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Sex Workers and Clients [message #1663] Tue, 25 March 2014 12:10 Go to next message
Twheeler is currently offline  Twheeler
Messages: 1
Registered: March 2014
Location: Washington DC
I have two suggestions on questions for clients, and one for FSWs:

1) I would separate out (a) "exchange of gifts/other goods for sex" from (b) "exchange of money for sex / paid for sex"; in the last 12 months and 'ever'. That is, it would be helpful if these two questions (and thus, definitions of 'clients') were asked and reported separately. I would keep the question on whether one of the last 3 sex partners included a commercial sex worker (c). By doing this, we can begin to separate out "formal commercial sex" from "informal/transactional sex" that are financially-motivated but not high-volume commercial sex per se, because the programmatic implications of these two are very different.

2) For those who answer yes to items (b) or (c), I would ask about the number of different female sex workers or women they paid to have sex with in the last year, and the average number of times they have sex with one paid partner/sex worker.

The reason for suggestion #2 is that even if we get an underestimate of the client population size from the household survey (from question #1b-c), we could use information from gained from #2 to generate indirect estimate of client population size by using this information together with FSW behavioural surreys and FSW size estimations (as per Cote et al. and Alary et al.) [and FSW data is, in general, more widely available]

3) Finally, if possible, I would also recommend that we ask women about sex work as well (as the most recent Uganda DHS has done), and similarly separate out "receipt of gifts/other goods for sex" from (b) "receipt of money for sex or have been paid for sex"; in the last 12 months and 'ever'. I recognize that this would probably still give us underestimates of the size of FSW populations because of social desirability bias, but I think the information could nonetheless be helpful because it adds additional data to appraisals of sex work, in a landscape where FSW data collection is not yet systematic across all countries.

By having these, and if enough of a sample of men and women who respond 'yes' to questions 1b-c or 3b, then even from the DHS, we can begin to measure 'disparities' in burden of infection, reproductive health indicators, and access/uptake of health care services (including ART) across risk-groups. While FSW- and client-specific surveys will provide better surveillance data on all these indicators because they could target a more representative sample of FSW and clients, I think it would still be helpful to leverage the DHS for more FSW/client data despite limitations from social desirability and other limitations brought on by how well household surveys could capture FSW and client populations.

Tisha Wheeler
Senior Technical Adviser Key Populations
Re: Sex Workers and Clients [message #1708 is a reply to message #1663] Tue, 01 April 2014 11:54 Go to previous message
kstoebenau is currently offline  kstoebenau
Messages: 2
Registered: March 2014
Location: Washington D.C.

The STRIVE Research Programme Consortium (RPC) Working Group on Transactional Sex and HIV (TS-WG) would like to express its support of the recommendations shared by Tisha Wheeler of USAID concerning the importance of distinguishing sex work from informal transactional sex (TS). We strongly agree with the importance of making such a distinction, both on epidemiological and intervention related grounds. We have generated a separate message detailing our recommendations concerning transactional sex in particular entitled "Capturing Transactional Sex."

Kirsten Stoebenau, PhD
Gender and Population Specialist
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