Are HIV and reproductive health services adapted to the needs of female sex workers? Results of a policy and situational analysis in Tete, Mozambique

Abstract

BackgroundIn the context of an implementation research project aiming at improving use of HIV and sexual and reproductive health (SRH) services for female sex workers (FSWs), a broad situational analysis was conducted in Tete, Mozambique, assessing if services are adapted to the needs of FSWs.MethodsMethods comprised (1) a policy analysis including a review of national guidelines and interviews with policy makers, and (2) health facility assessments at 6 public and 1 private health facilities, and 1 clinic specifically targeting FSWs, consisting of an audit checklist, interviews with 18 HIV/SRH care providers and interviews of 99 HIV/SRH care users.ResultsThere exist national guidelines for most HIV/SRH care services, but none provides guidance for care adapted to the needs of high-risk women such as FSWs. The Ministry of Health recently initiated the process of establishing guidelines for attendance of key populations, including FSWs, at public health facilities. Policy makers have different views on the best approach for providing services to FSWs—integrated in the general health services or through parallel services for key populations—and there exists no national strategy. The most important provider of HIV/SRH services in the study area is the government. Most basic services are widely available, with the exception of certain family planning methods, cervical cancer screening, services for victims of sexual and gender-based violence, and termination of pregnancy (TOP). The public facilities face serious limitations in term of space, staff, equipment, regular supplies and adequate provider practices. A stand-alone clinic targeting key populations offers a limited range of services to the FSW population in part of the area. Private clinics offer only a few services, at commercial prices.ConclusionThere is a need to improve the availability of quality HIV/SRH services in general and to FSWs specifically, and to develop guidelines for care adapted to the needs of FSWs. Access for FSWs can be improved by either expanding the range of services and the coverage of the targeted clinic and/or by improving access to adapted care at the public health services and ensure a minimum standard of quality.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1551-y) contains supplementary material, which is available to authorized users.

Achieving the first 90 for key populations in sub‐Saharan Africa through venue‐based outreach: challenges and opportunities for HIV prevention based on PLACE study findings from Malawi and Angola

“…In SSA, national efforts to reach KP with HIV testing services (HTS) and other HIV prevention offerings have traditionally relied upon generalized, facility‐based approaches . Such approaches have not been tailored to the unique needs and preferences of KP nor sufficiently addressed the myriad barriers that make facility‐based services inaccessible for many KP .…”

Reproductive Healthcare Needs of Sex Workers in Rural South Africa: A Community Assessment

“…Sex workers are at a higher risk of experiencing GBV from clients, controllers, law-enforcement, family, and intimate partners, among others, and many of the participants in this study expressed concern and fear regarding GBV [7]. A comprehensive approach to prevent and respond to GBV can include awareness of current protective policies and law, training of law-enforcement, and creation of programs to promote economic security [8]. Financial deprivation is a significant social factor contributing to sex work and a motivation to remain in the profession.…”

“…Assessing reproductive health needs through the community allows for receptive and responsive programs to expressed needs rather than outside perceived issues. Further, training health care workers in stigma-reducing sensitization and support for FSW health may improve care in the community and identify other sources of vulnerability, including increased assessment of high-risk issues [4,8,11].…”

Impact of a “Diagonal” Intervention on Uptake of Sexual and Reproductive Health Services by Female Sex Workers in Mozambique: A Mixed-Methods Implementation Study

“…The baseline situational analysis demonstrated that the public sector was by far the main provider of SRH services in the area, with the private sector playing only a marginal role and the Night Clinic having limited coverage and scope of services ( 23 , 24 ). The public SRH services were, however, not adapted to the needs of FSWs, faced serious limitations in terms of staff, space, equipment and supplies, and access by FSWs was hampered by them being asked for bribes, being poorly treated by some care providers, stigmatization and breaches of confidentiality.…”