What is the Program?
ORCHID uses a peer-based face-to-face outreach approach to educate women who engage in indoor sex work, helping them to feel comfortable engaging in intimate discussions about their sexual health in order to empower them to make competent, informed sexual health decisions. Outreach occurs in massage parlours where sex work takes place. On an annual basis, ORCHID maintains relationships with 25 to 34 massage parlours in and around Vancouver.
ORCHID’s services are offered in the first language spoken by the women, which is usually Mandarin or Cantonese. A research component of the project was established to better understand and document the educational needs, demographic characteristics and STI incidence of the target population. While this component is not required to implement ORCHID, it provides valuable information to the ORCHID team as well as HIV and STI testing services to the women in the massage parlours.
Why Was the Program Developed?
Though the majority of sex work in Canada takes place indoors, outreach and research addressing the needs of sex workers in Canada has largely been focused on those who work at street level. Indoor sex workers can also be vulnerable to violence and face multiple barriers to accessing services and education, particularly when the workers are newcomers to Canada or do not speak English as a first language. And, while exchanging sex for money is not illegal in Canada, many of the activities that surround it are, including being found in “brothels” and soliciting sex in a public place. Consequently, brothels or indoor commercial sex establishments are often disguised as massage parlours, which regularly close and reopen elsewhere, making it difficult for service providers to locate and keep track of them and their employees.
Specific challenges faced by female Asian indoor sex workers when it comes to protecting themselves from STIs include:
- Absence of condom-wearing policies
- Lack of access to nonjudgmental health resources, social services and police/legal support
- Reluctance of massage parlour managers (who are usually male) to discuss the sexual health issues of their female employees
- Difficulty negotiating safer sexual practices in English
- Heightened risk of violence, discrimination, social isolation, poverty and addiction
In recognition of the impact of these issues, in 2004 the Asian Society for the Intervention of AIDS (ASIA)—in collaboration with the British Columbia Centre for Disease Control, the University of British Columbia and Simon Fraser University—began to develop an outreach program for Asian women working in sex establishments disguised as massage parlours. The resulting project has been continuously revised to improve its capacity to meet the needs of women employed as sex workers in massage parlours in the Vancouver area. It is a unique example of successfully building relationships with indoor commercial sex work establishments over a long period of time.
How Does the Program Work?
The ORCHID project is delivered in two components: outreach and research. Both involve the delivery of services to indoor sex workers.
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.
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
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.
A History of Trust Building
The ORCHID project originally sought only to provide Asian women employed by massage parlours with sexual health information and support. During a series of police raids on massage parlours in Vancouver in 2006, women who were working in many of the parlours supported by ORCHID were taken to precincts throughout the province, completely unaware of the legal process and their rights.
When outreach teams went to visit the parlours on their routes following the raids, many establishments had either moved or refused to let teams in. Parlours assumed the ORCHID project was responsible for informing the police about their location and the services they were providing. Project coordinators had to once again determine the location of massage parlours where Asian women were offering sexual services to clients and approach them anew.
Meanwhile, ORCHID applied for a grant from the Law Foundation of British Columbia to obtain funding in conjunction with the Pivot Legal Society for the creation of literature on the legal rights of sex workers. The resulting series of pamphlets (published in both traditional and simplified Chinese) explains the relationship of sex work to child protection, the police, immigration rights, and municipal and federal law.
Not only has this addition to the project provided the target clientele with an important and much-needed resource, it has also armed outreach teams with a clear indicator for parlour managers that they are not affiliated with the police, making it easier for the outreach teams to gain entry.
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.
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 of 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.
- 1 project coordinator
- 2 outreach team members per route
The project coordinator must understand the cultural nuances of commercial sex work, massage parlours and the communities that sex workers and managers come from. ORCHID has been coordinated successfully by both men and women.
The outreach teams are comprised of two workers. Both must identify as women and be comfortable and nonjudgmental when speaking about sex. One worker must be a current or former sex worker (the peer) and one must speak the first language of the women on that team’s route. Each parlour tends to employ women who share the same first language, and, whenever possible, each outreach team’s route consists of parlours in which the same primary language is spoken.
Mandarin and Cantonese are the predominant first languages spoken at the massage parlours served by ORCHID; however, as new massage parlours employing women who speak other languages are discovered and approached, volunteers and peers speaking these languages are recruited.
ORCHID utilizes the services of researchers to learn more about the women and to offer HIV and STI testing. However, having researchers on the team is not required to implement the program. The service delivery team can administer a demographic questionnaire and offer HIV and STI testing and counselling, if they have the training to do so. However, for ORCHID, having two arms of the project has been helpful, as it has allowed each arm to focus on its area of expertise. The research arm is experienced in administering questionnaires and STI tests to “vulnerable” populations and is able to report on the research to further improve the service delivery.
