Background: There is currently an outbreak of syphilis in Marion County, Indiana that is predominately confined to the community of men who have sex with men (MSM). There is concern that this outbreak will move into the female sex worker (FSW) community, which may act as a bridge to the heterosexual community. FSW have traditionally been a hard to reach community due to social and legal constraints.
Objectives: To develop a program that will build trust in the FSW community and allow us to offer public health services to that community in a way that best fits their needs. This provision of services will enhance our sentinel surveillance efforts for the entire county.
Methods: Using theoretical constructs derived from the PRECEDE-PROCEED model, we observed high traffic areas, identified key opinion leaders, held focus groups, interviewed women working the streets, and established a relationship with an incarceration diversion program for FSW.
Results: Predisposing factors identified include limited educational opportunities, poverty and drug use. Enabling factors identified include a health department presence at community events, provision of services in a field based setting and word of mouth referrals. Reinforcing factors include free testing cards for FSW to distribute within their social network and personal care packets consisting of toiletries, condoms, lube, and a snack.
Conclusions: We learned that it is important to become a trusted part of the community and not be associated with punitive action, which may be associated with activities in which the women may be involved.
Implications for Programs, Policy, and/or Research: Even in the absence of an active syphilis outbreak, local health departments should foster relationships with hard to reach populations in order to have such relationships established before an outbreak occurs. This will enable true sentinel surveillance and allow early identification of potential outbreaks.