Female sex workers and their gatekeepers in China: implications for HIV/STI prevention

Conceptualizing Community Engagement for Mental and Brain Health Research in Low- and Middle-Income Countries: A Case of Kilifi County, Kenya

Community engagement (CE) has increasingly been recognized as a critical element for successful health promotion and intervention programs. However, the term CE has been used to mean different things in different settings. In this article, we explore how CE has been conceptualized in the field of mental and brain health in Kilifi County, Kenya. We used ethnographic methods encompassing focused group discussions, key informant interviews, and observations with 65 participants, purposively recruited from Kilifi County. Data were transcribed verbatim and thematically analyzed. Our findings show that community members and stakeholders had diverse perceptions of and experiences with CE. Factors such as trust between researchers and community members, sensitization, and awareness creation were key for acceptance of research projects. Partial involvement in research, lack of access to information, poverty and socio-economic challenges, and financial expectations from researchers hindered CE and led to resistance to participation in research projects. For effective CE, there is a need to work closely with community gatekeepers, create awareness of the research projects, use local languages, and ensure continuous engagement that promotes equitable research participation. Our findings suggest that tacit knowledge, context, and mechanisms for research are all critical features of CE and should be considered to enhance acceptance and sustainability of mental and brain health interventions in Kenya.

The effects of social networks on HIV risk behaviors among Vietnamese female sex workers: a qualitative study

INTRODUCTION

Female sex workers (FSWs) experience heightened vulnerability to HIV and other health harms, and cross-border FSWs face additional challenges due to language issues, higher mobility, and weaker negotiation skills. Given the critical role of social network factors in HIV transmission, it is imperative to explore the social network characteristics of Vietnamese cross-border FSWs in China to enhance AIDS prevention and control.

METHODS

We conducted semi-structured interviews with 22 Vietnamese FSWs in Hekou County, Yunnan Province from May to July 2018. The samples were selected using a purposive sampling strategy and stopped when reached theoretical saturation. Data collection and analysis were conducted iteratively to identify themes within the data. Participants reported their social relationships and how these relationships affected their HIV risk behaviours. All the interviews were recorded, transcribed verbatim, and reviewed. Thematic analysis was used to analyse the data.

RESULTS

Among 22 Vietnamese FSWs, the median age was 23.5. Concerning social networks, interviews revealed that their social networks were composed of three components: Workplace networks (customer, boss, colleague), Hometown networks (spouse or boyfriend, family member, fellow villager), and Social institutions networks (Chinese social institutions network, Vietnamese social institutions network). None of these networks can simply support or hinder Vietnamese FSWs' preventive high-risk HIV behaviours, and the impact is achieved through each network's ways. Within the workplace network, the predominant influence is the ascendancy-submissiveness dynamic that exists among customers, bosses, and VFSWs. In the hometown network, familial responsibilities emerge as the principal factor impacting VFSWs. Meanwhile, within the social institution network, pivotal roles are played by the Chinese CDC and the Vietnamese government in the dissemination of HIV knowledge.

CONCLUSIONS

The social networks of Vietnamese female sex workers exert a dual impact on high-risk HIV behaviors. Interventions should be designed and tailored to address the specific contextual factors and challenges associated with social networks among cross-border FSWs in China and other similar settings.

Working with economically vulnerable women engaged in sex work: Collaborating with community stakeholders in Southern Uganda

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT03583541.

Finding the way into a global industry

Purpose

Gatekeepers in social research are regularly taken for granted in the associated methods literature, yet they constitute an interesting social phenomenon in themselves as powerful and normally unpaid agents of research access. Questions relating to the recruitment of potential gatekeepers and to the nature of the rewards that they might seek are under-considered and locating key gatekeepers is often characterised (perhaps inadvertently) as a matter of luck or happenstance. The paper aims to discuss these issues.

Design/methodology/approach

This paper is a multi-sited ethnography based on maritime industry conferences held annually in Europe and Asia. The two authors attended 18 of these conferences either as regular delegate or as a speaker. In these conferences, they maintained fieldnotes and formally and informally interviewed participants both face to face and e-mail.

Findings

Every year executives come together at commercially organised conferences focussed upon human resource management in the shipping industry. At these events, major global players discuss a programme of issues related to the business of recruiting and training seafarers. However, these international conferences are both much more and much less than they seem. They are crucial in establishing reputational capital and provide researchers with key venues for negotiating research access.

Originality/value

This paper argues that unlike most conferences, these can only be seen as “field configuring events” to a very limited extent but that they nonetheless serve an important purpose in securing symbolic, and more significantly reputational, capital for both individual delegates and interested academics. The paper further argues that resourceful researchers can mobilise such capital in their favour in negotiating research access contributing new ideas to the literature on gatekeepers and on research access.

Work environments and HIV prevention: a qualitative review and meta-synthesis of sex worker narratives

Background

Sex workers (SWs) experience a disproportionately high burden of HIV, with evidence indicating that complex and dynamic factors within work environments play a critical role in mitigating or producing HIV risks in sex work. In light of sweeping policy efforts to further criminalize sex work globally, coupled with emerging calls for structural responses situated in labour and human-rights frameworks, this meta-synthesis of the qualitative and ethnographic literature sought to examine SWs’ narratives to elucidate the ways in which physical, social and policy features of diverse work environments influence SWs’ agency to engage in HIV prevention.

Methods

We conducted a meta-synthesis of qualitative and ethnographic studies published from 2008 to 2014 to elucidate SWs’ narratives and lived experiences of the complex and nuanced ways in which physical, social, and policy features of indoor and outdoor work environments shape HIV prevention in the sex industry.

Results

Twenty-four qualitative and/or ethnographic studies were included in this meta-synthesis. SWs’ narratives revealed the nuanced ways that physical, social, and policy features of work environments shaped HIV risk and interacted with macrostructural constraints (e.g., criminalization, stigma) and community determinants (e.g., sex worker empowerment initiatives) to shape SWs’ agency in negotiating condom use. SWs’ narratives revealed the ways in which the existence of occupational health and safety standards in indoor establishments, as well as protective practices of third parties (e.g., condom promotion) and other SWs/peers were critical ways of enhancing safety and sexual risk negotiation within indoor work environments. Additionally, working in settings where negative interactions with law enforcement were minimized (e.g., working in decriminalized contexts or environments in which peers/managers successfully deterred unjust policing practices) was critical for supporting SWs’ agency to negotiate HIV prevention.

Conclusions

Policy reforms to remove punitive approaches to sex work, ensure supportive workplace standards and policies, and foster SWs’ ability to work collectively are recommended to foster the realization of SWs’ health and human rights across diverse settings. Future qualitative and mixed-methods research is recommended to ensure that HIV policies and programmes are grounded in SWs’ voices and realities, particularly in more under-represented regions such as Eastern Europe and Sub-Saharan Africa.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-015-2491-x) contains supplementary material, which is available to authorized users.

Contextual influence on condom use in commercial sex venues: A multi-level analysis among female sex workers and gatekeepers in Guangxi, China

This study aims to assess the influence of commercial sex venues on consistent condom use among female sex workers (FSWs) and to examine associations between individual and venue level factors and consistent condom use with clients. Analysis was based on a sample of 637 FSWs and 123 gatekeepers from 51 venues in Guangxi, China. Multi-level logistic regression using Bayesian simulation via Markov Chain Monte Carlo was applied to investigate whether FSWs' individual propensity to use condom with clients was statistically dependent on the venue of working. Multi-level modeling revealed considerable variability across venues in the likelihood of consistent condom use with clients among FSWs. Characteristics at both individual and venue levels helped to explain the observed variation. Certain venue-level factors exerted their influence on condom use over and above the effect of individual-level characteristics. The contextual influence exerted on condom use behaviors among FSWs may imply a potential to harness the path to individual behaviors from a higher and more dominant level, and shed light on the design of more effective sexual risk reduction intervention among venue-based FSWs.