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
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.
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.
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