A collaborative methodology for investigating the ethical conduct of research on female sex workers in the Philippines.

Designing research in an ethical, non-exploitative manner that investigates concerns around privacy, confidentiality, and voluntariness is imperative for female sex work populations (Shaver, 2005; Urada & Simmons, 2014). Some community-led interventions, especially those focused on empowerment, education, and economic independence, have been effective with female sex workers across the globe (Biradavolu, Blankenship, Jena, Dhungana, 2012; Kerrigan et al., 2006; Swendeman, Basu, Das, Jana, & Rotheram-Borus, 2009; Sherman et al., 2000). To avoid disillusionment from sex workers and their managers when they do not see positive changes resulting from research, designing and adapting interventions is a critical research aim for this population. This article is a companion publication with “Social and Structural Constraints on Disclosure and Informed Consent for HIV Survey Research Involving Female Sex Workers and their Managers in the Philippines” (Urada & Simmons, 2014), a study examining the contextual factors that influence participants’ disclosure of sensitive topics in non-governmental survey interviews and their consent to participate in HIV prevention intervention research. However, the collaborative methodology in this study may be useful for research carried out with female sex workers in other similar contexts. This paper focuses on the collaborative aspects of the methodology in the aforementioned study. The more general methodological approach is summarized in the companion paper noted above. This qualitative study explored the ethical issues of female sex workers’ participation in HIV prevention research. The study's main findings included the following. Informed consent was constrained by perceived government coercion and skepticism that research results would translate into community benefits. Disclosure was also constrained by distrust; sex workers did not trust that confidentiality would be maintained. They also felt many of the survey questions were intrusive, particularly those that were meant to elicit information about substance use and sex work. Structural constraints imposed by police also played a significant role in non-disclosure. Police raids were common and sex workers and managers were frustrated by the government’s inability to stop police from using condoms as evidence of prostitution. In conclusion, HIV interventions must move beyond didactic prevention workshops, include female sex workers in intervention design and implementation, and aim to reduce social and structural constraints on participation. As indicated in the main paper, our methodological aims were to be as transparent and participatory as possible, without causing harm to participants through heightened visibility or extensive time commitments. Sex work is highly stigmatized and illegal in the Philippines, as is common elsewhere, and women commonly do not disclose sex work to family members. The sex workers who participated in the study were also especially concerned about losing clients and the money they generated. Even the relatively small fees for work permits from the health department were difficult for women to pay. Collaboration with our Community Advisory Boards and the Peer Ed ME PAMACQ (Peer Educators Movement for Empowerment of Pasay, Manila, Caloocan and Quezon City) enhanced recruitment efforts, the development of rapport with the female sex workers and their managers, and helped to produce relevant findings and continued collaboration.