HIV-related risk behaviors among Asian female sex workers in San Francisco

Background: Asian massage parlors where customers pay for sexual services can be found in large cities in the U.S. Asian masseuses with limited English skills engage in unprotected sex with customers in a harsh work environment. This study aims to describe HIV risk behaviors among masseuses based on the baseline data of a health promotion intervention study.

Methods: Twenty-three massage parlors were identified in downtown, San Francisco. A total of 105 masseuses (46 Vietnamese, 34 Koreans, 25 other Asian ethnicities) were interviewed using a baseline questionnaire.

Results: Vietnamese were older (M=38 years), less educated, and earned less than Koreans (M=33 years) and other Asians (M=34 years). In the past six months, inconsistent condom use with customers was at 11% for vaginal sex and 20% for oral sex. Inconsistent condom use for vaginal sex was associated with being older and having a higher depression score. Korean masseuses were more likely to have sex with customers under the influence of alcohol and be forced by customers to have sex with than other groups. Vietnamese masseuses were less likely to be acculturated and receive social support, and more likely to be depressed compared with other groups.

Conclusions: Ethnic differences in HIV risk behaviors among Asian masseuses could be attributed to social and cultural contexts in which masseuses engage in sex work. Despite of a huge public health impact, Asian masseuses have been neglected. Culturally appropriate intervention programs for Asian masseuses are needed to address HIV/STIs, substance abuse, and mental health problems.