Tingting Shen and Joanne Csete
HIV prevalence in China is low in the general population but higher among certain key affected populations, including sex workers. Providing and purchasing sexual services are criminal offenses. Police engage in humiliating and repressive practices against sex workers. A study reported here based on the experience of over 500 sex workers highlights that the human rights abuses that sex workers face at the hands of the police directly undermine the country’s HIV response toward sex workers. An important element of this phenomenon is the police’s use of condoms as evidence of sex work, which impedes sex workers’ possession and use of condoms. Whereas in some countries, sex worker collectives have helped empower sex workers to stand up to the police and safeguard their use of condoms, restrictions on civil society in China make such a strategy impossible. Removing sex work and related activities as offenses under the law in China, however politically difficult it might be, would ease this situation. Short of that, improving the coordination among and strategic harmony of public health and police roles and authorities would be useful.
China’s HIV epidemic is characterized by low prevalence in the general population but higher prevalence among key affected populations, including people who inject drugs, sex workers, and men who have sex with men. According to government figures, sexual transmission accounts for most new HIV cases; in 2014, about 25% of new cases were estimated to be linked to sex between men. There is no authoritative consensus on the number of female sex workers in China, but most estimates suggest there are several million. There is limited information on the number of (cisgender) male and transgender sex workers. (Unless otherwise noted, in this paper “female sex workers” refers to cisgender women in sex work, and “male sex workers” refers to cisgender men. “Transgender women” refers to persons who have made a gender transition from male to female.) Sex work is prohibited under administrative law, and some activities associated with sex work are criminal offenses, as described in more detail below.
While Chinese authorities continue to crack down on sex work, the government has set up policies and programs to prevent the sexual transmission of HIV, including the extensive rollout of condom and HIV testing programs. Undermining the public health outcomes of condom programs, police often search for and confiscate condoms from sex workers and use condoms as evidence of sex work in order to detain or punish sex workers. While this practice has been reported in many articles, there has been little investigation of its impact on sex workers’ lives and human rights, as recounted by sex workers themselves. Mechanisms have been established from the central to local levels to coordinate and mobilize relevant departments, including police and security officials, in support of HIV prevention, but these mechanisms have failed to work. The government has also emphasized the importance of involving public security in the HIV response, including supporting the promotion of condoms in entertainment venues.4 However, to date there is no definitive guiding document or plan on how exactly the police should carry out this order or who is responsible for ensuring whether and how they do so. This article explores that gap, highlighting sex workers’ first-hand accounts of police practices and their impact on sex workers’ ability to protect themselves from HIV. Other evidence related to the health impact of policing on sex workers with respect to HIV is also reviewed.