The Wedding of Qualitative Research and Public Health Policy

Sandra Teresa Hyde, Ph.D., M.P.H.

Harvard University Medical School

 http://www.tsinghua.edu.cn/docsn/shxx/site/xsjl/3.htm

I want to begin with two marvelous jokes by Professor Pan Suiming.

The Prostitute says to her customer, ¡°Move your head, I am watching TV.¡± A family of three was talking about prostitution. The husband said,¡± One act with a prostitute in some city is worth three years¡¯ salary!¡±  The wife immediately responded,  ¡°Then, never visit a prostitute.¡± The daughter unexpectedly said, ¡°I should do this work.¡± (Pan Suiming in Gail Hershatter 1997:392).

Introduction

I open with this quote from Pan Suiming because it captures some of generational attitudes and economic incentives for sex work within contemporary China.  In honor of Pan Suiming¡¯s work on prostitution in China, this paper focuses on my ethnographic research among prostitutes and their clients in Jinghong, Xishuangbanna Dai-L¨¹e Autonomous Prefecture in Yunnan.  During eighteen months of intensive fieldwork in 1996, summer 1997, and summer 2000, on the emergence of the HIV/AIDS epidemic in southwest China, I observed prostitutes and their clients in the city of Jinghong.  Also, in line with qualitative research methods, I conducted twenty interviews with men and women of diverse occupations.   In this paper I want to highlight five key points: 1) that Chinese male tourists are the customers of sex workers in Jinghong; 2) that there is currently a keen awareness of HIV/AIDS among female sex workers in Jinghong; 3) that condoms are readily available in private drugstores and sex shops; 4) that sex workers regard foreign men rather than Chinese men as having AIDS; and, 5) that sex workers do have a certain amount of power to make choices about how to protect themselves.  

As such this paper is divided into three parts. Part one focuses on prostitution in a global context.  Part two on my ethnography of one hair salon/brothel and how prostitutes talk about xingbing (STDs). Part three provides a list of policy recommendations for the prevention of HIV/AIDS among sex workers.

Sex Workers in a Global Context

Sex workers now constitute a key medical and social focus within both narrative and statistical accounts of how STDs and AIDS are spread across the globe including inside China (Pan Suiming 1992 & 1999, Farmer 1996, Gil 1993). [i][i]  Sex workers are perceived as an epidemiological threat to their customers the world over because AIDS is a sexually transmitted disease and prostitutes are engaged in exchanging sex for money.  Many countries have noted that the epidemic spreads along transportation lines and trucker¡¯s routes that are often lined by small brothels. Therefore, the global AIDS pandemic universally marks female sex workers¡¯ bodies as stigmatized bodies.   In parts of sub-Saharan Africa the AIDS virus is traced through these truck routes in countries such as Tanzania, Zambia, Uganda, the Central African Republic, South Africa and the Congo.  Regarding sex workers in the United States, several studies have pointed to a different narrative in which prostitutes are more vigilant about safer sex practices compared to women in the general population.  For example in San Francisco, sex workers have developed unique ways to protect themselves, such as putting on condoms with their mouths so their clients are not fully aware of the condoms (Stewart 1999).[ii][ii]   Although up to forty-four percent of the prostitutes in southeast Asian countries such as Thailand are HIV positive, the types of methods used to protect against sexually transmitted diseases, or the lack of access to public health interventions, are not well understood by public health workers (Beyer 1998:23).

            Ronald Weitzer (2000) notes that in discussions of prostitution there is often a passive neglect about defining exactly what kind of work prostitutes perform in what location.  As Weitzer notes,  ¡°sex work is a generic term for commercial sex services, performances, or products given in exchange for material compensation¡± (Weitzer 2000:5).  In this paper,  I use the Chinese term jinu (prostitute) which is commonly used on the street to explain various different kinds of prostitutes.  In Jinghong all of the women I came in contact with performed a variety of services that ranged from providing simply massages (aimo) to actual hand jobs (tuiyou), to having sex with men back in their hotel rooms.  In some feminist and social work circles in Yunnan, for example, at the Women and Children¡¯s Law Project in Jinghong, the western term for sex worker (xing gongzuozhe) has been appropriated as a modern term of respect for the women that work in the sex industry.  In Jinghong I worked closely with several women in one hair salon that I call the New Wind.  This salon provides evidence of the changing political economy in Jinghong, and in general in a tourist town near China¡¯s border with Laos.

