Philippine Council for Health Research and Development Department of Science and Technology

CAPSULE RESEARCH PROPOSAL (1) Program / Project Title

A Comprehensive Demographic Profile and Sexual Practices and Behaviors of Female Commercial Sex Workers (FSWs) in Iligan City: Basis for HIV/AIDS Health Intervention and Local Policy Formulation
(2) Program/Project Leader Gender/Agency/Address/Telephone/Fax/Email Project Leader: Cheryl T. Tuddao, RN MAN Clinical Instructor Iligan Medical Center College 09202179306 Cheryl.tuddao@gmail.com Project Staff: Jose Dennis O. Mancia Coordinator, Extension Program Iligan Medical Center College 09066592786 josedennis_mancia@yahoo.com Belen Boquida, RN Clinical Instructor Iligan Medical Center College James A. Margaja, RMT College of Medical Technology Iligan Medical Center College sputum_black@yahoo.com Dindo Donald A. Manulat, Jr. Research and Publication Coordinator Iligan Medical Center College 09154904969 dindo_manulat@yahoo.com (3) Implementing Agency Iligan Medical Center College (IMCC) (4) Cooperating Agency (cies) City Health Office (Iligan City) City Social Welfare and Development (5) Research and Development Station Iligan Medical Center College San Miguel Village, Pala-o, Iligan City 9200

(6) Research Area (please check) X Communicable diseases __ Degenerative and lifestyle related Disorders ____Nutrition ____Occupational health _____Environmental health

(7) Introduction
Female commercial sex workers are at high risk for infection with HIV, and their clients may act as a bridging population by spreading HIV to the general population. Comprehensive HIV surveillance among sex workers includes surveillance of HIV infection, of sexually transmitted infections and of risk behavior. Surveillance of HIV infection among female commercial sex workers is critical for countries, like the Philippines, with low-level or concentrated HIV epidemics, and can help in monitoring the response to the HIV epidemic in countries with a generalized epidemic. Female commercial sex workers are a vulnerable population, and particular attention needs to be paid to human rights issues including consent, confidentiality and stigma. Collaborations with key players in the local sex work scene - sex workers themselves in the first place - and alliances with salient institutions and groups are key to the success of surveillance among sex workers. Surveillance activities should have a strong link to interventions targeted at sex workers. Surveillance for HIV infection among sex workers can be institution- or community-based. Institutional settings include screening programs for registered sex workers, of sexually transmitted diseases clinics, and re-education camps. Specific sources of bias need to be considered in different settings, and must be measured - through the collection of sociodemographic and behavioral data - to allow a correct interpretation of prevalence data and time trends. Community-based HIV infection surveillance can be conducted in a probability sample of the sex worker population, thereby reducing selection bias. This requires the mapping of sex workers' contact venues, and drawing a random sample from the resulting sampling frame. In regions where HIV infection is rare among female sex workers, surveillance of risk behavior and

sexually transmitted infections (STI) will indicate the potential for spread of HIV infection. In Iligan City, the need for surveillance for HIV infection has become imperative, not only determining the modes of transmission of the disease, but also in providing appropriate interventions to prevent the spread of HIV/AIDS in the area. Although there are limitations in collecting accurate data and information of the prevalence of HIV/AIDS in the city, but the increase of female commercial sex workers (especially after typhoon Sendong), as well as, the absence of intervention by the local government and private institutions to monitor and implement programs and activities that address the phenomenon of HIV/AIDS, can provide a clear picture of the possible increase of the disease. It is in this particular context that this research project shall be undertaken.

