Access to and utilisation of healthcare services by sex workers at truck-stop clinics in South Africa: A case study

Fobosi, Siyabulela Christopher; Lalla-Edward, Samanta Tresha; Ncube, Sydney; Buthelezi, Firoza Haffejee Brendan MaughanBrown Thulasizwe; Matthew, P; Kadyakapita, A; Slabbert, Mariette; Hankins, Catherine; Venter, François; Gomez, Gabriela B.

doi:10.7196/samj.2017.v107i11.12379

Cited by 11 publications

(9 citation statements)

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“…31 Dedicated services have demonstrated their effectiveness in reaching FSW of all ages in the SSA setting. [32][33][34] Finally, continuing to address stigma at various levels (individual, community, facility) is critical for supporting reduction in HIV infections, regardless of the population group. 35 FSW expressed doubts over the accuracy of oral fluidbased HIVST, with some describing retesting regardless of the result.…”

Section: Discussionmentioning

confidence: 99%

Feasibility and acceptability of a peer-led HIV self-testing model among female sex workers in Malawi: a qualitative study

et al. 2021

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ObjectivesHIV testing is the gateway to HIV prevention and care services. Female sex workers (FSW) may benefit from HIV self-testing (HIVST), which offers greater control and confidentiality than other approaches. However, FSW also have unique vulnerabilities, making it critical to understand their perspective of HIVST to best contextualise HIVST to their needs. This study explored feasibility and acceptability of providing oral fluid-based peer-led HIVST to FSW to inform tailored HIVST delivery approaches.DesignQualitative study.SettingMalawi.ParticipantsThirty-nine FSW who had obtained a HIVST kit and eight peer distributors.ResultsPeer distributors’ accounts suggested that peer-led HIVST is feasible. Overall, FSW spoke positively about peer-led HIVST and younger FSW preferred it to facility-based HIV testing. FSW highlighted both greater control of their testing experience and that HIVST could allow them to avoid discriminatory attitudes frequently experienced in public facilities. Some also felt that HIVST kits could enable them to establish the HIV status of their sexual partners, better informing their decisions about condomless sex. Despite overall acceptance of HIVST, a few expressed doubts in the procedure. Some FSW already aware of their HIV-positive status reported using HIVST. A few accounts suggested peer pressure to self-test predominantly from peer distributors.ConclusionsThis study enabled us to explore feasibility and acceptability of peer-led HIVST among FSW, as well as potential shortcomings of the HIV testing modality. Peer distributors are a welcome additional model. However, they should avoid distribution in actual venues. Programmes should ensure a range of testing options are available and expand peer’s representation. Study findings will be used to tailor the HIVST distribution model to ensure its enhanced uptake among key populations in general and FSW, specifically.

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Section: Discussionmentioning

confidence: 99%

Feasibility and acceptability of a peer-led HIV self-testing model among female sex workers in Malawi: a qualitative study

et al. 2021

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“…Peer-implemented outreach is associated with improved uptake of HIV services [ 20 , 22 ], and this evidence informed the South African National Sex Worker HIV Plan to emphasise a peer-led approach [ 6 ]. Qualitiative research supports a preference for sex worker-friendly clinics in which interacting with sensitised staff is a motivator to attend services [ 16 , 17 , 23 , 24 ]. Access may also be facilitated by after-hours and mobile services at sex work hotspots [ 23 – 25 ].…”

Section: Introductionmentioning

confidence: 99%

The HIV Cascade of Care and Service Utilisation at Sex Work Programmes Among Female Sex Workers in South Africa

et al. 2022

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Female sex workers (FSWs) in South Africa experience a uniquely high prevalence of HIV. We describe the HIV cascade of care (CoC) in FSWs in South Africa, and explored service utilisation at sex work programmes. A cross-sectional, study enrolled FSWs across 12 sites in South Africa. Participants were recruited using chain-referral method. Inclusion criteria: ≥ 18 years, cis-gender female, sold/transacted in sex, HIV positive. 1862 HIV positive FSWs were enrolled. 92% were known positive, 87% were on antiretroviral treatment (ART). Of those on ART, 74% were virally suppressed. Younger FSWs were significantly less likely to be on ART or virally suppressed. Female sex workers using HIV services from specialised programs were 1.4 times more likely to be virally suppressed than non-program users. The pre-COVID-19 pandemic HIV CoC amongst FSWs in South Africa shows striking improvement from previous estimates, and approaches achievement of 90:90:90 goals.

