Programming Connection

ORCHID 

Asian Society for the Intervention of AIDS (ASIA)
Vancouver, British Columbia
2010

How Does the Program Work?

The outreach component is administered by teams of two people, each consisting of a peer (a woman who is a current or former sex worker and who is paid for her work with ORCHID) and a volunteer. Each outreach team engages monthly with three to five massage parlours to offer:

  • Information and resources on safer sex and legal issues affecting sex workers
  • An opportunity for sex workers to talk about their work to an outreach worker and fellow sex workers
  • Assessments and referrals to other social and health services available to sex workers

The three to five parlours visited by each outreach team are collectively referred to as that team’s “route.” 

The research component of the project is delivered by two researchers who visit massage parlours to collect information from sex workers and provide point-of-care STI and HIV testing. During this component of the project, the research team visits parlours weekly to offer testing.

Location

ORCHID coordinates outreach to massage parlours in Vancouver and some surrounding cities, including: Burnaby, Richmond and Surrey. To date, the ORCHID project has delivered services to 55 different sex work locations. At any given time, regular contact exists between the project and 25 to 30 different massage parlours. Some additional establishments take packages with safer-sex literature and supplies from ORCHID but deny that sexual services are being offered in their establishments.

Recruitment and Engagement

Outreach workers

Originally, peer outreach workers were recruited through collaboration with another organization, but now that ORCHID has developed more solid relationships with women working in massage parlours, the majority of peers are recruited directly by outreach teams.

Volunteer outreach workers are recruited through flyers posted at the University of British Columbia and Simon Fraser University. The content of the flyers generally includes a description of the project and contact information for the ORCHID Project coordinator.

When the project first began, many outreach team members experienced burnout from frustration with massage parlour managers who were (as many continue to be) reluctant to grant access to their employees. The ORCHID project coordinators responded by rotating outreach teams to different parlour routes to ensure that each group was engaged and able to interact with women in the establishments. As relationships with managers have improved over time, outreach workers are now assigned to regular routes to ensure consistency, which helps to build and maintain trust with the massage parlours.

Massage Parlour Managers

To convince massage parlours to participate in the ORCHID project, outreach teams begin by having informal conversations with the establishments’ managers. This is often a difficult process, as many managers are hesitant to become involved for fear of legal consequences. Outreach team members must, therefore, be dedicated to a long-term commitment to the project.

  • Step 1: Identify massage parlour locations
    ORCHID identifies massage parlour locations by searching the adult entertainment advertisement sections in newspapers and magazines.
  •  Step 2: Confirm where sexual services are being offered by Asian women.
    To determine which locations listed in newspapers and magazines employ Asian sex workers, ORCHID administrators visit online forums that have been created by and for clients to discuss sexual services and the women who perform them. ORCHID administrators find that these forums portray women in grotesque and demeaning ways. For this reason, they are only accessed by ORCHID administrators and not by the volunteer team members.
  • Step 3: Approach massage parlours
    Outreach teams approach those massage parlours that employ Asian women, bringing a letter explaining the project activities to the manager along with a small gift (such as a box of cookies) which, particularly in Chinese culture, is commonly accepted as a gracious gesture and demonstrates cultural sensitivity and respect.

    At the beginning of the first visit, teams provide a language-specific explanation to the manager (and possibly the women) of what ORCHID is and what ORCHID can offer to them. They are presented with an outreach package and told that ORCHID can visit the parlour once a month to drop off supplies. The face-to-face visits are critical in building trust, as telephone calls have been unsuccessful and mailed literature can be confusing for the manager and easily lost, ignored or discarded.

    If the parlour is not responsive to the initial visit, the outreach team does not insist. They leave and return in approximately one month. During the first few visits to a parlour, it is important for outreach workers to wear identifiable ORCHID shirts and bring ORCHID pamphlets, legal rights cards, small purses with condoms and lube and the outreach package.

  • Step 4: Maintaining engagement
    The outreach team visits each of the massage parlours on its route once a month. It is not uncommon for outreach workers to meet with a massage parlour manager regularly over the space of a year or longer before being allowed to communicate directly with sex workers.

Since ORCHID first began, more managers have become willing to accept outreach teams into their establishments, as the reputation of the project has built trust among proprietors and sex workers alike.

