How have risks of HIV impacted Asian women in Los Angeles that are working in massage parlors as sex work?

There has been a rapid growth on the risks for contracting HIV for women in minority groups. Although many studies on HIV risks and prevention focuses on African American and Latina women, there are very few studies on HIV risks and preventions focusing on Asians. However, the risks of HIV in Asian living in the United States is rapidly growing, even faster than all the other ethnic groups. The purpose of this study is to focus on the factors that affect HIV related risk behaviors among Asian women working at massage parlors in Los Angeles. This study will focus on factors like working condition, knowledge on HIV/STIs prevention, violence, substance usage, health, condom usage, and many more.

This study is a cross-sectional study and will be using questionnaires to conduct the research. Keyworks: HIV risk, risk behavior, massage parlor, Asian workers, Los Angeles HIV Related Risk Behaviors Among Asian Massage Parlor Workers in Los Angeles The risk of contracting and transmitting STIs and HIV has grown very rapidly over the past decade, especially for women of color. Studies also showed that women of color are more at risk for new HIV infections than any other groups (as cited in Nemoto et al., 2003). There are many studies that have done research on HIV risks on women of color, but these studies mainly focused on African American or Latina women (as cited in Nemoto et al., 2003). Studies on Asian women and HIV risks have been neglected and are limited.

One main reason for the limited studies on Asian women and HIV risks is due to the “model minority” stereotype that has be placed upon Asians (Nemoto et al., 2003). However, there are a lot of evidences that show the increase in AIDS/HIV within the Asian communities (Nemoto et al., 2003). Findings showed that Asians-Americans and Latinas are more likely for STI/HIV/AIDS risks than any other ethnic groups (as cited in Pulerwitz et al., 2002) One article found that Asians and Pacific Islanders in San Francisco were more likely to contract and transmit HIV during sexual transmission while other racial groups were more likely to contract HIV infection through drug usage (as cited in Nemoto et al., 2003). Findings also showed that HIV infection rates Asians and Pacific Islanders women living in the United States have grown to 42% by the end of 2001, which is the highest percentage compared to women in other racial groups (as cited in Nemoto et al., 2004).

Because of the large number of Asians and Pacific Islanders living in San Francisco, this causes a rapid growth of HIV/AIDs cases in Asian Americans (Cochran et al., 1991) Women who are sex workers are very much at high risk for the contraction and transmission of HIV infections in the United States (Lim et al., 2016). According to Lim (2016), there are two categories of sex work: direct and indirect. Direct sex workers’ main purpose is to sell sex in places like brothels (as cited in Lim et al., 2016). Indirect sex workers’ main purpose is to provide some sort of non-sexual services (ex: singing, drinking, massages) in places of entertainment (ex: karaoke lounge, massage parlors, bars, restaurants) but will engage in sexual acts for extra income (as cited in Lim et al., 2016). Direct sex work is known to be safer due to brothels enforcing rules upon safe sex such as enforcement of condom usage and constantly getting tested (as cited in Lim et al., 2016). Indirect sex work is known to be risky because acts of service is more hidden and because of this, there is a lack of rules for condom usage and getting tested (Lim et al., 2016).

In another article, “Sexual safety practices of massage parlor-based sex workers and their clients,” Kolar (2014) talks about indoor sex work. Indoor sex work usually sells sex in areas like massage parlors, hotels, brothels, etc. unlike street-based sex work (Kolar & Atchison & Bungay, 2014). A researcher by the name of Farley (2005) made a reply to Ronald Weitzer about his views on indoor prostitution. Weitzer believe that indoor prostitution like massage parlors “have a positive effect in terms of providing a service that clearly men want” (as cited in Farley, 2005). Weitzer also believe that indoor prostitution is less harmful than street prostitution (Farley, 2005). Farley concluded in her article that most of the women she interviewed for her study said that they all want to escape both indoor and on the street (Farley, 2005). She also made a point about how moving prostitution indoors will not change the fact that there will still be violence places upon women who work in these jobs (Farley 2005).

Massage parlors have been rapidly growing in large cities like San Francisco, Los Angeles, and New York (Nemoto et al., 2005). Because the Asian population is very high in those cities, those who work at massage parlors are mainly Asian (Nemoto et al., 2005). In the United States, massage parlors would mainly employ Asians who are immigrants (as cited in Chin et al., 2015). Working in massage parlors can be risky. Asian women who work in massage parlors are not only at risk for HIV/STIs, but they are also at risk for things like customer violence, psychological trauma, and many more (as cited in Chin et al., 2015). Because most of the women hired are immigrants, many don’t understand or speak English well or even at all. In the article, “Sexual Practices of Heterosexual Asian-American Young Adults: Implications for Risk of HIV Infection”, Cochran (1991) talked about how it would be very difficult to teach many of these women sex education and how to prevent STIs and HIV due to the vast amount of languages and distinct cultures with Asian minority group (Cochran et al., 1991).

