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

BACKGROUND Globally, HIV prevalence among female sex workers (FSWs) is higher than in the general population, makingHIV research among FSWs an important undertaking. However, due to the stigma associated with sexwork, FSWs are a hidden population difficult to engage in research studies. This formative research studyconsidered methodological practices that were acceptable and suitable to FSWs and that would ensure optimalparticipation in the South African Health Monitoring Study (SAHMS), an integrated biological-behaviouralsurvey (IBBS). METHODS The study was conducted in Durban, Johannesburg and Cape Town in 2013. Through purposive sampling, 91FSWs participated in focus group discussions. Twenty-one researchers and stakeholders working closely withFSWs and FSWs themselves participated in in-depth interviews. Data was collected using a semi-structuredqualitative interview guide. RESULTS Respondent-driven sampling was cited as the preferred recruitment method. Participants providedrecommendations on IBBS study procedures, study logistics and the disposition of study staff. The majority ofparticipants were confident that FSWs enrolled in IBBS would be willing to test for HIV, as well as accept theuse of biometrics and laptops. Participants’ concerns about confidentiality and study staff attitudes were citedas common barriers to participation. CONCLUSION Participation of FSWs in an IBBS is important to determine HIV prevalence and inform preventionstrategies. Using a participatory approach to engage FSWs in research studies can help ensure ethicalresearch 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 communityempowerment.