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

Omara Afzal,Molly Lieber,Ann Marie Beddoe

doi:10.5334/aogh.2706

Omara Afzal, Molly Lieber + Show 1 more

Open Access

https://doi.org/10.5334/aogh.2706

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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.

Highlights

The Limpopo province of South Africa is one of the poorest in the country
In South Africa, there is little information on the numbers, characteristics, behaviors, and health needs of female sex workers (FSW), though estimations for HIV in varying FSW communities range from 45% to 60%, and it is estimated that approximately 20% of new HIV infections involve sex work, signifying a need for health attention [5, 6]
The knowledge, attitudes, and practice (KAP) survey consisted of 32 questions assessing the following: basic demographics, reproductive health care/basic obstetrical care, family planning, sexually transmitted infections, and gender-based violence experiences

Summary

Introduction

The Limpopo province of South Africa is one of the poorest in the country. It has a population of over 5 million people, 80% percent of whom live below the poverty line [1]. Farm work and sex work have become important sources of economic survival, for women in this region Of these two groups, female sex workers (FSW) are vulnerable and are at high risk for sexually transmitted infections (STIs) and other medical and social comorbidities. 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 understand regional barriers and attitudes regarding reproductive health care needs. 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. We helped foster community ownership, setting the stage for future implementation of sustainable and cooperative health programming

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