Female sex workers (FSWs) play a key role in HIV/AIDS transmission and their gatekeepers play a crucial role in shaping their behaviors. Limited studies are available on the relationship between FSWs and gatekeepers. In the current study we used an ethnographic approach to examine the dynamic and multidimensional relationship of FSWs and their gatekeepers from the perspectives of both parties. We recruited 38 FSWs and 16 gatekeepers from different types of commercial sex venues in Guangxi, China, and conducted in-depth individual interviews. Our data suggest that FSWs and gatekeepers maintain an interdependent and reciprocal relationship during their business practice, but gatekeepers exert significant influence and control over FSWs. Designing culturally appropriate HIV/STI-prevention programs requires us to take advantage of the unique and crucial roles of gatekeepers. We conclude with a call for structural interventions to protect FSWs’ occupational health and safety.
BlankenshipK. M.BiradavoluM. R.JenaA.GeorgeA. (2010). Challenging the stigmatization of female sex workers through a community-led structural intervention: Learning from a case study of a female sex worker intervention in Andhra Pradesh, India. AIDS Care, 22(Suppl. 2), 1629–1636. doi:10.1080/09540121.2010.516342.
2.
ChoiS. Y.HolroydE. (2007). The influence of power, poverty and agency in the negotiation of condom use for female sex workers in mainland China. Culture Health & Sexuality, 9, 489–503. doi:10.1080/13691050701220446
3.
CorraM.WillerD. (2002). The gatekeeper. Sociological Theory, 20, 180–207. doi:10.1111/1467-9558.00158
4.
GhoseT.SwendemanD. T.GeorgeS. M. (2011). The role of brothels in reducing HIV risk in Sonagachi, India. Qualitative Health Research, 21, 587–600. doi:10.1177/1049732310395328
5.
GilV. E.WangM. S.AndersonA. F.LinG. M.WuZ. O. (1996). Prostitutes, prostitution and STD/HIV transmission in mainland China. Social Science and Medicine, 42, 141–152. doi:10.1016/0277-9536(95)00064-X
6.
Guangxi Center for Disease Control and Prevention. (2009). Update on HIV/AIDS epidemic in Guangxi. Nanning, Guangxi, China: Author.
7.
HongY.FangX.LiX.LiuY.LiM. (2008). Environmental support and HIV prevention behaviors among female sex workers in China. Sexually Transmmitted Diseases, 35, 662–667. doi:10.1097/OLQ.0b013e31816b322c
8.
HongY.LiX. (2008). Behavioral studies of female sex workers in China: A literature review and recommendation for future research. AIDS & Behavior, 12, 623–636. doi:10.1007/s10461-007-9287-7
9.
HongY.LiX. (2009). HIV/AIDS behavioral interven-tions in China: A literature review and recommendation for future research. AIDS & Behavior, 13, 603–613. doi:10.1007/s10461-008-9483-0
10.
HuangY.HendersonG. E.PanS.CohenM. S. (2004). HIV/AIDS risk among brothel-based female sex workers in China: Assessing the terms, content, and knowledge of sex work. Sexually Transmitted Diseases, 31, 695–700. doi:10.1097/01.olq.0000143107.06988.ea
JanaS.BasuI.Rotheram-BorusM. J.NewmanP. A. (2004). The Sonagachi Project: A sustainable community intervention program. AIDS Education & Prevention, 16, 405–414. doi:10.1521/aeap.16.5.405.48734
13.
JeffreysE. (2004). China, sex, and prostitution. New York: Routledge.
14.
KerriganD.EllenJ. M.MorenoL.RosarioS.KatzJ.CelentanoD. D.SweatM. (2003). Environmental-structural factors significantly associated with consistent condom use among female sex workers in the Dominican Republic. AIDS, 17, 415–423. doi:10.1097/01.aids.000-0050787.28043.2b
15.
La PelleN. (2004). Simplifying qualitative data analysis using general purpose software tools. Filed Method, 16, 85–108. doi:10.1177/1525822X0325922
16.
LeCompteM. D.SchensulJ. J. (1999). Designing and conducting ethnographic research. Walnut Creek, CA: AltaMira.
17.
LiQ.LiX.StantonB.FangX.ZhaoR. (2010). A multilevel analysis of gatekeeper characteristics and consistent condom use among establishment-based female sex workers in Guangxi, China. Sexually Transmitted Diseases, 37, 700–705. doi:10.1097/OLQ.0b013e3181e1a2b2
18.
LiaoS. S.HeQ. Y.ChoiK. H.HudesE. S.LiaoJ. F.WangX. C.MandelJ. S. (2006). Working to prevent HIV/STIs among women in the sex industry in a rural town of Hainan, China. AIDS & Behavior, S35–S45. doi:10.1007/s10461-006-9143-1
19.
LillestonP.ReubenJ.ShermanS. G. (2012). “This is our sanctuary”: Perceptions of safety among exotic dancers in Baltimore, Maryland. Health & Place, 18, 561–567. doi:10.1016/j.healthplace.2012.01.009
20.
