Qualitative Study On The Organizational Structure And Influencing Factors Of High-risk Sexual Behavior Of Older Female Sex Workers In Qingdao City

1、BackgroundIn recent years, the AIDS infection in the elderly population shows a trend of rapid growth, and seriously do harm to the health of the elderly. Unsafe sex with Old Female Sex Workers (OFSWs) is the most important transmission. AIDS is spreading to the elderly population by OFSWs. For the effective prevention of the spread of ⅢⅤ/AIDS and sexually transmitted diseases in the world, we must work for the main AIDS/SID infection source among OFSWs. There arc few OFSWs sex risk nature study and epidemiological background data in China, and these data have an important role in the development of the measures to reduce the risk of HIV infection among OFSWs and elderly population.2、ObjectivesThis qualitative study aimed to understand the reasons and ways of the OFSWs entrance into the sex industry, as well as their social network structure, and reveal the AIDS/STD related risk factors uncleared before, including: personal, interpersonal and environmental factors on OFSWs risk behavior.3、MethodsThe method of the study is qualitative interviews of the OFSWs and their bosses. In-depth interviews were conducted among the OFSWs, and group interviews among the foreman and bosses. Interviews were guided by trained professionals with informed digital recording, to facilitate the collation of data and checking of interviews afterwards.4^Results4.1The background information of OFSWsDemographic characteristics:22OFSWs were interviewed, the age ranged from35to60years, with the average age of43years. Education level was low. In this study,19OFSWs were divorced or widowed, and21have one or two children. Before their entrance into the sex industry, they mostly engaged in some low-paying jobs. In addition to a OFSWs in nightclub work, the other21are low-level sex workers. The22OFSWs deny having a history of STD and AIDS, the low prevalence of STD and AIDS has been confirmed by site owners and pimps. Characteristics of OFSWs commercial sexual partners:OFSWs reception1-2clients per day, the number of clients they reception depends on the police management degree and OFSWs work activity. Commercial sexual partners aged40-60years, mainly migrant workers and elderly widows.Price of sexual services:OFSWs mainly provide low-level services,30-200RMB a time, mainly50-100RMB. The average monthly income is about two or three thousand RMB.4.2Reason and approach to entrance into sex industryThe main reasons that OFSWs entranced into the sex industry mainly are economic factors, the social environment and the attractiveness of service work. Kconomic factors are the most important and the most direct cause, and can be strengthened by other factors. Older women’s economic pressure come from divorced or widowed, children and debt dependent. Older women is in a obvious weak position in employment, they cannot find a suitable job to support the family in the case of economic difficulties, so they had to seek new ways to solve the economic difficulties. The characteristic less labor with more income of sex service work attracted these old women.In this study, there was no women entrance into the sex industry because of coercion or being trafficked. Most of them are on the basis of their own will, in the persuasion of others to enter the industry. Introduction of a friend or fellow is the most important way to their entry into the sex industry, followed the way of exposure to this industry and tempted.4.3The Organizational structure of the OFSWsSimilar to the structure of the sexual services with other sex workers worldwide, OFSWs is divided into the place based OFSWs (formal) and station street OFSWs (informal). The place based OFSWs are formal, and there will be a third party to assist in commercial transactions. Station street OFSWs recruit in parks, streets and other independent soliciting customers of sex workers or others.4.3.1The Organizational structure of the station street OFSWsStation Street OFSWs generally solicit in the streets, parks or the Internet, a few are introduced by pimps and other workers. They have more than a soliciting pathway in this study. The OFSWs usually consult with the clients face-to-face of the details about the transaction detail, such as location, price and so on. In the course of negotiations, these OFSWs will judge whether the clients have a violent tendency by the age of the clients, appearance and language features. Whether the clients is safe is the most important factor. Sex transaction happened in individual apartments, hotels or introducer or guests at home, specifically determined by negotiation between the OFSWs and their customers. There will be a secondly screening in the sex trade with the clients. OFSWs exam the clients by visual inspection to determine their health status, and if an abnormal situation was found, the sex trade will stop. Moreover, in addition to determine the security of the clients. OFSWs also negotiate on own more concerned with the guests before the sex trade, such as condom use and sexual intercourse way. If at this time clients refuse to use condoms or require non-normal sexual intercourse, many OFSWs also stop this transaction. 4.3.2The Organizational structure of the place based OFSWsThe place based OFSWs work in roadside beauty shops, massage parlors or ballroom. The study found that only a few OFSWs work in places, and basically in the low-end places. When guests come to these establishments, OFSWs are usually allocated by spaces bosses and clients. There is not fixed sex trade places in the low-end service establishments. The OFSWs can place the guests take out transactions or in the establishments. This mainly depends on the negotiation of the guests and sex workers. Sex workers who work in the low-end service establishments generally do not have very strict rules to comply, with the provisions of the commission to the boss after the sex trade. No labor contract signed between spaces and sex workers, sex workers can leave the place any time.4.4The impact of environmental factors and social network factors on OFSWs high-risk sexual behavior4.4.1High-risk sexual behavior in commercial sexIn the study, OFSWs are high condom use level, OFSWs express that they have developed a habit of regular condom use. Places boss and foreman also confirmed that over90%of the sex trade use condoms. However, in some cases, some OFSWs may compromise. Reason to give up consistent condom use include:Guests increase transaction prices; transactions with the familiar guests; elderly clients refuse to use condoms because of erectile dysfunction, several reasons may exist at the same time. In addition,70%of the OFSWs reflect that they have encountered condom breakage and slippage. Although most of the OFSWs have a high condom use level with commercial sexual partners, but they did not use condoms with non-commercial frequently.4.4.2Factors affect sexual risk behavior in the sex tradeIn the sex trade, the factors that affect sexual risk behaviors include:personal factors, interpersonal factors (social network factors) and environmental factors. Personal factors affected sexual risk behaviors including OFSWs HIV/STD awareness of the situation and danger awareness and attitudes towards the use of condoms, condom use self-efficacy and substance abuse. In the study, OFSWs show a positive attitude towards condom use, there is no obvious substance abuse. HIV/STD known and the awareness of the danger and the use of condoms, self-efficacy is a major factor affecting OFSWs insist on condom use.Interpersonal factors affected sexual risk behaviors including peer network, sexual network, and places boss and pimp. Which companions of OFSWs can provide them with moral and material support, commercial sexual partners affect the use of condoms, places boss and pimp provide sex trade support, such as help OFSWs to attract guests in the areas, supply free condoms, help them to solve troublesome guests and protect their security.Environmental factors affect the sexual behavior including accessibility of condom and health services, sex workers stigma and violence factors. Although different ways of access to condoms. OFSWs can easily get condoms. To facilitate the access to health services OFSWs showed a higher rate of condom use. The stigma of sex workers make a lot of OFSWs an extremely negative in terms of interpersonal relationships, to deprive them of access to health services in a timely manner, and not conducive to health promotion activities to promote.5、Conclusion5.1Majority of The Qingdao older women sex workers (OFSWs) are divorced and widowed. condom use level is high.5.2OFSWs entrance into the sex industry mainly because of economic reasons, to raise up their young or school children in the most important driving force to entrance into the sex industry."Laoxiang" played an important role in the process of promoting their entry.5.3the organization of OFSWs shows a form of freedom, the OFSWs can get a limited protection by third parties in the sex trade. 5.4Individual factors social network factors and environmental factors OFSWs, in high-risk sexual behavior affect.