Objectives: To identify key factors affecting condom use among male sex workers (MSW) who serve men in China.
Method: In-depth semi-structured face-to-face interviews in Beijing and Shanghai, China. Informants were recruited through referral from a non-governmental organisation with a strong men who have sex with men (MSM) network and the snowball technique.
Results: Between 2004 and 2005, 30 MSW were interviewed (Beijing n = 14; Shanghai n = 16). The MSW in this study were mainly single, young, homosexual, rural migrants with secondary education. None practised safer sex in their home towns. Until they migrated to big cities and entered the sex industry, they did not develop safer sex practices. They reported high condom use at work, but more than half of them (n = 17) had not been tested for HIV. Four factors, derived from the interviews and correlated to their rural background, sexual orientation and sex work identity, put MSW at risk of HIV/sexually transmitted infections (STI): incorrect AIDS knowledge; economic hardship; homosexual orientation and over-trusting in sexual relationships.
Conclusion: MSW, a distinctive but often neglected group in both studies and sentinel surveillance among the MSM population in China, deserve special attention. There is not only potential for HIV/STI infection among the MSM population but also for infecting the general public. Education and prevention programmes should take their three major interlocking identities: rural migrant, sex worker and homosexual into consideration in social, cultural and economic contexts in China.