Knowledge and representations of sex workers by GPs in Brussels: a qualitative study using semi-structured interviews.

Abstract

A majority of sex-workers (SWers) do not have a GP aware of their professional activity, which prevents appropriate support to this group. One of the reasons is fear of the doctors' judgment. The objective of this research is to identify how sex-work is perceived by primary care practitioners, and how they follow-up this public. This qualitative study using semi-structured interviews with 12 GPs practicing in Brussels was conducted from October 2021 to March 2023. Results show a lack of understanding of what SW is, of the legal context and of the people who practice it. Doctors know about related health issues, but not about their proportion or origin. The main factor identified as leading to SW is economic insecurity. Sample analysis shows theoretical positions close to a pro-sex stance (néo-réglementarisme). This study demonstrates that primary care doctors' knowledge of SW is limited, and that these limitations can lead to stigmatisation and suboptimal treatment. The following recommendations are to: draw up a list of doctors who can welcome SWers without being judgmental and make this list available to associations active in the field of SW; co-construct a training course, in partnership with SWers, aimed at GPs (it would include sections on the historical and legal context, the approach to harm reduction and substance abuse, PreP, PEP, and a communication guide); and teach courses on marginalised populations with specific health needs during the initial training of medical students.