Abstract
BackgroundResearchers are increasingly recognizing the importance of addressing sexual and drug-related HIV risk within the context of intimate relationships rather than solely focusing on individual behaviors. Practical and effective methods are needed to recruit, screen, and enroll the high risk and hard-to-reach couples who would most benefit from HIV interventions, such as drug-using female sex workers (FSWs) and their intimate, non-commercial partners. This paper outlines a bi-national, multidisciplinary effort to develop and implement a study protocol for research on the social context and epidemiology of HIV, sexually transmitted infections (STI), and high risk behaviors among FSWs and their non-commercial male partners in Tijuana and Ciudad Juarez, Mexico. We provide an overview of our study and specifically focus on the sampling, recruitment, screening, and successful enrollment of high risk couples into a public health study in this context.Methods/DesignWe used targeted and snowball sampling to recruit couples through the female partner first and administered a primary screener to check her initial eligibility. Willing and eligible females then invited their primary male partners for couple-based screening using a couple verification screening (CVS) instrument adapted from previous studies. The CVS rechecked eligibility and separately asked each partner the same questions about their relationship to "test" if the couple was legitimate. We adapted the original protocol to consider issues of gender and power within the local cultural and socioeconomic context and expanded the question pool to create multiple versions of the CVS that were randomly administered to potential couples to determine eligibility and facilitate study enrollment.DiscussionThe protocol successfully enrolled 214 high risk couples into a multi-site public health study. This work suggests the importance of collaborating to construct a study protocol, understanding the local population and context, and drawing on multiple sources of input to determine eligibility and verify the legitimacy of relationships. We provide a practical set of tools that other researchers should find helpful in the study of high risk couples in international settings, with particular relevance to studies of FSWs and their intimate partners.
Highlights
Researchers are increasingly recognizing the importance of addressing sexual and drug-related HIV risk within the context of intimate relationships rather than solely focusing on individual behaviors
Through a detailed explanation of our methodological approach, we demonstrate the need for collaborative processes in constructing a protocol, maintaining sensitivity to the local population and socioeconomic context, and drawing on multiple sources of input to determine eligibility and verify the legitimacy of relationships in order to ensure the successful recruitment of high risk couples
No lifetime use of cocaine, methamphetamine, or heroin No sex work in last month Plans to break up with partner No sex with partner in last month Worried about intimate partner violence (IPV) Never exchanged sex for money, drugs, or other items Unwilling to bring in partner for screening Relationship < 6 months Plans to move in 18 months Would refuse treatment for sexually transmitted infections (STI) Does not have a steady partner Primary partner is female Age < 18
Summary
Researchers are increasingly recognizing the importance of addressing sexual and drug-related HIV risk within the context of intimate relationships rather than solely focusing on individual behaviors. Practical and effective methods are needed to recruit, screen, and enroll the high risk and hard-to-reach couples who would most benefit from HIV interventions, such as drug-using female sex workers (FSWs) and their intimate, noncommercial partners. This paper outlines a bi-national, multidisciplinary effort to develop and implement a study protocol for research on the social context and epidemiology of HIV, sexually transmitted infections (STI), and high risk behaviors among FSWs and their non-commercial male partners in Tijuana and Ciudad Juarez, Mexico. This paper outlines a bi-national, multidisciplinary effort to develop and implement a study protocol for research on the context and epidemiology of HIV, sexually transmitted infections (STIs), and high risk behaviors among FSWs and their primary, non-commercial male partners in Tijuana and Ciudad Juarez, Mexico. We provide a practical set of tools that other researchers should find helpful in the study of high risk couples in international and resourcepoor settings, with particular relevance to studies of FSWs and their intimate partners
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