Open Access Study protocol

Evaluating the effectiveness of personal resilience and enrichment programme (PREP) for HIV prevention among female sex workers: a randomised controlled trial

Winnie Wing-Yan Yuen1*, William Chi-Wai Wong1, Catherine So-Kum Tang2, Eleanor Holroyd3, Agnes Fung-Yee Tiwari4, Daniel Yee-Tak Fong4 and Weng Yee Chin1

Author affiliations

1 Department of Family Medicine & Primary Care, 3/F., Ap Lei Chau Clinic, The University of Hong Kong, 161 Main Street, Ap Lei Chau, Hong Kong, China

2 Department of Psychology, Faculty of Arts and Social Sciences, National University of Singapore, Block AS4, #02-07, 9 Arts Link, Kint Ridge 117570, Singapore

3 Asian and Gender Studies, RMIT University, PO Box 71, Bundoora 30038, Australia

4 School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China

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Citation and License

BMC Public Health 2013, 13:683  doi:10.1186/1471-2458-13-683

Published: 26 July 2013



Female sex workers (FSWs) are often considered as the vector, if not reservoir, of HIV and other sexually transmitted infections. Building upon the existing evidence on the role of psychological health in sexual health, the aim of this protocol is to describe a trial investigating the effectiveness of the Personal Resilience and Enrichment Programme (PREP), a resilience-promoting intervention that targets at psychological well-being i.e. self-esteem, self-efficacy and coping, to facilitate adaptation and ultimately safe sexual practices among FSWs, which could be an innovative strategy in controlling the spread of these infections.


A total of 132 FSWs will be recruited and randomly assigned to either the intervention or usual care (control) groups in a multi-centred randomised controlled trial. Based on the resilience framework, this intervention is comprised of six weekly sessions focused on the awareness, expression and management of emotions, identifying roles and personal strengths, and effective problem-solving skills. Complex intervention assessment on both intervention process and effectiveness will be adopted when the primary outcome reduction of sexual risk behaviour and other psychological outcomes include their perceived stress, self-esteem, self-efficacy, coping overall resilience, and psychological distress will be measured at baseline, post-treatment and 3-month post-intervention and differences assessed by ANOVA. The relationship of resilience factors, psychological health and HIV preventive behaviours will be evaluated using structural equation modelling.


It is anticipated that this study will increase our understanding of the relationships between individual resilience attributes, positive adaptation, psychological health and sexual health practices. If successful, this programme will provide an innovative direction for HIV prevention by applying the personal resilience factors to promote both psychological well-being and safe sex for this high risk population.

Trial Registration


Randomised controlled trial; Female sex workers; HIV prevention; Resilience; Protocol