The New Wind Hair Salon in Jinghong

Development in Xishuangbanna has meant that a small town on the Lancang river has become a local site for sex tourism.  Jinghong is a city of prostitution (piaocheng) according to the local folklore, and more importantly, in terms of the local economy  it provides Han Chinese male tourists with a sex tourist destination. According to scholar Qin Hongping (1995), ninety percent of the tourists who came to Jinghong are Han Chinese from all over mainland China (only ten percent foreigners).  These Chinese cadres and businessmen pay for evening entertainment provided by female sex workers.  What Han male tourists come to Jinghong to consume, besides the scenery and the wildlife, are the local minority women. However, the majority of the prostitutes are not minority women but migrant Han women from Sichuan and Guizhou, who dress in traditional Dai clothing to attract Han males.  The Han migrant women, just like the Han male customers who consume them, provide the allure that is marketed in tourist brochures and billboards displaying Dai women.  Prostitution practices within this Han Chinese governed Dai autonomous region constitute a ¡°site of desire¡± (Manderson and Jolly 1997:1).   What Han tourists¡¯ purchase are fantasies of a beautiful Dai woman who will appease their sexual desires. 

Jinghong¡¯s streets are lined with small shops and at every corner there are hair salons (meirongting or lifadian) that are often legal fronts for illegal brothels.  Let¡¯s enter the New Wind Hair Salon.

Dancing between the colored lights on a summer evening, the sounds of crickets compete with taxi engines.  Disturbing the pace of a slow evening stroll, Madam Liu[iii][iii] gathers her blue and white polyester suit in her hands, and cackling in her Guizhounese accent, shouts at the top of her lungs to men passing-by:   "Do you want your hair washed? How about a massage?  My girls here give great massages!" 

Most men ignore Madam Liu or just stare, others opt for the hair wash.  While men sit in her salon chair, she begins to encourage and negotiate with a man to purchase a female escort for the evening.   A massage is a euphemism for a hand-job (tuiyou ¨C the literal translation is pushing out oil).   Most on-site services never go beyond a massage and a hand-job.  Sometimes local men pay for particular women for the evening.  Madam Liu¡¯s salon is clean with whitewashed walls and a large red plastic awning that falls limp under the immense humidity.  Her white-painted front room presents the conventional accoutrements of a beauty salon: chairs, bottles of shampoo, brushes, combs, curling irons, blow dryers, and a large electric water boiler.  Another room next door has three massage tables, frilly flowered curtains divide the space between each table, and a larger electric water heater sits above the sink next to a door leading to a bathroom out the back.  Liu¡¯s two rooms are divided spatially, one shadowed with tinted glass and the other bright with white tiles.  On the walls are posters of beautiful white and Asian women with different hairstyles. 

            In the summer of 1997, there were over 100 small salons like Madam Liu¡¯s in Jinghong.  By the summer of 200, there were 200 salons like Madam Liu¡¯s in Jinghong city. They ranged from beauty salons that only cut hair, to salons that cut hair and had a prostitution business on the side like Madam Liu's place, to places that are salons in name only.   Madam Liu's place served a dual function: It was foremost a legitimate hair salon that provided legal haircuts and massages for male tourists, and secondarily, it was an illegal sexual massage parlor for the middle-class male tourists that stayed in the nearby three-star hotel.[iv][iv]  Madam Liu often worked from one o¡¯clock in the afternoon to one o¡¯clock in the morning, beginning with hair cuts in the afternoon and ending in the early morning hours with ¡°out-calls¡±, where her female staff went with men to their hotel rooms for paid sex.  When I first came to know Madam Liu in 1997, she had four women working for her -- Xiao An and Xiao You from rural northwestern Yunnan, and Xiao Zhang and Xiao Zhou, from rural villages in Sichuan.  Liu provided housing for her workers, paid their medical bills, bought them clothes, told them what to wear, how to apply make-up, and when and how to receive customers.  Madam Liu was in effect a padrone; she and her staff were in a patron-client relationship.  This did not mean that the staff had no power to negotiate or maneuver within the confines of the salon or within the larger community in Xishuangbanna.  Staff members often refused the likes of a customer based on the way he looked, the car he drove, or just out of boredom. 

While the encounters at the salon involved mainly giving hand-jobs (tuiyou) in the back room, sexual encounters that required condoms were always outside the salon. Men would negotiate these encounters by driving or walking up to the salon, and discussing the price and the place with Madam Liu.  She would then yell at one woman to come over and go with the man to his hotel.  Usually, they just went, smiling at me as they left.  At other times, a woman would refuse, depending on the circumstances and her impression of the man.  Xiao Zhu, in particular, did not always follow Madam Liu's demands, and a shouting match ensued between the two of them. Often, Xiao Zhu won. She did not have to do what Madam Liu demanded.

