HIV risk behaviors among male customers of Asian massage parlors in San Francisco

Background: Our previous studies reported that Asian female sex workers at massage parlors in San Francisco did not always use a condom with customers because of masseuses' and customers' attitudes toward practicing safer sex and subjective assessment of risk of HIV/STIs as well as unspoken rules at massage parlors. Methods: Thirty four Asian, African American, and Caucasian male customers who regularly engaged in sex with Asian masseuses in San Francisco were recruited through advertisements. Five separate focus groups were conducted covering topics such as substance use, sexual practices with masseuses and private partners, and attitudes and cultural ideas toward masseuses. Results: Most participants were aware of the importance of condom use during vaginal sex with masseuses; however, inconsistent condom use was reported by a few customers. Almost all participants denied condom use for oral sex. Having sex under the influence of substances was commonly described: Asian participants were likely to have sex with masseuses while intoxicated, whereas African American and Caucasian participants tended to have sex with masseuses under the influence of drugs. Overall, participants had low HIV/AIDS knowledge and did not feel susceptible to HIV/STIs. Due to the masseuses' cultural backgrounds, gender, and immigrant statuses, participants perceived masseuses as submissive and vulnerable, and exerted control over the masseuses, which could possibly lead to forced or unprotected sex. Conclusions: Understanding the cultural biases toward Asian masseuses and the masseuse-client dynamic is crucial to developing effective intervention programs targeting both clients and masseuses.