Xiaomei, a sex worker in China, had just gone into a room with her client when police officers swarmed in and restrained both of them. They began rifling through things, looking under the bed and in the bathroom, and they picked up the quilt and shook it. Xiaomei (not her real name) knew they were looking for condoms. “A policeman in his thirties suddenly grabbed my handbag, reached in, and pulled out several condoms,” she said. The cop said, “She’s carrying quite a few!” After that, the police took Xiaomei and her client to the station.
In 2015, we spent a year working with four Chinese organizations that provide HIV prevention services to sex workers, to document a dilemma that sex workers in China commonly face: condoms, the same tools they use to try to protect themselves from sexually transmitted infections, including HIV, are also one of the main tools police use to incriminate them. As an international organization advocating for the right to health for marginalized populations, Asia Catalyst had been receiving reports since 2006 from Chinese NGOs about the police practice of searching and confiscating condoms from sex workers. Yet, there was no hard data on the issue, limiting public debate on the impact of law enforcement on sex workers’ health and rights.
Beginning in late 2014, over the course of a year, we conducted research among 517 female, male, and transgender sex workers in three major cities in China, research we outline in a report, “The Condom Quandary: A Study of the Impact of Law Enforcement Practices on Effective HIV Prevention among Male, Female, and Transgender Sex Workers in China,” which we released this week. We found that the implementation of China’s HIV response strategies among sex workers is severely hampered by laws, policies, and police practice. Our research showed that contact with police is an inevitable part of the life of female, male, and transgender sex workers—more than half of the workers in our survey reporting having been interrogated. And interrogations are often accompanied by the confiscation of condoms, a practice that not only endangers the lives of the sex workers and their clients, but also undercuts the country’s own efforts to stem the spread of sexually transmitted diseases.
China has long taken a punitive approach to sex work, but sex workers in China have recently experienced the harshest crackdown in a decade. The “strike hard” campaigns which began in Beijing and Dongguan in 2010 and 2014 respectively, ultimately spawning a nationwide crackdown. These campaigns led to the shutdown of thousands of entertainment venues and the detention of tens of thousands of sex workers.
Condoms have come to play a central role in police activity around sex work. According to the participants in our survey, police officers stop sex workers on the street, open their bags, and search for condoms; they burst into rooms to look for condoms in wastebaskets, beds, and quilts; and they even remove the trousers of clients in order to find condoms. Police raid rooms rented by sex workers, as well as bars and massage parlors. Many of the people we surveyed told us that finding condoms was the deciding factor in whether or not authorities detained them.
Unsurprisingly, the danger of detention for carrying condoms discourages sex workers from using them. As Xiao Yan, a female sex worker from the Southwest of China, puts it: “Streetwalking keeps you on pins and needles; as soon as I see them [police], I run away, and if it is too late, I just throw away my money and condoms to spare myself trouble. I don’t know how many condoms I’ve thrown away. ”
Among the subjects of our survey, while 67.8 percent of sex workers who had not been interrogated by police reported carrying and consistently using condoms, only 47.7 percent of those whom police had interrogated continued regular condom use. Sex workers who had had brushes with law enforcement told us that they are more likely to agree to clients’ demands to not use condoms, reduce the numbers of condoms they carry, not carry at all, or try various methods to hide condoms in concealed places.
This is the opposite outcome of the one China’s National Health and Family Planning Commission has tried to achieve. The country has well-intentioned HIV prevention programs targeting key populations including sex workers. A highly effective health tool, correct (male) condom use can reduce HIV and other sexually transmitted infections (STIs) by up to 94 percent. Condoms play a central role in China’s HIV strategy; the government allocates funding every year for the purchase and free distribution of condoms to key populations, including sex workers. In many provinces, entertainment venues are required to display condoms publicly. The implementation of these strategies is critical, as HIV and other STIs are still a major public health concern in China. Globally, sex workers are 12 times more likely to acquire HIV than the general population. In China, the HIV epidemic is primarily sexually transmitted: of 103,500 new cases diagnosed in 2014, 92.2 percent were through sexual contact. The STI epidemic in general is increasing; in 2015, syphilis and gonorrhea were among the top five reported cases of transmitted infections in China.
Police crackdowns on sex work have caused policy confusion. Managers of entertainment venues used to allow access to health workers for HIV prevention work with sex workers. But following police crackdowns on sex work, such as the wave of “vice raids” in 2014, managers have told health staff that no target groups worked at their venues, and they were afraid to display condoms. Our research found law enforcement actions decreased the overall availability of condoms in sex work venues, despite health department requirements that condoms be on display.
China is not the only country to use possession of condoms as evidence of sex work, but there is also a slow-growing movement to rethink and reform these practices. New York City and San Francisco, two U.S. cities that, in recent years, decided not to use condoms as evidence in prostitution cases (with some provisions), reckoned that the value of condoms for HIV and disease prevention far outweighed any utility in enforcement of anti-prostitution laws.
The effectiveness of condoms as evidence in prostitution cases is very limited. At most, condoms can only serve as collateral evidence when other key factors of prostitution have already been satisfied. Carrying unused condoms may indicate that a person may intend to engage in sexual activity, and a used condom indicates that sexual activity has likely occurred. But, it cannot prove that people engaged in sexual activity for payment. Sex work can also take place without the use of condoms. For these reasons, condoms have limited probative value.
The Chinese government has largely taken a pragmatic, progressive stance in its HIV response, paying for most of the country’s HIV interventions and concentrating its efforts on key populations. But its punitive approach to sex work undermines not only its own public health goals, but also the human rights of sex workers. Ironically, health department and community based organizations’ efforts to prevent HIV and other STIs among sex workers may only serve to provide evidence of prostitution to law enforcement officers.
China should review and reform its policies with the aim to better align its law enforcement and public health goals; otherwise, its efforts and resources are wasted. “The State allows condoms to be brought into hotels, guest houses and venues where high-risk sex occurs, and I feel that, in this respect, the State has made progress,” says sex worker Li Huixian. “So then why do the police still use them [condoms] as evidence of prostitution? I feel this runs counter to national policies,” she says. “It really needs to change.”