            Madam Liu kept close watch on her staff and distributed condoms to those women working on out-calls and visiting men at their hotels.   On these out-calls the women would present themselves at the front desk of the hotel as there to wash clothes, deliver food, or just visit a patron at the hotel.  On these occasions, Madam Liu would open one of the drawers in the front room and take out one condom and ceremoniously hand  it to Xiao Zhu or Xiao Zhang.   She would remind them of their code words. "Say you are there to wash clothes, and don't forget to tell them this when you knock on the door."   It was on these out-calls that ¡°unsafe sexual practices¡± came into play.  Though the women often insisted that they used condoms, they also remarked that some Chinese men did not like to use them because they decreased sensation.   Liu said that in Thailand, by contrast, condoms are the norm but Chinese men are not used to them. Liu remarked she had traveled to Thailand twice for vacations.

Talking about Xingbing

STDs have now overtaken tuberculosis to become the third most common category of infectious disease in China after dysentery and hepatitis.  Since the introduction of market reforms in the early 1980s, the Center for Disease Prevention in Beijing attributes this increase to changes in social mores, the rise in promiscuity and the low levels of risk-awareness among ordinary people (AFP Newsgroup May 6, 1999).  By the end of 1999, China had almost one million reported infections of sexually transmitted diseases. When I left China in the summer of 1997, there were six thousand reported cases of HIV infection, and by the end of 1998, the estimated number of cases had jumped to 500,000 (Liu Baoying 2000).  By April 2000, Liu Baoying reported in the People's Daily (Renmin Ribao) that the Chinese incidence of AIDS was increasing by twenty to thirty percent over each previous year.  It is with these statistics in mind, that I locate both sexual practices in a hair salon and the market for condoms in pharmacies, sex shops, and in a hair salon cum brothel.   The sexual practices that these locations suggest demonstrate that a new politics of sexuality is emerging within sight of the HIV/AIDS epidemic in the city of Jinghong. 

            Everyone who worked at the New Wind talked about AIDS, syphilis and gonorrhea (aizibing, meidu, linbing) and how to prevent them.   Xiao You, Xiao An, Xiao Zhou and Xiao Zhang, all repeatedly that all you need to do is "keep yourself clean" (baohu ziji, baohu ganjing) which meant no more than bathing after servicing a customer.  This idea of keeping yourself clean meant no more to Xiao You, Xiao An, Xiao Zhou, Xiao Zhang and Madam Liu than washing regularly and using condoms with those customers who would agree to use them.    They often remarked if you baohu ziji, baohu ganjing then taking care of yourself and keeping clean would prevent you from getting AIDS.  When the staff at the salon joked about AIDS, it was to accuse one another of having it.  Xiao Yuan said Xiao Zhang was so thin that she must have AIDS.   Despite Madam Liu's request for me to find her more foreigners, the workers at the salon said they would never have sex with foreign men, and men from Thailand in particular.  They all had AIDS.  While Madam Liu, the owner of the salon, would pass out condoms to women working on out-calls, none of the prostitutes in the salon said they came into contact with public health officials let alone ones giving out condoms.  The women who worked at the New Wind never saw or knew anyone with AIDS in Jinghong.  Xiao An's cousin, who was also from Ruili, spoke about a man she knew in Ruili who had AIDS. 

            As a former AIDS counselor in the United States, I often lapsed into my diatribe about how difficult AIDS is to transmit through casual physical contact; how crucial it is for Xiao Zhang, You, Zhou and Zhu to use condoms to prevent further sexual transmission.  In response they all vociferously agreed.  Nonetheless, they often contradicted themselves when it came to the practice of using condoms.  They used them religiously.  They used them over their customer¡¯s objections. They used them only when customers did not object.  It was apparent that condoms were in plentiful supply.  As we have seen, Jinghong was full of shops carrying condoms.  They came in small boxes promoting ¡°pregnancy prevention covers¡± (biyun tao) with glossy photographs of sexy white and Han women seductively posed in lingerie. 

Sex Toys, Condoms and HIV/AIDS Prevention

 Whereas the Chinese state has made great strides in addressing the AIDS epidemic with full force, the current decentralization of provincial and county power means that in those counties where public health officials are eager to prevent AIDS, programs exist.  In those counties where public health officials are reticent, programs for AIDS prevention take a back seat to other priorities. [v][v]  In many geographic locales in China very little is currently understood about the relationship between prostitution practices and the spread of HIV, apart from the speculation that women with many male partners are prone to infecting themselves, their clients, their boyfriends and husbands (see Hyde 1999).   This lack of knowledge is partially explained by the fact that prostitution is labeled as a crime against the state; it is not a legal nor regulated industry (Hershatter 1997; Remick 1997; Gil 1993; Pan Suiming 1999).[vi][vi]  In addition, the recent decline of China¡¯s public health system means that many people must fend for themselves in terms of accessing health care services.   In a recent study, the World Health Organization claims that China¡¯s health status has declined dramatically in the past ten years.  China moved down forty-four points, from a country rank of 144 to 188, due to the increasing privatization of health care, and the uneven access to care among China¡¯s poor (New York Times June 21, 2000).  Although the AIDS epidemic inside China has forced changes in socialist health care policy and attitudes toward sexuality, the sitgmatization of prostitution continues.  Even with this stigmatization, the current practice of providing condoms to prostitutes and the proliferation of condom sales in Jinghong shows at least the potential for marketing safer sex practices within a sex tourism site.

