11 - Street-Level Health Officials

Summary

This chapter is about the local health officials who implement China’s surveillance and behavioral outreach health policies for estimating the prevalence of HIV/AIDS and reducing its occurrence among sex workers. These policies set out clear guidelines for targeting certain types and numbers of sex workers for HIV/AIDS testing and outreach, with the goal of obtaining accurate knowledge of the overall sex worker population and reaching out to the individuals who present the greatest concerns to public health. These policies are also designed to protect the individual rights of sex workers, a prerequisite for obtaining higher quality data and increasing the likelihood that public health interventions will yield safer sexual behaviors. Yet frontline health workers often deviate from these rules, as obstacles within China’s health bureaucracy complicate proper policy implementation. Local health officials must also contend with two powerful entities that are predisposed to oppose their work: the sex industry and the police. Taken together, these challenges lead health agents to focus their testing and outreach efforts on hostesses instead of low-tier sex workers – even though women in the low tier are most in need of health interventions – and result in other irregularities in policy implementation with grave public health consequences.