Social and structural constraints on disclosure and informed consent with female sex workers and their managers in the Philippines

This qualitative research explored the experiences of female sex workers (FSWs) participating in behavioral HIV prevention research, including their process of consent to research, their knowledge of research ethics, barriers to disclosure of sensitive topics, and the necessary conditions for their involvement in interventions. Individual interviews were conducted with 20 FSWs and 10 establishment managers working in night clubs, karaoke bars and spas/saunas in the Philippines, using semi-structured interview guides. In addition, four community advisory board meetings were conducted to collect feedback on the study design and assist with the interpretation of findings (N=12 individuals). Emergent themes included FSW issues with trust (e.g. research in general, interviewers), especially around confidentiality/privacy, intrusiveness of survey questions, sense of being forced by government to do surveys, and the belief that nothing would happen as a result of the research. FSWs expressed desire to actively participate in intervention design/implementation, learn new skills (e.g. job training), and receive compensation equivalent to their pay while away from work. Both FSWs and managers expressed frustration with government support (e.g. their inability to stop police raids, and unaffordable fees for registration/clinic services). The results suggest the need to improve HIV prevention research practices with FSWs by: 1) addressing barriers to respect, trust, and/or disclosure stemming from risks in the structural environment and/or the research process itself; and by; 2) developing a more transparent and participatory approach to HIV prevention research that engages FSWs in the research process in order to reduce perceived and actual risks to participants.