(8) Significance
As most people would probably believe, the predominant mode of HIV transmission is through sexual contact. The risk of acquiring HIV infection during a single sexual contact depends on several factors. Most important, of course, is the likelihood that the contact is with an HIV-infected partner. Because the prevalence of HIV varies widely between populations within regions as well as between countries, the rates of sexual transmission also vary. Other factors affecting the efficiency of sexual transmission include the type of sexual practice; the infectivity of the source partner; coexisting sexually transmitted infections in either partner, particularly those causing genital ulceration; and consistency of condom use. HIV transmission has been attributed to vaginal, anal and, less frequently, oral intercourse. The long term objectives of conducting a research study on the sexual practices and the mode of transmission of HIV/AIDS among the female commercial sex workers in Iligan City are: (1) to determine the different sexual practices and behaviors to which female commercial sex workers are engaged in; (2) to provide an early warning system for the potential spread of HIV/AIDS to the general population; (3) to aid in planning and designing appropriate interventions for sex workers and their sexual partners; (4) to monitor the impact on sex workers of the national response to the HIV epidemic including interventions targeted at sex workers, and (5) to provide information to help mobilize an increased response to HIV. Declining trends in HIV and STI prevalence and rising trends in safer sex behavior can help increase public and political support for HIV prevention activities, whereas trends in the opposite direction argue for renewed efforts to promote safe behavior among sex workers and their sex partners.

(9) Review of Related Literature Sex workers and their partners have played an important role in the HIV epidemics of many countries across the world where heterosexual transmission is the main mode of transmission. In these countries they are considered a core group, in that they have a high prevalence of HIV infection, and contribute disproportionately to the transmission of HIV due to their large number of sexual partners. In these countries sex workers form an identifiable population that has high HIV prevalence rates, before HIV is established among the general population. In Abidjan, Cte d'Ivoire, HIV prevalence rates reached high levels among female sex workers at 38% in 1986, 68% in 1990 and 80% in 1992-1994, well before HIV prevalence rates increased among antenatal clinic attenders with 3% in 1986 and 13.8% in 1999. Testing of stored sera from Nairobi, Kenya, gives an even better picture of how HIV infection affected female sex workers before spreading among the general population. HIV prevalence increased among female sex workers from 4% in 1981 up to 82% in 1983, well before the increase among pregnant women from 0% in 1981 to 2% in 1985 and up to 25% in 1995. In Bangkok, Thailand, HIV prevalence rates among brothel-based female sex workers increased from 0% in 1985-1986 to 3.1% in 1989, to 13.6% in 1991, and 33.3% in 1992. HIV prevalence rates among antenatal clinic attenders increased later with 0% in 1989, 0.6% in 1991, and 1.1% in 1992. In regions where HIV infection is rare among female sex workers, surveillance of risk behavior and sexually transmitted infections (STI) will indicate the potential for spread of HIV infection. HIV is transmitted primarily through sexual contact, parenteral exposure to blood or blood products, and perinatally from infected mothers to their infants. In epidemiologic studies among homosexual men, the risk of HIV acquisition increases with the number of sexual partners, the frequency of receptive anal intercourse, and practices associated with rectal trauma such as receptive fisting and anal douching. No sexual activity potentially involving the exchange of semen or blood, however, should be considered without risk. The relative efficiency of HIV transmission through various sexual practices was difficult to estimate precisely because most HIV-infected homosexual men in epidemiologic studies had engaged in multiple practices. Although the frequency of female-to-female transmission would seem to be quite low, such HIV infections associated with traumatic sexual practices have been reported. Most cases of HIV infection reported among bisexual women and lesbians are attributed to injecting drug use or heterosexual contact. Most heterosexual transmission of HIV occurs during vaginal intercourse, although some studies suggest that receptive anal intercourse increases the risk of HIV transmission from an infected man to a woman. Some infected persons may be more efficient transmitters than others, perhaps owing to differences in viral strains or other factors. Transmission efficiency is inversely related to the immunologic status of the infected partner. In studies conducted among spouses and other steady sexual partners of HIV-infected persons, male-to-female, female-to-male, and male-to-male sexual transmission of HIV increased as the index partners T-helper lymphocyte numbers declined. These findings are not surprising, because the quantity of HIV in blood and semen increases as the disease progresses and the immune system weakens. Several studies have documented that infections such as Haemophilus ducreyi, Treponema pallidum, herpes simplex virus, and other pathogens causing genital or anal ulcers facilitate acquisition or transmission of HIV through sexual contact, most likely by disrupting the genital or anal skin and mucous membranes. Undoubtedly, the higher rates of untreated genital ulcer disease contribute to the high rates of sexual transmission of HIV observed in some areas of the developing world. Several investigators have reported increased risks of HIV acquisition for women with cervical infections with Neisseria gonorrhoeae or Chlamydia trachomatis or with cervical ectopy. To the extent that coexisting sexually transmitted infections increase the rate of HIV transmission, populations throughout the world with higher rates of these infections are at higher risk of HIV infection. Conversely, preventing and treating other sexually transmitted infections should have a beneficial effect on preventing HIV transmission. Cohort studies of couples discordant for HIV infection clearly indicate that consistent condom use reduces heterosexual as well as homosexual HIV transmission by 90% compared with inconsistent use or nonuse of condoms. Finally, preliminary studies suggest that antiretrovirals may reduce but not eliminate the risk of HIV transmission through sexual contact. However, it is unknown if treatment of HIV infection will lower infectiousness at a population level, there is a need to continue interventions that decrease sexual risk behavior and to treat sexually transmitted infections as known effective strategies that can lower the sexual transmission of HIV.

Officially, the Philippines is a low-HIV-prevalence country, with less than 0.1 percent of the adult population estimated to be HIV-positive. As of August 2012, the Department of Health (DOH) AIDS Registry in the Philippines reported 10,514 people living with HIV/AIDS (PLWHA). Of the 10,514 HIV positive cases reported from 1984 to 2012, 92% (9,637) were infected through sexual contact, 4% (420) through needle sharing among injecting drug users, 1% (59) through mother-to-child transmission, <1% (20) through blood transfusion and needle prick injury <1% (3). No data is available for 4% (375) of the cases. Cumulative data shows 33% (3,147) were infected through heterosexual contact, 41% (3,956) through homosexual contact, and 26% (2,534) through bisexual contact. From 2007 there has been a shift in the predominant trend of sexual transmission from heterosexual contact (20%) to males having sex with other males (80%). Overseas workers from the Philippines (e.g., seafarers, domestic helpers, etc.) account for about 20 percent of all HIV/AIDS cases in the country. Aside from female commercial sex workers who are most-at-risk, men who have sex with men (MSM), with 395 new human immunodeficiency virus (HIV) infections among within this group from January to September 2008 alone, 96% up from 2005s 210 reported infections. A spokesperson of the National Epidemiology Center (NEC) of the Department of Health says that the sudden and steep increase in the number of new cases within the MSM community, particularly in the last three years (309 cases in 2006, and 342 in 2007), is tremendously in excess of what (is) usually expected, allowing classification of the situation as an epidemic". Of the cumulative total of 1,097 infected MSMs from 1984 to 2008, 49% were reported in the last three years (72% asymptomatic); 108 have died when reported, and slightly more MSMs were reportedly already with AIDS (28%). Among MSM's, ninety percent of the newly infected are single (up to 35% of past cases reported involved overseas Filipino workers or OFWs and/or their spouse), with the most of the affected people now only 20 to 34 years old (from 45 to 49 years old in the past). The highest number of infections among MSMs is from Metro Manila, though increasing infection rates were also noted in the cities of Angeles, Cebu, and Davao. 1 to 3 percent of MSM's were found to be HIV-positive by sentinel surveillance conducted in Cebu and Quezon cities in 2001. Another at-risk group are injecting drug users (IDUs), 1 percent of whom were found to be HIV-positive in Cebu City in 2005. A high rate of needle sharing among IDUs in some areas (77 percent in Cebu City) is of concern. Sex workers, because of their infrequent condom use, high rates of sexually transmitted infections (STIs), and other factors, are also considered to be at risk. In 2002, just 6 percent of sex workers interviewed said they used condoms in the last week. As of 2005, however, HIV prevalence among sex workers in Cebu City was relatively low, at 0.2 percent. Several factors put the Philippines in danger of a broader HIV/AIDS epidemic. They include increasing population mobility within and outside of the Philippine islands; a conservative culture, adverse to publicly discussing issues of a sexual nature; rising levels of sex work, casual sex, unsafe sex, and injecting drug use. There is also high STI prevalence and poor health-seeking behaviors among at-risk groups; gender inequality; weak integration of HIV/AIDS responses in local government activities; shortcomings in prevention campaigns; inadequate social and behavioral research and monitoring; and the persistence of stigma and discrimination, which results in the relative invisibility of PLWHA. Lack of knowledge about HIV among the Filipino population is troubling. Approximately two-thirds of young women lack comprehensive knowledge on HIV transmission, and 90 percent of the population of reproductive age believe you can contract HIV by sharing a meal with someone. The Philippines has high tuberculosis (TB) incidence, with 131 new cases per 100,000 people in 2005, according to the World Health Organization. HIV infects 0.1 percent of adults with TB. Although HIV-TB co-infection is low, the high incidence of TB indicates that co-infections could complicate treatment and care for both diseases in the future.

