Barriers to HIV and sexual and reproductive health care for female sex workers in Tete, Mozambique: results from a cross-sectional survey and focus group discussions

doi:10.1186/s12889-016-3305-5

. 2016 Jul 20:16:608.

doi: 10.1186/s12889-016-3305-5.

Barriers to HIV and sexual and reproductive health care for female sex workers in Tete, Mozambique: results from a cross-sectional survey and focus group discussions

Yves Lafort¹, Faustino Lessitala², Balthazar Candrinho³, Letitia Greener⁴, Ross Greener⁴, Mags Beksinska⁴, Jenni A Smit^{4

5}, Matthew Chersich^{6

7}, Wim Delva^{6

8

9}

Affiliations

¹ International Centre for Reproductive Health, Ghent University, Gent, Belgium. yves.lafort@ugent.be.
² International Centre for Reproductive Health-Mozambique, Maputo, Mozambique.
³ Direcção Provincial de Saúde de Tete, Tete, Mozambique.
⁴ MatCH Research Unit (Maternal, Adolescent and Child Health Research Unit), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa.
⁵ Discipline of Pharmaceutical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
⁶ International Centre for Reproductive Health, Ghent University, Gent, Belgium.
⁷ Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
⁸ The South African DST/NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), University of Stellenbosch, Stellenbosch, South Africa.
⁹ Center for Statistics, Hasselt University, Diepenbeek, Belgium.

PMID: 27440108
PMCID: PMC4955167
DOI: 10.1186/s12889-016-3305-5

Barriers to HIV and sexual and reproductive health care for female sex workers in Tete, Mozambique: results from a cross-sectional survey and focus group discussions

Yves Lafort et al. BMC Public Health. 2016.

. 2016 Jul 20:16:608.

doi: 10.1186/s12889-016-3305-5.

Authors

Yves Lafort¹, Faustino Lessitala², Balthazar Candrinho³, Letitia Greener⁴, Ross Greener⁴, Mags Beksinska⁴, Jenni A Smit^{4

5}, Matthew Chersich^{6

7}, Wim Delva^{6

8

9}

Affiliations

¹ International Centre for Reproductive Health, Ghent University, Gent, Belgium. yves.lafort@ugent.be.
² International Centre for Reproductive Health-Mozambique, Maputo, Mozambique.
³ Direcção Provincial de Saúde de Tete, Tete, Mozambique.
⁴ MatCH Research Unit (Maternal, Adolescent and Child Health Research Unit), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa.
⁵ Discipline of Pharmaceutical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
⁶ International Centre for Reproductive Health, Ghent University, Gent, Belgium.
⁷ Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
⁸ The South African DST/NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), University of Stellenbosch, Stellenbosch, South Africa.
⁹ Center for Statistics, Hasselt University, Diepenbeek, Belgium.

PMID: 27440108
PMCID: PMC4955167
DOI: 10.1186/s12889-016-3305-5

Abstract

Background: In the context of an operational research project in Tete, Mozambique, use of, and barriers to, HIV and sexual and reproductive health (HIV/SRH) commodities and services for female sex workers (FSWs) were assessed as part of a baseline situational analysis.

Methods: In a cross-sectional survey 311 FSWs were recruited using respondent driven sampling and interviewed face-to-face, and three focus group discussions were held with respectively 6 full-time Mozambican, 7 occasional Mozambican and 9 full-time Zimbabwean FSWs, to investigate use of, and barriers to, HIV/SRH care.

Results: The cross-sectional survey showed that 71 % of FSWs used non-barrier contraception, 78 % sought care for their last sexually transmitted infection episode, 51 % of HIV-negative FSWs was tested for HIV in the last 6 months, 83 % of HIV-positive FSWs were in HIV care, 55 % sought help at a health facility for their last unwanted pregnancy and 48 % after sexual assault, and none was ever screened for cervical cancer. Local public health facilities were by far the most common place where care was sought, followed by an NGO-operated clinic targeting FSWs, and places outside the Tete area. In the focus group discussions, FSWs expressed dissatisfaction with the public health services, as a result of being asked for bribes, being badly attended by some care providers, stigmatisation and breaches of confidentiality. The service most lacking was said to be termination of unwanted pregnancies.

Conclusions: The use of most HIV and SRH services is insufficient in this FSW population. The public health sector is the main provider, but access is hampered by several barriers. The reach of a FSW-specific NGO clinic is limited. Access to, and use of, HIV and SRH services should be improved by reducing barriers at public health facilities, broadening the range of services and expanding the reach of the targeted NGO clinic.

Keywords: Care seeking; Female sex workers; HIV; Mixed methods; Mozambique; Sexual and reproductive health.

