We're published!!

While I have not personally seen it, word on the street is that an article Deb and I wrote about findings from the first phase of this study was published in the most recent issue of $pread magazine (http://www.spreadmagazine.org/). The article focuses on the women’s responses to what they do and do not enjoy about sex work, and we are thrilled that the first published article from our study is in a sex worker produced and run media. Hooray!

The long overdue post

Well, this is beyond overdue. My apologies. The good news is that since it has been almost 6 months since our last post, we have a lot to share with you.

As of Wednesday, March 28th, we now have 86 participants!! Other folks that we spoke to who have used the same methodology that we are using, Respondent Driven Sampling, shared with us that it would take a few months before people really started coming in. I have to be honest, during those first few months, I had my doubts that this would catch. In hindsight launching in the middle of October more than likely was part of the slow beginning as people are typically quite busy that time of year with Thanksgiving, the various December holidays, and then New Year celebrations. Regardless, come the middle of January, we reached that tipping point and have been busy ever since.

To date we have planted 12 seeds, and 5 of those have come in. As a reminder, a seed is that first woman to do the interview who represents a part of the sex worker community that we have not seen yet in the study. Of the 5 seeds, it is really only 1 that has taken off. It would be fabulous to have some of these other seeds take off. Nonetheless, the seed that did take off has now branched out so many times, that we have a very diverse group of women. At this point, the women who are not coming in are the non-street based workers who are more financially secure. It’s tricky since for these women the $40 we pay for the first visit is potentially not incentive enough to get them to come in, especially if they are used to making $100+ for an hour of their time. Also, in San Francisco it is pretty easy to get free HIV and STI testing, so the fact that we offer those tests and treatment may also prevent this from being a priority for some women. We will keep planting seeds in this demographic, so only time will tell if they will take off.

We have had a handful of women who have either never tested for HIV before, or have never previously returned for their results. While I understand the financial incentive may play a big role in getting some of these women in, I know that the safe and compassionate environment we create at site is what gets them to come back. Additionally we have had many women do the interview who shared that they have never spoken to another person about the sex work that they do. So, a big huge thank you to all the interviewers and counselors working on this project, as without them, this would not be possible.

Based on what the women have shared with their interviewers, we have created referral sheets for counseling, methadone programs, buprenorphine programs, resources for newly HIV+ women (or women who knew their status but have not accessed care), Hep C resources in the Bay Area, and needle exchange. If anyone reading this works in the Bay Area and would like to see these sheets, please send me an e-mail and I will get a copy to you.

SWEAT Phase II - Electric Boogaloo

It's official! The second phase of SWEAT launched on Monday, October 16, 2006. We have the research site two times a week, Monday evenings and Wednesday mornings/early afternoon, at St. James Infirmary (www.stjamesinfirmary.org). The first week of operation was quite slow, and I think that was exactly how it was supposed to be. It gave all of us two extra times to administer the interview to each other, as well as an opportunity to do a mock run through in the lab.

The lab run through, which was Blake's fabulous idea, was super helpful since there is a lot to be done there. Every person that participates in the study is tested for Trichomonas (a rapid test that produces the result in 10 minutes), Oral/Rectal/Vaginal Gonorrhea and Chlamydia, Herpes Simplex Virus II, Syphilis, HIV (rapid or standard), and Hepatitis A, B, and C. The Trichomonas test is a self-collected vaginal swab, and the rectal and vaginal gonorrhea and chlamydia tests also involve a self-collected swab. So all together, 4 swabs are collected, 4 tubes of blood, and potentially one finger stick if the participant wants a rapid HIV test.
Whew! It's a lot of work.

Last night, I am pleased to report, we had our first participant!! Now we just need a few more of the initial seeds (those first people we have selected to do the interview) to come in and we will really be rolling. At this point of the phase, each participant receives three coupons she can give to her female sex worker friends. These women with the coupons can then call in to see if they are eligible or drop in during the first hour of operation. Already one of the coupon recipients from the interviewee last night has called in and she has an appointment for tomorrow's shift.

Thanks to all the hard work of Deb, Blake, Clara, Ginger, Sage, Heather, Reshma, Melanie, Jen, Abby, and myself, this phase has been meticulously thought out and tweaked. I can only hope that means that we will encounter very few hurdles and speed bumps along the way.

Oh, in case potential participants are reading this, please think about drinking lots of water starting 24 hours prior to your visit to make the blood collection easier.

SWEAT Instrument

The good news first: We received approval from the University of California San Francisco's Committee on Human Research to ask all the questions we wanted. Hooray! Now, the realistic news: We wanted to ask too many questions.

Earlier this week Ginger and I did a practice run through of the instrument in CAPI (Computer Administered Personal Interview) and at an hour and a half into it, we barely were half way through the interview and both of us had lost interest. This does not bode well for the participants. So, it is back to the editing board. Deb, Ginger and I met yesterday and did an initial cutting of questions. After processing those edits, it is clear that we will need to cut some more. The last thing we want is an excessive interview. The plus side to this is that i already had all the questions entered into the software program, so once we cut the extra questions i won't have to do much work in the program aside from deletion and fixing some skip patterns.

SWEAT in Vegas

Wow, has it really been this long since the last post? I do apologize and promise you that the delay does not mean we have not been busy.

The beginning of July found Ginger and Alix in Las Vegas, Nevada for the Re-visioning Prostitution Policy Conference. To find out more about the conference, go here: Conference Info

At the conference, Alix gave the presentation "The SWEAT Project: Female Sex Workers’ perspectives on systems of criminalization, decriminalization, and legalization." Does anyone reading this know how to post a power point presentation to a blog? If so, let me know, as i would love to share the presentation with you. In the mean time, if you would like a copy of the presentation, send me your e-mail address and i will forward it to you. As a sneak preview, here is the abstract for the presentation:

This presentation will focus on the findings from the first phase of the SWEAT (Sex Worker Environmental Assessment Team) research project conducted by UCSF in conjunction with SJI. In this first phase we conducted 60 one-on-one, semi-structured interviews with current sex workers of all genders (female = 40; men = 10; TG = 10). For the purpose of this presentation, I will explore the female participants' reflections on what they would like to see changed, if anything, with the current policy of criminalization. 30 of the women shared their perspectives on this topic. Of these 30 women, 2 shared the benefits that accompany decriminalization and criminalization, 2 shared the benefits of criminalization and some other type of system, 34 responses were given. 14 wanted some change but did not specify a preference for decriminalization or legalization, 8 advocated for decriminalization, and 2 spoke to their desire to see sex work legalized. Interestingly, 10 (33.33%) of the women preferred that sex work remain criminalized. I will explore the reasons that influence the women's responses and discuss the ways in which this information can inform decriminalization efforts.

We at SWEAT were grateful to have the opportunity to share this important information with the conference attendees and you.

Our first CAB meeting!

On Tuesday, June 6th we had our first Community Advisory Board (CAB) meeting. We are extremely fortunate to have 11 committed, diverse, insightful, fabulous members. This first meeting allowed us to provide more information about the project to the CAB members, as well as receive their feedback about our interview instrument. It was clear each member put a lot of thought and energy into reviewing the instrument before the meeting, as they each came equipped with brilliant feedback.

It became clear through the members' feedback that we are trying to cover too many topics in our instrument. While it would be great to cover all the topics we want, we need to focus the instrument and make sure we are measuring what we proposed we would. Specifically, individual risk factors for HIV and STIs (sexually transmitted infections), as well as social network characteristics.

The SWEAT research team will now go back and incorporate their suggestions into the instrument, and then resubmit it to CHR (the internal review board at UCSF) for approval. Let's hope that CHR approves all the questions that we want.

Once we gain approval, we will be able to set a launch date, and will then call upon the CAB members to help recruit the initial seeds (those first female sex workers that enroll in the study).

Workin' on the instrument

Since the last post, we have all been busy finalizing the interview instrument. While this is an amazingly tedious process, it is also extremely exciting. This is our chance to create an interview instrument that addresses all the realities individuals experience as sex workers. We are being extremely mindful of the terms we use, and how we phrase our questions to prevent influencing the responses we get. Once we agree that we have completed the instrument, we will then give it to our (soon to exist) community advisory board for feedback. Then, we will incorporate their feedback and be ready to submit it to the Internal Review Board for approval.

In addition to this process, Abby has been busy becoming a pro at the Computer Assisted Personal Interviewing software we will use to administer the interview. The great thing about this software is it will help prevent data entry errors during the interview, and prevent data entry errors later since we will not have to enter the information from a paper form.

Ginger has been hard at work creating Sexually Transmitted Infection Information sheets to make available for the research participants. What is truly great about these sheets is that she put not only the standard Western medical information and advice, but also established non-Western advice.