In addition, intimidation, such as fear of threats and victimization from massage parlor managers and customers, has contributed to unsafe sexual practices among Asian masseuses. The qualitative study showed that Asian masseuses face difficult choices over condom use due to economic incentives to earn extra money through not using a condom, as well as keeping relationships with regular customers. Based on the baseline data collected from 105 Asian masseuse participants, 11% and 19% of the participants reported having engaged in unprotected vaginal and oral sex with customers during the past 30 days, respectively. The study identified 23 “Asian” massage parlors in downtown San Francisco. A health promotion study for Asian masseuses in San Francisco was implemented in 2002. Typically, customers pay massage fees at massage parlor premises and enter into a massage room and negotiate sexual services.
Commercial sex venues at massage parlors in the USA are distinguished by the service providers (mostly Asian immigrant women from South Korea, China, Vietnam, Thailand, and other Asian countries) and service delivery systems which are based on private negotiations between Asian masseuses and customers to exchange money for sexual services. Prostitution is illegal in San Francisco and other large cities in the USA however, male customers are able to negotiate with female sex workers (FSWs)/masseuses for sexual services at massage parlors. Also, customers’ and masseuses’ perceptions toward relationships at massage parlors and power dynamics need further investigation to promote safe work environments and 100% condom use at massage parlors. Culturally appropriate HIV/STI prevention programs (e.g., communication about and practicing 100% condom use) are needed to target both customers and Asian masseuses at multiple levels (individual, owner/manager, work environment, and community levels). Some customers sought emotional attachment with Asian masseuses and expressed stereotypical views toward them as being docile and submissive. Customers perceived massage parlors as being a safe place compared with street sex venues. Their sexual behaviors with Asian masseuses were influenced by perceptions about vulnerability toward HIV/STIs, substance use behaviors, and masseuses’ initiation of condom use, which was often governed by unspoken rules at parlors.
A pervasive view among patrons was that they could engage in sex with masseuses without using a condom if they offered extra money. Based on focus groups for male customers who frequented Asian massage parlors in San Francisco, the present study described their sexual and drug use behaviors and attitudes toward practicing safe sex with Asian masseuses.