A 4-Day training on community-based surveys, held on the 14th- 17th August 2019 in Dhaka, Bangladesh, was organized by the HIV/AIDS Research and Welfare Centre (HARC) for the Key Population Research and Advocacy (KPRA) project. With technical support from APNSW, HARC provided comprehensive data collection training to 11 sex workers from 3 cities in Bangladesh.
The priority topics and key issues of discussion included:
1. Understanding the KPRA project
During the training, the HARC project manager highlighted the key objectives and activities of the KPRA project and the importance of the project for sex workers in Bangladesh.
2. The basic principles of interviewing
Participants identified the following as the principals of interviewing:
· Having no judgment, stigma or discrimination
· Being attentive and listening carefully
· Spending enough time to better understand responses
· Not giving false hope or fake information
3. Detailed discussion on questionnaires
The participants discussed and identified correlations between the different questions and suggested including additional criteria for eligibility, such as “respondents having been in the same city for at least 12 months” to ensure experience and response is specific to the city the interview will be conducted in. According to the participants, HIV is rare among sex workers in Bangladesh, so a large number of questions in the questionnaire will not be applicable in Bangladesh
4. Interview practice
HARC peer workers introduced 10 sex workers to the training venue for participants to practice interviewing, which lasted 45 – 60 minutes. With this practice, participants were able to approximate the time it would take to conduct the real interviews and have planned to allocate 40-45 minutes for each interview.
5. Mapping clinical services
The participants conducted a city mapping activity to identify facilities for clinical services that were accessible to sex workers. Global Fund was identified as the main donor for sex workers, with Light House and Save the Children as the main implementing partners. In Dhaka city, 15 Light House and Save the Children drop-in-centers (DiC) as well as other facilitates used by sex workers for clinical services were mapped. The most popular service centers for sex workers are DiCs, and in some areas where no DiC’s are funded by the Global Fund, such as in Rajshahi, other facilities were identified where services for testing and treating STIs/HIV can be accessed. It was noted that HIV testing is increasing among sex workers in Bangladesh, with many different places to test and treat STIs/HIV, including:
a) Clinic based testing in all DiC and other NGOs facilities, where both HIV and STIs testing and treatments are available.
b) Satellite based testing services in hotspot locations with doctors and peer workers conducting testing for only HIV.
c) Community based testing in outreach centers by trained sex workers, to test for only HIV.
In all cities, there are specialized SRHR service providers, with the most common being Marries Stops International (MSI). While, it is not free, MSI is more or less sex worker friendly and sex workers are comfortable using their services.
6. Group work and discussion on common issues for sex workers
Barrier to clinical services for sex workers was discussed and participants identified the following as the key issues:
· Stigma and discrimination in clinics by staff
· No confidentiality in clinics
· Clinic hours: Clinics often close by 3:00pm
· Inattentive doctors: Doctors don’t want to listen to patient problems
· Availability of medicines
· Long process to access services: Sex workers do not have enough time
· Money: Especially where services are not free and often service charge for some services are high in places
· Lack of self-awareness: Especially for new, young sex workers
· Distance of service centers
· Fear: Afraid of positive result of diseases, especially HIV
· Gatekeeper blockage: Pimps, madam, supervisors often block clinic visits
· Irregular work hours of service providers: Staff and Doctors not in the clinic
· Poor quality of services
· Location and environment: the waiting places are not comfortable, such as it being too hot
· Law enforcement: Violence and police arrests, leading to money being taken away that would otherwise be spent on health services
Concluding comments from participants:
All the participants have shown their commitments to collect data in the field as soon as possible.
“During the interview, I thought that I would not be able to do it. Even at the beginning of the training I thought that it would be difficult for me. After the training, I am confident that I can do it and I proved it through the test interview that I can do it.”
“The facilitation was so friendly, and easy to understand. I was scared at the beginning but now all are clear to me. Even the questionnaire is very easy to understand. I am sure it will be an excellent research.”
“I got new skills and new knowledge on research and I am sure I will be able to do good work.”
“I did many research and got many trainings before, but they were different from this one. We just didn’t talk about questionnaires; we discussed the links/correlations among questions and other issues related to research.”