The National Institute of Alcohol Abuse and Alcoholism (NIAA), a part of the National Institutes of Health (NIH), will pay $2.6 million in U.S. tax dollars to train Chinese prostitutes to drink responsibly on the job.

Dr. Xiaoming Li, the researcher conducting the program, is director of the Prevention Research Center at Wayne State University School of Medicine in Detroit.
 
The grant, made last November, refers to prostitutes as "female sex workers"--or FSW--and their handlers as "gatekeepers." 

"Previous studies in Asia and Africa and our own data from FSWs [female sex workers] in China suggest that the social norms and institutional policy within commercial sex venues as well as agents overseeing the FSWs (i.e., the 'gatekeepers', defined as persons who manage the establishments and/or sex workers) are potentially of great importance in influencing alcohol use and sexual behavior among establishment-based FSWs," says the NIH grant abstract submitted by Dr. Li.

"Therefore, in this application, we propose to develop, implement, and evaluate a venue-based alcohol use and HIV risk reduction intervention focusing on both environmental and individual factors among venue-based FSWs in China," says the abstract.

The research will take place in the southern Chinese province of Guangxi.

Guangxi is ranked third in HIV rate among Chna's provinces--and is a place where the sex business is pervasive, Li said.

“The purpose of the project is to try and develop an intervention program targeting HIV risk and alcohol use,” Li told CNSNews.com. “So basically, it’s an alcohol and HIV risk reduction intervention project."

The researcher outlined three components of the intervention program in the abstract for the project:

“(1) gatekeeper training with a focus on changing or enhancing the protective social norms and policy/practice at the establishment level; (2) FSW (female sex workers) training with a focus on the acquisition of communication skills (negotiating, limit setting) and behavioral skills (e.g., condom use skills, consistent condom use); and (3) semi-annual boosters to reinforce both social norms within establishments and individual skills,” wrote Li.
 
The doctor said the heart of the study involves “a community-based cluster randomized controlled trial among 100 commercial sex venues in Beihai, a costal tourist city in Guangxi.”

"We anticipate that the venue-based intervention program will be culturally appropriate, feasible, effective and sustainable in alcohol use and sexual risk reduction among FSWs," says the NIH grant abstract.

Li said his study is being done in China rather than the U.S. because prostitution occurs with alcohol use in the United States like it does in China, Americans will be able to benefit from the project’s findings.

“We want to get some understanding of the fundamental role of alcohol use and HIV risk,” he said. “We use the population in China as our targeted population to look at the basic issues. I think the findings will benefit the American people, too.”

Li said minimal research has been conducted on the link between alcohol use and prostitution as it relates to HIV.

“Alcohol has been a part of the commerce of sex for many, many years. Unfortunately, both global-wise (and) in the United States, very few researchers are looking at the complex issue of the inter play between alcohol and the commerce of sex,” he told CNSNews.com.

The grant is one of several “international initiatives” sponsored by the National Institutes of Health.

Ralph Hingson, director of epidemiology and prevention research at NIAA, told CNSNews.com, “There are many Americans who travel to China each year and they should be made aware of the HIV problem.”

Hingson said that Americans will be able to apply the studies findings to the American situation because 1.2 million Americans are currently living with HIV.

Li’s research includes exploration, development, implementation and evaluation. Currently, the project stands at the exploration stage, which the doctor expects to last 18 months.

“The first phase is kind of an exploratory study just trying to get a good understanding of the phenomena in the population of female sex workers in China. The second phase is the program development,” the professor told CNSNews.com.

Phase two will be based on the first year of the study and on “field observations,” he added. The third phase will be the implementation and evaluation of the program.

“Prostitution is illegal in China but it exists in China," Li told CNSNews.com, “but the Chinese government and the society’s attitude towards prostitution is complicated.”

According to Li, there may be as many as 10 million female prostitutes in China with the majority raging from teenagers to those in their 20s.

“We see a lot of governmental initiatives in China, like 100 percent condom distribution promotion programs, so they deliver condoms in those (prostitution) venues," he added.

“The global literature indicates an important role of alcohol use in facilitating HIV/AIDS transmission risk in commercial sex venues where elevated alcohol use/abuse and sexual risk behaviors frequently co-occur,” Li wrote when introducing the project last November.

"We expect that the intervention will improve protective normative beliefs and institutional support regarding alcohol use and HIV protection,” he added.

The NIH proposal hypothesizes that the program will decrease "problem drinking and alcohol-related sexual risk" among prostitutes that participate.
 
"We hypothesize that the venue-based intervention will change and enhance the protective social norms and institutional policies at the establishment level and such enhancement, accompanied by individual skill training among FSWs, will demonstrate a sustainable effect within commercial sex establishments in decreasing problem drinking and alcohol-related sexual risk, increasing consistent and correct condom use, and reducing rates of HIV/STD infection among FSWs," says the NIH abstract.