ABSTRACT
Commercial sex work (CSW) is central to understanding both the Chinese and
Asian HIV/AIDS epidemics. In the case of China, the commercial sex industry is
becoming a significant mode of transmission of HIV/AIDS to the general popu-
lation. In general, these have been kick-started by intravenous drug use (IDU)
populations with subsequent widespread heterosexual transmission necessary for
full-blown generalized epidemics to take place. In Asian countries that have experi-
enced large-scale epidemics among the general population, heterosexual transmis-
sion via CSW has been a necessary precondition. This is partly because the sexual
mixing pattern in Asia, reliant upon a class of professional sex workers, is also an
efficient pattern for rapid spread of HIV as commercial sex workers (CSWs) act as
a continuing reservoir of infection (Grassly et al., 2003).1 Given the far greater
absolute numbers that engage in risky sexual activity, it is now predicted that het-
erosexual transmission will become the dominant mode of transmission in China
(Wu, Rou and Cui, 2004: 10). Indeed, evidence increasingly suggests that the epi-
demic is already spreading swiftly from high-risk groups to the general population
via sexual transmission (Zhang, 2004: 1156). According to the sentinel surveillance
data available, between 1997-2002 the proportion of reported HIV cases attributed
to sexual transmission doubled from 5.5 to 10.9 percent of the total number of
cases according to one official estimate (Han et al., 2010: ii47). Corresponding to
the movement out of the predominantly male-IDU population, the infection rate of
women has increased, as noted in Chapter 2. The proportion of female HIV cases
rose from 15 percent in 1998 to nearly 40 percent in 2004 (State Council Aids
Working Committee Office and the UN Theme Group on HIV/AIDS, 2004: 4).2
More recent estimates suggest that about 44 percent of individuals with HIV were
infected through sexual transmission (Gill, Huang and Lu, 2007: 4). Among new
cases in 2005, about 50 percent were via sexual transmission, the other half being
infected through IDU. In areas of Yunnan, Henan, and Xinjiang, HIV prevalence
exceeds 1 percent among pregnant women and those receiving premarital HIV test-
ing (ibid.: vi). Prevalence among Chinese sex workers has risen from only 0.02
percent in 1996 to 0.93 percent in 2004 (ibid.). Recent estimates suggest 127,000
sex workers (SWs) and their clients are living with HIV/AIDS, that is, 20 percent