With the rise of the market economy, certain state functions have been replaced.  Individuals now have the opportunity to purchase birth control beyond the eyes of the state¡¯s appointed birth control and local anti-epidemic station representatives. Even if the Chinese state still enforces the one-child policy among registered Han population, many of my young informants told me they preferred the discretion that purchasing birth control through shops provided. This does not mean the state cannot provide condoms to married couples and single men and women if they choose to, just that many young people find it more convenient and discrete to purchase them elsewhere.  One friend, Xiao Mei, owns a small pharmacy that has a large selection of condoms.

Xiao Mei who works in her parents small pharmacy, says she sells lots of condoms, ranging in price from a couple of yuan to expensive imported ones from Japan and England for over ten yuan each (there were 8.4 yuan to the dollar as of August 2000).   I perused these condoms, examining the small boxes that were packaged in groups of three, ten and twelve.  Condoms were definitely part of the market economy in Jinghong:  I found condoms in plentiful supply in just about every small pharmacy and hotel convenience shop.  Not only were condoms sold in these small establishments but also the men who frequent the brothels in Jinghong also purchase them.  While conducting follow-up fieldwork in the summer of 2000, I discovered Jinghong had an even wider variety of condoms available at the small pharmacies and a much more visible presence of STD clinics that provided health care practitioners to treat STDs than three years earlier.  What had changed in my three-year absence was a growing awareness that the city of Jinghong had a large sexually transmitted disease problem on its hands.  

By the summer of 2000, Jinghong also had its very own new sex shop that catered to the town¡¯s many sex tourists.  In speaking with Xiao Wang, the owner, a young woman in her early thirties, she said they opened in May and that she was trying to make good quality condoms available on the local market.  Her shop included condoms made by joint ventures, such as those between Germany and China, and condoms that were manufactured in China that cost anywhere from a couple of yuan to twenty-yuan for a packet of three.   In Xiao Wang¡¯s opinion the foreign condoms were of a higher quality than the Chinese varieties.   This was reflected in the packaging of condoms in general.  A brand called ¡°strong man¡± (nanzihan) ¡°ultra thin¡± (xiangxing chaobao), with ¡°family taste in mind¡± (jiating zhuang) had a picture of a white couple on the box.[vii][vii]    Whiteness here can be read as a sign of sexual knowledge. There was a general perception that white people knew how to have sex, where whiteness was a sign of the erotic (see Schein 1994).   Whiteness here also represents the new ways that desire is marketed.  The images on these condom boxes did not suggest tastefully dressed Han women wandering through a park, but they depicted pleasurable, romantic encounters between white heterosexual couples. 

If condoms are readily available through private drugstores, hotels and sex shops, then what can be done about promoting the use of condoms as a means of to prevent the spread of STDs and HIV/AIDS?

What Should be Done?

A second question is what should be done to stave off a Thailand-like epidemic  inside China?   There are efforts currently underway in China, and particularly in Yunnan, to prevent the further spread of AIDS.  Two of the non-governmental organizations (NGOs) that I worked with, the Save the Children Foundation (SCF) and the Australian Red Cross, have been at the forefront of prevention campaigns in Yunnan.  The Australian Red Cross, with the assistance of Yan Hailin, Li Guozhi, Ann Mehaffey, and Audrey Swift, conceived an impressive peer education and training program.  This training program aimed to bring middle-school, high school and college youth together to comprehend the basic parameters of risk, as well as the basic ways to prevent the transmission of AIDS.  The Peer Education Program, where I assisted as both a survey worker and trainer in Menglian County, Kunming and Jinghong cities, is currently educating and training a small new cadre of youth, to conduct peer education trainings about sex, drugs and AIDS throughout Yunnan, and in parts of Sichuan.  

 The second peer education project was organized by Save the Children Foundation through the initial assistance and expertise of Doctor Nagib Hussein, in conjunction with Drs. Li Jianhua and Li Xiaoliang, and now Cao Hong.  The prevention project has been well received by middle schools throughout Yunnan.  Although the original trainings for the Australian Project were quite tedious due to the lack of Mandarin language skills by the Australian¡¯s coordinator for the project, Dr. Hussein, who studied medicine as a guest of the Chinese government in the mid-1980s in Shanghai, had an intimate understanding of the China and Mandarin Chinese.  With these two projects, there has been a outgrowth in cooperation between the Chinese government and international NGOs in AIDS prevention.  What has been crucial in developing these two projects has been the qualitative research, including my own ethnographic research in setting the groundwork for developing these outreach trainer programs.  Without a clear understanding of the ethnographic context and exactly what sex workers do in their daily practice, effective prevention is unattainable.  As a public health worker, I cannot emphasize enough that programs need to be location and dialect specific, addressing the specific locality and the local cultural norms.  Preventing the transmission of HIV/AIDS is never easy, however, one way to understand what prevention techniques might work is to ask one¡¯s informants.  What exactly do sex workers themselves say works, or could work. 

