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Strategies for Recruiting Steady Male Partners of Female Sex Workers for HIV Research

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Abstract

Steady male partners of female sex workers (FSW) are a key population for HIV prevention, but researchers face challenges finding and recruiting this population. We conducted 40 in-depth interviews with FSW and steady male partners of FSW in Santo Domingo, Dominican Republic about how to engage steady male partners in HIV research. Participants cautioned that male partners might be unwilling to participate because of discomfort disclosing intimate information and cultural norms of masculinity. They recommended inviting male partners to research offices, instead of venue-based recruitment, because it was more private and trust-promoting. Most participants suggested that FSW could refer their partners or men could refer their friends who have FSW partners. Participants emphasized that referrals could break down trust-related barriers that prevent male partners from participating. Establishing an environment of respect and trust in the research setting can aid referral processes as individuals who participate communicate their positive experiences to their networks.

Resumen

Parejas fijas masculinas de mujeres trabajadores sexuales (MTS) son una población clave para la prevención de VIH, pero investigadores enfrentan desafíos para reclutar esta población. Hicimos cuarenta entrevistas en profundidad con MTS y parejas fijas masculinas de MTS en Santo Domingo, Republica Dominicana sobre como reclutar parejas masculinas en investigaciones de VIH. Participantes mencionaron que parejas fijas masculinos puede negar participación en un estudio por miedo de divulgar información intima y por normas culturales de masculinidad. Recomendaron invitar parejas masculinos a oficinas de investigación, en vez de reclutar en bares/clubes, porque oficinas son mas privado y confiado. La mayoría de participantes surgieron que MTS pueden referir sus parejas o que hombres pueden referir sus amigos quienes tienen una pareja MTS. Participantes enfatizaron que referencias podrían romper barreras relacionado a confianza que previenen que los hombres participan. Establecer un ambiente de respeto y confianza en el lugar de investigación puede facilitar el proceso de referencia porque participantes comunican su experiencia positiva con sus redes.

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References

  1. UNAIDS. Global Report: UNAIDS Report on the Global AIDS Epidemic 2012. Geneva: UNAIDS; 2012.

  2. Baral S, Beyrer C, Muessig K, et al. Burden of HIV among female sex workers in low-income and middle-income countries: a systematic review and meta-analysis. Lancet Infect Dis. 2012;12(7):538–49.

    Article  PubMed  Google Scholar 

  3. Shahmanesh M, Patel V, Mabey D, Cowan F. Effectiveness of interventions for the prevention of HIV and other sexually transmitted infections in female sex workers in resource poor setting: a systematic review. Trop Med Int Health. 2008;13(5):659–79.

    Article  PubMed  Google Scholar 

  4. Halli SS, Ramesh B, O’Neil J, Moses S, Blanchard JF. The role of collectives in STI and HIV/AIDS prevention among female sex workers in Karnataka. India. AIDS Care. 2006;18(7):739–49.

    Article  CAS  Google Scholar 

  5. Asthana S, Oostvogels R. Community participation in HIV prevention: problems and prospects for community-based strategies among female sex workers in Madras. Soc Sci Med. 1996;43(2):133–48.

    Article  CAS  PubMed  Google Scholar 

  6. Kerrigan D, Moreno L, Rosario S, Gomez B, Jerez H, Barrington C, et al. Environmental-structural interventions to reduce HIV/STI risk among female sex workers in the Dominican Republic. Am J Public Health. 2006;96(1):120–5.

    Article  PubMed Central  PubMed  Google Scholar 

  7. Ford K, Wirawan DN, Suastina W, Reed BD, Muliawan P. Evaluation of a peer education programme for female sex workers in Bali, Indonesia. Int J STD AIDS. 2000;11(11):731–3.

    Article  CAS  PubMed  Google Scholar 

  8. Kerrigan D, Telles P, Torres H, Overs C, Castle C. Community development and HIV/STI-related vulnerability among female sex workers in Rio de Janeiro, Brazil. Health Educ Res. 2008;23(1):137–45.