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References

1. Scorgie F, Chersich MF, Ntaganira I, Gerbase A, Lule F, Lo YR. Socio-Demographic Characteristics and Behavioral Risk Factors of Female Sex Workers in Sub-Saharan Africa: A Systematic Review. AIDS Behav. 2012;16(4):920–33. doi: 10.1007/s10461-011-9985-z. - DOI - PubMed
1. Baral S, Beyrer C, Muessig K, Poteat T, Wirtz AL, Decker MR, et al. Burden of HIV among female sex workers in low-income and middle-income countries: a systematic review and meta-analysis. Lancet Infect Dis. 2012;12(7):538–49. doi: 10.1016/S1473-3099(12)70066-X. - DOI - PubMed
1. Pruss-Ustun A, Wolf J, Driscoll T, Degenhardt L, Neira M, Calleja JMG. HIV Due to Female Sex Work: Regional and Global Estimates. Plos One. 2013;8(5):e63476. doi: 10.1371/journal.pone.0063476. - DOI - PMC - PubMed
1. Cwikel JG, Lazer T, Press F, Lazer S. Sexually transmissible infections among female sex workers: an international review with an emphasis on hard-to-access populations. Sex Health. 2008;5(1):9–16. doi: 10.1071/SH07024. - DOI - PubMed
1. Soohoo M, Blas M, Byraiah G, Carcamo C, Brown B. Cervical HPV infection in female sex workers: a global perspective. Open AIDS J. 2013;7:58–66. doi: 10.2174/1874613601307010058. - DOI - PMC - PubMed

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[1] Scorgie F, Chersich MF, Ntaganira I, Gerbase A, Lule F, Lo YR. Socio-Demographic Characteristics and Behavioral Risk Factors of Female Sex Workers in Sub-Saharan Africa: A Systematic Review. AIDS Behav. 2012;16(4):920–33. doi: 10.1007/s10461-011-9985-z. - DOI - PubMed

[2] Scorgie F, Chersich MF, Ntaganira I, Gerbase A, Lule F, Lo YR. Socio-Demographic Characteristics and Behavioral Risk Factors of Female Sex Workers in Sub-Saharan Africa: A Systematic Review. AIDS Behav. 2012;16(4):920–33. doi: 10.1007/s10461-011-9985-z. - DOI - PubMed

[3] Baral S, Beyrer C, Muessig K, Poteat T, Wirtz AL, Decker MR, et al. Burden of HIV among female sex workers in low-income and middle-income countries: a systematic review and meta-analysis. Lancet Infect Dis. 2012;12(7):538–49. doi: 10.1016/S1473-3099(12)70066-X. - DOI - PubMed

[4] Baral S, Beyrer C, Muessig K, Poteat T, Wirtz AL, Decker MR, et al. Burden of HIV among female sex workers in low-income and middle-income countries: a systematic review and meta-analysis. Lancet Infect Dis. 2012;12(7):538–49. doi: 10.1016/S1473-3099(12)70066-X. - DOI - PubMed

[5] Pruss-Ustun A, Wolf J, Driscoll T, Degenhardt L, Neira M, Calleja JMG. HIV Due to Female Sex Work: Regional and Global Estimates. Plos One. 2013;8(5):e63476. doi: 10.1371/journal.pone.0063476. - DOI - PMC - PubMed

[6] Pruss-Ustun A, Wolf J, Driscoll T, Degenhardt L, Neira M, Calleja JMG. HIV Due to Female Sex Work: Regional and Global Estimates. Plos One. 2013;8(5):e63476. doi: 10.1371/journal.pone.0063476. - DOI - PMC - PubMed

[7] Cwikel JG, Lazer T, Press F, Lazer S. Sexually transmissible infections among female sex workers: an international review with an emphasis on hard-to-access populations. Sex Health. 2008;5(1):9–16. doi: 10.1071/SH07024. - DOI - PubMed

[8] Cwikel JG, Lazer T, Press F, Lazer S. Sexually transmissible infections among female sex workers: an international review with an emphasis on hard-to-access populations. Sex Health. 2008;5(1):9–16. doi: 10.1071/SH07024. - DOI - PubMed

[9] Soohoo M, Blas M, Byraiah G, Carcamo C, Brown B. Cervical HPV infection in female sex workers: a global perspective. Open AIDS J. 2013;7:58–66. doi: 10.2174/1874613601307010058. - DOI - PMC - PubMed

[10] Soohoo M, Blas M, Byraiah G, Carcamo C, Brown B. Cervical HPV infection in female sex workers: a global perspective. Open AIDS J. 2013;7:58–66. doi: 10.2174/1874613601307010058. - DOI - PMC - PubMed

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Barriers to HIV and sexual and reproductive health care for female sex workers in Tete, Mozambique: results from a cross-sectional survey and focus group discussions

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Barriers to HIV and sexual and reproductive health care for female sex workers in Tete, Mozambique: results from a cross-sectional survey and focus group discussions

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