MoriskyD. E.ChiaoC.SteinJ. A.MalowR. (2005). Impact of social and structural influence interventions on condom use and sexually transmitted infections among establishment-based female bar workers in the Philippines. Journal of Psychology and Human Sexuality, 17, 45–63. doi:10.1300/J056v17n01_04
21.
MoriskyD. E.PenaM.TiglaoT. V.LiuK. Y. (2002). The impact of the work environment on condom use among female bar workers in the Philippines. Health Education & Behavior, 29, 461–472. doi:10.1177/109-01981020290040
22.
PanS. (1997). Three red light district in south of China. Guangzhou, China: Qunyan Chubanshe Press.
23.
RenX. (1999). Prostitution and economic modernization in China. Violence Against Women, 5, 1411–1436. doi:10.1177/10778019922183453
RubinH.RubinI. (1995). Qualitative interviewing: The art of hearing data. Thousand Oaks, CA: Sage.
26.
RyanG. W. (2004). Using a word processor to tag and retrieve blocks of text. Field Methods, 16, 109–130. doi:10.1177/1525822X03261269
27.
RyanG. W.BernardH. R. (2000). Data management and analysis methods. In DenzinN. K.LincolnY. S. (Eds.), Handbook of qualitative research (2nd ed., pp. 769–801). Thousand Oaks, CA: Sage.
28.
ScamblerG.PaoliF. (2008). Health work, female sex workers and HIV/AIDS: Global and local dimensions of stigma and deviance as barriers to effective interventions. Social Science & Medicine, 66, 1848–1862. doi:10.1016/j.socscimed.2008.01.002
29.
ShahmaneshM.PatelV.MabeyD.CowanF. (2008). Effectiveness of interventions for the prevention of HIV and other sexually transmitted infections in female sex workers in resource poor setting: A systematic review. Tropical Medicine & International Health, 13, 659–679. doi:10.1111/j.1365-3156.2008.02040.x
30.
ShannonK.KerrT.AllinottS.ChettiarJ.ShovellerJ.TyndallM. W. (2008). Social and structural violence and power relations in mitigating HIV risk of drug-using women in survival sex work. Social Science & Medicine, 66, 911–921. doi:10.1016/j.socscimed.2007.11.008
31.
ShannonK.StrathdeeS. A.ShovellerJ.RuschM.KerrT.TyndallM. W. (2009). Structural and environmental barriers to condom use negotiation with clients among female sex workers: Implications for HIV-prevention strategies and policy. American Journal of Public Health, 99, 659–665. doi:10.2105/AJPH.2007.129858
32.
ShermanS. G.ReubenJ.ChapmanC. S.LillestonP. (2011). Risks associated with crack cocaine smoking among exotic dancers in Baltimore, MD. Drug & Alcohol Dependence, 114, 249–252. doi:10.1016/j.drugalc-dep.2010.10.003
33.
SilvermanD. (1993). Interpreting qualitative data: Methods for analysing talk, text, and interaction. Thousand Oaks, CA: Sage.
SweatM. D.DenisonJ. A. (1995). Reducing HIV incidence in developing countries with structural and environmental interventions. AIDS, S251–S257. Retrieved from www.ncbi.nlm.nih.gov/pubmed/8819593
36.
TuckerJ.RenX.SapioF. (2010). Incarcerated sex workers and HIV prevention in China: Social suffering and social justice countermeasures. Social Science & Medicine, 70, 121–129. doi:10.1016/j.socscimed.2009.10.010
37.
WuZ.SullivanS. G.WangY.Rotheram-BorusM. J.DetelsR. (2007). Evolution of China’s response to HIV/AIDS. Lancet, 369, 679–690. doi:10.1016/S0140-6736(07)60315-8
38.
YangH.LiX.StantonB.FangX.ZhaoR.DongBHongY. (2005). Condom use among female sex workers in China: Role of gatekeepers. Sexually Transmmitted Diseases, 32, 572–580. doi:10.1097/01.olq.0000175418.48665.95
39.
YiH.MantellJ. E.WuR.LuZ.ZengJ.WanY. (2010). A profile of HIV risk factors in the context of sex work environments among migrant female sex workers in Beijing, China. Psychology, Health & Medicine, 15, 172–187. doi:10.1080/13548501003623914
40.
YiH.ZhengT.WanY.MantellJ. E.ParkM.CseteJ. (2012). Occupational safety and HIV risk among female sex workers in China: A mixed-methods analysis of sex-work harms and mommies. Global Public Health, 7, 840–855. doi:10.1080/17441692.2012.662991
41.
ZhengT. (2009). Red lights: The lives of sex workers in postsocialist China. Minneapolis: University of Minnesota Press.
42.
ZhangC.HongY.LiX.ZhouY.LiuW.ShanQ.SuS. (2013). Psychological stressors in the context of commercial sex among female sex workers in China. Healthcare for Women International. Advance online publication. doi:10.1080/07399332.2013.838247
43.
ZhangC.LiX.HongY.SuS.ZhouY. (2013). Relationship between female sex workers and gatekeeper: The impact on female sex worker’s mental health in China. Psychology, Health & Medicine. Advance online publication. doi:10.1080/13548506.2013.869612
