Female sex workers and gatekeeper relationship: Development of a culturally appropriate scale

Background: A majority of female sex workers (FSWs) in developing countries work in entertainment establishments. Global literature suggests that gatekeepers (managers or owners of the establishments) exert significant influences on FSWs' HIV/STI prevention behaviors. However, to date, there was no available scale that measures the FSW-gatekeeper relationship (F-G relationship).

Methods: We first conducted in-depth interviews with 16 gatekeepers and 36 FSWs in Guangxi, China. The qualitative data were used to develop a culturally appropriate scale that measures the F-G relationship. The scale was tested among 1,022 FSWs in Guangxi, China through a cross-sectional survey. All participants were recruited from different types of entertainment establishments through community outreach.

Results: The final F-G relationship scale consists of 8 items measuring three dimensions: trust, communication, and support. The Cronbach Alpha of the scale was 0.83. Younger FSWs reported better F-G relationship than older FSWs. F-G relationship was strongly associated with perceived environmental support in HIV/STI prevention (p<.001). FSWs of better F-G relationship reported higher rates HIV testing (p<.05) and consistent condom use (p<.005).

Conclusion: The F-G relationship scale developed from qualitative research demonstrates good reliability and validity. Future HIV/STI prevention programs targeting FSWs need to consider the G-F relationship and include gatekeepers into culturally appropriate programs.