There are two research questions for this study: What are the social factors that affects the HIV related risk behaviors among Asian women living in Los Angeles who are working in massage parlors? How have risks of HIV impacted Asian women in Los Angeles that are working in massage parlors as sex work? Proposed Method Design This study is a cross-sectional study. Nothing within the study will be manipulated or changed. This study will be questionnaire/survey-based study. There will be a set of questions for the interviewers to ask and the participants to answer. The questionnaire will be asked and answered individual and will all be collected in the end for results. Because the participants will be providing information about themselves, this is known as the self-report data. Participants There will be no less than 100 and no more than 300 people participating in this study. In order to participate in this study, participants must be women, living in the Los Angeles area, 18 years or older and identify themselves as Asian or Pacific Islanders. To participate, they must have given sexual favors in exchange for money and have formerly worked or are currently working at a massage parlor. Participants who are bilingual or have some knowledge in the English language are preferred but are not limited to.

Procedure Similar to a few articles, participants will be recruited for this study by contacting advertisements found in newspapers, community health service agencies, sending emails to the establishments themselves about the proposal, massage schools, social media, asking other massage parlor workers to refer other workers, referral system method, etc. (Takahashi et al., 2013). Massage parlor workers who are interested in participating in the study will meet up with an interviewer privately. All interviews will be conducted face to face using verbal questionnaire. The questionnaire should take around 1-2 hours depending on how in-depth a participant goes into about each question. Interviewers will first give a small summary of what will be asked during the questionnaire. All participants are required to give informed consent before the start of the interview.

Informed consent will be typed on a blank sheet of paper and read verbally by the interviewer. Consent from participants must be given verbally and also, they must sign the paper after consenting. Participants will be informed that anything that is told to the interviewers will be confidential and that their identities will remain anonymous. Participants will also be informed that they are allowed to withdraw at any time during the interview, even when the interview is over. Debriefing will be done at the end of the interview if the participants would like to discuss about the study more in detail. This provides more information to the participants if they were feeling confused about it in the beginning. It is also provided in order clear up any misconceptions the participants may have had during the questionnaire.

Measures After reviewing 10 different articles on Asian massage parlor workers, Nemoto’s (2003) questionnaire was the best method for this type of proposal. The questions that would be asked during the questionnaire includes participants’ age, ethnicity, education, living situation, marital status, sexual activities and condom use with customers, sexual activities and condom use with private partners, substance usage, working conditions, exposure to violence, knowledge on STIs/HIV risk factors and condom use skills, and health (Nemoto et al., 2003). Discussion The study will touch upon important factors that can lead to the risks of Asian women contracting STIs and HIV when working at massage parlors in Los Angeles. This study will go in-depth on how factors such as sexual activities with customers versus private partners, the consistency in condom usage, substance use, violence, and knowledge on HIV and health can affect risk behaviors. It is suspected that this study will have lot of limitations. One main limitation would be getting massage parlor workers to participate in the study.

Most massage parlor owners would be reluctant to allow people to come and interview their workers. This can cause the possibility for sampling error due to the number of participants are allowed in the study and possibly the lack of participants the study might have. The limit of no more than 300 participants can cause an issue with generalizability because it might not represent the different Asian backgrounds. The lack of representatives within different Asian backgrounds may also be limited because of the lack of participants. Another limitation would be the language barrier. Most Asian women who works in massage parlors have low English-speaking skills. Also, there is a possibility of not being able to hire bilingual interviewers for certain languages. This problem will limit massage parlor workers who are only able speak their own language to participate in this study.

Another limitation will be that participants may answer questionnaires not based on their own experiences but based on what they think the research wants them to say. Because of the sensitive topics (ex: drug use, violence, and personal psychological traumas) will be asked in the questionnaire, participants may be more likely to give inaccurate answer due to feelings of shame. This study may not give an accurate depiction of Asian women working in massage parlors, but it might help spark many more researchers to further look into this these studies and research on it themselves. Future research should look into topics that talk about HIV prevention interventions and seeing whether they are effective for Asian women working in massage parlors.