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“…Alternatively, they may choose not to inform healthcare workers that they are sex workers, which Scorgie points out could lead to sub-optimal medical treatment. In a study by Fobosi and colleagues on truck-stop clinics in South Africa, sex workers articulated this reticence as being "shy" about seeking treatment at public hospitals [27]. Sex workers who register their "shyness" seem to distort the problem of healthcare avoidance as an individual failing or a personal lack of assertiveness, rather than placing the focus on broader systemic issues within health and society.…”

Section: How Do Sex Workers Experience Existing Healthcare Services?mentioning

confidence: 99%

“…This has been well documented, for example, in sex work-specific clinics where staff have received sensitisation training, such as in inner-city Johannesburg [33][34][35]. The Fobosi study on roadside wellness clinics recorded sex worker respondents' satisfaction with "friendly staff", how some clinics were open at night time and even included services that users didn't expect, like malaria screening [27]. The opening quote of this chapter includes a description of Penelope Zulu's painful experience with harsh healthcare staff when she went to a health facility for a general check-up.…”

Section: The Power Of Positive Experiencesmentioning

confidence: 99%

Stigma, Denial of Health Services, and Other Human Rights Violations Faced by Sex Workers in Africa: “My Eyes Were Full of Tears Throughout Walking Towards the Clinic that I Was Referred to”

Richter

Buthelezi²

2021

Sex Work, Health, and Human Rights

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An ethical and forward-looking health sector response to sex work aims to create a safe, effective, and non-judgemental space that attracts sex workers to its services. Yet, the clinical setting is often the site of human rights violations and many sex workers experience ill-treatment and abuse by healthcare providers. Research with male, female, and transgender sex workers in various African countries has documented a range of problems with healthcare provision in these settings, including: poor treatment, stigmatisation, and discrimination by healthcare workers; having to pay bribes to obtain services or treatment; being humiliated by healthcare workers; and, the breaching of confidentiality. These experiences are echoed by sex workers globally. Sex workers’ negative experiences with healthcare services result in illness and death and within the context of the AIDS epidemic act as a powerful barrier to effective HIV and STI prevention, care, and support. Conversely positive interactions with healthcare providers and health services empower sex workers, affirm sex worker dignity and agency, and support improved health outcomes and well-being. This chapter aims to explore the experiences of sex workers with healthcare systems in Africa as documented in the literature. Findings describe how negative healthcare workers’ attitudes and sexual moralism have compounded the stigma that sex workers face within communities and have led to poor health outcomes, particularly in relation to HIV and sexual and reproductive health. Key recommendations for policy and practice include implementation of comprehensive, rights-affirming health programmes designed in partnership with sex workers. These should be in tandem with structural interventions that shift away from outdated criminalized legal frameworks and implement violence prevention strategies, psycho-social support services, sex worker empowerment initiatives, and peer-led programmes.

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Access to and utilisation of healthcare services by sex workers at truck-stop clinics in South Africa: A case study

Cited by 11 publications

References 0 publications

Feasibility and acceptability of a peer-led HIV self-testing model among female sex workers in Malawi: a qualitative study

Feasibility and acceptability of a peer-led HIV self-testing model among female sex workers in Malawi: a qualitative study

The HIV Cascade of Care and Service Utilisation at Sex Work Programmes Among Female Sex Workers in South Africa

Stigma, Denial of Health Services, and Other Human Rights Violations Faced by Sex Workers in Africa: “My Eyes Were Full of Tears Throughout Walking Towards the Clinic that I Was Referred to”

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