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Member Research & Reports

Member Research & Reports

Maryland Research Finds that Family, Workplace Networks Influence Condom Use by Older Female Sex Workers in China

A study by researchers in the University of Maryland School of Public Health found that family and workplace networks influenced the use of condoms by female sex workers (FSWs) aged 35 years and older in China.


Published in the Journal of Sex Research, the study included in-depth interviews with 63 older FSWs and six focus group interviews with pimps and owners of roadside salons and hotels in three Chinese cities to determine network factors that influence condom use. Previous research in 2011 found that 21 percent of those newly infected with HIV in China were 50 years or older, up from 2 percent in 2000. The majority of older adults with HIV or STIs reported commercial sex with older FSWs.

“Older female sex workers are extremely vulnerable to acquiring and transmitting HIV,” said Dr. Hongjie Liu, study author and associate professor of epidemiology and biostatistics. “The financial responsibility of raising children, social isolation, and client refusal all deter older female sex workers from using condoms.”

Within family networks, defined as relationships with husbands and children, older female sex workers’ relationships with their children negatively influenced condom use, as financial hardship and family responsibility motivated them to engage in more risky sexual behavior to earn money.

In regards to workplace networks, researchers examined the influence of clientele; coworkers/sex worker peers; and pimps, venue owners and bosses on the use of condoms by older FSWs.

Researchers found that clients’ preferences deter the use of condoms by older FSWs, as competition for clients reduces negotiation power. Additionally, older FSWs’ clients tend to be rural-to-urban migrant workers and old men, populations that generally have low support for condom use.

Sex workers who did not live with their families tended to have frequent contact with FSW peers, which increased informational, tangible, and emotional support for condom use. Peer support ranged from safe sex education to buying condoms in bulk at lower prices. Conversely, socially isolated older FSWs, who frequently hid their work from their families, lacked social support from their peers to use condoms.

Older FSWs’ relationships with pimps, venue owners, and bosses had a mixed influence on condom use. While pimps and owners generally held a supportive attitude toward condom use, financial incentives to retain clients counterbalanced that attitude. They did, however, support free HIV/STI prevention activities for FSWs provided through local government health agencies.

In this study, the mean age of sex workers was 42 years old, and the mean age they started sex work was 38 years old. Older female sex workers frequently begin sex work after being laid off, divorced, or migrating from rural to urban areas, in contrast to research on young FSWs in China, who tend to quit sex work in their 30s after earning enough money to start a private business, such as a beauty salon, a shop for selling clothes, or a small restaurant.

Research on network-based factors that influence safe sex behaviors among older FSWs is important to shape effective HIV-prevention activities.

Journal article: