The sex workers told us about their working situations, including their perceived risks. But they also talked about the benefits of sex work, as well as the strategies that they used to a) reduce risks and b) increase benefits. Below, we describe this holistic view of the working environment of sex workers in Savannakhet province from their own perspective.
Perceived risks and strategies to reduce risks
Participants reported six categories of risks related to their work: 1) STIs/HIV, 2) unintended pregnancy, 3) violence, 4) stigma, 5) being cheated, and 6) social and economic insecurity. For each of these risks, participants had a set of strategies for reducing them (Table ). These risks and related strategies are presented below.
Negative outcomes for FSWs in Laos and strategies to avoid them
1) Risks of STIs/HIV and strategies to reduce this risk
Risks of STIs/HIV were extensively reported in all FGDs and in-depth interviews. Discussions indicated that sex without a condom was perceived as a source of acquiring STIs/HIV. However, alternative sex acts (oral and/or anal sex) were also perceived to be risky. The most common source of risk that sex workers expressed was when clients took off a condom during the sexual act or if the condom broke: “Clients use a condom when starting intercourse but later take it off in between. This is very bad. This may lead us to die because of AIDS” [KI, aged 18 from nightclub]. Some women reported that they did not accept alternative sex acts requested by their clients because of the risk involved. Many perceived that oral sex was “dirty” because the mouth is for “eating rice”.
"“With oral sex you risk swallowing STIs/HIV into the stomach while sucking the cock, whereas anal sex is painful and later causes infections. Both are risks, so there is no need to do these” [KI, aged 23 from beer bar & restaurant]."
Sex workers had different strategies for reducing risk. In all five FGDs the participants said that using condoms is an effective preventive measure to prevent STIs/HIV.
"“Our work is risk, we use a condom to protect ourselves, if we don’t use a condom’ we would get infected and die because of AIDS” [17–31 years old FSW in FGD3]."
Condom breakage or clients removing the condom during sex was difficult to prevent. To manage this, a woman carried her own condoms that she knew were reliable:
"“You will never know how many condoms the clients will use and at night it is difficult to find even one condom. The best way is to carry many good condoms” [KI, aged 26 from beer bar]."
Women learned through experience how to avoid making mistakes with condoms, such as observing if clients used reliable condoms, checking the expiration date, and double-checking that the condom was still in place:
2) Unintended pregnancy and strategies to reduce risk of pregnancy
"“We look at the condom when the clients change sexual position or use our fingers to touch the cock in between the transaction to feel if the condom is still in place or not” [21–31 years old FSW in FGD5]."
The second source of risk that featured clearly in sex workers′ work environment was unintended pregnancy. Many women reported getting pregnant with an unknown client after engaging in sex work: “I got pregnant after I was at this work for three months” [KI, aged 18 from nightclub]. Some women said pregnancy is not easy to avoid: “Sex workers are at risk of pregnancy when clients force to have sex without a condom” [17–26 years old FSW in FGD4].
Another woman explained that pregnancy out of wedlock also meant a risk of social stigma and great shame:
"“If we go home pregnant, our parents would get seriously angry and complain like ‘I have a bad daughter’… They would not listen to us because they would feel ashamed that their daughter is pregnant without Basy ‘wedding ceremony’” [18–31 years old FSW in FGD3]."
Sex workers’ primary strategy to avoid pregnancy was to use another contraceptive method in addition to a condom (e.g. dual protection).
"“Condoms can prevent STIs/HIV, but not a pregnancy. If I use both condoms and oral contraceptive pills it is safer. This way, when the condom is ruptured the pill still protects me from an unwanted pregnancy” [KI, aged 24 from beer bar & nightclub]."
Another woman commented that when having sex with a boyfriend it is not possible to use a condom, thus increasing the risk of pregnancy. Therefore she used the withdrawal method:
"“When I have sex with my boyfriend we do not use a condom but we use the withdrawal technique to avoid risk of pregnancy” [KI, aged 23 from beer bar & guesthouse]."
Some women said that they did not apply the “withdrawal technique” with clients because of fears of getting STIs or pregnancy. One strategy for avoiding being a social outcast due to pregnancy was to have an abortion. This is illustrated below:
3) Violence and strategies to reduce risk of violence
"“If my parents knew that I got pregnant then I would absolutely be killed. No matter how much money someone paid me to keep the baby, I would have an abortion” [KI, aged 19 from beer bar & karaoke bar]."