In the languid days and warm nights I spent with Madam Liu and her staff, Xiao Zhu, Xiao You and Xiao Zhang, I recognized just when and where they would take precautions against HIV/AIDS.  They placed AIDS firmly on the bodies of foreigners, white foreign bodies, and occasionally, they mentioned that they would not service Pakistani or Burmese men who worked in Jinghong. They too might have AIDS.  While condoms are plentiful in Xishuangbanna, it seems, according to my friend, Xiao Liu, a pharmacist in Jinghong, that her male customers purchase cheap condoms and her female prostitute customers the expensive ones.   When I asked prostitutes about this, they said they had more faith in the expensive brands, and that the Japanese and British condoms were the best.  However, the underlying problem in all of these situations is that men, I am told Chinese men especially, do not like to use condoms.  

 Whereas in many countries across the globe condom use is still highly controversial, it often goes against the grain of cultural norms and sexual conduct, China, I dare say, is not one of them.  The Maoist regime of birth regulation has made birth control a part of everyday life in China.  Today it is just a question of what kind or what brand of birth control.  This statement leads to a second intervention.  If the Chinese state added condoms to their armamentarium of state sponsored birth control options then, condoms would begin to be more accepted and more readily available, for everyone.  More important, mere distribution and accessibility of condoms is not enough. In drawing to a close, I wish to reveal some of my informants¡¯ suggestions for AIDS education and prevention.

?                  Madam Liu wanted the police not to presume that just because a young women was carrying a condom, she was a prostitute, and therefore not entitled to protect herself.  Accomplishing this would require educating the local police force and gaining their permission to allow sex workers to carry and distribute condoms.

?                  Dr. Yang, a psychiatrist a the Yunnan Drug Institute, suggested that the hotels in all major cities could provide free condoms to their customers, like putting mints on the bed covers at night.  This would require the education and cooperation of the local tourist bureaus.  I have spoken to many hotel owners in Jinghong who would be amenable to this practice.

?                  Tourist agencies could be enlisted to distribute information about STDs and HIV through the promotional material that they provide male tourists with about their services.

?                  Since the local drug stores and in particular the sex shops, do not often have any idea about the expiration date of their condoms, there needs to be quality controls set up to monitor how condoms are distributed and sold.

?                  To begin working closely with the madams and owners of hair salons/brothels on the importance of educating their employees about safer sex practices.  A longer-range goal would be to change the actual behavioral norms so that condom use among male clients would be considered the norm rather than the exception for all sexual transactions.  In addition, alliances could be made with successful outreach and prevention projects in places like Chiangmai northern Thailand, or with Pink Triangle in Malaysia, to allow Chinese public health projects to gain from the experience other countries in Southeast Asia.  A train the trainers approach could incorporate trained sex worker educators that would enlist local sex workers in educating their peers about prevention (see Cianna Stewart 1999)

Conclusion

            To conclude I would like to comment on the local climate of police surveillance of sex workers and some of the obstacles to effective prevention. The local government  officials in Jinghong vary widely in terms of their general attitudes about sex work, sex workers and HIV/AIDS.  There is currently just as much a desperate need for education programs for the local police as there is for clients of sex workers.  If most of the people in China with HIV are men, then there needs to be more of a focus on them, and not just the female sex workers.  Overt emphasis on women means that sex workers are doubly burdened to perform and generate income, and make sure both they and  their partners are protected.   In terms of surveillance in Jinghong, sex workers do get randomly arrested and turned over to the local police, where they are often driven north into  Simao County and left there.  However, as one police officer said, ¡°like a poisonous weed¡±, sex workers merely return to Jinghong and their work.  While yanda campaigns have targeted brothels, it often means the hair salons/brothels close down for a few days and then re-open once the yanda has passed.  In addition, many police in Jinghong would like to make prostitution quasi-legal and have the opportunity to regulate it as in the state of Nevada in the western United States.  Other cities, like Tianjin, in China have begun to tax prostitution again, and this is one option for the police in Jinghong.  However, the obstacles for prevention of HIV do not solely reside under the jurisdiction of the local police, it appears that the main obstacles for self protection of sex workers in Jinghong our individual customer¡¯s attitudes -- the fact there is no norm for condom use, even if there is large market for condoms.  In order to change this situation major campaigns for condom use and sexual health need to be presented in a tasteful way to the clients that use these salons.  Condoms need to make a more visible presence in the salons, and not just remain hidden in small drawers in back rooms.