- Latex gloves
- Sexual health and legal information pamphlets in the first language of target clientele
- Gifts for parlour managers (such as cookies or other culturally appropriate items)
- Gifts for female sex workers (such as Chinese-style purses in which safer-sex supplies can be stored)
- STI and HIV tests
- Honoraria for peer outreach workers. ORCHID pays peers $15/hour for outreach, meetings/training and to create outreach packages (labelling condoms and collating resources)
- Condoms, purses and snacks
- Translation and printing of informational pamphlets
Given the sensitive nature of the project, funding must be long-term and sustainable.
- Given the criminalized nature of indoor sex work, establishments that offer sex work often close and reopen, either in the same location or elsewhere. This can make it difficult to keep track of where sex work is taking place and maintain ongoing relationships with business managers and sex workers.
- Building trust with people involved in sex work, either as sex workers or managers, can be a challenge. Multiple contacts with venues can be required prior to being granted access or successfully engaging sex workers with education and resources.
- Indoor sex workers may move from one establishment to another, making it difficult for outreach workers to maintain ongoing contact with women and therefore building and maintaining trust.
- Volunteer retention can be difficult when volunteers are faced with repeated rejection from massage parlour managers.
In February and March 2008, an independent consultant evaluated the ORCHID project. The evaluation was based on a method called triangulation that involves compiling data from diverse sources and via multiple methods to ensure a valid and comprehensive understanding of the subject matter. Interview and survey questions were based on questions posed by the project coordinator and were developed in consultation with peers. Peers’ input and feedback for the survey design was a highly valuable contribution to the evaluation, as it facilitated the development of a community-relevant approach to questioning.
The evaluation involved conducting 14 interviews (with the project coordinator, the executive director, the research coordinator, three peers, four volunteers and four key community members). The consultant also conducted 10 surveys of recipients of ORCHID services and one survey of a manager of a massage parlour in which ORCHID provided services. The results of this analysis indicated that the project is highly valued at all levels of engagement. For more information about the evaluation and the evaluation report, please contact ORCHID.
According to both the survey and interviews, women engaged in sex work experienced an improvement in their:
- Use of condoms
- HIV and STI transmission and prevention knowledge
- Ability to effectively communicate with clients about safer sexual practices
- Awareness of support and medical services, such as HIV and other STI testing
- Sense of trust and community in an environment where being mistrustful, secretive and self-sufficient is often the norm
- Ease in communicating with the outreach team
Outreach worker perspectives
During interviews, peer outreach workers reported experiencing:
- A sense of giving back to their community
- Increased ability to communicate, work in groups and manage the care of their own social and health issues
- Attraction to the safe and supportive environment provided by the project—empowering some of the peer outreach workers to look toward moving on to another profession
During interviews, volunteer outreach workers reported:
- Learning new interpersonal, cross-cultural communication skills
- Gaining new experiences and knowledge, particularly from working with peer outreach workers.
- A decrease in assumptions and prejudices as knowledge of female sex workers is increased
In addition to the external evaluation, ORCHID assesses the needs of the women in the parlour by asking informal questions about their satisfaction with current ORCHID services and interest in future services. The team also takes note of questions asked by the women and parlour owners, which is recorded using the ORCHID Outreach Report. This information is used to inform future outreach activities and visits.
The ORCHID team asserts that, based on its experience, the program is effective, as evidenced by the following:
- The women in the parlours continue to speak to and build relationships with the outreach teams.
- Over time the women discuss private details of their lives with the outreach teams.
- Women call ORCHID for services based on referrals from other sex workers.
- Gaining entry to massage parlours where sexual services are being provided requires patience and persistence to firmly establish trust with managers and sex workers.
- Understanding the complex social, legal, economic and cultural issues involved in indoor sex work is critical in connecting with female Asian sex workers employed in massage parlours.
- Providing safer-sex information in the primary language of the target population increases the ability of sex workers in this group to understand and apply the information.
- Working with partner organizations to meet different needs of the target population can build trust with sex workers as well as their employers, in turn establishing the project’s reputation as trustworthy with a more extensive community of sex workers.
- In cases where peers have disclosed their own experience in the sex trade with sex workers, the outreach team develops trusting relationships more quickly with the women they serve.
For more information on the ORCHID project, please contact:
Asian Society for the Intervention of AIDS (ASIA)
Suite 225-119 West Pender St.
Vancouver, British Columbia
V6B 1S5 Canada