The third major source of risk was violence from clients. This included non-paid coerced sex, sexual harassment, rejecting use of condoms, slapping or pinching, verbal abuse, threats with a knife or some other objects, threatening that money and belongings would be taken, and rape or gang rape. The women perceived that violence was embedded within their working environment: “After the clients pay then we are treated as sexual objects to release their sexual pleasure; they have the right to beat us” [KI, aged 24 from beer bar]. Physical violence often occurred when clients were unsatisfied with the service and when the woman did not follow the client’s demands such as refusing to perform oral or anal sex: “He was very angry; he grabbed my hair while pulling my head to his cock and said ‘Do it for me now… suck it now!’” [22–30 years old FSW in FGD4].
Sex workers reported several strategies to avoid violence from customers, such as choosing clients carefully, and doing what clients asked for. One strategy was to carefully watch clients before deciding whether to have sex with them or not:
"“Clients prefer to spend hours talking and drinking before taking a girl for sex. While serving beers and snacks with some music, we observe and consider the clients and check references with friends” [KI, aged 24 from beer bar]."
Women reported that the risk of physical assault by clients was greater when clients tried to get cheap or free sex and additional time without paying. One woman illustrated how this risk could be reduced:
"“The agreement time had elapsed but he did not finish. Giving up the sex could have led to me being beaten. The best was to continue the sex; do what the client wants as quickly as possible and keep quiet till he is finished” [KI, aged 19 from beer bar & karaoke bar]."
The women also suggested that bringing a cell phone was a security measure when they went outside the working place with a client since it could be used if help was needed. Some stated that being able to visit a place where a security guard who can easily be asked for help during the service is available can also protect against violence.
Sex workers reported how they feared being arrested by police, especially on national holidays such as Lao National Day, during elections and on military days. Many complained that although all the official documents were completed and they had paid their working and village fees, the police still claimed the women were breaking the law. Strategies to reduce risk of violence/coercion included paying bribes, and being prepared to change location. Bribes were commonly reported:
4) Stigma and strategies to reduce stigma
"“I knew the ‘police’ wanted to have free services such as drinks, snacks and sex and my ‘pimp’ also encouraged me to do so. I managed to do this and the problem was solved. Some of them are our clients now, so we don’t have to worry next time” [18–31 years old FSW in FGD3]."
Women said that working in entertainment places increased the likelihood of being judged with disrespect due to perceived improper behavior. Fear of disclosure about one’s profession, e.g. being identified by relatives while working and meeting people who they knew, were great concerns. Feelings of shame and low self-value were frequently reported: “Sex workers are perceived as a source of diseases and cannot be accepted in this society” [KI, aged 24 from beer bar]. Another woman added: “I hate clients who call me kalee ‘bitch’, if they call me a bar woman it sounds better and I can feel happy with it. The word kalee hits my head suddenly” [18–24 years old FSW in FGD3].
Sex workers also worried about the impact of their work on love relationships. They feared being rejected and also being divorced if the profession was revealed after marriage. Such fears caused uncertainty and also made women leave love relationships when there was a risk of being disclosed. One woman described how her social image could stop her from marrying:
"“I am not really sure if we are going to marry. I am afraid that if my in-laws and husband find out about my work then they will say ‘how dare you step your foot into my house?’” [KI, aged 24 from beer bar & nightclub]."
One sex worker argued that there are many men who marry ‘a bitch’. In her opinion, some mind about this and some do not:
"“…if he married ‘a bitch’ and she turned to be good, people would praise her. Well, in the past, we may be bad, but now we turn to be good and build the family status” [17–26 years old FSW in FGD2]."
Sex workers also did not visit their families when sick in order to avoid stigma. They reported that people in the village stigmatized women returning to the village in poor health and often associated ill-health in women with having a deviant behaviour like selling sex. In order to avoid stigma and disgrace the sex workers avoided going home when sick.
"“I will not go home when ill because people would think that I do a bad job ‘sell sex’. I wait until I am better” [KI, aged 23 from beer bar & restaurant]."
On the other hand, some sex workers said that having money and wearing expensive clothes was also an effective method to reduce stigma. One woman said confidently that money could give her social status, despite her profession:
"“When I give up this work I will have money or things to show for my efforts. If not, then people could say ‘she did the work but she got nothing’. When I have money I can wear expensive clothes and use a good mobile phone. Then people will never look down on me” [18–31 years old FSW, FGD3]."
