Abstract
BackgroundGlobally, female sex workers (FSWs) are considered a key population group due to the high HIV prevalence. Studies show that there are various factors in some contexts that render FSWs marginalised, which limits their access to sexual reproductive health (SRH) services. Access to SRH services are particularly challenging in countries where sex work is criminalised such as is the case in South Africa. Evidently, there are alternative ways in which FSWs in this context receive non-stigmatising SRH care through non-governmental organisations. The aim of this study was to understand the functioning of these non-governmental health care services as well as to document the experiences of FSWs utilising these services.MethodsEleven focus group discussions were held with 91 FSWs. In addition, 21 in-depth individual interviews with researchers, stakeholders and FSWs were conducted. Interview guides were utilised for data collection. Informed consent was obtained from all participants. Data were analysed thematically.ResultsThe FSWs expressed challenges related to SRH care access at public health facilities. The majority felt that they could not consult for SRH-related services because of stigma. The non-governmental health and advocacy organisations providing SRH services to FSWs through their mobile facilities utilising the peer approach, have done so in a way that promotes trust between FSWs and mobile health care providers. FSWs have access to tailored services, prevention materials as well as health information. This has resulted in the normalising of HIV testing as well as SRH seeking behaviours.ConclusionThis study has established that health and advocacy organisations have attempted to fill the gap in responding to SRH care needs of FSWs amidst intersecting vulnerabilities. FSWs’ engagement with these organisations has encouraged their willingness to test for HIV. However, it is important to note that these organisations operate in urban areas, thus FSWs operating outside these areas are most likely exposed to compounding health risks and lack access to tailored services.
Highlights
Female sex workers (FSWs) are considered a key population group due to the high HIV prevalence
Five broad themes were identified for aspects related to health care access, namely, barriers to health care, health and advocacy organisations, the role of health and advocacy organisations, benefits of health and advocacy organisations, and challenges experienced by health and advocacy organisations working with female sex workers (FSWs)
It is evident that the non-governmental health and advocacy organisations in this context have taken the initiative to provide health care access to FSWs through peer-led sexual reproductive health (SRH) care and psychosocial services
Summary
Female sex workers (FSWs) are considered a key population group due to the high HIV prevalence. Nearly 40% of FSWs in sub-Saharan Africa are living with HIV [2] This is due to the nature of their work which involves multiple partnerships, limited access to health care because of stigma and discrimination, as well as criminalisation [3,4,5,6]. A call has been made for concerted efforts to address the susceptibility of FSWs to new HIV infections if South Africa is to achieve the UNAIDS 90–90-90 targets. These targets stipulate that 90% of all people need to know their status, 90% of all people with HIV should be on antiretroviral therapy (ART) and 90% of those receiving ART to achieve viral suppression by 2020 [7]
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