Contraceptive service delivery in Kenya: A qualitative study to identify barriers and preferences among female sex workers and health care providers

Abstract Background Globally, female sex workers (FSWs) are considered a key population group due to the high HIV prevalence. Studies show that there are various factors in some contexts that render FSWs marginalised, which limits their access to sexual reproductive health (SRH) services. Access to SRH services are particularly challenging in countries where sex work is criminalised such as is the case in South Africa. Evidently, there are alternative ways in which FSWs in this context receive non-stigmatising SRH care through non-governmental organisations. The aim of this study was to understand the functioning of these non-governmental health care services as well as to document the experiences of FSWs utilising these services. Methods Eleven focus group discussions were held with 91 FSWs. In addition, 21 in-depth individual interviews with researchers, stakeholders and FSWs were conducted. Interview guides were utilised for data collection. Informed consent was obtained from all participants. Data were analysed thematically. Results The FSWs expressed challenges related to SRH care access at public health facilities. The majority felt that they could not consult for SRH-related services because of stigma. The non-governmental health and advocacy organisations providing SRH services to FSWs through their mobile facilities utilising the peer approach, have done so in a way that promotes trust between FSWs and mobile health care providers. FSWs have access to tailored services, prevention materials as well as health information. This has resulted in the normalising of HIV testing as well as SRH seeking behaviours. Conclusion This study has established that health and advocacy organisations have attempted to fill the gap in responding to SRH care needs of FSWs amidst intersecting vulnerabilities. FSWs’ engagement with these organisations has encouraged their willingness to test for HIV. However, it is important to note that these organisations operate in urban areas, thus FSWs operating outside these areas are most likely exposed to compounding health risks and lack access to tailored services.

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Knowledge About Sexually Transmitted Infections (STIs) and Attitudes Toward Female Sex Workers With STI Symptoms Among Health Care Providers in Laos

Asia Pacific Journal of Public Health ◽

10.1177/1010539511416223 ◽

2011 ◽

Vol 24 (6) ◽

pp. 940-952 ◽

Cited By ~ 6

Author(s):

Ketkesone Phrasisombath ◽

Sarah Thomsen ◽

Jan Hagberg ◽

Vanphanom Sychareun ◽

Elisabeth Faxelid

Keyword(s):

Health Care ◽

Sexually Transmitted Infections ◽

Health Care Providers ◽

Sex Workers ◽

Female Sex Workers ◽

Care Providers ◽

Sexually Transmitted ◽

Female Sex

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Medical Students’ Knowledge and Attitudes Toward Female Sex Workers and Their Occupational Risk Factors

International Journal of Medical Students ◽

10.5195/ijms.2014.97 ◽

2014 ◽

Vol 2 (3) ◽

pp. 104-108 ◽

Cited By ~ 1

Author(s):

Jenna T. Nakagawa ◽

Muge Akpinar-Elci.

Keyword(s):

Health Care ◽

Medical Education ◽

Medical Students ◽

Sex Workers ◽

Female Sex Workers ◽

Medical Training ◽

Physician Attitudes ◽

Care Providers ◽

Occupational Risk Factors ◽

Female Sex

Background: The tendency for female sex workers to seek health care is highly influenced by physician attitudes and behavior. By identifying medical students' attitudes toward female sex workers and assessing their knowledge of barriers to seeking care, we can focus medical training and advocacy efforts to increase access to care and improve public health outcomes. Methods: In this cross-sectional study, medical students from various countries were invited to participate in an online survey with close-ended questions and Likert scale statements. Responses were quantified and knowledge and attitude scores were assigned based on knowledge of barriers to seeking care and agreement with positive and negative attitude statements. Results: A total of 292 medical students from 56 countries completed the survey, of whom 98.3% agreed that it will be their job to provide treatment to patients regardless of occupation. Self-identified religious students conveyed more negative attitudes toward female sex workers compared to those who did not identify themselves as religious (p<0.001). Students intending to practice in countries where prostitution is legal conveyed more positive attitudes compared to those intending to practice in countries where prostitution is illegal (p<0.001). Conclusion: Medical students largely agreed on the importance of providing care to female sex workers as a vulnerable group. In addition to addressing knowledge gaps in medical education, more localized studies are needed to understand the religious and legal influences on attitudes toward female sex workers. Such information can help focus the efforts in both medical education and communication training to achieve the desired behavioral impacts, reconciling the future generations of health care providers with the needs of female sex workers.

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Oral PrEP: Is it only a pill to be swallowed: a qualitative study among female sex workers in India

10.21203/rs.3.rs-19029/v1 ◽

2020 ◽

Author(s):

Seema Sahay ◽

Archana Verma ◽

Suhas Shewale ◽

Sampada Dhayarkar ◽

Athokpam Bijeshkumar ◽

...

