News: China Exclusive: Anti-AIDS Campaign Spotlights Sex Workers
By Zhou Yan, Xinhua General News Service
4 May 2005
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Tan Meirong never expected her job as a gynecologist would take her to beauty parlors in the city's " red-light" district for friendly little chats with prostitutes.

For the young doctor based in Liuzhou, south China's Guangxi Zhuang Autonomous Region, the word "doctor" took a new meaning in 2003, when the hospital she works for signed up a public health program financed by the World Bank to curb the spread of AIDS among susceptible groups -- sex
workers in particular.

The nature of her job changed dramatically. Instead of sitting in a consulting room waiting for her patients, she goes to beauty parlors, hotels, nightclubs and other entertainment outlets that may feature prostitution.

Her job is to prevent AIDS and other venereal diseases among sex workers in Liuzhou, a passageway to the notorious drug production center the "Golden Triangle" between Myanmar, Thailand and Laos, by persuading them to use condoms to protect themselves and offering checkups and consulting services on basic health issues.

China's campaign to fight AIDS and safeguard public health has finally spotlighted sex workers, a group who some view as sinners and earners of undeserved income.

"I'M A DOCTOR, NOT A POLICEMAN OR A JUDGE"

Liuzhou, a city with 3.64 million permanent residents, has nearly 10,000 drug users, 21 percent of whom are HIV carriers, according to the local public security bureau.

Each year, about 250,000 migrant workers flow into the city from the countryside, mostly young people who have hardly received any formal education and know little about safe sex.

Statistics provided by the city's public health administration say at least 10 percent of the city's confirmed HIV cases were transmitted via sex. In 2000, the figure was only three percent.

Incomplete statistics suggest the HIV infection rate is 1.5 percent among sex workers, a group of nearly 5,000 scattered in more than 1,000 beauty salons, karaoke bars and massage services in the downtown areas, according to a recent survey.

"Sex services are offered under the table even after years of crackdown," said Huang Haibo, a health official. "It's difficult to determine the exact number of sex workers, let alone to talk face to face with them."

Huang said four downtown hospitals have opened outpatient departments to treat venereal diseases and to prevent AIDS/HIV transmission among the vulnerable group.

The hospital where Tan Meirong works, the No. 2 Workers' Hospital affiliated with Liuzhou Air Compressor Group, is one of these four.

"It was not easy at all to start with. I found the biggest obstacle was learning how to enter those facilities and win the prostitutes' trust," said Tan. "Though many agreed to accept a checkup, very few of them showed up -- they thought we were undercover policemen."

But Tan and her colleagues persisted -- they readjusted their schedules in order to provided free checkups to the prostitutes. " The results were astonishing: of the 151 that accepted the checkup, one third were suffering from venereal diseases," she said.

To win the girls' trust, Tan would bring them little gifts, such as dainty key rings or stockings, along with condoms and leaflets about AIDS and venereal diseases, printed with the hospital's consulting hotline.

"One girl was in tears when I brought her a cake on her birthday -- she became a prostitute at 16 and had never celebrated her birthday before," said Tan.

Once she won their trust, the girls began to visit Tan at the clinic. "I'd receive eight to 20 phone calls a day on my cell phone when I'm out of town. Sometimes runners of entertainment outlets would invite me to their places to answer the girls' queries and even invite me to dinners."

After two years of meetings with sex workers, Tan said she could tell at a glance which beauty parlors or bars offer sex services. "But my job as a doctor never changed. I'm not a policeman or a judge. Everyone that comes to me is a patient and my job is to provide them with medication, remind them to protect themselves and respect their privacy."

CHANGING MENTALITY

Experts say the city's move to offer consulting services and medication to sex workers is changing its people's mentality.

"Prostitutes and druggers were perceived to be sinners who ought to be put behind bars or under forced labor," said Wu Zunyou, a researcher with Chinese Center for Disease Prevention and Control. "Today people have come to understand they're a disadvantaged group that need help."

According to Tan Meirong, many prostitutes she met knew very little about how venereal diseases were transmitted. "Nearly 25 percent of them believed having dinner at the same table was a means of transmission."

Thanks to the sustained efforts of Tan and her fellow gynecologists, the girls have learned a lot more about how to protect themselves from disease -- 70 percent of them now believe a condom protects them from AIDS, according to the disease prevention and control center in Liuzhou.

Incomplete statistics provided by the center say at least 61 percent of the sex workers use condoms, compared with 30 percent before the doctors' intervention.

"It's no easy job," said Dai Zhicheng, president of China Association for Venereal Disease and AIDS Control and Treatment. Sex workers who need medication always think twice before going to the hospital because they fear facing doctors' apathy or reproaches."

A friendly little chat with a gynecologist who treats them as ordinary patients, therefore, has a wondrous effect, he said.

Promoting the use of condoms among the AIDS-vulnerable population, mainly prostitutes and drug users, has also topped the agenda of the Chinese government in its fight against AIDS, according to a circular issued by the State Council in 2004.

China's action plan for AIDS prevention for 2001 to 2005 said the country will popularize the use of condoms among at least half of the AIDS-susceptible population by the end of 2005.

Last year, the southwestern Yunnan Province started to provide condoms in hotel rooms with the other toiletries like toothpaste, as part of its effort to control the spread of AIDS.

Yunnan Province, which had 13,948 HIV positive cases and 841 AIDS patients at the end of 2003, has also inked the decision into a local law on AIDS prevention, the first provincial law of its kind in China.

A LONG WAY TO GO

For Tan and her colleagues, the support of police and the general public is indispensable. "Police once confiscated all the condoms I sent to a beauty parlor and used them as evidence against its owner," she said.

Following that event, the local public health bureau included police officers, judicial workers and market regulators in their training programs on AIDS prevention and convinced police not to relate condoms to prostitution.

"Dispatching condoms at hospitality facilities is somewhat contradictory to our crackdown on prostitution," said Ren Dongyang, a police officer with Liuzhou Public Security Bureau. "But disease prevention is a life-and-death issue and is therefore more important than the crackdown."

Still, Ren insisted that promoting health education among sex workers and offering them checkups do not mean prostitution has been legalized in China. "Far from it," he said.
The officer said he would like to contribute to AIDS prevention, too, but a policeman is not entitled to do that according to Chinese law. "I just hope more policies will be made to better regulate the hospitality industry."

By February 2005, Guangxi Zhuang Autonomous Region had 11,979 HIV carriers, the third largest number in China following Yunnan and Henan provinces, according to regional AIDS control authorities, who said young people account for the majority of the HIV cases.

According to an assessment report on China's AIDS prevention and control released by the Ministry of Health released early last year, HIV cases had been reported in each of the Chinese mainland 's 31 provinces, autonomous regions and municipalities.
Ministry of Health figures say there are 840,000 HIV carriers on the mainland, of whom 80,000 suffer from AIDS.

Source: The PUSH Journal

A posting from Sex-Work (sex-work@eforums.healthdev.org)

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sex-work and HIV/AIDS.