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

Abstract

BackgroundIn 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.MethodsIn 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.ResultsThe 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.ConclusionsThe 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.

Meeting need vs. sharing the market: a systematic review of methods to measure the use of private sector family planning and childbirth services in sub-Saharan Africa

“…Forty-seven of the 53 studies used household survey data to estimate use of private sector family planning and/or childbirth services; the majority of these studies used the Demographic and Health Surveys ( n = 27), while others used data from demographic surveillance sites [ 34 , 35 ], national maternal health surveys [ 36 ], or other smaller, sub-national surveys [ 23 , 24 , 37 – 50 ]. Three studies conducted surveys that sampled women at a health facility [ 51 ], market [ 52 ], or through respondent-driven sampling [ 53 ]. The remaining three studies used routine health service statistics to estimate the proportion of facility births that occurred within the private sector [ 54 – 56 ].…”

Unmet Need for Family Planning and Experience of Unintended Pregnancy Among Female Sex Workers in Urban Cameroon: Results From a National Cross-Sectional Study

“…71 This may be particularly relevant given there are already well-characterized barriers affecting FSWs' access to family planning through public clinics. 72,73 Further qualitative research to assess personal considerations, barriers, and facilitators of voluntary contraceptive use among FSWs in Cameroon, including emergency contraception, could better inform local family planning delivery strategies and integration of services adapted to the needs and preferences of FSWs. Elsewhere, it has been demonstrated that FSWled mobilization for HIV services through community drop-in centers has been associated with reductions in HIV incidence among FSWs in Tanzania.…”

Sexual and reproductive health services utilization by female sex workers is context-specific: results from a cross-sectional survey in India, Kenya, Mozambique and South Africa

“…The findings on the use of HIV prevention and care services and of where FSWs seek care have been published elsewhere [22, 23]. The findings on the policy analysis and the other - qualitative - components of the situational analysis are also available [24–26]. …”