            Finally, in closing I would like to emphasize that all these efforts to curb the spread of AIDS inside China, require practitioners and public health professionals to see AIDS as something that defies borders, ethnic groups, and identity politics within a post-socialist state.   Without neglecting to take into account that the market and cultural politics play an integral role in how people function in their everyday lives, AIDS prevention could work.   To really build on the everyday practices of AIDS means to take flight, to understand that epidemics are not grounded in one people, or one place, they do not respect the lines on a map.  In this paper, I have presented one view of the contemporary sex work industry in southwest China looking toward the politics of sex work and the socialist state in transition with an eye on workable prevention techniques.

Bibliography

Ai Feng Wang Song. 1995. Daizu wenxue shi,  Kunming: Yunnan minzu chubanshe.  (A Cultural History of the Dai, Kunming: Yunnan Provincial Minority Press).

American Foreign Press Newsgroup, May 6, 1999.

Appadurai, Arjun.  1996 Modernity at Large: Cultural Dimensions of Globalization. Minneapolis, Minnesota: University of Minnesota Press.

Beyer, Chris. 1998. The War in the Blood: Sex, Politics and AIDS in Southeast Asia, London and New York: Zed Books.

Bishop, Ryan and Lillian Robinson. 1998. Night Market: Sexual Cultures and the Thai Economic Miracle, New York: Routledge.

Chung, Juliette. 1999.  Struggle for National Survival: Chinese Eugenics in a Transnational Context, 1896-1945. Ph.D. Dissertation, Department of History, University of Chicago.

Davis, Sara. 1999.  Singers of Sipsongbanna: Folklore and Authenticity in Contemporary China, Ph.D. Dissertation, Department of Asian and Middle Eastern Studies, University of Pennsylvania.

Delacoste, Fr¨¨d¨¨rique, and Priscilla Alexander. 1987.  Sex Work: Writings by Women in the Sex Industry, Pittsburgh, Pennsylvania: Cleis Press

Dikkoter, Frank .1995. Sex, Culture and Modernity in China: Medical Science and the Construction of Sexual Identities in the Early Republican Period. Honolulu: University of Hawaii Press.

Erwin, Kathleen. 2000.  ¡°Heart-to-Heart, Phone-to-Phone: Family Values, Sexuality, and the Politics of Shanghai's Advice Hotlines.¡± In the Consumer Revolution in Urban China, Deborah S. Davis (Ed.). Berkeley: University of California Press.

Evans, Grant. 2000.   Where China Meets Southeast Asia: Social and Cultural Change in the Border Regions, edited by Grant Evans, Chris Hutton and Kuah Khun-eng, ISEAS, Singapore.

Farmer, Paul, Margaret Connors,  and Janie Simmons (Eds).  1996. Women, Poverty, and AIDS : Sex, Drugs, and Structural Violence.  Monroe, Maine: Common Courage Press.

______, Paul. 1992.  AIDS and Accusation: Haiti and the Geography of Blame. Berkeley: University of California Press.

Fan Zhiwei. 1990. Xingbing fangyi shouce.  (The Manual for the Prevention and Cure of STDs), Zhonguo renmin gongheguo weisheng bu, weisheng fanyi ce  (The People¡¯s Republic of China Ministry of Health, Health Prevention Section),  Nanjing: Jiangsu kexue jishu chubanshe.

Feingold, David. 1998. ¡°Sex, Drugs and the IMF: Some Implications of Structural Readjustment for the Trade in Heroin, Girls and Women in the Upper Mekong Region,¡± A Special Issue of Refuge , Cargo: The Global Traffic in Women and Children.

Foucault, Michel. 1978.  History of Sexuality, Volume 1: An Introduction, translated by Robert Hurley, New York: Random House.

Foucault, Michel.  1991   "Governmentality." in The Foucault Effect: Studies in Governmental Rationality, ed. Graham Burcell et al. Chicago: University of Chicago Press.

_______, 1980   The History of Sexuality. Volume 1 An Introduction.  Trans. Robert Hurley. New York: Vintage Books.

Gil, Vincent. 1993. "Sexual Culture and HIV/AIDS in the People's Republic of China," Paper presented at the 92nd Annual American Anthropology Meeting, Washington, D.C. November 17-21.

Gladney, Dru.  1994     ¡°Representing Nationality in China: Reconfiguring Majority/Minority Identities.¡±  The Journal of Asian Studies  53.11: 92-123.

