is prevalent, harmful among FSWs and male clients, but under-researched. Research in this area in more diverse settings and with standardized measures is required. The review underscores the importance of integrated intervention for alcohol use and related problems in multilevel contexts and with multiple components in order to effectively reduce alcohol use and its harmful effects among FSWs and their clients.

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Alcohol use among female sex workers and male clients: an integrative review of global literature

Sexual transmission of HIV in China is rapidly increasing in part driven by commercial sex work. This article examines variations in occupational control among one type of brothel-based prostitutes in China and the relationship between the terms and content of this work and the risk of HIV/AIDS. Organizational factors are discussed as part of the current political economic and social context of sex work in China. The analysis is based on ethnographic observation and in-depth interviews conducted in south China in 2000 and 2001 involving 158 female prostitutes from 45 brothels in 4 red light districts. Qualitative analysis of interview and observational data used development of thematic codes measuring occupational control. Brothel-based female sex workers in China are a heterogeneous population displaying considerable variability in the organization of life and work relationships with managers and clients ability to negotiate condom use knowledge of sexually transmitted diseases and HIV and occupational identity all of which may result in different risks of acquiring HIV. HIV prevention activities in China must focus on sociocultural aspects of sex work. Such interventions depend on detailed knowledge of its organization. The results of this study demonstrate the importance of prevention activities directed at the brothel managers and clients as well as the sex workers. (authors)

HIV／AIDS risk among brothel-based female sex workers in China： Assessing the terms, content, and knowledge of sex work

The nature of extra-relational sex in societies with rapidly changing sexual mores and widespread commercial sex remains under-explored. The 2006 Sexuality Survey of China provides a national probability survey with data on 3,567 people 18–49 years old who were in a marital (89%) or dating/cohabiting (11%) relationship. In attitudes, extramarital sex was completely unacceptable to 74% of women and 60% of men and either somewhat or completely unacceptable to 95% of women and men. Most (77%) women wanted severe punishment of men’s short-term commercial sex and women’s jealousy was equally elevated by their primary partner’s episodes of commercial and non-commercial sex. Nevertheless, the prevalence of infidelity during the last 12 months was 4.5% (women’s non-commercial sex), 11.0% (men’s non-commercial), and 5.5% (men’s commercial), with each percent matching or exceeding the median for other countries. In multivariate equations for non-commercial infidelity, men’s infidelity was significantly more responsive to sexual dissatisfaction with his primary partner while women’s was more responsive to deficits in love. In commercial sex, men were uninfluenced by primary partner deficits in love, sexual satisfaction or oral sex–pursuing, it would seem, simply a greater variety of sexual partners. In a “trading up” pattern, women partnered with low income men had elevated infidelity. The minority of women reporting early masturbation and premarital sex were just as likely as men with these backgrounds to have elevated infidelity. The Chinese patterns provide ample material for deliberations on gender similarities and differences in extra-relational sex.

Sexual infidelity in China: prevalence and gender-specific correlates.

The control of HIV and other sexually transmitted infections (STI) is a challenge in China, with female sex workers (FSW) and male clients suspected as bridge groups. This study used a 2006 national probability survey of 2,707 adult men. Among men 15–49 years old, the prevalence of FSW contacts last year was 4.2% (95% CI, 3.3–5.2) overall, with 7.2% (CI, 5.9–8.7) in urban and 1.8% (CI, 1.0–3.3) in rural areas. In urban areas, the men most at risk for FSW were high income, often traveled, engaged in business entertaining, ages 25–39, and had early sex histories. When compared to men with only wife or stable sex partner, those most likely to report STI last year also reported FSW sex of any type (aOR,13.10; CI, 5.87–29.42). Additionally, when compared to men reporting consistent condom use with FSW, men with inconsistent condom use had elevated STI (aOR, 3.71; CI, 1.18–11.66). Additional efforts are needed for high income men in urban areas, and on consistent condom use with FSW.

Clients of Female Sex Workers: A Population-Based Survey of China

Male clients of sex workers have been overlooked in China's HIV prevention efforts This study aims to examine men's practices and attitudes toward extramarital sexual relationships, motivations for visiting female sex workers (FSWs), perceptions of sexually transmitted infection (STI)/HIV risk and risk prevention strategies used One hundred and eighty-six clients of FSWs with varying socio-economic statuses were interviewed in different sex work settings Men described no conflict between their role as a client and a responsible family provider They described social pressure from peers and business partners to visit FSWs, sexual pleasure and companionship as motivators to seek commercial sex While some men reported no risks associated with visiting FSWs, others identified risks such as being arrested by the police, robbed by gangs and threatening the health of their families by contracting a STI This study underscores the diversity of FSW clients and the need to understand the beliefs and behaviours of different client types to develop appropriate HIV prevention programmes It also demonstrates the feasibility of recruiting different types of male clients, a hard-to-reach population for Chinese HIV prevention efforts

Understanding the diversity of male clients of sex workers in China and the implications for HIV prevention programmes

The Chinese Government periodically enforces anti-prostitution laws through regular police presence in red light districts and through the arrests of brothel managers and sex workers. One of the most intense crackdowns on prostitution occurred throughout China in 2010. Using the 'structure-agency' framework and ethnographic approach, this paper examines the influence of the 2010 government anti-prostitution crackdown on female sex workers (FSWs). We observed 10 red light districts (6 cities and 2 counties) and interviewed 107 FSWs, 26 managers and 37 outreach workers working with FSWs. The findings describe variations in police practices and diverse strategies adopted by FSWs in response to police actions. The strategies include: soliciting sex outside of establishments in less visible channels, increasing the mobility and flexibility of sex work, changing sexual practices, sharing knowledge of how to identify policemen disguised as male clients and building personal relationships with local police. Our study suggests that, rather than disappearing as a result of crackdowns, the terms and content of sex work changed as a result of the FSWs' responses to police practices. Some of these responses potentially increased the health risks associated with sex work, but others laid the foundation for an effective response to police practices.

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Yingying Huang

Papers

HIV／AIDS risk among brothel-based female sex workers in China： Assessing the terms, content, and knowledge of sex work

Sexual infidelity in China: prevalence and gender-specific correlates.

Clients of Female Sex Workers: A Population-Based Survey of China

Understanding the diversity of male clients of sex workers in China and the implications for HIV prevention programmes

Government crackdown of sex work in China: Responses from female sex workers and implications for their health