Another tactic recommended to avoid suspicious negative reactions was to wear inconspicuous clothing like Sinn ‘a Lao style skirt’, to not wear short dresses or use heavy cosmetics or coloring the hair when going home. Participation in village activities when going home was mentioned as an opportunity to get in contact with people they knew. Such contacts helped to show the women’s solidarity and respect of the traditional culture, which could significantly reduce negative perceptions.
5) Being cheated and preventive tactics to avoid being cheated
Another major source of risk cited by sex workers was being cheated. Those who cheated the women were fellow friends, clients, and boyfriends. Some women mentioned that friends had introduced them into their work without mentioning that they were expected to carry out sex work, as shown in the following quote:
"“At first I did not know that I had to have sex with clients because my friend told me that I just come to work as a hostess in the bar” [KI, aged 23 beer bar & restaurant]."
Sexual services usually took place outside the bars in places such as guesthouses, hotels, in the client’s room, or in a very remote area. Such unfamiliar environments increased the risk of being cheated and blackmailed by clients. Sex workers commonly reported that they were refused payment, or received lower payment than negotiated. Clients could also force sex workers to have sex for free by using a knife and or a sharp object as well as taking her money, mobile phone or other belongings. Strategies to avoid being robbed were to carry small sums of money and be clear in negotiations.
"“Don’t take lots of money. It can get you in trouble. Keep in mind that men who have sex with you are a type of brutal enemy” [18–31 years old FSW in FGD3]."
Other sex workers said that the most important thing to discuss was the type of service, the price and the length of the service before the agreement was made:
"“Before going out, I need to talk about what type the service is needed, short period or overnight stay, and that he must pay me first. If I do not get paid up-front, I will not go and have no reason to trust such unfamiliar clients” [KI, aged 31 from beer bar & restaurant]."
Being cheated by pimps was rarely reported. Some sex workers explained that pimps asking for money or payment for being in the bar were not cheating but provided a contribution to their business.
6) Social and economic insecurity and strategies to reduce this risk
The final source of risks mentioned by sex workers was social and economic insecurity. Women indicated that financial problems imposed mental and emotional distress because of less resources and ability to support their families. Causes of financial problems were health conditions (e.g. being infected with STIs and getting pregnant) and being cheated by clients, fellow friends or boyfriends. Women frequently reported not sharing information and ideas about health issues such as treatment of STIs, testing for HIV or pregnancy testing with their peers because of fears of being disclosed, leading to a lower income or even loss of work. A beer bar sex worker aged 30 from FGD5 said:
"“I don’t talk to friends about my genital symptoms because friends who are jealous of me might disclose it to clients. Also I may be asked to stop working for a while, or even not be allowed to work in this bar if the bar owner knows about this. I wait and quietly visit a health clinic alone”."
Many participants reported that they sometimes fought and competed amongst themselves for generous clients. This created mistrust between those working at the same venue:
"“I don’t trust anyone. No one is worth trusting in this venue and they are all in business” [KI, aged 18 from nightclub]."
Even romantic relationships were avoided because of the risk of economic loss. It was mentioned in all FGDs that engaging in sex work is for money but not for love. Having a love relationship takes time away from making money:
"“Having a boyfriend is a weak point. The guy would give us some money first then he would find reasons to get money from us and because of love we give him the money that we earned” [18–24 years old FSW in FGD1]."
Perceived benefits and strategies to increase benefits
In addition to telling us about the risks of sex work, participants spontaneously reported three categories of benefits related to their work: 1) financial security and ways to increase income, 2) fulfilling social obligations and getting self-value and 3) sexual pleasure and strategies to increase pleasure (Table ). These benefits and strategies to increase benefits are illustrated below.
Positives outcomes of sex work in Laos and strategies to increase chances to achieve them
1) Financial security and ways to increase income
Participants reported that sex work is an easy and good source of income compared to other jobs. They said that sex work was suitable for a low-educated person because working in a bar does not require formal training or skills and is quickly learned.
"“When I first started working in this bar I did not know how to take care of clients. I spent time observing and asked my friend who worked in the same bar. Soon I could work myself” [18–24 years old FSW in FGD1]."
