Wahed Tasnuva, Alam Anadil, Sultana Salima, Rahman Monjur, Alam Nazmul, Martens Monika, Somrongthong Ratana
College of Public Health Sciences, Chulalongkorn University, Bangkok, Thailand.
Research to Policy Limited, Mirpur, Dhaka, Bangladesh.
PLoS One. 2017 Jul 31;12(7):e0182249. doi: 10.1371/journal.pone.0182249. eCollection 2017.
This study aimed to identify the barriers female sex workers (FSWs) in Bangladesh face with regard to accessing sexual and reproductive health (SRH) care, and assess the satisfaction with the healthcare received.
Data were collected from coverage areas of four community-based drop-in-centers (DICs) in Dhaka where sexually transmitted infection (STI) and human immunovirus (HIV) prevention interventions have been implemented for FSWs. A total of 731 FSWs aged 15-49 years were surveyed. In addition, in-depth interviews (IDIs) were conducted with 14 FSWs and 9 service providers. Respondent satisfaction was measured based on recorded scores on dignity, privacy, autonomy, confidentiality, prompt attention, access to social support networks during care, basic amenities, and choice of institution/care provider.
Of 731 FSWs, 353 (51%) reported facing barriers when seeking sexual and reproductive healthcare. Financial problems (72%), shame about receiving care (52.3%), unwillingness of service providers to provide care (39.9%), unfriendly behavior of the provider (24.4%), and distance to care (16.9%) were mentioned as barriers. Only one-third of the respondents reported an overall satisfaction score of more than fifty percent (a score of between 9 and16) with formal healthcare. Inadequacy or lack of SRH services and referral problems (e.g., financial charge at referral centers, unsustainable referral provision, or unknown location of referral) were reported by the qualitative FSWs as the major barriers to accessing and utilizing SRH care.
These findings are useful for program implementers and policy makers to take the necessary steps to reduce or remove the barriers in the health system that are preventing FSWs from accessing SRH care, and ultimately meet the unmet healthcare needs of FSWs.
本研究旨在确定孟加拉国女性性工作者在获得性与生殖健康护理方面面临的障碍，并评估她们对所接受医疗服务的满意度。
数据收集自达卡四个社区外展中心的覆盖区域，这些中心已针对女性性工作者实施了性传播感染（STI）和人类免疫病毒（HIV）预防干预措施。共对731名年龄在15至49岁的女性性工作者进行了调查。此外，还对14名女性性工作者和9名服务提供者进行了深入访谈。根据在尊严、隐私、自主权、保密性、及时关注、护理期间获得社会支持网络的机会、基本便利设施以及机构/护理提供者选择等方面的记录分数来衡量受访者的满意度。
在731名女性性工作者中，353名（51%）报告在寻求性与生殖健康护理时面临障碍。提及的障碍包括经济问题（72%）、接受护理时的羞耻感（52.3%）、服务提供者不愿提供护理（39.9%）、提供者的不友好行为（24.4%）以及就医距离（16.9%）。只有三分之一的受访者报告对正规医疗服务的总体满意度得分超过50%（得分在9至16分之间）。定性研究中的女性性工作者报告称，性与生殖健康服务不足或缺乏以及转诊问题（例如，转诊中心的费用、不可持续的转诊服务或未知的转诊地点）是获得和利用性与生殖健康护理的主要障碍。
这些研究结果有助于项目实施者和政策制定者采取必要措施，减少或消除卫生系统中阻碍女性性工作者获得性与生殖健康护理的障碍，最终满足女性性工作者未得到满足的医疗需求。
