Social and structural constraints on disclosure and informed consent with female sex workers and their managers in the Philippines
Aim: This project explored the experiences of female sex workers (FSWs) working in night clubs, karaoke bars, and spa/saunas in the Philippines in participating in behavioral HIV prevention research, including their process of consent to research, their knowledge of research ethics, barriers to disclosure of sensitive topics, and the necessary conditions for their involvement in HIV research prevention interventions.
Participants: 7 former interviewers participated in a focus group, and 20 FSWs and 10 establishment managers were interviewed individually as key informants about the research process. Method: This qualitative research used semi-structured interview guides for the individual interviews, focus group, and community advisory board meetings, and ethnographic approaches.
Results: Emergent themes include FSW issues with trust of the research and interviewer, intrusiveness of survey questions, problems seeing any changes made as a result of the research, and feeling forced by government to do surveys. FSWs expressed desire to actively participate in intervention design and implementation and to learn new skills and obtain job training to learn other ways to earn money. Both FSW and managers expressed dissatisfaction with government support: having to pay for clinic health exams, and managers expressed problems with the government’s ability to intervene around police raids and bribes.
Conclusion: This project has the potential to improve HIV prevention research practices with FSWs by 1) foregrounding ethical issues by addressing barriers to respect, trust, and/or disclosure stemming from risks in the structural environment or micro-level social aspects of the research process and 2) developing a more transparent and participatory approach to HIV prevention research that engages participants/ FSWs in the research process in order to reduce perceived and actual risks to participants.
Selected Recent Publications and Presentations
Urada, L.A., Simmons, J. (2014) "Social and structural constraints on disclosure and informed consent for HIV survey research with female sex workers and their managers in the Philippines". Journal of Empirical Research on Human Research Ethics, 9(1), 29-40.
Urada, L.A., Simmons, J. (2014) "A collaborative methodology for investigating the ethical conduct of female sex workers in the Philippines". Journal of Empirical Research on Human Research Ethics, 9(1), 41-45.
Urada, L.A., Strathdee, S.A., Morisky, D.E., Schilling, R.F., Pimentel-Simbulan, N., Estacio Jr, L.R. & Raj, A. (2013). "Sex work and its associations with alcohol and methamphetamine use among female bar and spa workers in the Philippines". Asia-Pacific Journal of Public Health. Online Jan. 22, 2013.
Urada, L.A., Morisky, D.E., Hernandez, L.I., & Strathdee, S.A. (2013). "Social and structural factors associated with consistent condom use among female entertainment workers trading sex in the Philippines". AIDS and Behavior, 17(2), 523-535.
Urada, L.A., Raj, A., Cheng, D.M., Quinn, E., Bridden, C., Blokhina, E.A., Krupitsky, E., Samet, J.H. (in press). "History of intimate partner violence is associated with sex work but not STI among HIV-positive female drinkers in Russia". International Journal of STD/AIDS.
Hiller, S. P., Urada, L. A., Lozada, R., Syvertsen, J., Ojeda, V. D. (in press). "Social support and recovery among Mexican female sex workers who inject drugs". Journal of Substance Abuse Treatment.
Davtyan, M., Munoz, K., Urada, L., & Brown, B. (2013). "Transactional Sex: A Client’s Perspective from Peru". Electronic Journal of Human Sexuality, 16.
Urada, L.A., Goldenberg, S. M., Shannon, K., & Strathdee, S.A. (in press). Sex Work. In Baumeister, J., Ward, L. M., George, W., & Pfaus, J. (Eds.), APA Handbook of Sexuality. Washington, D.C.: American Psychological Association.
Urada, L.A., Strathdee, S.A., Morisky, D.E., Schilling, R.F., Pimentel-Simbulan, N., Estacio Jr, L.R. & Raj, A. (January, 2013). "Sex work and its associations with alcohol and methamphetamine use among female bar and spa workers in the Philippines". Society for Social Work and Research Annual Conference, San Diego, CA.
Urada, L.A. (February, 2013). Disempowerment and engagement: Sex workers and female bar/spa workers in the Philippines. Panel on “Sexual health and empowerment of female sex workers in several countries” with Brown, B., Yarborough, D., & Swendenman, D. UC Global Health Day, UC Global Health Institute, Riverside, CA.
Urada, L.A., Goldenberg, S. M., Shannon, K., & Strathdee, S.A. (August, 2013). Sex Work. Panel on “Sexuality and social issues: Current advances and directions for the future” with Tolman, D., McClelland S. & Hernandez, K. American Psychological Association Convention, Honolulu, HI.
Urada, L.A. & Simmons, J. (November, 2013). Social and structural constraints on disclosure and informed consent with female sex workers and their managers in the Philippines. Panel on “Enhancing the responsible conduct of HIV prevention research across culturally and globally diverse populations” with Fisher C., Reed E., & Pearson C. American Public Health Association Annual Meeting and Exposition, Boston, MA.
Urada, L.A., Morisky, D.E., Pimentel-Simbulan, N., Silverman, J.G., & Strathdee, S.A. (2012). "Condom negotiations among female sex workers in the Philippines": Environmental Influences. PLoS ONE 7(3):1-9, doi: 10.1371/journal.pone.0033282. Epub 2012 Mar 20.
Urada, L.A., Malow, R.M., Santos, N.C., Morisky, D.E. (2012). "Age differences among female sex workers in the Philippines: Sexual risk negotiations and perceived manager advice". AIDS Research and Treatment, doi: 10.1155/2012/812635. Epub 2012 Jul 17.