______, 1991. Muslim Chinese: Ethnic Nationalites in the People's Republic.   Cambridge University Press.

Gilmartin, Christina.  1994    Engendering China: Women, Culture, and the State.  Harvard Contemporary China Series 10.  Cambridge, Massachusetts: Harvard University Press. 

Harrell, Stevan, ed.  1995  Cultural Encounters on China's Ethnic Frontiers.  Seattle: University of Washington Press.

Hart, Angie. 1998.  Buying and Selling Power: Anthropological Reflections on Prostitution in Spain, Boulder, Colorado: Westview Press.

Hershatter, Gail. 1997.  Dangerous Pleasures: Prostitution and Modern Twentieth-Century Shanghai, Berkeley: University of California Press.

Honig, Emily.  1992   Creating Chinese Ethnicity: Subei People in Shanghai 1850-1980.   New Haven: Yale University Press.

Hsieh, Shi-chung. 1995.  ¡°On the Dynamics of Tai/Dai-L¨¹e Ethnicity: An Ethnohistorical Analysis,¡± in Stevan Harrell (Ed.),  Cultural Encounters on China¡¯s Ethnic Frontiers, Seattle: University of Washington Press.

Hyde, Sandra Teresa. 2001.  "Sex Tourism Practices on the Periphery: Eroticizing Ethnicity and Pathologizing Sex on the Lancang" in Nancy Chen et. Al. (editors), Ethnographies of the Urban in 1990s China, Durham, North Carolina: Duke University Press.

____, Sandra Teresa. 1999.  Sex, Drugs and Karaoke: Making AIDS in Southwest China, Ph.D. Dissertation, Department of Anthropology, UC Berkeley.

Kempadoo, Kamala and Jo Doezema. 1998.   Global Sex Workers: Rights, Resistance, and Redefinition, New York: Routledge.

Keyes, Charles. 1996.  ¡°Who are the Dai-L¨¹e?¡±.  Conference Paper presented at The 1996 Tai Studies Conference in Chiang Mai, Thailand.

King, Anthony. 1996   ¡°Introduction: Cities, Texts and Paradigms.¡±  Re-presenting the City:  Ethnicity, Capital and Culture in the 21st-Century Metropolis.  Ed. Anthony King.  New York: New York University Press. 

Kohrman, Matthew. 1999. "Grooming Quezi: Marriage Exclusion and Identity Formation Among Disabled Men in Contemporary China," American Ethnologist, Volume 26, no. 4: 890-909.

Litzinger, Ralph. 2000. ¡°Questions of Gender: Ethnic Minority Representation in Post-Mao China,¡± Bulletin of Concerned Asian Scholars, Volume 32, no. 4: 3-14.

Li Xuezhong. 1996. Yunnan gonganzhi,  Kunming: Yunnan renmin chubanshe, (Yunnan Public Security Gazette, Kunming: Yunnan Publishing House, November).

Liu Baoying. 2000.  "At the Convening of a Meeting of the State Council on the Prevention and Cure of STDs and AIDS, Li Lanqing, Urged Every Level of Government and their Leaders to Attach Great Importance in Working for the Prevention and Eradication of AIDS,¡±  (Li Lanqing zai quowu yuan zhaokai de fangzhi aizibing xingbing bandaohui shang qiangdiao geji zhengfu he lingdao yao gaodu zhongshi aizibing yu kongzhi gongzuo) Renmin Ribao, April 5, 2000.

McClintock, Anne (ed.). 1993. A Special Issue on Sex Work and Sex Workers, Social Text, Winter: 1-83.

Mascia-Lees, Frances and Sharpe, Patricia,  1992  Tattoo, Torture, Mutilation and Adornment, Albany: State University of New York Press.

Manderson, Leonore and Margaret Jolly. 1997.  Sites of Desire: Economies of Pleasure: Sexualities in Asia and the Pacific, Chicago: University of Chicago Press.

Odzer, Cleo. 1994.   The Patpong Sisters: An American Woman's View of the Bangkok Sex World, New York: Blue Moon Books.

Ong, Aihwa and Don Nononi (Ed). 1997  Ungrounded Empires: The Cultural Politics of Modern Chinese Transnationalism.  New York: Routledge. 

Ortner, Sherry. 1974.  ¡°Is Female to Male as Nature is to Culture?¡± in Women Culture and Society,  Michelle Z. Rosaldo and Louise Lamphere (eds.), Stanford: Stanford University Press.

Pan, Suiming. 1999.  Cunzai yu huangmiu: Zhongguo dixia xing chanye kaocha, Qunyan chubanshe, Beijing.  (Existing in Falsehoods: An Investigation of China¡¯s Underground Sex Industry).   (Beijing, Qunyan Publishing House). 

