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Vulnerabilities and opportunities for improving sexual and reproductive health and rights for adolescent female sex workers in Kunming

Xudong Zhang (UGent)
(2015)
Author
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(UGent) and (UGent)
Organization
Abstract
In China, the estimated number of FSWs in 2005 was 2.8-4.5 million. Social stigma and the political regimen against female sex workers (FSWs) are reflected in laws criminalising FSWs and their clients. In China, sex workers bear the reputation of “social evil” and “bridge population of HIV/STI”. For those women who use drugs and sell sex, the impact of criminalization and discrimination is doubled. The moral debates and law enforcement’s periodical crack-down against FSWs interfere with public health responses. FSWs under 20 years of age account for almost 15%-40% of FSWs. However there are few channels or opportunities to have their voices heard and they are given the least attention in research and programmatic intervention delivery. This PhD thesis consists of three research studies based in Kunming, China between 2010 and 2012. It aims to identify vulnerabilities and assess opportunities for improving sexual and reproductive health and rights for adolescent FSWs. To achieve this objective, the first cross-sectional quantitative study was conducted with 201 adolescent FSWs to assess their socio-demographic characteristics, working contexts, HIV/STI prevalence, sexual risk factors and health–seeking behaviour (Article 1); as well as their contraceptive practices and predictors of prior abortion and use of modern contraception (Article 2). A second cross-sectional quantitative study was conducted with 310 adolescent FSWs in 2012 to describe knowledge level and information sources regarding sexual and reproductive health, and to assess factors associated with unmet need for modern contraceptives and unintended pregnancy (Article 3). A third qualitative study among adolescent girls who use amphetamine-type stimulants (ATS) and sell sex explores the culture of ATS use, their own perspectives on sex work, their needs for health and social development. These studies aim to assist in recognizing the disparities and vulnerabilities to adverse health outcome and long-term development in this vulnerable group of girls, and could inform more effective health initiatives for adolescent female sex workers. Our study shows similar HIV and STI prevalence rates among adolescent FSWs in comparison with adult FSWs in China. While our studies indicate adolescent FSWs’ sexual and reproductive health risks are in relation to low utilization of public healthcare, dual protection and effective modern contraceptive methods, less contact with existing intervention services, as well as substance use, poor education level and knowledge on sexual health and family planning. Adolescent FSWs’ vulnerabilities result in high rates of unplanned pregnancies and abortion, which are much higher than other sexually-active young women of the same age in China. Our study among female adolescent drug users who sell sex shows clustering of risk factors, leading to adverse health outcomes. Interestingly, these girls do not regard themselves as ‘sex workers’, which presents an important gap in health programme delivery that target FSWs. Experiences of these young girls demonstrated that long-term compulsory detoxification and rehabilitation enhances their social exclusion and likely minimizes their chance to develop their social skills and well-being. Our findings suggest that, early intervention and continuous integrated HIV/STI prevention into family planning services in an age-appropriate approach is the key to ensure their sexual and reproductive health rights and secure their future. Policy-makers should ensure allocation of adequate resources to facilitate initiatives from the public health system and civil society aimed at wide improvements of sexual and reproductive health services and HIV prevention for vulnerable girls. Further longitudinal research with the same population is needed to test in how far these risk factors are true determinants for HIV/STI infection, unplanned pregnancy and unmet need for contraception among adolescent FSWs.

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Chicago
Zhang, Xudong. 2015. “Vulnerabilities and Opportunities for Improving Sexual and Reproductive Health and Rights for Adolescent Female Sex Workers in Kunming”. Ghent, Belgium: Ghent University. Faculty of Medicine and Health Sciences.
APA
Zhang, Xudong. (2015). Vulnerabilities and opportunities for improving sexual and reproductive health and rights for adolescent female sex workers in Kunming. Ghent University. Faculty of Medicine and Health Sciences, Ghent, Belgium.
Vancouver
1.
Zhang X. Vulnerabilities and opportunities for improving sexual and reproductive health and rights for adolescent female sex workers in Kunming. [Ghent, Belgium]: Ghent University. Faculty of Medicine and Health Sciences; 2015.