Female sex workers can be defined as women who exchange sex for money or goods. However, some female sex workers are more visible and identifiable than others. For example, in Burkina Faso in addition to highly visible professional sex workers, women serving in bars and cabarets, women selling fruit and vegetables, and students were included in a peer education program as occasional sex workers. Similarly, in many Asian countries, direct female sex workers, who work in brothels and have no other occupation than sex work, are distinguished from indirect sex workers, who work in massage parlors, bars, and other establishments and may sell sex to supplement their income. HIV surveillance among sex workers needs to take these differences into account, by precisely characterizing which groups of sex workers are included in the surveillance. Different types of sex workers will need to be accessed with different methods, as discussed below. A correct interpretation of trends over time will also need to take these differences into account. The sex work scene differs greatly from place to place. There are differences in legal status, in work settings, in sexual practices, and in social acceptance. HIV surveillance methodologies and approaches therefore need to be adapted to the local situation. To facilitate access to sex workers and to ensure proper use of the results of HIV surveillance, alliances need to be forged. Such alliances need to be built with sex workers' groups, with authorities (police, health authorities, social services), with gatekeepers (brothel owners and pimps), with groups and institutions representing women's interests [non-governmental organizations (NGOs), the Ministry of Women's Affairs, family planning associations, human rights groups], and with specific intervention programs. These organizations and groups may facilitate access to the sex worker populations either because of their legal mandate (police, health authorities) or because they have already established a working or social relationship with sex workers. For example, in a study in the Gambia the co-operation of the bar owner was a decisive factor in selecting the study sites. Working with established peer educators is particularly valuable as it may contribute to reducing suspicion about potential harm to sex workers. Meeting with the sex workers and explaining the purpose of surveillance, incorporating their expertise and utilizing them as adjunct researchers is highly recommended. In a study in Italy, access to sex workers for behavioral surveillance was facilitated through the Italian Committee for Civil Rights of Prostitutes, an organization of sex workers. Providing stakeholder organizations with feedback on the results of the surveillance not only engages their interest and co-operation but contributes to a heightened sense of the need for prevention. One objective of HIV surveillance is to aid in planning specific interventions. Therefore no surveillance should be conducted without collaboration with existing interventions, or if no interventions exist yet, without the intention to create services based upon the results of the first surveillance results. The process of initiating surveillance activities and consolidating the HIV prevention services that go with them may in itself strengthen the partnerships and build up the capacities needed to expand surveillance activities in the future. The stable partners of sex workers may be at particularly high risk for HIV infection, but they also risk infecting their partners sex workers, as condom use in these couples is typically low. Surveillance and services for sex workers should include their stable partners, whenever possible. Sex work is either illegal or socially undesirable in most countries. Conducting surveillance among sex workers may entail dangers, including the breach of confidentiality of individual results, and negative reactions to publicized results by site, nationality, or other characteristics that may identify a community. Several examples of the negative impact of both official and unofficial surveillance among sex workers have occurred in Bangladesh. In one, unofficial testing led to the incarceration of HIV-seropositive sex workers through a breach of confidentiality. In another, after the official dissemination of surveillance results, social welfare agencies and police forcefully evicted women from the surveyed brothels, spreading them through the city and compromising existing HIV prevention efforts. These dangers need to be carefully considered in the planning and design of surveillance activities. Both behavioral and serologic information on HIV can be collected through different designs, i.e. cross-sectional surveys, repeat sentinel sero-surveys, and prospective studies. Surveillance among sex workers should be conducted on a regular basis every year. Repeat cross-sectional studies represent the preferred design both for HIV infection surveillance and for behavioral surveillance. HIV infection surveillance can be conducted at institutions or in the community, as discussed below.

