Open Access Highly Accessed Study protocol

Study protocol for the recruitment of female sex workers and their non-commercial partners into couple-based HIV research

Jennifer L Syvertsen12, Angela M Robertson2, Daniela Abramovitz2, M Gudelia Rangel3, Gustavo Martinez4, Thomas L Patterson5, Monica D Ulibarri5, Alicia Vera2, Nabila El-Bassel6, Steffanie A Strathdee2* and Proyecto Parejas

Author Affiliations

1 Department of Anthropology, University of South Florida, 4202 East Fowler Avenue, SOC 107, Tampa, FL 33620-7200, USA

2 Division of Global Public Health, School of Medicine, University of California at San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0507, USA

3 El Colegio de La Frontera Norte, Carretera Escénica Tijuana -Ensenada, Km 18.5, San Antonio del Mar, 22560 Tijuana, Baja California, Mexico

4 Salud y Desarrollo Comunitario de Ciudad Juárez A.C. (SADEC) and Federación Mexicana de Asociaciones Privadas (FEMAP), Ave. Malecón No. 788 Col. Centro C.P., 32000 Ciudad Juárez, Chihuahua, Mexico

5 Department of Psychiatry, University of California at San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0603, USA

6 Columbia University School of Social Work, 1255 Amsterdam Avenue, New York, NY 10027, USA

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BMC Public Health 2012, 12:136  doi:10.1186/1471-2458-12-136

Published: 20 February 2012



Researchers are increasingly recognizing the importance of addressing sexual and drug-related HIV risk within the context of intimate relationships rather than solely focusing on individual behaviors. Practical and effective methods are needed to recruit, screen, and enroll the high risk and hard-to-reach couples who would most benefit from HIV interventions, such as drug-using female sex workers (FSWs) and their intimate, non-commercial partners. This paper outlines a bi-national, multidisciplinary effort to develop and implement a study protocol for research on the social context and epidemiology of HIV, sexually transmitted infections (STI), and high risk behaviors among FSWs and their non-commercial male partners in Tijuana and Ciudad Juarez, Mexico. We provide an overview of our study and specifically focus on the sampling, recruitment, screening, and successful enrollment of high risk couples into a public health study in this context.


We used targeted and snowball sampling to recruit couples through the female partner first and administered a primary screener to check her initial eligibility. Willing and eligible females then invited their primary male partners for couple-based screening using a couple verification screening (CVS) instrument adapted from previous studies. The CVS rechecked eligibility and separately asked each partner the same questions about their relationship to "test" if the couple was legitimate. We adapted the original protocol to consider issues of gender and power within the local cultural and socioeconomic context and expanded the question pool to create multiple versions of the CVS that were randomly administered to potential couples to determine eligibility and facilitate study enrollment.


The protocol successfully enrolled 214 high risk couples into a multi-site public health study. This work suggests the importance of collaborating to construct a study protocol, understanding the local population and context, and drawing on multiple sources of input to determine eligibility and verify the legitimacy of relationships. We provide a practical set of tools that other researchers should find helpful in the study of high risk couples in international settings, with particular relevance to studies of FSWs and their intimate partners.

Methods; Recruitment; Eligibility screening; Couple-based research; Female sex workers; Mexico