MLA
Zhang, Xudong. “Vulnerabilities and Opportunities for Improving Sexual and Reproductive Health and Rights for Adolescent Female Sex Workers in Kunming.” 2015 : n. pag. Print.
@phdthesis{5895137,
  abstract     = {In China, the estimated number of FSWs in 2005 was 2.8-4.5 million. Social stigma and the political regimen against female sex workers (FSWs) are reflected in laws criminalising FSWs and their clients. In China, sex workers bear the reputation of {\textquotedblleft}social evil{\textquotedblright} and {\textquotedblleft}bridge population of HIV/STI{\textquotedblright}. For those women who use drugs and sell sex, the impact of criminalization and discrimination is doubled. The moral debates and law enforcement{\textquoteright}s periodical crack-down against FSWs interfere with public health responses. FSWs under 20 years of age account for almost 15\%-40\% of FSWs. However there are few channels or opportunities to have their voices heard and they are given the least attention in research and programmatic intervention delivery.
This PhD thesis consists of three research studies based in Kunming, China between 2010 and 2012. It aims to identify vulnerabilities and assess opportunities for improving sexual and reproductive health and rights for adolescent FSWs. To achieve this objective, the first cross-sectional quantitative study was conducted with 201 adolescent FSWs to assess their socio-demographic characteristics, working contexts, HIV/STI prevalence, sexual risk factors and health--seeking behaviour (Article 1); as well as their contraceptive practices and predictors of prior abortion and use of modern contraception (Article 2). A second cross-sectional quantitative study was conducted with 310 adolescent FSWs in 2012 to describe knowledge level and information sources regarding sexual and reproductive health, and to assess factors associated with unmet need for modern contraceptives and unintended pregnancy (Article 3). A third qualitative study among adolescent girls who use amphetamine-type stimulants (ATS) and sell sex explores the culture of ATS use, their own perspectives on sex work, their needs for health and social development. These studies aim to assist in recognizing the disparities and vulnerabilities to adverse health outcome and long-term development in this vulnerable group of girls, and could inform more effective health initiatives for adolescent female sex workers.
Our study shows similar HIV and STI prevalence rates among adolescent FSWs in comparison with adult FSWs in China. While our studies indicate adolescent FSWs{\textquoteright} sexual and reproductive health risks are in relation to low utilization of public healthcare, dual protection and effective modern contraceptive methods, less contact with existing intervention services, as well as substance use, poor education level and knowledge on sexual health and family planning. Adolescent FSWs{\textquoteright} vulnerabilities result in high rates of unplanned pregnancies and abortion, which are much higher than other sexually-active young women of the same age in China. Our study among female adolescent drug users who sell sex shows clustering of risk factors, leading to adverse health outcomes. Interestingly, these girls do not regard themselves as {\textquoteleft}sex workers{\textquoteright}, which presents an important gap in health programme delivery that target FSWs. Experiences of these young girls demonstrated that long-term compulsory detoxification and rehabilitation enhances their social exclusion and likely minimizes their chance to develop their social skills and well-being. Our findings suggest that, early intervention and continuous integrated HIV/STI prevention into family planning services in an age-appropriate approach is the key to ensure their sexual and reproductive health rights and secure their future. Policy-makers should ensure allocation of adequate resources to facilitate initiatives from the public health system and civil society aimed at wide improvements of sexual and reproductive health services and HIV prevention for vulnerable girls.
Further longitudinal research with the same population is needed to test in how far these risk factors are true determinants for HIV/STI infection, unplanned pregnancy and unmet need for contraception among adolescent FSWs.},
  author       = {Zhang, Xudong},
  isbn         = {9789078128342},
  language     = {eng},
  pages        = {V, 178},
  publisher    = {Ghent University. Faculty of Medicine and Health Sciences},
  school       = {Ghent University},
  title        = {Vulnerabilities and opportunities for improving sexual and reproductive health and rights for adolescent female sex workers in Kunming},
  year         = {2015},
}