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

Abstract

Background: In the Limpopo province of South Africa, access and availability of women's health services are limited and many challenges exist for a growing population of transient sex workers. This study was developed to place communities at the forefront to more specifically understand regional barriers and attitudes regarding reproductive health care needs. Objective: To build strong community partnerships, gain understanding of issues in women's health services, and collaborate with community members to address those issues. Methods: A mixed-methods study approach was used in rural South Africa. Participants were recruited through voluntary interest from a local health clinic performing outreach for migrant female sex workers. We (1) created partnerships and built trust within the community and (2) worked collaboratively to collect both qualitative and quantitative data, using community groups to discuss health needs as well as "knowledge, attitude, and practice" (KAP) surveys. Findings: Ninety-four sex workers participated. The survey data identified risk factors to poor reproductive healthcare outcomes, including limited education, young age at first sexual contact, large number of sexual partners, little knowledge of sexually transmitted infections, distrust in the use of healthcare facilities, and limited use of contraception. Community discussion groups revealed a desire for easier and more accessible healthcare, showing the biggest barriers to care are lack of money and transportation, and safety concerns related to profession, including fear of violence from partner and/or client. With input from civic leaders, public interest, and community outreach groups, a community advisory board was successfully formed for future collaboration. Conclusion: By working with local stakeholders and sex workers, we created an interactive and tailored assessment to discuss healthcare disparities. We helped foster community ownership, setting the stage for future implementation of sustainable and cooperative health programming.

Women Who Sell Sex in Eastern and Southern Africa: A Scoping Review of Non-Barrier Contraception, Pregnancy and Abortion

“…A number of barriers to contraceptive services were identified in the studies. These include: long clinic wait times [ 22 ]; having to pay medical fees [ 22 , 28 ]; being asked for bribes [ 38 ]; inconvenient clinic operating hours [ 22 , 42 ]; perceived compulsory HIV testing at clinics [ 22 ]; discriminatory provider-client interactions [ 22 ]; inadequate care [ 38 , 58 ]; paucity of available services [ 58 ]; stigmatisation [ 29 , 38 , 42 ]; breaches in confidentiality [ 38 ]; lack of transport [ 28 ]; negative partner influences [ 22 , 28 ].…”

The sexual and reproductive healthcare challenges when dealing with female migrants and refugees in low and middle-income countries (a qualitative evidence synthesis)

“…Communication and linguistic barriers make it problematic for migrants to steer the healthcare system and restrict healthcare personnel from providing proper services to migrants, which reduces the effectiveness of initiatives of health promotion aimed at them [ 15 , 63 ]. For example, migrants’ inability to effectively explain illness signs and symptoms may reduce the likelihood of syndromic infection detection, resulting in insufficient HIV and STI treatment [ 64 , 65 ]. Numerous studies have shown that in order to improve the experience and usage of services for migrants and refugees, health practitioners must be culturally competent and including language proficiency [ 17 , 66 , 67 ].…”

Violence Against Women Who Sell Sex in Eastern and Southern Africa: A Scoping Review

“…While samples were diverse across the papers reviewed, including urban based WSS, mobile WSS, and younger WSS, WSS living in rural areas were not included. Some studies in the region address rural-based WSS (e.g., Afzal et al, 2020), but these do not address violence. This limits diversity across the review, and hence the generalizability of the findings in relation to WSS in rural areas.…”