Strategic Response on HIV among Sex Workers in China - Literature review Example

Running Header: Strategic Response on HIV among Sex Workers in China Student’s Name: Instructor’s Name: Course Name & Code: Date of Submission: Introduction This paper will describe on the HIV and the impacts it has on sex workers in China. It also describes various recommendable actions and strategies undertaken by Chinese government and public health sector in response to HIV among sex workers. Commercial sex work in China is prostitution that is both direct (main profession) and indirect (engaging in transactional sex) that has widespread in China for the last 20 years of economic reforms (Xue, 2005). Sex workers are found from rural towns of China, big cities, and along trucking routes according to Xue (2005). In China, people who involve themselves in buying and selling sex pose a major high-risk behavior for HIV exposure in China. Commercial sex is one of the key drivers of HIV spread as well as the major group known to be contracting HIV at a very high rate in China. Commercial workers are known to transmit HIV infections to a large part of society. HIV has many social, cultural, and political impacts among the sex workers and the entire population in China. However, government through public health has responded to HIV issues among sex-workers by laying appropriate measures and strategies. Preventing HIV among those involved in the sex trade has been a major breakthrough in the fight against HIV by Chinese Government and other global governments (House of Commons & International Development Committee, 2006). In general, sex workers community in China is noted to have highest number of HIV infected persons that greatly influences the overall pattern of the AIDS epidemic. Therefore, HIV prevention interventions will provide a great assistance towards curbing the rising HIV transmission and its effects among the sex workers in China. This is achievable through setting of and coming up with strong strategic plans and recommendations of reducing HIV spread among the sex workers. Sex Workers Distribution in China According to William, Edward & Laumann, (2007), the estimated number of commercial workers is more than one million in China. The alarming increase rates in HIV prevalence among the sex workers have been in southern China provinces with Guangxi having the highest prevalence of HIV among commercial sex workers with 10 percent (Edward & Laumann, 2007). Other includes Guangdong with 3 percent and Yunnan with 5 percent (Edward & Laumann, (2007). In Chongqing municipality, there was rose of HIV infections attributed to sexual transmission among sex workers from 10 percent to 23 percent after some years with this high number of infected sex workers having a great impact on the life of Chinese society (Edward & Laumann, 2007). It is worthy to note that sex workers and their clients are the bridge for the epidemic to take off in urban centers, in particular the booming China’s southern province cities, special economic zones, and other areas bordering Hong Kong (David & Chris, 2007). The main clients of commercial sex workers in China include middle-class men and entrepreneurs; men in the highest 5 percent of income were 33 times more likely to have bought sex compared to lowest 40 percent of income (David & Chris, 2007). Impacts of HIV on sex workers in China According to Zunyou, Keming & Haixia, (2004), Illness, disability, and death caused by HIV have a great impact on sex workers in China and the sex workers infected with HIV usually experience a great burden economically towards catering for their deteriorating health. HIV/AIDS in most instances results to incapability of one to be productive that eventually results to instability of financial capacity. This leads to decline of investments that would have been used in future. This is because of high demand of health bills and health related bills (Zunyou, Keming & Haixia, 2004). The little amount of money sex workers get is used to cater for their health other than doing useful economic activities as illustrated by Yan, (2008). The diversion of available resources and investments to health related services as a means of reducing the HIV impacts in the bodies of sex workers is a major impact economically. Many sex workers in China turn to black-market drug sellers instead of formal health care sector whereby these black-market drug sellers usually sell overpriced and ineffective drugs to them hence straining them financially (Yan, 2008). The economic impact is also viewed in terms of its effects on the country because of diversion of resources to cater for HIV/AIDS between CSW as well as their decreased production because of the disease effects. Therefore, this calls for Chinese government to lay down strategies and recommendations that will curb the rising effects of HIV among the sex workers. According to Lieber et el (2006), One of the major social impacts that Chinese commercial sex workers face in society is stigma that has prohibited effective HIV/STD identification, prevention, and care. Stigmatization is not only due to their HIV status but also due to their position as sex workers hence society has certain values, beliefs, behavioral and emotional reactions to commercial sex workers and their HIV status. According to some sex workers in China, they felt that society had negative feelings about their status (Lieber et el (2006). They felt as if society viewed them to have incapacity to adhere to sexuality norms hence warranting the avoidance of infected individual. HIV status was also seen to promote anticipation of negative emotions such as embarrassment, fear, and shame as well as devalued social roles and status among the sex workers. HIV infected commercial sex workers view themselves as socially unacceptable in the society. Stigma is a major contributor of HIV related deaths among the commercial sex workers; this is because of the fear towards seeking necessary treatment in public health centers. This has also led them to live in denial, as they fear that society may have a negative attitude about them (Lieber et el, 2006). HIV-related stigma and discrimination hinder efforts in mounting an effective response to the prevention, treatment and care of commercial sex workers in China (Jelke & Nana, 2009). In most regions of China, society does not socially accept sex workers mainly because they are seen as the key transmitters of HIV infections. Therefore, setting strategies and recommendations that will reduce the impacts of social stigmatization among the commercial sex workers. This will be put in place by the Chinese government as an effort to curb the rising number of HIV infections among sex workers according to Jelke & Nana, (2009). As illustrated by Paul, (2008), sex workers often see themselves as marginalized and criminalized part of society by the government in China hence this has led to many of them hiding their status as sex workers and as individuals with HIV status. Therefore, it has become extremely difficult for them to be tracked and monitored by the government related HIV departments making it hard for them to have access to HIV prevention programmes. Sex workers feel that the government sees them as the core transmitters of HIV infections other than a community that bears the greatest impact of the HIV epidemic. Commercial sex workers in real sense feel that political view of their HIV status as ‘bridge’ population for the HIV transmission. According to Commercial Sex workers, there are not protected by the law because no legislation and policies protecting them and in some instances illegalization of sex work, this acts as a major barrier to condom and testing promotion among sex workers and their clients. This calls for a different political view regarding HIV status among sex workers hence it is also crucial for the government to encourage sex workers to seek for preventative ways as a way of curbing the spread of HIV among them (Watts, 2003). HIV and other Challenges facing Sex workers in China Joseph & Dudley, (2009) argues that, Sex workers are not only faced with stigmatization challenges but other political, economical, and social challenges as well. Some of these challenges have led to slowed efforts of seeking prevention to spread of HIV infections among the sex workers. Stigmatization and fear of disclosing the status are the major challenges that sex workers are experiencing in China and this has led to their inability of sex workers to access the public health areas that provide drugs and other HIV related information and services. Some sex workers may be denied access to services by some health services providers because of their HIV status. With no access to these services, sex workers face a higher risk of HIV infection and even more likely to pass on HIV after being infected. Lack or inadequate accessibility of HIV related information, care, and drugs are other problems or challenges that sex workers are undergoing in China (Joseph & Dudley, 2009). Inability to negotiate for their rights when dealing with their clients is a major contributing factor among the sex workers like in case a client declines to use protection, this leads to higher transmission of HIV among them. They are increasing cases of rape among the sex workers in China, which is also transmitting HIV rapidly (Joseph & Dudley, 2009). Lack of equal employment and education opportunities especially for women has led to the rise of this group of sex workers and this has become a major barrier for the Chinese government in its efforts to curb the rising cases of HIV among the sex workers (Joseph & Dudley, 2009). HIV among Injecting Drug Users, Plasma Donors, MSM, and MCT In China, HIV transmission has also been on rise among Injecting drug users. This is mainly due to