Where Do Female Sex Workers Seek HIV and Reproductive Health Care and What Motivates These Choices? A Survey in 4 Cities in India, Kenya, Mozambique and South Africa

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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Sexual IPV and non-partner rape of female sex workers: findings of a cross-sectional community-centric national study in South Africa

SSM - Mental Health ◽

10.1016/j.ssmmh.2021.100012 ◽

2021 ◽

pp. 100012

Author(s):

Rachel Jewkes ◽

Kennedy Otwombe ◽

Kristin Dunkle ◽

Minja Milovanovic ◽

Khuthadzo Hlongwane ◽

...

Keyword(s):

South Africa ◽

Sex Workers ◽

Female Sex Workers ◽

National Study ◽

Cross Sectional ◽

Female Sex

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Occupational barriers to accessing and adhering to antiretroviral therapy for female sex workers living with HIV in South Africa

Occupational and Environmental Medicine ◽

10.1136/oemed-2019-105947 ◽

2020 ◽

Vol 77 (2) ◽

pp. 100-106 ◽

Cited By ~ 2

Author(s):

Lauren E Parmley ◽

Carly A Comins ◽

Katherine Young ◽

Mfezi Mcingana ◽

Deliwe Rene Phetlhu ◽

...

Keyword(s):

South Africa ◽

Antiretroviral Therapy ◽

Coping Strategies ◽

Sex Workers ◽

Female Sex Workers ◽

Hiv Disclosure ◽

Female Sex ◽

Adherence Support ◽

Wage Loss ◽

Living With Hiv

ObjectivesWhile female sex workers (FSW) are nearly 14 times more likely to be living with HIV than non-FSW, less than 40% of FSW living with HIV are on antiretroviral therapy (ART). We sought to understand how the work environment influences ART access and adherence for FSW in preparation for the Siyaphambili trial.MethodsFSW living with HIV (n=24) and key informants (n=15) were recruited to participate in semistructured in-depth interviews using maximum variation and snowball sampling, respectively. FSW were recruited on key variants including type of sex work venue, primary work time and history of ART use. Data were collected between September and November 2017 in Durban, South Africa. Interviews were audio-recorded, transcribed and translated. Data were then coded applying grounded theory in Atlas.ti.ResultsFSW experienced occupational barriers to adherence including work-related migration, substance use and theft of ART on the job. Fear of wage loss due to HIV disclosure to clients and brothel managers prevented some FSW from accessing ART at their clinic and taking medications while working. FSW employed coping strategies to overcome barriers including sharing ART with colleagues, carrying small supplies of ART and visiting the clinic prior to appointments for ART refills. Further, some FSW received adherence support from colleagues who were also living with HIV.ConclusionsConsidering these occupational pressures on FSW and supporting positive coping strategies are important when designing and implementing HIV treatment programmes. Findings suggest strengthening social cohesion and supporting differentiated care efforts to improve HIV outcomes among FSW living with HIV.

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Living with HIV: Challenges in Reproductive Health Care in South Africa

African Journal of Reproductive Health ◽

10.2307/3583312 ◽

2004 ◽

Vol 8 (1) ◽

pp. 92 ◽

Cited By ~ 16

Author(s):

Maria de Bruyn

Keyword(s):

South Africa ◽

Health Care ◽

Reproductive Health ◽

Reproductive Health Care ◽

Living With Hiv

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Strategi Peer Educator untuk Peningkatan Kesadaran Pekerja Seks Perempuan terhadap Kesehatan Reproduksi

Jurnal Sosiologi Andalas ◽

10.25077/jsa.6.1.1-11.2020 ◽

2020 ◽

Vol 6 (1) ◽

pp. 1-11

Author(s):

Lidya Febrina

Keyword(s):

Reproductive Health ◽

Social Exchange ◽

Sex Workers ◽

Female Sex Workers ◽

Social Exchange Theory ◽

Research Approach ◽

Peer Educators ◽

Descriptive Research ◽

Female Sex ◽

Peer Educator

This article presents the results of research on peer educator strategies to raise female sex workers' awareness of reproductive health. The objectives of this study were 1) to describe the strategies used by peer educators to build sex worker awareness of workers' reproductive health; 2) Identifying barriers to peer educators in providing education on reproductive health to female sex workers. To achieve the research objectives, the theory used is the Social Exchange Theory of George C, Homans and the research approach used is qualitative with descriptive research type. To obtain data, researchers used in-depth interviews and observation techniques. The results showe that the strategies used by peer educators in providing education about reproductive health were: coercion, giving advice, and persuasion. Meanwhile, the obstacles found by peer educators in providing education on reproductive health were: the imbalance of exchanges between peer educators and female sex workers and the distrust of female sex workers in peer educators.

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