The interpretation of time trends of HIV infection is difficult, as, in all countries, sex workers are known to be notoriously mobile. It is essential that the changing composition of the group is tracked as the interpretation of time trends can easily be confounded by changes in the socio-demographic composition of the group. It is therefore necessary to collect socio-demographic and behavioral data when conducting HIV surveillance. Two approaches are possible. The first is to collect comprehensive socio-demographic and behavioral information from the same individuals who are providing specimens for HIV testing. This can be carried out at clinics that provide voluntary confidential HIV testing, where results are linked to the sex worker and shared with her. However most clinical settings produce poor results regarding behavioral data collection. Furthermore HIV infection surveillance conducted at clinics that provide voluntary confidential HIV testing is subject to both selection bias and refusal bias. The second approach is to conduct behavioral surveillance separately from HIV infection surveillance. Separate behavioral surveillance among sex workers has been successfully conducted in several countries in Asia. Where sample frames are carefully constructed to include sex workers of all categories, the behavioral data that is collected should be fairly representative of all sex workers. Behavioral surveillance may include the following socio-demographic and behavioral indicators: age, education, type of work site, length of time at present site, length of time in sex work, number of clients per week or in last 24 h, country/region of origin, language, condom use with last client, condom use with last non-client, type of sexual practice, substance abuse, other occupation, income, exposure to interventions, and sexually transmitted diseases (STD) treatment-seeking behavior. Some behavioral information may measure risk for HIV infection, e.g. sharing equipment to inject drugs or inconsistent condom use. The behavioral surveillance data needs have been discussed in greater detail elsewhere. Data on ethnic identity should be handled carefully as they can lead to stigmatization. In situations where unlinked anonymous HIV testing is conducted, it is not possible to collect comprehensive socio-demographic and behavioral information linked to the samples, because the collection of these data could compromise the anonymous nature of the surveillance. A bare minimum of socio-demographic variables, such as age, length of time in sex work, education, and country/region of origin may be linked to the samples. Comparison between the distribution of these socio-demographic characteristics in the HIV infection surveillance data set and the separate behavioral surveillance data set may make it possible to determine whether the sample of women included in the HIV infection surveillance is representative of the wider sex worker population.
While the most frequent (86%) mode of transmission is still through sexual intercourse (Ditangco, 2006). This has been an alarming situation since it implies poor safe sex practices amongst Filipinos. Moreover, those who are considered economically productive are commonly affected while Filipino migrant workers were seen to be in an increasing HIV/AIDS cases. This year, the Department of Health (DOH) projected an increase of 14,000 HIV/AIDS cases which belongs to the1539 age group (Crisostomo, 2012).Compared to last years figure, 2,349 HIV cases were reported, which 94 of it has developed in to AIDS. In 2011, an average of seven HIV cases were reported every day, while this year, there will be a projected average of 38 HIV cases per day. From 1984 to 2007, an average of one HIV case per day was recorded (Femalenetwork.com, n.d.). With this, despite the current programs implemented by the DOH, more interventions and policies regarding HIV/AIDS should be implemented within the Philippine context. As more Filipinos acquire the disease, which most of them are young professionals, the need for more information dissemination on reproductive health and safe sex education must be a priority as it implies the idea that, still, prevention is better than cure.

(10) Objectives General Objective: This study aims to assess the sexual behaviors and practices of female sex workers in Iligan City and recommend actions for health intervention and policy formulation. Specific Objectives: Specifically, this study seeks to: 1. 2. 3. 4. Determine the demographic profile of respondents in terms of age, marital status, number of children/dependents; educational attainment and income of street-based and commercial-based FSWs; Determine the different sexual behaviors and practices in terms of frequency of sexual contact and activity; use of contraceptives , multiple partner practices; type of sex work and services, and clienteles, Determine the different motivations and/or reasons of FSWs in engaging in sexual practices and activities; Compare the profile of sexual practices and behaviors of street-based and commercial-based FSWs.

(10) Methodology The respondents shall mainly come from within the most vulnerable population to HIV/AIDS in Iligan City. Snowball strategy will be used among female sex workers to ensure maximum number of respondents. If respondents are minors, two copies of free prior informed consent will be administered before the actual conduct of the interview. For respondents who are above 17 years old, strict observance of research ethics, particularly in the administration of free prior informed consent shall also be conducted prior to the interview proper. KIIs shall be conducted individually in a private and secure place away from distractions and disturbance. RESEARCH OBJECTIVES MODE OF DATA COLLECTION MAIN VARIABLES/ INDICATORS TO BE COLLECTED . age, marital status; number of children; educational attainment; income and general health status. RESPONDENTS/ PARTICIPANTS

1. To determine the demographic profile of female commercial sex workers in terms of age, marital status, number of children and educational attainment and income;

. conduct face-to-face interview with female commercial sex workers using guided questionnaire.

