Lafort Yves, Jocitala Osvaldo, Candrinho Balthazar, Greener Letitia, Beksinska Mags, Smit Jenni A, Chersich Matthew, Delva Wim
International Centre for Reproductive Health, Ghent University, Ghent, Belgium.
International Centre for Reproductive Health-Mozambique, Maputo, Mozambique.
BMC Health Serv Res. 2016 Jul 26;16:301. doi: 10.1186/s12913-016-1551-y.
In the context of an implementation research project aiming at improving use of HIV and sexual and reproductive health (SRH) services for female sex workers (FSWs), a broad situational analysis was conducted in Tete, Mozambique, assessing if services are adapted to the needs of FSWs.
Methods comprised (1) a policy analysis including a review of national guidelines and interviews with policy makers, and (2) health facility assessments at 6 public and 1 private health facilities, and 1 clinic specifically targeting FSWs, consisting of an audit checklist, interviews with 18 HIV/SRH care providers and interviews of 99 HIV/SRH care users.
There exist national guidelines for most HIV/SRH care services, but none provides guidance for care adapted to the needs of high-risk women such as FSWs. The Ministry of Health recently initiated the process of establishing guidelines for attendance of key populations, including FSWs, at public health facilities. Policy makers have different views on the best approach for providing services to FSWs-integrated in the general health services or through parallel services for key populations-and there exists no national strategy. The most important provider of HIV/SRH services in the study area is the government. Most basic services are widely available, with the exception of certain family planning methods, cervical cancer screening, services for victims of sexual and gender-based violence, and termination of pregnancy (TOP). The public facilities face serious limitations in term of space, staff, equipment, regular supplies and adequate provider practices. A stand-alone clinic targeting key populations offers a limited range of services to the FSW population in part of the area. Private clinics offer only a few services, at commercial prices.
There is a need to improve the availability of quality HIV/SRH services in general and to FSWs specifically, and to develop guidelines for care adapted to the needs of FSWs. Access for FSWs can be improved by either expanding the range of services and the coverage of the targeted clinic and/or by improving access to adapted care at the public health services and ensure a minimum standard of quality.
在一项旨在改善女性性工作者对艾滋病毒及性与生殖健康服务利用情况的实施研究项目背景下，在莫桑比克太特市开展了广泛的情况分析，评估服务是否符合女性性工作者的需求。
方法包括：（1）政策分析，包括审查国家指南并与政策制定者进行访谈；（2）对6家公立和1家私立卫生机构以及1家专门针对女性性工作者的诊所进行卫生设施评估，包括一份审核清单、与18名艾滋病毒/性与生殖健康护理提供者进行访谈以及对99名艾滋病毒/性与生殖健康护理使用者进行访谈。
大多数艾滋病毒/性与生殖健康护理服务都有国家指南，但没有一份指南针对适应女性性工作者等高风险女性需求的护理提供指导。卫生部最近启动了为包括女性性工作者在内的重点人群在公共卫生机构就诊制定指南的进程。政策制定者对于为女性性工作者提供服务的最佳方式存在不同看法——是纳入一般卫生服务还是通过针对重点人群的并行服务——并且不存在国家战略。研究区域内艾滋病毒/性与生殖健康服务的最重要提供者是政府。除了某些计划生育方法、宫颈癌筛查、性暴力和基于性别的暴力受害者服务以及终止妊娠服务外，大多数基本服务广泛可得。公立设施在空间、人员、设备、常规供应和适当的提供者做法方面面临严重限制。一家针对重点人群的独立诊所为该地区部分女性性工作者群体提供的服务范围有限。私立诊所仅以商业价格提供少数服务。
总体而言，需要提高优质艾滋病毒/性与生殖健康服务的可及性，特别是针对女性性工作者的服务，并制定适应女性性工作者需求的护理指南。可以通过扩大服务范围和目标诊所的覆盖范围，和/或通过改善在公共卫生服务中获得适应性护理的机会并确保最低质量标准，来提高女性性工作者的可及性。