expansive sharing of needles resulting to transmissions. This is most common even among sex workers. There is need for establishing harm reduction measures such as drug substitutes and needle exchange programs as argued by Joan, Arthur & Tony, (2006). HIV in China especially in Henan, Hunan, Hebei, and Shanxi provinces has also affected blood plasma donors greatly in mid-1990s as Sex workers blood samples was mixed with other with little oversight and control (Joan, Arthur & Tony, 2006). This led to high spread of HIV to both public and donors due to use of contaminated collection practices resulting to 24 percent of current HIV infections (Joan, Arthur & Tony, 2006). Men who have sex with men are also another group of people greatly affected by HIV and this group is not well investigated hence prone to HIV at a higher rate. However, the Chinese government is undertaking necessary measures to reduce transmission among these people (Joan, Arthur & Tony, 2006). Mother-to-Child transmission is also another channel that is greatly playing a great part in China. However, Chinese government has provided free drugs for HIV-infected pregnant women in order to prevent transmission of HIV to newborn babies with programs for pregnant women being started across different health centers in China (Joan, Arthur & Tony, 2006). Government response in HIV control among sex workers As a way of combating this rising risks and spread of HIV among the sex workers, Chinese Government has restructured and funded its public health through set up of institutions like National Free Antiretroviral Therapy in most parts of China (Kartikeyan, 2007). Access to HIV treatment among sex workers is becoming increasingly popular and available in most areas. In 2003, Chinese government responded to the rising challenges of HIV among sex workers as well as in the entire Chinese republic (Kartikeyan, 2007). The proposed strategy of preventing secondary transmission of HIV is an essential part of the Chinese government response to HIV. This is being achieved through increased voluntary counseling and testing (VCT) facilities in almost every area in China and in particular, where sex workers are in majority. China is in a good position to benefit from its targeted intervention strategies of curbing HIV. Chinese government has increased its response to tackle HIV through its increased funding of HIV preventative measures (Kartikeyan, 2007). By the end of 2003, government commitment had become a priority for the Chinese government State Council as well as high-level response body led by vice Premier Wu Yi (Kartikeyan, 2007). This rapid response by the Chinese government has been to bear fruits in the sex workers community in terms of reducing the effects of HIV in them. As Coughlan, Mindel & Estcourt, (2001) argues, the establishment of programs such as China CARES by the government is a clear indication that Chinese Government is strongly concerned with the sex workers who are greatly affected by this epidemic. This program started in March and it was a clear indication of government move from silence to fully action against the increasing threats of HIV infections among commercial sex workers and entire country. The other strategy that Chinese government has come up with is preventing secondary transmission of HIV (Coughlan, Mindel & Estcourt, 2001). This is through identification of currently infected sex workers and providing them with the necessary knowledge, skills, and social support as a way of transmitting AIDS to other people. The government has increased access to ARV drugs among the sex workers; this is through increased HIV centers. There has been increased encouragement by Chinese government to widespread testing capacity in areas with large number of sex workers. These areas have increased capacity for AIDS care and support due to government intervention. In China, they are national law and local regulations that permit the mandatory HIV testing of many categories of people. Government active testing invites members of vulnerable groups including sex workers (Xue, 2005). There is significant social pressure from health workers and local authorities for sex workers to take HIV test. In China, the statute on AIDS prevention (2006) expects local government to give confidential HIV testing and free ARV drugs and it strictly outlaws discrimination against those people living with HIV with guaranteed rights to health care and employment among others (Xue, 2005). Recommendable Public Health Response to HIV among Sex Workers There is need for the health care system to increase basic HIV care to areas with high number of sex workers. This is through increased supply of ARV drugs as well as increased educational encouragement for those sex workers to participate in HIV testing and control measures. This is through educating them on the need to know their status. In cases where sex workers are found with