    Article  PubMed  Google Scholar 

  9. Faugier J, Cranfield S. Reaching male clients of female prostitutes: the challenge for HIV prevention. AIDS Care. 1995;7(Suppl 1):S21–32.

    Article  PubMed  Google Scholar 

  10. Pickering H, Todd J, Dunn D, Pepin J, Wilkins A. Prostitutes and their clients: a Gambian survey. Soc Sci Med. 1992;34(1):75–88.

    Article  CAS  PubMed  Google Scholar 

  11. Yang C, Latkin C, Luan R, Nelson K. Condom use with female sex workers among male clients in Sichuan Province, China: the role of interpersonal and venue-level factors. J Urban Health. 2010;87(2):292–303.

    Article  PubMed Central  PubMed  Google Scholar 

  12. Miller GA, Mendoza W, Krone MR, et al. Clients of female sex workers in Lima, Peru: a bridge population for sexually transmitted disease/HIV transmission? Sex Transm Dis. 2004;31(6):337–42.

    Article  PubMed  Google Scholar 

  13. Murray L, Moreno L, Rosario S, Ellen J, Sweat M, Kerrigan D. The role of relationship intimacy in consistent condom use among female sex workers and their regular paying partners in the Dominican Republic. AIDS Behav. 2007;11(3):463–70.

    Article  PubMed  Google Scholar 

  14. Pitpitan EV, Chavarin CV, Semple SJ, Magis-Rodriguez C, Strathdee SA, Patterson TL. Hombre Seguro (Safe Men): a sexual risk reduction intervention for male clients of female sex workers. BMC Public Health. 2014;14:475.

    Article  PubMed Central  PubMed  Google Scholar 

  15. Zhang C, Li X, Su S, Zhang L, Zhou Y, Shen Z, et al. Prevalence of HIV, syphilis, and HCV infection and associated risk factors among male clients of low-paying female sex workers in a rural county of Guangxi, China: a cross-sectional study. Sex Transm Infect. 2014;90(3):230–6.

    Article  PubMed  Google Scholar 

  16. Sabido M, Lahuerta M, Montoliu A, et al. Human immunodeficiency virus, sexually transmitted infections, and risk behaviors among clients of sex workers in Guatemala: are they a bridge in human immunodeficiency virus transmission? Sex Transm Dis. 2011;38(8):735–42.

    PubMed  Google Scholar 

  17. Yam EA, Mnisi Z, Sithole B, Kennedy C, Kerrigan DL, Tsui AO, et al. Association between condom use and use of other contraceptive methods among female sex workers in Swaziland: a relationship-level analysis of condom and contraceptive use. Sex Transm Dis. 2013;40(5):406–12.

    Article  PubMed  Google Scholar 

  18. Deering KN, Bhattacharjee P, Bradley J, Moses SS, Shannon K, Shaw SY, et al. Condom use within non-commercial partnerships of female sex workers in southern India. BMC Public Health. 2011;11(Suppl 6):S11.

    Article  PubMed Central  PubMed  Google Scholar 

  19. COPRESIDA. Segunda Encuesta de Vigilancia de Comportamiento con Vinculacion Serologica en Poblaciones Claves. Santo Domingo, Dominican Republic; 2014.

  20. Shah NS, Shiraishi RW, Subhachaturas W, et al. Bridging populations-sexual risk behaviors and HIV prevalence in clients and partners of female sex workers, Bangkok, Thailand 2007. J Urban Health. 2011;88(3):533–44.

    Article  PubMed Central  PubMed  Google Scholar 

  21. Fleming PJ, Barrington C, Perez M, Donastorg Y, Kerrigan D. Amigos and amistades: the role of men’s social network ties in shaping HIV vulnerability in the Dominican Republic. Cult Health Sex. 2014;16(8):883–97.

    Article  PubMed Central  PubMed  Google Scholar 

  22. Barrington C, Fleming P, Rosario S, Moya M, Kerrigan D. Social networks and HIV prevention: Qualitative Insights from an Intervention with Male Clients of Female Sex Workers in Santo Domingo, Dominican Republic. 139th Annual Meeting of the American Public Health Association; Washington, D.C.; 2011.

