“I Felt Very Small and Embarrassed by the Health Care Provider When I Requested to be Tested for Syphilis”: Barriers and Facilitators of Regular Syphilis and HIV Testing Among Female Sex Workers in Uganda

Abstract

Background: Periodic testing of female sex workers (FSW) for sexually transmitted infections (STIs) is a core component of global and national responses to achieve population-level STI elimination. We conducted a qualitative study to explore barriers and facilitators of regular syphilis and HIV testing among FSW in Uganda. Methods: Within a quasi-experimental study among 436 FSW to assess the effect of peer education and text message reminders on uptake of regular STI and HIV testing among FSW, we conducted 48 qualitative interviews in four cities in Uganda from August-December 2018. We purposively selected FSW who tested for syphilis and HIV every 3-6 months; 12 FSW were interviewed in each city. Sex worker interviews explored: 1) reasons for periodic syphilis and HIV testing; 2) barriers and facilitators of testing; 3) experiences of testing; and 4) challenges faced while seeking testing services. Data were analyzed using thematic content analysis. Results: Thematic analysis revealed individual- and health system-level barriers and facilitators of testing. For syphilis, barriers were: a) interpersonal stigma, low perceived severity of syphilis and testing misconceptions (individual); and b) judgmental provider attitudes, paucity of facilities offering syphilis testing, stock outs of test kits and high cost (health system). Facilitators were: c) desire to remain healthy, get married and have children, knowing the benefits of early treatment, influence of male partners/clients and normative testing behaviors (individual); and d) sex worker clinics offering dual syphilis/HIV testing (health system). For HIV, barriers included: a) internalized stigma (individual); and b) unfavorable clinic hours, stigma, discrimination, and unfriendly provider (health system). Facilitators were: a) motivations to stay healthy and attract clients, habitual testing, self-efficacy, doubts about accuracy of negative test results, and use of post-exposure prophylaxis (individual);: and d) availability of testing facilities (health system). Syphilis and HIV had some similar Ttesting barriers and facilitators. overlapped substantially for both infections.Conclusions: HIV programs are likely to be important entry points for syphilis testing among FSW. Multi-level interventions to address testing barriers should consider focusing on these service delivery points. Extending the dual syphilis and HIV testing approach to FSW may improve the testing uptake for both infections at public health facilities and decrease population-level incidence.

Determinant Factors of Antenatal Clinic on Female Sex Workers Attendance within Nairobi County, Kenya

“…Unfavourable clinic operating times are some challenges FSWs encounter while seeking ANC services. In a study done in Uganda, participants shared that during the day, when the antenatal clinics are open, they rest after working the whole night (Muhindo et al, 2021). The operating hours, cost, poor infrastructure, lack of confidentiality/privacy, and distance to health facilities where most SRH is available often affect FSWs' access to ANC services (Wahed et al, 2017).…”