. target respondents

2. To determine the sexual practices and behaviors of the respondents;

. conduct face-to-face interviews with respondents using guided questionnaire;

. Sexual behaviors and practices such as frequency of sexual contact and activity; use of contraceptives , multiple partner practices; type of sex work and services, and clienteles, etc.

. FSWs;

3. To determine the motivations in engaging in sexual activity of target respondents.

. conduct face-to-face interviews with respondents using guided questionnaire; . conduct analytical comparison of profile re different sexual practices and behaviors of street-based and commercial-based FSWs.

. motivation of engaging in sexual activity of FSWs.

. FSWs;

4. Compare the profile of sexual practices and behaviors of street-based and commercialbased FSWs.

. different sexual practices and behaviors of street-based and commercial-based FSWs.

. FSWs

In analyzing data, use of statistical tools like computing percentages and constructing graphs to show differences of sexual practices and behaviors between street-based and commercial based FSWs shall be applied.

To understand better how the data will be treated and interpreted in the study, strict ethical consideration of confidentiality shall be observed. Data codification shall be employed and personal circumstances of respondents will be strictly coded using aliases and other means. In the collection and interpretation of data, interpreters and statisticians will only be given coded information. If the need arises for interpreters and statisticians to obtain specific information to validate data that need exposure of respondent, respective interviewer must accompany the respondent, with prior consent, before another interview will be undertaken. All data and information shall be kept in password computers/compact disks/flask disks and locked cabinet in the research office that only the Project Leader and the Research Director have access to. In the event that information has to be destroyed after five (5) years, paper and CD shredders shall be used to obliterate all information that, in one way or another, has relation to the study. In terms of the dialect to be used in the study, Cebuano or local (Visayan) will be employed in administering interview guide. The researcher will make sure that languages used in the KIIs are understood by participants. In data processing, researchers will look into the patterns of similarities and differences in the data. Data matrices, tables and figures will be prepared as basis for interpretation and analysis. Data validation shall be done with research project stakeholders prior to finalization of the study.

Research Design A cross sectional research study will be used to determine the sexual behavior and practices of commercial sex worker in one point in time in selected areas in Iligan City. Sample Groups Key informants are selected from health providers, law enforcement agencies, NGOs working with sex workers, community key informants, brothel owners and pimps in determining the mapping of female sex workers (FSWs). In general, 60 street-based and 60 commercial-based FSWs shall be the minimum subjects of this study. However, if more subjects are willing to participate, an increase of number of subjects shall be appreciated. The definition of female sex workers (FSW), in this study refers to women selling sex in exchange for money or goods. Inclusion criteria for the respondents are as follows: a. Females sex workers at least 18 years old and above regardless of marital status, number of children/dependents; educational attainment and income; b. A resident of Iligan City regardless of years of residency. c. Female sex workers may be street based or commercial based ( brothel establishment for prostitution such as bars, pubs and inns) d. Nevertheless, female sex workers that has mental or psychiatric disorder are exclusive from this study such aggressive (with the potential to harm self and other people), psychotic and others. Sampling Procedure a. Initial mapping. This strategy allows gathering the indicators and concentrations of female sex workers in Iligan City. It will utilized the data collected from key informants such as the health providers, law enforcement agencies, NGOs working with sex workers, community key informants, brothel owners and pimps. Using the above data, selected geographical locations with a high prevalence of female sex workers will be identified. b. Ethnographic mapping is intended to help establish a picture of work settlement patterns and characteristics of female sex worker. It helps to identify and cultivate contacts with social networks of female sex workers in each of the location. It is also useful to develop an in-depth understanding of major networks in terms of frequency of sexual contact and activity; use of contraceptives, visual materials, multiple partner practices; type of sex work and services, and clienteles. The principal tools that will be used in this stage were participant observation and semi structured interviews with key informants. c. Field reports are produced for each section. Initial daytime observation is followed by observation during the weekends and evening hours. After sufficiently establishing the safety and security of the researchers, the researchers carry out observations during evening/night hours. In each of the identified locations, semi-structured qualitative interviews will be carried out with the female sex workers. These interviews address several issues including current and past sexual practices and behavior and their motivations/ reasons for the sex work. Multiple snowball samples will be started and directed to involve overlapping and non-overlapping social circles of sex workers and the clients (Kumar, E & et.al)