HIV, they are encouraged to seek for medical care including ARVs and other guideline information. Public health should address the issue of condoms access by providing them in plenty in accessible areas for sex workers by the public health department as clearly illustrated by Kartikeyan, (2007). It is important for Chinese government and public health to take an initiative of understanding how the commercial sex industry functions in terms of business. This will act as an initial step towards eliminating the rising effects of HIV in the society. It is also crucial and recommendable for Chinese government to establish the main reasons behind rising number of sex workers. In most occasions, unemployment plays a key role in the establishment and spread of HIV. Therefore, Chinese government should put all the necessary efforts in improving employment opportunities among the young people regardless of their gender. It is also important for Chinese government to set up achievable outcomes in trying to eradicate HIV effects. Some of the outcomes that should focus on include an increased level of condom use as well as safer sex among the sex workers together with their clients. The second outcome; increased sex worker participation and control over their social and working conditions and the third outcome is; decrease in the number of sexually transmitted infections taking place among commercial sex workers (Xue, 2005). Some of the other steps and effective measures that can be taken into consideration are educating sex workers and their clients about HIV are another effective measure. Encouraging of peer education on sex workers to inform and teach them about HIV. The government, public health, and other NGO’s in China should assist sex workers in forming groups together that will help them in overcoming effects of HIV including stigmatization that communities attach to sex workers and HIV (Felissa & Jerry, 2009). These groups will as well assist them in getting required health services for the affected and reduction of HIV transmission to the clients. Those not affected will also be encouraged on using the appropriate preventive measures to reduce the rates of infection. Other effective measure that government and concerned organizations should put in place is ensuring they are laws and policies respecting the rights and human rights of sex workers. This will reduce the fear they have on political and government institutions about their work status. It is also important for the government and concerned NGOs to encourage women to seek for any available employment opportunities without much regarding sex work as an employment opportunity. These strategies and recommendations if taken into consideration by Chinese government will have some implications in HIV prevention programmes (Felissa & Jerry, 2009). Chinese government should address society-based care and support capacity foundations for the sex workers that will give social and relief services to the sex workers and that will serve as a breakthrough towards cutting down the levels of HIV spread among the high-risk group and society in general (Catherine, 2008). Government should also set up risk reduction measures as a way of curbing the spread of HIV in China. It is recommendable that public service in collaboration with government to set-up long-term counseling and support mechanism and to increase basic clinical care capacity for HIV among sex-workers. The health services in areas with higher number of sex workers should be more equipped and funded in ensuring fully and successful diagnosis and treatment of the virus. In fact, this should be treated as an urgent problem among the sex workers. It is important to note that lack of absence of meaningful treatment programs will be a major obstacle towards preventing HIV transmission by sex workers. Extensive training and educating sex workers who are not affected with HIV should be carried out as this will be a major breakthrough in reducing the effects and spread of HIV in Chinese sex workers industry Bertelsmann, (2007). Strategies undertaken in India on HIV among sex workers International HIV & AIDS Charity (2010) argues that, In India, the Sonagachi programme to assist sex workers has been set up in central district of central Kolkata (Calculata). This was started in 1992 with the main goal of assisting sex workers in overcoming HIV on their own means. Sonagachi project is based on 3R that means ‘respect’ for sex workers and others involved. The third R means ‘Reliance’ on the sex workers to undertake the programme: ‘recognition’ of the rights for sex workers. It also encourages the use of condoms while addressing social and economic challenges facing the sex workers. This programe has led to impressive results as condom use has rose to 86 percent in 2001 from 27 percent in 1992. Avahan programme was started 2003 across India in six high-prevalence states aiming