  23. Robertson AM, Syvertsen JL, Ulibarri MD, Rangel MG, Martinez G, Strathdee SA. Prevalence and correlates of HIV and sexually transmitted infections among female sex workers and their non-commercial male partners in two Mexico-USA border cities. J Urban Health. 2014;9(4):752–67.

    Article  Google Scholar 

  24. Ulibarri MD, Roesch S, Rangel MG, Staines H, Amaro H, Strathdee SA. “Amar te Duele” (“Love Hurts”): sexual relationship power, intimate partner violence, depression symptoms and HIV risk among female sex workers who use drugs and their non-commercial, steady partners in Mexico. AIDS Behav. 2014;. doi:10.1007/s10461-014-0772-5.

    PubMed  Google Scholar 

  25. Syvertsen JL, Robertson AM, Strathdee SA, Martinez G, Rangel MG, Wagner KD. Rethinking risk: Gender and injection drug-related HIV risk among female sex workers and their non-commercial partners along the Mexico-U.S. border. Int J on Drug Policy. 2014;. doi:10.1016/j.drugpo.2014.02.005.

    Google Scholar 

  26. Palinkas LA, Robertson AM, Syvertsen JL, Hernandez DO, Ulibarri MD, Rangel MG, et al. Client perspectives on design and implementation of a couples-based intervention to reduce sexual and drug risk behaviors among female sex workers and their noncommercial partners in Tijuana and Ciudad Juarez, Mexico. AIDS Behav. 2014;18(3):583–94.

    Article  PubMed  Google Scholar 

  27. Lowndes CM, Alary M, Gnintoungbe CA, et al. Management of sexually transmitted diseases and HIV prevention in men at high risk: targeting clients and non-paying sexual partners of female sex workers in Benin. AIDS. 2000;14(16):2523–34.

    Article  CAS  PubMed  Google Scholar 

  28. Barrington C, Latkin C, Sweat MD, Moreno L, Ellen J, Kerrigan D. Talking the talk, walking the walk: social network norms, communication patterns, and condom use among the male partners of female sex workers in La Romana, Dominican Republic. Soc Sci Med. 2009;68(11):2037–44.

    Article  PubMed Central  PubMed  Google Scholar 

  29. Sweat M, Kerrigan D, Moreno L, Rosario S, Gomez B, Jerez H, et al. Cost-effectiveness of environmental-structural communication interventions for HIV prevention in the female sex industry in the Dominican Republic. J Health Commun. 2006;11(Suppl 2):123–42.

    Article  PubMed  Google Scholar 

  30. Kerrigan D, Moreno L, Rosario S, Sweat M. Adapting the Thai 100% condom programme: developing a culturally appropriate model for the Dominican Republic. Cult Health Sex. 2001;3(2):221–40.

    Article  Google Scholar 

  31. COPRESIDA. 1era Encuesta de Vigilancia de Comportamiento con Vinculacion Serologica en Poblaciones Vulnerables. Santo Domingo, Dominican Republic; 2008.

  32. Barrington C, Kerrigan D. Debe cuidarse en la calle: normative influences on condom use among the steady male partners of female sex workers in the Dominican Republic. Cult Health Sex. 2014;16(3):273–87.

    Article  Google Scholar 

  33. IX Censo Nacional de Poblacion y Vivienda: Informe General. Oficina Nacional de Estadistica; 2012.

  34. Halperin DT, de Moya EA, Perez-Then E, Pappas G, Garcia Calleja JM. Understanding the HIV epidemic in the Dominican Republic: a prevention success story in the Caribbean? J Acquir Immune Defic Syndr. 2009;51(Suppl 1):S52–9.

    Article  PubMed  Google Scholar 

  35. UNAIDS, COPRESIDA, DIGECITSS. HIV Modes of Transmission Model: Analysis of the distribution of new infections in the Dominican Republic and recommendations for prevention. Santo Domingo, Dominican Republic; 2010.