Keyword(s):

Alcohol Use ◽

Qualitative Study ◽

Sex Workers ◽

Female Sex Workers ◽

Theory Approach ◽

Care Providers ◽

Targeted Interventions ◽

Female Sex ◽

Willingness To Use ◽

Oral Prep

Abstract Background Empowering female sex workers (FSWs) through women controlled HIV prevention option has been in focus globally. The success of targeted interventions among FSWs indicates that this population could become an important and feasible target for oral PrEP (Pre Exposure Prophylaxis). A qualitative study was conducted to study FSWs’ willingness to use oral PrEP in India.Methods In-depth interviews (n=39) and two focus group discussions (n=14) were conducted at 3 high HIV prevalence urban and rural sites in India among FSWs. Key informant interviews (n=34) were conducted with a bisexual man, 6 brothel keepers and 27 Health Care Providers (HCPs). The study explored issues around willingness to use oral PrEP. The study was approved by the respective institutional ethics committee of the study sites. Thematic analysis using the grounded theory approach was used to analyze the data in N-VIVO version 8.0. Results FSWs were willing to use daily oral PrEP and hoped to use it as an alternative to the male condom. One of the emerging themes showed that the situations of condom-less sex over which FSWs had no control. This made them desire oral PrEP which was easy to use and geared to provide independence, financial gains, and privacy. HCP initiated oral PrEP was not acceptable. However, HCPs pointed out safety monitoring needs. For FSWs, safety concerns pertained to their own physical/ aesthetic attributes and reproductive system in a major way. Adherence emerged as a challenge because of: 1) FSWs’ prevalent habit and need of alcohol use; 2) their notion of daily dosing being too mundane; 3) Stigma because Oral PrEP is ARV based. Alcohol use and dread of repetitive dose bring forth the need for long-acting oral PrEP. Conclusion Oral PrEP is acceptable among FSWs; it should be rolled out alongside strong messages on STI protection given the perceptions of FSWs that oral PrEP might replace condoms. Education about ARV-based oral PrEP needs to be spelled to prevent stigma. Adherence counseling should take cognizance of FSWs’ lifestyle, specifically making oral PrEP less of a mundane task.

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Actions taken by female sex workers (FSWs) after condom failure in semi urban Blantyre, Malawi

10.21203/rs.3.rs-31147/v1 ◽

2020 ◽

Author(s):

Donatien Twizelimana ◽

Adamson S Muula

Keyword(s):

Sexual Intercourse ◽

Health Care Providers ◽

Sex Workers ◽

Access To Health Care ◽

Female Sex Workers ◽

Hormonal Contraceptives ◽

Post Exposure Prophylaxis ◽

Care Providers ◽

Female Sex ◽

Study Participants

Abstract Background Little is known about action taken by female sex workers (FSWs) after condom failure during sexual intercourse. The objective of this study was to investigate the actions taken by FSWs after condom failure among FSWs in semi – urban, Blantyre in Malawi. Methods A cross sectional, qualitative study was conducted among FSWs in Blantyre, Malawi between May and July 2019. Snowballing technique was used to recruit study participants in four purposively selected study sites. Focus group discussions and in-depth interviews were conducted by trained research assistants among 40 FSWs. Data were analyzed using thematic content analysis. Results Study participants reported different actions taken after condom failure. Many FSWs reported to have stopped sex immediately and changed the condom and then resumed sexual intercourse. Other than condom replacement no further actions were taken. Few FSWs reported to have stopped sexual intercourse and thereafter sought medical care which included post-exposure prophylaxis for HIV, sexually transmitted infections’ treatment, and emergency hormonal contraceptives. Urination, vaginal douche, and squatting after condom failure were reported as actions taken by some participants with the aim to avoid HIV transmission and pregnancy. Some FSWs interviewed reported to have not stopped sexual intercourse and no any other actions were taken after condom failure. Some FSWs reported to have douched, squatted or asked for higher pay from their clients after condom failure. Conclusion We reported some inadequate behaviors among FSWs after condom failure. Health programs should develop interventions for safe sex among FSWs to prevent STIs including HIV, and unplanned pregnancies. There is a need to address misconceptions related to health illiteracy among FSWs. There are interpersonal, structural and policy factors hindering FSWs’ access to health care providers.

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Unmet contraceptives needs among Female Sex Workers (FSWs) in semi urban Blantyre, Malawi

10.21203/rs.3.rs-34458/v3 ◽

2020 ◽

Author(s):

Donatien Twizelimana ◽

Adamson S Muula

Keyword(s):

Side Effects ◽

Health Care Providers ◽

Sex Workers ◽

Female Sex Workers ◽

Outcome Variable ◽

Categorical Variables ◽

Care Providers ◽

Steady Partner ◽

Female Sex ◽

History Of

Abstract Background: Research has paid limited attention to understanding factors that are associated with unmet contraceptive needs among female sex workers. In order to fill this knowledge gap, we estimated the prevalence of unmet contraceptive needs and examined associated factors among FSWs in semi urban Blantyre, Malawi. Methods: We used systematic sampling to recruit 290 female sex workers in semi urban Blantyre between February and March 2019. In this cross sectional study, we used questionnaire interviews to collect quantitative data. We calculated the mean and standard deviation for continuous variables and proportions for categorical variables to describe the data. Logistic regression analysis was used to investigate the association between unmet needs (the outcome variable) and explanatory variables such as: having a steady partner, fear of contraceptives’ side effects and having a history of sexually transmitted infections. Results: Out of the 290 study participants 102 (35.2%) reported unmet contraceptive needs. The following factors were significantly associated with unmet contraceptive needs in multivariate analysis: female sex workers’ history of physical and sexual violence by clients [OR 3.38, 95% CI (1.10, 10.43)], p<0.03, participants with a steady partner [OR 3.28, 95% CI (1.89, 5.68)], p<0.001, and participants who feared side effects of contraceptives [OR 2.99, 95% CI (1.73, 5.20)], p<0.001. Conclusion: Reproductive Health services should address barriers to contraceptives use for instance: violence by female sex workers’ clients, fear and misinformation on contraceptives. There is need to improve awareness of contraceptives. Specific health promotion interventions on female sex workers engaged in a steady partnership are recommended. It is important to enhance the knowledge, attitudes, and counseling skills of health care providers in order to address unmet contraceptive needs among female sex workers in semi-urban Blantyre.

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