Abstract
BackgroundFemale sex workers (FSWs) are extremely vulnerable to adverse sexual and reproductive health (SRH) outcomes. To mitigate these risks, they require access to services covering not only HIV prevention but also contraception, cervical cancer screening and sexual violence. To develop context-specific intervention packages to improve uptake, we identified gaps in service utilization in four different cities.MethodsA cross-sectional survey was conducted, as part of the baseline assessment of an implementation research project. FWSs were recruited in Durban, South Africa (n = 400), Mombasa, Kenya (n = 400), Mysore, India (n = 458) and Tete, Mozambique (n = 308), using respondent-driven sampling (RDS) and starting with 8-16 ‘seeds’ identified by the peer educators. FSWs responded to a standardised interviewer-administered questionnaire about the use of contraceptive methods and services for cervical cancer screening, sexual violence and unwanted pregnancies. RDS-adjusted proportions and surrounding 95% confidence intervals were estimated by non-parametric bootstrapping, and compared across cities using post-hoc pairwise comparison tests with Dunn–Šidák correction.ResultsCurrent use of any modern contraception ranged from 86.2% in Tete to 98.4% in Mombasa (p = 0.001), while non-barrier contraception (hormonal, IUD or sterilisation) varied from 33.4% in Durban to 85.1% in Mysore (p < 0.001). Ever having used emergency contraception ranged from 2.4% in Mysore to 38.1% in Mombasa (p < 0.001), ever having been screened for cervical cancer from 0.0% in Tete to 29.0% in Durban (p < 0.001), and having gone to a health facility for a termination of an unwanted pregnancy from 15.0% in Durban to 93.7% in Mysore (p < 0.001). Having sought medical care after forced sex varied from 34.4% in Mombasa to 51.9% in Mysore (p = 0.860). Many of the differences between cities remained statistically significant after adjusting for variations in FSWs’ sociodemographic characteristics.ConclusionThe use of SRH commodities and services by FSWs is often low and is highly context-specific. Reasons for variation across cities need to be further explored. The differences are unlikely caused by differences in socio-demographic characteristics and more probably stem from differences in the availability and accessibility of SRH services. Intervention packages to improve use of contraceptives and SRH services should be tailored to the particular gaps in each city.
Highlights
Female sex workers (FSWs) are extremely vulnerable to adverse sexual and reproductive health (SRH) outcomes
Plain english summary Sex workers are a severely stigmatised population and extremely vulnerable to adverse health outcomes related to having frequent sexual intercourse, such as unwanted pregnancies, cervical cancer, or sexual violence
In four different cities in resource-limited countries, Durban in South Africa, Tete in Mozambique, Mombasa in Kenya, and Mysore in India, a representative sample of female sex workers and explored to what extent they are sufficiently using the services providing prevention and care for these risks
Summary
Female sex workers (FSWs) are extremely vulnerable to adverse sexual and reproductive health (SRH) outcomes. To mitigate these risks, they require access to services covering HIV prevention and contraception, cervical cancer screening and sexual violence. Female sex workers (FSWs) are amongst the most vulnerable for adverse sexual and reproductive health (SRH) outcomes, because of multiple sexual contacts with different partners [1]. Programmes with FSWs in sub-Saharan Africa and South Asia have generally focussed on HIV prevention and care and rarely address access to other SRH services, such as contraception, care for unwanted pregnancies, cervical cancer screening, and sexual and gender-based violence (SGBV) services [5, 6]. In the context of an implementation research project to improve SRH among FSWs, we assessed gaps in the use of SRH services, other than HIV prevention and care, in four settings in Africa and India, and evaluated to what extent use of SRH services was context-specific
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