Study protocol for the recruitment of female sex workers and their non-commercial partners into couple-based HIV research

Researchers are increasingly recognizing the importance of addressing HIV risk within the context of intimate relationships rather than solely focusing on individual behaviors. A growing body of evidence suggests that couple-based interventions may be more efficacious than individual-based interventions in promoting safer sex behaviors and reducing drug use. However, a recent review of couple-based interventions cautioned that additional research is needed to build a stronger theoretical and methodological basis for couples focused HIV interventions] Practical and effective methods are needed to recruit, screen, and enroll high risk couples into studies in diverse social and cultural contexts. In particular, protocols are needed to recruit the socially marginalized 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 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. This work includes an adaptation of a protocol developed by McMahon and colleagues (2003)   that recruits couples first through the female partner, and then screens both partners to verify couple status prior to enrollment.

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. We provide a practical set of tools that other researchers should find helpful in the study of high risk couples in international and resource poor
settings, with particular relevance to studies of FSWs and their intimate partners.

Year of publication: 
Jennifer L Syvertsen and others