This study of Asian immigrant female venue-based sex workers in New York City (NYC) and Los Angeles (LA) aims to develop strategies for efficiently and effectively targeting HIV risk-reduction interventions to high-risk sex-work venue clusters. Female sex workers are at high risk for sexually transmitted infections, such as HIV, and highly vulnerable to violence and exploitation. A substantial portion of female sex workers are Asian immigrants, whose vulnerability is exacerbated because sex work for immigrant women may be part of a larger strategy to pay off migration debts and to ensure subsistence when there is a lack of other employment alternatives. Most health-related research on sex work has focused on street prostitution, leaving substantial gaps in knowledge about HIV risk for "indoor" or "off-street" sex workers, who have become dominant in the sex work industry in recent years. Indoor or off-street sex work occurs in venues such as massage parlors, or is negotiated in venues such as bars and hotels. The growth in the indoor or off-street venue-based sex work industry in NYC has been traced in part to arrests of street-based sex workers, driving sex work into indoor venues. Similarly, in LA, police monitoring of indoor venues such as massage parlors has contributed to expansion of indoor sex work in venues not requiring monitoring and licensure, such as aromatherapy firms and tanning salons. Regarding HIV risk, the few existing studies on immigrant indoor venue-based female sex workers indicate that a combination of factors limit consistent condom use, including coercion from clients, financial incentives and condom use policies at venues. Other research on sex workers in general suggests that HIV risk varies widely by the form of sex work, sex worker and client demographics, and presence of other risk factors, particularly substance use. These factors may cluster geographically, offering an opportunity to more efficiently and effectively target risk reduction interventions. In the proposed study, we aim to 1) test a conceptual model that explains why there are lower rates of HIV sexual risk behavior in some indoor sex work venue clusters in order to ascertain the relative importance of sex workers'HIV knowledge and attitudes, venue culture, geographic location and local policy enforcement;and 2) use findings from the first aim to develop venue-level and geographically targeted intervention strategies for efficiently and effectively reducing HIV risk in high-risk sex-work venue clusters. The study uses GIS mapping of sex-work venue locations, in- depth interviews with sex workers, and an analysis of local policies regulating indoor venue-based sex work. Two sites (NYC and LA County), comprising the largest concentrations of Asian immigrant populations in the US, and three ethnic immigrant sex worker populations (Chinese, Korean, and Vietnamese) are the focus for data collection and analysis. Findings will form the foundation for future studies to develop and test geographically targeted risk reduction interventions aimed at high-risk indoor sex work venues and venue clusters.
This study aims to provide a better understanding of indoor or off-street venue-based sex work (as opposed to street-based sex work) among Asian immigrant women in NYC and LA and the factors associated with heterosexual HIV risk behaviors in sex work encounters. Our study design will allow us to clarify the variations in HIV risk among Asian ethnic groups and locations and to explain why some venues and venue clusters exhibit higher rates and different types of HIV risk behaviors than others. The results will inform venue cluster- based interventions, which can leverage the spatial proximity and possible interactions among sex workers and supervisors in venue clusters for more efficient and effective HIV prevention interventions. Few studies to-date have sought to characterize the geo-spatial context that may influence HIV risk. Moreover, by comparing two major metropolitan areas having the largest concentrations of Asian immigrant populations, this study will provide insight into how different systems of enforcement of local policies and laws affect HIV risk behaviors, raising awareness about the health impact of various policy approaches to regulating the sex work industry. Findings from this study will form the foundation for developing strategies for geographically targeted risk reduction interventions aimed at high-risk indoor sex work venues and venue clusters - addressing key recommendations of the National HIV/AIDS Strategy concerning intensify[ing] HIV prevention efforts in the communities where HIV is most heavily concentrated and expand[ing] targeted efforts to prevent HIV infection using a combination of effective, evidence-based approaches.