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”

Abstract

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 These should be in tandem with structural interventions that shift away from outdated criminalized legal frameworks and implement violence prevention strategies, psycho-social support services, sex worker empowerment initiatives, and peer-led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.

Cervical cancer screening programs for female sex workers: a scoping review

“…This alternative directly responds to FSWs expressed needs for friendly, non-stigmatizing, non-judgmental services and FSWstargeted interventions (85). Moreover, these results are consistent with previous findings where positive experiences within healthcare services and sex-work-specific services improve FSWs engagement with healthcare and health outcomes (86). Nonetheless, it entails working on destigmatizing and decriminalizing sex work.…”

Maternal health and maternal health service utilization among female sex workers: A scoping review

“…In addition, many of the barriers identified in this review that contribute to phase I delays—such as external stigma, internalized stigma, negative perceptions of the health care system, and fear of disclosure—are likely bolstered by the criminalization of sex work. 68 Thus, efforts to decriminalize sex work and prevent police harassment may be essential to better supporting pregnant and postpartum FSWs’ access to MHS.…”

“…But, concerningly, the majority of existing facilities/programs for FSWs rely on support from international donors with limited direct government funding, and many programs are implemented as a part of research activities. 64 , 68 As a result, the long-term sustainability of programs is often uncertain—something which threatens the health of FSWs who rely on such programs and can undermine trust in health services. 64 Thus, if additional facilities/programs are established to support the general and maternal health of FSWs, it is of critical importance that stable funding mechanisms and implementation strategies are identified to ensure these programs have longevity and scalability.…”