Limitations of the study: As to snowballing , the selection of the respondents are more likely their acquaintances . Hence, the survey results cannot generalize to the whole FSWs population in Iligan City.

DUMMY TABLES (sample) Frequency Distribution of Respondents Profile

PROFILE Age Marital status No. of children Educational Attainment Income Total STREET BASED FSW COMMERCIAL BASED FSW TOTAL

(11) Major Activities

ACTIVITY JUL Organizing of Research Team Procurement of Supplies Formulation of Research Instruments Gathering of Secondary Data Determination of Respondents Stakeholders Meeting Pre-Testing of Survey Questionnaire Obtaining of Free and Prior Informed Consent Actual Interviews of Respondents Data Collection (FGDs and KIIs) Data Processing and Analysis Data Validation and Cross Validation Finalization of Data and Survey Results Post-Survey Debriefing and Presentation of Results to Stakeholders Post-Survey Evaluation and Planning AUG SEPT OCT

TIME FRAME 2013 NOV DEC JAN FEB

MAR

APR

2014 MAY JUN

(12) Expected Output Came up with comprehensive demographic profile and sexual practices and behaviors of street-based and commercial-based female commercial sex workers in Iligan City, as basis for health intervention and local policy formulation;

(13) Target Beneficiaries Local community, government agencies, non-government organizations , Department of Health, Department of Social Welfare and Development.

(14) Implementation Schedule Duration: (1 year) Planned Start Date: (April 2013-January 2014) Planned Completion Date: (January 2014) (15) Estimated Budget by Source Sources of Funds and Amount (PhP) PCHRD Assistance Agency Other Sources Counterpart 60,000 78,000 138,000

Particulars I. Personal Services (PS) Project Leader Research Assistant Php6,500.00/mo x 12 mos. Sub-Total for PS II. Maintenance and Other Operating Expenses Travel and Transportation Supplies and Materials Communications Reproduction and Photocopying Representation Professional Services Sub-Total for MOOE III. Capital Outlay (CO) Sub-Total for PS and MOOE Administrative Cost (10%) Grand Total

10,000 11,000 9,000 11,500 52,000 80,000 173,500 311,500 31,150 342,650

(16) Was the proposal submitted to funding agencies other than PCHRD? _____YES ___x__ NO

If YES, please list down funding agencies where proposal was submitted: N/A ______________________________________________________________________________________________________

(17) Submitted by: SIGNATURE: NAME: Cheryl T. Tuddao, RN MAN Clinical Instructor

DESIGNATION: Project Leader DATE: June 7, 2013

List of References:

Crisostomo, S. (2012). DOH: HIV/AIDS to increase by 14,000 this year. Philippine National AIDS Council.Retrieved from

http://www.pnac.org.ph/index.php?mact=News,cntnt01,detail,0&cntnt01articleid=404&cntnt01or igid=15&cntnt01returnid=39 on June 25, 2012.

Ditangco, R. A. (2006). HIV/AIDS in the Philippines.The Journal of AIDS Research.Retrieved from http://jaids.umin.ac.jp/journal/2006/20060801/20060801012016.pdf on June 2, 2012. Femalenetwork.com. (n.d.). World Health Organization: HIV Cases in the Philippines Continue to Increase. Health and Wellness.Retrieved from http://www.femalenetwork.com/health-wellness/world-health-organizationhiv-cases-in-the-philippines-continue-to-increase/ on June 5, 2012. Modes of HIV Transmission http://www.health.am/aids/more/modes_of_hiv_transmission/#ixzz3qHs2Tml0 HIV and the Acquired Immunodeficiency Syndrome: Epidemiology of HIV infection and AIDS Jan 25, 2006

- www.plwha.org.[1]