ACCESSING TRUCK DRIVERS AND SEX WORKERS Recruitment and Data Collection Experiences from South African Sites ±1 pt ± pt ± pt pt 8 pt pt ter Template C e amount of conten (smaller font size) Fobosi SC 1 , Stadler J1, Buthelezi F1, Gomez GB2,3, Hankins C2,4, Hadingham J5, Lalla-Edward, ST1 1. Wits Reproductive Health and HIV Institute; 2. Amsterdam Institute for Global Health and Development; 3. Department of Global Health and Development, London School of Hygiene and Tropical Medicine, UK; 4. Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, UK; 5. North Star Alliance Background Truck drivers and sex workers are important groups to target in health prevention programmes because their occupations shape their risk of poor health outcomes, particularly HIV and STI acquisition. As highly mobile populations, they come into contact with new sexual networks and sexual cultures. Separated from family, intimate partners, and lacking easy access to health care support structures, their vulnerability is enhanced (1-3). They require health services that are both accessible and acceptable with regard to their everyday working lives. In an attempt to provide healthcare services to truck drivers and sex workers, the North Star Alliance (NSA) has set up roadside wellness clinics on major trucking routes in South Africa. These aim to provide health care services directly to truck drivers and sex workers on these routes. We are currently evaluating these wellness clinics among sex workers and truck drivers who are both users and non-users of the services. A major challenge in this undertaking is recruiting of participants and the research procedures (4-6). Here we present the challenges we experienced, and how we resolved them. Materials and methods Results Recruitment: Roadside wellness clinic staff assisted in the recruitment of participants and provided the research teams (consisting of female and male interviewers) with access to the clinic facilities to conduct interviews. Between October 2014 and March 2015, we enrolled and interviewed 46 truck drivers and 26 sex workers at all six roadside clinic sites. Challenges were experienced with both recruitment and interviews, with high rates of refusal and no shows. The following were the main obstacles faced: References: 1. Gomez, GB., Venter, WDF et al. (2009). “Sexual Behaviour of Female Sex Workers and Access to Condoms in Kenya and Uganda on the trans-Africa Highway”. AIDS Behav 13: 860-865. 2. Mupemba, K. (1999). "The Zimbabwe HIV prevention program for truck drivers and commercial sex workers: a behaviour change intervention." Resistances to Behavioural Change to Reduce HIV/AIDS Infection: 133-137. 3. Walden, V., K. Mwangulube, et al. (1999). "Measuring the impact of a behaviour change intervention for CSW and their potential clients." Health Education Research 14(4): 545-554 4. Shaver, FM. (2005). “Sex Work Research Methodological and Ethical Challenges”. Journal of Interpersonal Violence 20: 296-319. 5. Merli, MG et al. (2009). “Challenges to Recruiting Representative Samples of Female Sex Workers in China using Respondent Driven Sampling: How Much of the Network Do We See?” 6. Sanders, E. 2006. “Researching Prostitution: The Methodological Challenges of Researching Sex Work in Thailand”. Conference Proceedings – Thinking Gender – The NEXT Generation. Our sample size was 60 sex workers and 60 truck drivers. We aimed to recruit from six roadside wellness clinics in six provinces. Our research tools were semi-structured interview schedules that we estimated would take up to one hour to complete and were recorded on audiotape. Informed consent was sought before interviews commenced. Location of sites Challenge One: Participants lacked time for interviews. Truck drivers in particular are in a hurry to meet deadlines. They were often “rushing” to meet deadlines, and said that their employers were unsympathetic to the needs of the truck drivers: “bosses, they really bother us”. Resolution: We conducted interviews in the cabs of the trucks during lunch breaks and in the evening at the truck stops. This also provided an opportunity to observe and listen to men’s conversations about life as a truck driver. Challenge Two: Lack of incentives: Sex workers often refused interviews as they expected to be rewarded for participation, to compensate for the loss of income. Sex work competed with the time required to conduct the interviews, and some complained that we “asked too many questions”. Resolution: We negotiated with the clinic staff to enrol sex workers into the research and explained the aims more clearly. We also limited the interview time, but acknowledge that this meant that there was less substance. Challenge 3: Unavailability of participants at certain times of the day and night. Sex workers were seldom available during clinic opening hours as this clashed with their working hours. Resolution: Requested that sex workers come to the clinic during the day as they usually worked during the evenings. Challenge 4: Hostilities and antagonism between sex workers and clinics undermined our efforts to recruit and interview sex workers. Sex workers described being beaten by security guards patrolling the truck stops: “they do not want us here, they come with their dogs and rubber bullets”. Resolution: We expanded our recruitment to include the settlements surrounding the truck stops and negotiated sex workers’ access to the roadside clinics. Conclusion Our experiences highlight the challenges of conducting research among hard to reach populations, particularly within the work setting. Despite detailed planning and negotiations with key stakeholders we needed to be flexible in our recruitment plans and research activities. Our experiences also highlight some of the difficulties that roadside wellness centre clients may experience in accessing the services and need to be taken into consideration in future.