School of Applied Human Sciences, Department of Psychology, University of KwaZulu-Natal, Howard College Campus, Memorial Tower Building, 238 Mazisi Kunene Road Glenwood, Durban, 4041, South Africa.
Anova Health Institute, 12 Sherborne Road, Parktown, Johannesburg, 2193, South Africa.
BMC Health Serv Res. 2019 Oct 24;19(1):746. doi: 10.1186/s12913-019-4552-9.
BACKGROUND: Globally, 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. METHODS: Eleven 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. RESULTS: The 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. CONCLUSION: This 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.
背景：在全球范围内，性工作者（FSWs）由于 HIV 感染率高而被视为重点人群。研究表明，在某些情况下，FSWs 存在各种边缘化因素，这限制了他们获得性生殖健康（SRH）服务的机会。在性工作被定罪的国家，如南非，FSWs 获得 SRH 服务尤其具有挑战性。显然，在这种情况下，FSWs 可以通过非政府组织获得非污名化的 SRH 护理。本研究的目的是了解这些非政府医疗保健服务的运作情况，并记录 FSWs 利用这些服务的经验。
方法：与 91 名 FSW 进行了 11 次焦点小组讨论。此外，还对研究人员、利益相关者和 FSW 进行了 21 次深入的个人访谈。使用访谈指南收集数据。所有参与者均获得知情同意。数据进行了主题分析。
结果：FSWs 表达了在公共卫生设施获得 SRH 护理方面的挑战。大多数人认为，由于污名化，他们无法咨询与 SRH 相关的服务。提供 SRH 服务的非政府卫生和宣传组织通过利用同伴方法的移动设施为 FSW 提供服务，以促进 FSW 与移动医疗保健提供者之间的信任。FSWs 可以获得定制的服务、预防材料和健康信息。这导致 HIV 检测和寻求 SRH 的行为变得正常化。
结论：本研究表明，卫生和宣传组织试图在各种交叉脆弱性中填补 FSW 对 SRH 护理需求的空白。FSWs 与这些组织的互动鼓励了他们进行 HIV 检测的意愿。然而，值得注意的是，这些组织在城市地区运作，因此在这些地区以外运作的 FSW 很可能面临更严重的健康风险，并且无法获得定制的服务。
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