Stigma against female sex workers and the associated sexual risks

Background: There is an estimate 10 million female sex workers (FSWs) in China, most of them work in entertainment establishments. Despite their visible existence, FSWs are subject to stigma and discrimination from the society. Data on FSWs' perceived stigma and associated sexual risks are limited. The current study attempts to fill out the literature gap by examining the relationship between perceived stigma and sexual risks among FSWs in China.

Methods: A total of 1,022 FSWs were recruited through community outreach from different types of commercial sex venues in Guangxi, China. The FSWs completed a self-administered a cross-sectional survey on their demographics, perceived stigma, depression, and HIV/STI-related behaviors. The scale of perceived stigma against FSWs was developed from prior qualitative studies and had a Cronbah alpha of 0.83.

Results: The mean score of perceived stigma was 33.6 (ranged 17 to 57). Perceived stigma as strongly correlated with depression (p<.001). FSWs who perceived higher level of stigma were less likely to report consistent condom use (p<0.1), more likely to experience intimate partner violence from clients (p<0.05) and stable partners (p<.0001). After controlling for potential confounders, perceived stigma was still strongly associated with inconsistent condom use (p<.05).

Conclusion: The stigma against FSWs has become a barrier for FSWs' HIV/STI preventive behaviors. In interventions to reduce HIV risks among this vulnerable population, it is important to advocate for their rights and implement constructive policies to reduce stigma. Economic empowerment and educational opportunities are urgently needed for FSWs.