Once an outreach team has won the trust of a massage parlour manager, the team makes arrangements to visit the establishment when it is not busy to meet with the employees. The optimal time for entry into the parlours differs according to each particular establishment and its location.

For more information on engaging massage parlour managers, please see ORCHID Outreach Dos and Don’ts in Program Materials.

Sex Workers

Once outreach teams are allowed to enter the massage parlours, they offer small gifts to those women who are not with clients as a gesture of cultural sensitivity and respect, and they engage the women in conversation about the ORCHID project, sexual health and legal issues. Free condoms and lubricant in small Chinese-style purses, along with pamphlets on sexual health and legal issues, are also distributed. Women are often encouraged to speak to the ORCHID team because, in many cases, this is a new opportunity for them to learn about their sexual health, receive free safer-sex supplies and ask questions in complete confidentiality.

Training

Both peers and volunteers undergo an initial three-hour ORCHID training session, which covers an introduction to common STIs and HIV, as well as techniques for engaging parlours and delivering information to Asian women employed by massage parlours as sex workers.

The techniques taught have been developed over the course of the project. For example, if a parlour claims that no sex work is taking place on its premises, the complimentary Chinese-style purses with safer-sex supplies are offered with the suggestion that women can use them in their personal lives.

Ongoing training workshops that expand on the topics presented in the initial session are also provided. These scenario/discussion-based workshops address how best to translate information and work as a team to reach female sex workers. The concerns of outreach team members are addressed during training workshops and are reported regularly to project coordinators.

For more information on ORCHID’s training techniques, see Program Materials and contact ORCHID.

Outreach in Massage Parlours

After a relationship has been established with the sex workers according to ORCHID’s strategy for recruitment and engagement, the outreach team meets with women to identify how well they understand sexual health and legal rights issues. Subsequent visits are then organized to educate women on these and any additional issues they have requested information on. The outreach team typically visits each parlour once more to drop off additional safer-sex supplies.

The relationship between a parlour and the outreach team, as well as the atmosphere encountered during visits, varies from place to place and from visit to visit. At some parlours, outreach workers have long informal visits to build rapport and have educational conversations, whereas a small number of parlours are more rigid, allowing only enough time for a quick exchange of information and the distribution of packages. In parlours where casual conversations are allowed, outreach workers are able to spend more time with the women, brainstorming strategies to negotiate safer sex with clients and explaining their legal and health care rights.

Regardless the duration of a visit, the outreach team must:

  • Deliver packages immediately after entry
  • Ask how the parlour is doing (business wise) and determine if the parlour has had any recent issues with police
  • Establish if there is a need for street nurses, STI testing and/or workshops on STIs and safer sex

Key topics and resources provided by the outreach team include:

  • Answers to health-related questions
  • Sexual health education pamphlets
  • Safer-sex supplies in Chinese-style purses
  • Information on legal rights of sex workers
  • Health care referrals and support
  • Interpretation and translation services

Drawing on feedback from the target clientele, ORCHID plans to broaden future outreach efforts to include programming specifically targeted to women who are new to sex work, as these women may face even more challenges than their more seasoned colleagues.

There are also plans to make targeted safer-sex literature available to massage parlour managers and clients. Additionally, off-site workshops to provide women with self-defence training are being planned to help women negotiate safer sex with more aggressive clients.

After establishing critical rapport with sex workers and their employers, the outreach team requests if members of the ORCHID research group may also enter the establishment. This request is always directed to the massage parlour manager and is made by either the outreach team or the ORCHID project coordinator. It is stressed that the research team is safe and nonjudgmental and benefits sex workers by providing health care services. In addition, all women who participate in the research are offered a monetary honorarium, which also acts as an incentive. Consequently, many parlours agree to allow the research team to visit.

Once granted entry, the research team of two asks the women to complete a demographic questionnaire, which identifies key characteristics of Asian women employed as sex workers in massage parlours and assesses their knowledge of HIV and other STI risk. The researchers also provide on-site STI and rapid HIV testing.

With rapid HIV tests, results are delivered immediately, while STI results are delivered to the women within a week. Treatments are discussed in pre-test counselling, and in post-test counselling in the event of a positive test. To date, there have been no positive HIV tests. When treatment for an STI is required, the research team supplies the treatment. In cases where this is not possible (such as wart treatments), a letter explaining and requesting treatment is given to the infected woman, who can then pass it along to a physician. For more information on the number of tests administered, please see Program Materials.