_____, Suiming. 1992. ¡°Decipher the Myth of Prostitution. Shanghai Shehui  in Chinese, 87 (April 20,  1992).  Translated in JPRS-CAR-92-044 (June 24, 1992) pp: 55-56.

Parker, Andrew, M. Russo, D. Sommer, and P. Yaeger. 

      1993  Nationalisms and Sexualities.   New York: Routledge.

Qin Hongping. 1995. ¡°Li  zu shiji, jiakuai fazhan Xishuangbanna luyou shiye  (Taking Advantage of the Present Situation to Revitalize Xishuangbanna's Tourism Industry).¡± Xueshu lunwen ji  (A Collection of Research Papers from Xishuangbanna Education College).  Combined Issues 2 & 3: 71-73.

Remick, Elizabeth Justine. 1997.  Cadres, Clerks and Tax Farmers: State Building in Rural China, 1927-1937 and 1982-1992, Unpublished Dissertation, Department of Political Science, Cornell University.

Ruan, Fangyu.  1991  Sex in China: Studies in Sexology in Chinese Culture.   New York and London: Plenum,

Schein, Louisa. 1999.   ¡° Of Cargo and Satellites: Imagined Cosmopolitanism,¡± Postcolonial Studies, Volume 2, no. 3: 345-375.

_____, Louisa. 1997a. ¡°Gender and Internal Colonialism in China.¡±  Modern China  Volume 23, no. 1: 69-78.

_____, Louisa. 1997b. ¡°The Consumption of Color, and the Politics of White Skin in Post-Mao China,¡± Social Text, 41: 141-164.

Sigley, Gary, Fall 1998 ¡°Guest Editor¡¯s Introduction,¡± Issue on Sex, Chinese Sociology and Anthropology, Volume 31, no.1: 3-13.

Solinger, Dorothy. 1999. Contesting Citizenship in Urban China: Peasant Migrants, the State and the Logic of the Market, Berkeley: University of California Press.

Stewart, Cianna. 1999.  Lecture on the Wellness Project (formerly the Asian AIDS Project) and AIDS Prevention Among Sex Workers in San Francisco, UC Berkeley, Department of Women¡¯s Studies.

Stoler, Ann Laura. 1995.   Race and the Education of Desire: Foucault's History of Sexuality and the Colonial Order of Things, Durham: North Carolina Press.

Tuan, Yifu. 1998.   Escapism, Baltimore and London: Johns Hopkins Press.

Wang Lianfang. 1993  Yunnan Minzu Gongzuo Huiyi Lu, Yunnan Wenshi Ziliao Xuanze, di sishiwu zhang,  Yunnan Renmin Chubanshe,  (A Memoir and Record of Work Among Yunnan's Minorities), Yunnan Cultural History Data Collections, Volume 45, Yunnan People's Publishing House)

Weitzer, Ronald (ed.). 2000. Sex for Sale: Prostitution, Pornography, and the Sex Industry,  New York: Routledge.

White, Luise. 1990.  The Comforts of Home: Prostitution in Colonial Nairobi. Chicago and London: University of Chicago Press.

White, Tyrene. 1985.   Population Policy and Rural Reform in China 1977-1984: Policy Implementation and Interdependency at the Local Level, Ph.D. Dissertation.

Yin Shaoting.  1986  Shuo Zhang , Yunnan Difang Zhi Tongxun  (Speaking of Miasma.  The Communication Annals of Places in Yunnan).  No. 4: 69-74.

Zhang Li. 1998.  The Floating Population in the Post-Mao Socialist Order: Power, Identity, and the Formation  of a Nascent Civil Space in China.  Unpublished Dissertation, Anthropology Department, Cornell University.

Zhang Nuanxin, Qingchun Ji (Sacrificed Youth), China Youth Film Studio, 1985.

Zito, Angela and Tani Barlow.  1994. Body, Subject and Power. Chicago: University of Chicago Press.

Acknowledgments

My greatest heartfelt thanks go to those who offered me their hospitality, generosity, and assistance in Yunnan.  My fieldwork in southwest China on the HIV/AIDS epidemic (1995-1996, 1997, 2000) on which this paper is based was generously supported by the Fulbright-Hays Doctoral Dissertation Research Abroad Fellowship, the Wenner-Gren Foundation, the Center for AIDS Prevention Studies at UC San Francisco, and from UC Berkeley, a Foreign Language and Area Studies Fellowship, and, a Lowie Grant from the Department of Anthropology.  Parts of this paper have been presented at the American Anthropology Association Annual Meetings, the Association for Asian Studies, the Fairbanks Center for East Asian Research at Harvard University, and UC Berkeley¡¯s Center for Chinese Studies.  Last but not least, I wish to sincerely thank Jing Jun, Harriet Evans, Sara Friedman, and June Brady for their helpful suggestions on earlier drafts of this paper.