at sex workers. This has led to increased use of Condom among sex workers by 18 percent with HIV decline rate by 4 percent in Karnataka (International HIV & AIDS Charity, 2010). This is a recommendable example that Chinese government should practice. Conclusion Conclusively, Chinese government has increased attention and input in responding to HIV among the sex workers. It has put HIV basic needs and other related care including provision of condoms and ARV treatment as its first priority (Felissa & Jerry, 2009). This is as a measure of ensuring sex work sector does not become hub of HIV infections. This is an indication of its commitment in reducing the impacts of HIV among se workers. It is vital to know that adequate provision of care and treatment with capability of extending HIV cases through VCT and other health centers by the government can quickly scale up the preventative measures. According to gathered evidence from sex workers in China, those informed of their HIV status is an effective intervention leading to reduced risk of secondary transmission. Chinese government has established a National Five Year Action Plan for prevention and control of HIV according to Czeslaw, (2006). This calls for local authorities and NGOs develop targeting interventions among sex workers. It is important for the sex workers to be exposed to the society as a increasing their preventive precaution. This is because it is more difficult to reach them when they are hidden. According to recent statistics, HIV prevention programmes reach only 25 percent of sex workers. In 2003, only 19 percent of sex workers reported to have used condoms consistently (Li, Lin & Wu, 2006). The three major features that Chinese government has put in place towards changing the course of HIV epidemics among sex workers include addressing the specific behaviors causing most infections while providing particular services towards reducing risks associated with behaviors of sex workers. The second feature includes providing accessible information and services on a large scale in order to make an impact on HIV transmission. The third feature by Chinese government is ensuring adequate support from social, political and security environment in providing suitable HIV prevention services to sex workers and allowing them adopt safer behaviors. References Bertelsmann, S 2007, Asia: changing the world, Verlag Bertelsmann Stiftung, California. Catherine, S 2008, ‘Gendered Economic, Social, and Cultural Challenges to HIV/AIDS prevention and intervention for Chinese Women’, Journal of Human Behavior in the social Environment, vol. 17, no. 3, pp.339-360. Coughlan, E., Mindel, A & Estcourt, C 2001, ‘Male clients of female commercial sex workers: HIV, STDs and risk behavior’, International Journal of STD and AIDS, vol. 12, no. 10, pp. 665-669. Czeslaw, T 2006, Critical Issues in Contemporary China, Routledge, New York. David, C & Chris, B 2007, Public Health Aspects of HIV/AIDS in low and Middle, Springer, New York. Felissa, R & Jerry, D 2009, The person with HIV/AIDS: nursing perspectives, Springer Publishers, New York. House of Commons & International Development Committee 2006, HIV/AIDS: Marginalized groups and emerging epidemics, The Stationery Office, London. International HIV & AIDS Charity 2010, Sex workers and HIV prevention, Viewed 9 January 2011, http://www.avert.org/sex-workers.htm Jelke, B & Nana, K 2009, ‘Gender and HIV/AIDS; Critical Perspectives from the Developing World’, Ashgate Publishing Limited, Farnham. Joan, K, Arthur, K & Tony, S 2006, AIDS and Social Policy in China, Harvard University, Massachusetts. Joseph, T & Dudley, L 2009, Gender Policy and HIV in China: Catalyzing Policy Change, Springer, Beijing . Kartikeyan, S 2007, HIV and AIDS: basic elements and priorities, Springer, New York. Li, L., Lin, C & Wu, Z 2006, ‘Stigmatization and shame: consequence of caring for HIV/AIDS patients in China’, AIDS Care, vol. 10, no. 5, pp. 108-112. Lieber, E, Li, L., Zunyou, W, Mary, J., Jihui, G & National Institute of Mental Health (NIMH) Collaborative HIV Prevention Trial Group 2006, HIV/STD Stigmatization Fears as Health Seeking Barriers in China, vol. 10, no. 5, pp. 463-471. Paul, V 2008, Global HIV/AIDS medicine, Elsevier Inc, Beijing. Watts, J 2003, China faces up to HIV/AIDS epidemic, Lancet 2003, vol. 7, no. 3, pp. 362-412. William, L, Edward, O & Laumann, S 2007, ‘Sexual Behavior in China: Trends and comparisons’, International Journal of Epidemiology, vol. 33, no. 4, pp. 729-756. Xue, B 2005, ‘HIV/AIDS policy evolution in China’, International Journal STD & AIDS, vol. 16, no. 2, pp. 459-464. Yan, H 2008, Psychological Wellbeing and HIV Risks of Female Sex Workers in China, VDM Verlag, Michigan. Zunyou, W., Keming, R & Haixia, C 2004, ‘The HIV/AIDS Epidemic in China: History, Current Strategies and Future Challenges’, International Journal of Epidemiology, vol. 16, no. 1, pp.7-17. Read More