“Laugh at poverty, not at prostitution”: a mixed methods study of the drivers of HIV among male sex workers in China

Background
This paper presents the first mixed methods study of the HIV risk environments of MSW in China. Chinese MSW are highly stigmatised, occupying marginal social positions, undertaking illegal/hidden behaviours. They are at an increased risk of HIV infection due to multiple risk exposures.
Methods
The mixed methods research was conducted in Guangdong, China in 2011. Following ethnographic mapping, MSW (n=251) were surveyed using a structured questionnaire and a sub-sample (n=21) were interviewed in-depth.
Results
Levels of HIV knowledge varied according to a number of socio-economic variables. Reasons for entering sex work, and subsequent risk taking behaviours including drug use appeared to largely centre around economic needs or desires. The survey reveals that levels of condom use varied considerably by partner type and gender. Qualitative analyses suggest that issues of intimacy and stigma played an important role in this behavioural decision making process. These men also show very high levels of mobility, making them hard to reach.
Discussion
As a mixed methods study of MSW in China, we present a more nuanced exploration of the drivers of HIV in this marginalised group than previous work has been able to. We present evidence that may be useful in identifying potential avenues for more targeted interventions.