The methodological and practical concerns of conducting an integrated bio-behavioural survey with female sex workers: Lessons from the field

Abstract

Background: Globally, HIV prevalence among female sex workers (FSWs) is higher than in the general population, making HIV research among FSWs an important undertaking. However, due to the stigma associated with sex work, FSWs are a hidden population difficult to engage in research studies. This  formative research study considered methodological practices that were acceptable and suitable to FSWs and that would ensure optimal participation in  the South African Health Monitoring Study (SAHMS), an integrated biological-behavioural survey (IBBS).

Methods: The study was conducted in Durban, Johannesburg and Cape Town in 2013. Through purposive sampling, 91 FSWs participated in focus group  discussions. Twenty-one researchers and stakeholders working closely with FSWs and FSWs themselves participated in in-depth interviews. Data was  collected using a semi-structured qualitative interview guide.

Results: Respondent-driven sampling was cited as the preferred recruitment method. Participants provided recommendations on IBBS study procedures,  study logistics and the disposition of study staff. The majority of participants were confident that FSWs enrolled in IBBS would be willing to  test for HIV, as well as accept the use of biometrics and laptops. Participants’ concerns about confidentiality and study staff attitudes were cited as  common barriers to participation.

Conclusion: Participation of FSWs in an IBBS is important to determine HIV prevalence and inform prevention strategies. Using a participatory approach  to engage FSWs in research studies can help ensure ethical research implementation, inform methodological best practices and increase recruitment and  participation. Including FSWs in the planning and implementation of surveys can contribute to their sense of community empowerment.