The sex workers mentioned strategies for increasing their income e.g. engaging in risky sex and agreeing on the client’s sexual requests.
"“When we arrived at the hotel room, he did not want to use a condom based on the agreement. I asked him to give me more money… and then I got three times higher than the negotiated price” [KI, aged 24 from beer bar]."
"“Many clients need oral sex before vaginal or anal sex or both and you can use that to ask for more pay. Usually, men choose pleasure, but not the price” [18–30 years old FSW in FGD5]."
Sex workers explained that men want to visit sex workers because sex at home is not pleasurable and being nice to clients will give more benefits. One young woman applies this concept at first encounter with clients in the following way:
2) Fulfilling social obligations and getting self-value
"“When clients visit, I said Sabaidee ‘hello sir’ while smiling. I immediately invite them for a seat. I serve a glass of cold water first, talk to them softly and show my respect throughout the service. It doesn’t matter if I go for sex but in the end I usually have a very good tip” [KI, aged 19 from beer bar & karaoke bar]."
Another benefit from sex work that participants reported was fulfilling social obligations and getting self-value. Most women said that they engaged in sex work to support their families and care for the parents. They regularly sent money to their families and the amount depended on how much they could earn. Due to the poor living conditions and lack of employment opportunities in their home villages, some women said that they followed friends who worked as bar workers in the “big city” to find alternative ways to make a living and support their families.
"“After the wet rice farming season there is nothing much to do at home. My parents are farmers and they cannot raise many of us. Taking this job helps contribute to my family’s income” [KI, aged 18 from nightclub]."
Some women had dropped out of school because they needed to find a job in order to support their family. This motivated many of them to engage in sex work.
"“My parents borrow money to hire people for planting rice but the rice was dead after the flooding. They had to pay for the capital ‘the rice seed and the labor.’ If they could not pay back, our land would be confiscated. I don’t go to school and must work in the bar to gradually pay back the debt” [KI, aged 24 beer bar & nightclub]."
Another participant explained her situation in the following way:
"“In my case, I have to take responsibility for all of my parents’ expenses, even my brothers’ and sisters’ school’s fees. I decided do the job myself because there are many people who need my support” [24–31 years old FSW in FGD3]."
Some find the work very hard but a necessary fact of life as illustrated in the following citation:
"“I had first sex with a guy over here, after working in the bar. I got the ‘sell the virginity’ [deflowering fee] and that was the first money I earned. I saved some money for myself and also sent some to my parents” [KI, aged 26 from beer bar]."
Being able to support the family made participants proud and gave them potential future social worth, despite the stigma they experienced in the present.
"“I think that whatever they say to insult us, one day in the future they will praise us if we do good things for our family” [KI, aged 31 from beer bar and restaurant]."
Many women said that being a daughter requires obedience and sacrifice to the family’s demands, and that they were proud to be able to support the family.
3) Sexual pleasure and strategies to increase sexual feelings
"“Parents raise us since we were born, they dedicated a lot already. When they were sick it was hard for them to pay for health care. As a daughter, we cannot dare to see such them suffer. It is time to work for them now” [22–31 years old FSW in FGD3]."
A third benefit of sex work reported by many participants was sexual pleasure. Some sex workers claimed that having sex with clients did not give them pleasure because they only did it for money but without love: “Sexual pleasure with clients… I did not have such feeling because I did not love them and without love then not possible to have it” [KI, aged 18 from nightclub].
Another beer bar woman added:
"“When the clients finish then I get my money. They usually finish quick, but for me it takes time. But sometimes it is really great” [17–22 years old FSW in FGD4]."
Many sex workers noted that spending time to get sexual pleasure was lost time and they were reluctant to reach ‘sexual climax’ since they needed to find more clients, as this young women noted:
"“If I reached the peak point ‘orgasm’ then I will be very tired and then I cannot find more clients” [KI, aged 24 from beer bar]."
In contrast, many other women argued that sex work gave them not only money but also sexual pleasure and fun:
"“Working in the bar I have money, and I also enjoy sex” [24–31 years old FSW in FGD3]."
One beer bar worker remarked that she preferred to have polite and handsome clients and that such clients could increase her sexual pleasure:
"“Most of the time I select clients not only because of money but because they are both good looking and have good money. I like a good looking and clean one, it makes really great when having sex” [KI, aged 18 from nightclub]."