Stressors and mental health challenges faced by immigrant Chinese massage parlor workers in HIV prevention

Background: The prevalence of HIV/AIDS among Asian Americans in the US has grown substantially, especially for women. Between the years 2001-2004, the proportion of HIV/AIDS diagnoses among Asian American females aged 15-39 years increased more than other similar age racial/ethnic groups. Of particular concern, but little understood, is HIV risk among Asian immigrant women who are sex workers, especially the potential mediators and moderators for safer sex behavior (e.g., condom use). Method: Facilitator notes from twenty-two sessions of a culturally-tailored HIV prevention intervention program developed for Chinese monolingual massage parlor workers were coded and analyzed. Results: Study participants described mental health challenges including feelings of social isolation, shame and stress. There were multiple sources of stress which included: financial cost of immigration; need to financially support family with limited work options; inability to disclose to family and friends; harassment by customers. These sources of stress were also associated with the women choosing to enter the massage parlor/sex work industry (lack of available employment options) and not being able to exit the industry. Additional stresses were experienced when these women were arrested on suspicion of prostitution because of a lack of licensing (required by the state of California for masseuses). Implications: Addressing social isolation and mental health challenges of immigrant populations is a priority, however, more research is needed to clarify the mechanisms that influence HIV risk behaviors.