  36. Morse J. Determining sample size. Qual Health Res. 2000;10(1):3–5.

    Article  Google Scholar 

  37. Dworkin S. Sample size policy for qualitative studies using in-depth interviews. Arch Sex Behav. 2012;41:1319–20.

    Article  PubMed  Google Scholar 

  38. Guest G, Bunce A, Johnson L. How many interviews are enough? An experiment with data saturation and variability. Field Methods. 2006;18(1):59–82.

    Article  Google Scholar 

  39. Saldaña J. The coding manual for qualitative researchers. An introduction to codes and coding. Thousand Oaks: Sage; 2009. p. 1–31.

    Google Scholar 

  40. Atlas.ti (version 7.0). Berlin, Germany: Atlas.ti Scientific Software Development GmbH; 2012.

  41. Saldaña J. Writing analytic memos. The coding manual for qualitative researchers. Thousand Oaks, CA: Sage; 2009.

    Google Scholar 

  42. de Moya EA. Versiones y subversiones de la masculinidad en la cultura Dominicana. Perspectivas Psicologicas. 2003;3–4:186–92.

    Google Scholar 

  43. Connell RW. Masculinities. Berkeley: University of California Press; 1995.

    Google Scholar 

  44. Gilmore DD. Manhood in the making: cultural concepts of masculinity. New Haven: Yale University Press; 1990.

    Google Scholar 

  45. Galdas PM, Cheater F, Marshall P. Men and health help-seeking behaviour: literature review. J Adv Nurs. 2005;49(6):616–23.

    Article  PubMed  Google Scholar 

  46. Mustard CA, Kaufert P, Kozyrskyj A, Mayer T. Sex differences in the use of health care services. N Engl J Med. 1998;338(23):1678–83.

    Article  CAS  PubMed  Google Scholar 

  47. O’Brien R, Hunt K, Hart G. ‘It’s caveman stuff, but that is to a certain extent how guys still operate’: men’s accounts of masculinity and help seeking. Soc Sci Med. 2005;61(3):503–16.

    Article  PubMed  Google Scholar 

  48. Levant RF, Wilmer DJ, Williams CM, Smalley KB, Noronha D. The relationships between masculinity variables, health risk behaviors and attitudes toward seeking psychological help. Int J Mens Health. 2009;8(1):3–21.

    Article  Google Scholar 

  49. Addis ME, Mahalik JR. Men, masculinity, and the contexts of help seeking. Am Psychol. 2003;58(1):5.

    Article  PubMed  Google Scholar 

  50. Coles R, Watkins F, Swami V, Jones S, Woolf S, Stanistreet D. What men really want: a qualitative investigation of men’s health needs from the Halton and St Helens Primary Care Trust men’s health promotion project. Br J Health Psychol. 2010;15(Pt 4):921–39.

    Article  PubMed  Google Scholar 

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Acknowledgments

We would like to thank the study participants for sharing their time and stories with us. This research has been supported by the President’s Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Agency for International Development under the terms of the Project SEARCH Contract No. GHH-I-00-07-00032-00. We are grateful to the Carolina Population Center for training support (T32 HD007168) and for general support (R24 HD050924). We would also like to acknowledge Berenice Mercedes, Melchor Moya, Santo Rosario, and the Centro de Orientación e Investigación (COIN) for their contribution in developing and carrying out this research.

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Authors and Affiliations

  1. Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 302 Rosenau Hall, Chapel Hill, NC, USA

    Paul J. Fleming & Clare Barrington

  2. Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Paul J. Fleming & Clare Barrington

  3. HIV Vaccine Trials Unit, Instituto Dermatológico y Cirugía de Piel “Dr. Huberto Bogaert Díaz”, Santo Domingo, Dominican Republic

    Martha Perez & Yeycy Donastorg

  4. Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Deanna Kerrigan

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  1. Paul J. Fleming
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  2. Clare Barrington
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  4. Yeycy Donastorg
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  5. Deanna Kerrigan
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Correspondence to Paul J. Fleming.

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Fleming, P.J., Barrington, C., Perez, M. et al. Strategies for Recruiting Steady Male Partners of Female Sex Workers for HIV Research. AIDS Behav 19, 362–368 (2015). https://doi.org/10.1007/s10461-014-0894-9

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  • DOI: https://doi.org/10.1007/s10461-014-0894-9

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