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Table 1 Qualitative findings to inform the development of intervention programme and translation of strategies to foster participation

From: Using qualitative and community-based engagement approaches to gain access and to develop a culturally appropriate STI prevention intervention for foreign female entertainment workers in Singapore

Finding

Source

How the finding has informed the development of intervention programme or has led to the translation of strategies to foster participation

Socio-organisation

 Majority of the foreign FEWs were not directly employed by EEs but came on social visit passes of 1 to 2 months duration.

IDIs with EE owners and management staff, Thai and Vietnamese FEWs

It was not feasible to conduct interventions for foreign FEWs inside the EEs.

 The Thai and Vietnamese FEWs have their own preferred venues of congregation. This was particularly for Vietnamese FEWs who often stayed and worked within the study site.

IDIs with Thai and Vietnamese FEWs, observations, information from mystery client and critical incident techniques

Although foreign FEWs are hard-to-reach, they operated in well-defined EEs in geographically distinct areas in Singapore, enabling us to estimate their population size using the census enumeration method, gained access to them and held community-based interventions offering outreach services in the sites where they operated.

 The Thai and Vietnamese FEWs usually worked alone or in small groups of 2 to 3.

Peer educators were engaged to help in recruitment and to deliver the behavioural intervention sessions. These sessions were conducted in small groups of 3 to 4.

 The Thai and Vietnamese FEWs kept to themselves and only had a few trusted peers from their own ethnic community.

Sexual risk behaviours

 The reasons for non-condom use included misconceptions on the transmission and consequences of STI/HIV, low risk perception of contracting HIV/STI from paid/casual partner, lack of skills to negotiate or to persuade partner to use condom, unavailability of condoms in the EE setting and fear of the police using condom as circumstantial evidence.

IDIs with Thai and Vietnamese FEWs, corroborated with previous study finding in 2008 by the PI and another baseline survey in 2015

We incorporated topics like STI/HIV prevention, safe sex, condom negotiation and use in the behavioural intervention sessions.

We also facilitated condom use by providing FEWs access to free condoms and lubricants.

Access to health services

 Foreign FEWs faced difficulties in accessing STI/HIV preventive and treatment services such as fear of identity exposure, stigmatisation, cost and language differences.

IDIs with Thai and Vietnamese FEWs

We provided free testing of cervical chlamydia, cervical gonorrhoea and pharyngeal gonorrhoea through outreach services, along with provision of free treatment for those tested positive.

Needs and concerns

 Vietnamese FEWs were keen on having accessories and peer support group information for their work. Red is perceived as a symbol of luck and used as a lucky colour for wrapping gifts in Vietnamese custom.

IDIs with Vietnamese FEWs

We handed out a red pouch with accessories obtained from sponsors (tissue paper, mini mirror, moisturiser, face-mask and mini hand fan). We also gave all the Vietnamese FEWs a red packet (containing a card with contact details of the women’s care centre run by NGO where they could meet their peers for support) signifying luck (referred to as “lì xì” in Vietnamese). The reimbursement for study participation was also placed in a red packet.

 Their main concerns were identified as fear of identity exposure and arrest by anti-vice officers.

IDIs with Thai and Vietnamese FEWs

We assured anonymity of the study and did not collect any personal identifiers except for their contact numbers.

A neutral third-party, who was trusted by the FEWs held all the links to this study.

We also used premises trusted by FEWs to conduct the behavioural interventions, namely the shop of a peer educator, TCM clinic and empty space outside a convenience store located within the study sites.