Sex workers (methods)
As indicated in the mapping report, very few countries in Europe report behavioural surveillance among sex workers.
Two main methodological options have been used:
- surveys among convenience samples of sex workers (mainly female); these will be presented below
- insertion of a batch of questions related to the occurrence of sexual intercourse with sex workers, directed at men (mainly) in representative surveys in the general population (see general population methods)
Table 1 describes selected features of available methods for collecting behavioural data among sex workers.
Table 2 presents the best three methods proposed by the experts according to two different contexts
Table 1. Selected features of available methods for collecting behavioural data among among sex workers
|Sex work venue-based (b)||
|Respondent driven sampling (RDS) (c)||
Largely used for research rather than surveillance
Not yet piloted in sex workers but proved effective in MSM
Ward H, Day S, Green A, Cooper K, Weber J. Declining prevalence of STI in the London sex industry, 1985 to 2002. Sex Transm Infect 2004;80(5):374-6.
Sethi G, Holden BM, Gaffney J, Greene L, Ghani AC, Ward H. HIV, sexually transmitted infections and risk behaviours in male sex workers in London over a 10 year period. Sex Transm Infect 2006;82(5):359-63.
(b) Sex work venue-based
Folch C, Esteve A, Sanclemente C, Martró E, Lugo R, Molinos S, Gonzalez V, Ausina V, Casabona J. Prevalence of human immunodeficiency virus, Chlamydia trachomatis, and Neisseria gonorrhoeae and risk factors for sexually transmitted infections among immigrant female sex workers in Catalonia, Spain. Sex Transm Dis 2008;35(2):178-83.
Mills S, Saidel T, Magnani R, et al.. Surveillance and modelling of HIV, STI, and risk behaviours in concentrated HIV epidemics. Sex Transm Infect 2004;80(Suppl 2):ii 57–62
(c) Respondent driven sampling (RDS)
Uuskula A, Fischer K, Raudne R, Kilgi H, Krylov R, Salminen M, et al. A study on HIV and hepatitis C virus among commercial sex workers in Tallinn. Sex Transm Infect 2008;84(3):189-91.
Johnston LG, Sabin K, Hien MT, Huong PT. Assessment of Respondent Driven Sampling for Recruiting Female Sex Workers in Two Vietnamese Cities: Reaching the Unseen Sex Worker. Journal of Urban Health 2006;83(7): i16-i28.
No studies published yet
The table below presents the best three methods proposed by the experts according to two different contexts:
- the population is reachable in known settings and is not severely stigmatised
- the population is not very well known, not easy to reach, and/or stigmatised.
Table 2. Best three methods to access sex workers according to context
(NB does not include clients, as these will be included in general population surveys)
|Best methods||Main indication for preference|
|A. The population is reachable in known settings and is not severely stigmatised|
|1||Sex work venue-based||Sex work venues can be mapped and a systematic sampling method applied|
|2||Service-based||Can reach sex workers from many different sectors including dispersed venues|
|3||Internet||Access to wide range of sex workers, and many sex workers and client meet via the internet (but methods not yet tested)|
|B. The population is not very well known, not easy to reach, and/or stigmatised|
|1||Service-based||Health services often have contact with groups that are otherwise hidden, and can reach sex workers from a range of sectors|
|2||Sex work venue-based||Can be a rolling programme that combines mapping of sex work venues with survey|
|3||RDS||Could reach previously hidden sex workers by exploiting peer networks|