Male sex work in China: understanding the HIV risk environments of Shenzhen’s migrant money boys

摘要

This study contributes to our understanding of the social organisation and lived experience of men in China’s sex industry. It employs a social epidemiological model to analyse the multiple levels of influence on HIV (and other non-HIV) risks to which this highly marginalised group are exposed. It highlights the complex interrelations between different factors influencing the lives of male and transgender sex workers (MSW) in China. It is the first mixed methods study of its kind in the Chinese MSW context.udThe thesis analyses data collected during five months of fieldwork in Shenzhen, China. Working through a community-based MSW organisation, a participatory approach was taken to study design and data collection. Community advisory boards were organised and used to develop and test study instruments. A structured survey was undertaken with MSW (n=251), with a sub-sample purposely selected for semistructured interviews (n=21). Key informant interviews were conducted with representatives from local and international organisations (n=5). Multiple linear and binary logistic regressions were used for quantitative data analyses, while qualitative data were coded thematically. Both data types are given equal weight throughout the analysis.udThe thesis demonstrates how China’s recent macro-level social and economic changes, characterised here through the microcosm of life in the city of Shenzhen, interact with the lived experiences of the men in the study, driving their rural-urban migration and contributing to their entry into sex work. The phrase “laugh at poverty, not at prostitution” was used by many of the respondents to explain their decision to sell sex, but this apparently simple idiom belies a more complex reality in which economic factors intersect with social networks, sexual orientation and an escalation in the provision of sexual services. Sex work careers are represented as providing both opportunities (for escaping poverty, expressing sexual identity, and accessing cosmopolitan lifestyles), as well as risks. Risk, understood as a socially constructed phenomenon, refers not only to HIV transmission, but also violence from clients, control by mami (pimps), and entrapment and arrest by the police. Multiple risks and opportunities arise through a range of social and professional interactions between the different actors involved in the industry, necessitating their dynamic management by the MSW.udSex work, HIV and homosexuality alongside migrant identities are highly stigmatised in China, and the active management of these intersecting identities, in part through their sexual practices, allows the MSW in this study to continue in their work without ‘losing face’. The MSW have complex sexual networks of male and female, paid and paying, and non-commercial partners. In exploring their partner concurrency, this complexity is examined, through the lenses of stigma and identity.udLocal, emic understandings of ‘safe sex’ indicate that while levels of HIV fear are substantial among the MSW, and condom use is commonly discussed, safety and hygiene are frequently conflated, and both are associated with HIV-avoidance. Hygiene, through showering and general cleanliness, is considered an important part of ‘safe sex’ for this group, but also emerges as a metaphor employed to counter the perceived dirtiness of selling sex for some of the MSW.udThe findings highlight the complexities involved in selling sex for these men. They must actively negotiate their work, risks and identities, while also being subject to unequal power relations and forces largely beyond their control. This thesis aims to present a nuanced account of these dynamic processes.