Molloy E, Tiwana R, French B C, Christie C, Smailes H, Taylor J, Bradbury-Jones C
Department of Applied Health Sciences, School of Health Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom.
Department of Nursing and Midwifery, School of Health Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom.
Int J Nurs Stud Adv. 2025 Jul 30;9:100392. doi: 10.1016/j.ijnsa.2025.100392. eCollection 2025 Dec.
Sex workers are frequently regarded by health services as a homogenous group whose health needs are related exclusively to the services they provide. Little research has explored sex workers' health needs from their own perspectives.
To understand their healthcare needs from their experiences and perspectives.
We undertook a four phase multi-method study to assess the health needs of sex workers in Birmingham, UK. This article reports the findings from qualitative interviews with sex workers (phase three).
This study was conducted in the UK with sex workers living and/or working in Birmingham, UK.
20 sex workers (10 men, 6 women, 2 trans/non-binary, and 2 not disclosed), were interviewed who were over 18 (21-40yrs): offering paid for sexual services involving in-person interactions. Online only service providers were excluded. Participants were recruited via partner organisations, personal networks, and social media (X).
We undertook semi-structured interviews which explored healthcare needs and access for sex workers. Interviews were audio-recorded. Audio files were transcribed, and clean transcripts imported into NVivo to support data analysis. Transcripts were thematically analysed and mapped deductively against the adapted Andersen Model of Healthcare Service Utilisation.
Themes interpreted from interview analysis related to healthcare need, enabling factors, service provision and barriers to access. A further category "In an Ideal World" was interpreted inductively reflecting gaps in current healthcare service provision and access. Themes included: fear of judgement and stigma; social taboos; feeling unheard and dismissed by services (missed opportunities for engagement); judgmental service provision; and availability of tailored services and appropriately trained staff.
Many sex workers experiences were underpinned by frequent exposure to psychological and physical trauma and violence, either related to lifetime experiences, experiences as a sex worker, and through contact with healthcare or support services. The intersecting marginalised identities of many sex workers were also a feature of their trauma exposure and interactions with healthcare staff. Recommendations include creation of holistic services; training of non-judgemental staff with insight into the complexities of sex work and the intersections of the multiple marginalisations sex workers face; appropriate training for staff in statutory services, e.g., General Practitioner (GP) primary healthcare practices; trained points of contact who can advocate and educate within their services; availability of peer support; integrated service pathways incorporating 'fast track' referral systems between partner organisations.
卫生服务部门常常将性工作者视为一个同质化群体，认为其健康需求仅与他们所提供的服务相关。很少有研究从性工作者自身的角度去探索他们的健康需求。
从他们的经历和观点出发，了解他们的医疗保健需求。
我们开展了一项分四个阶段的多方法研究，以评估英国伯明翰市性工作者的健康需求。本文报告了对性工作者进行定性访谈（第三阶段）的结果。
本研究在英国进行，研究对象是在英国伯明翰市生活和/或工作的性工作者。
对20名性工作者（10名男性、6名女性、2名跨性别者/非二元性别者以及2名未披露性别者）进行了访谈，他们年龄均超过18岁（21 - 40岁），提供涉及面对面互动的有偿性服务。仅提供在线服务的人员被排除在外。参与者通过合作组织、个人网络和社交媒体（X）招募。
我们进行了半结构化访谈，探讨性工作者的医疗保健需求和获取途径。访谈进行了录音。音频文件被转录，干净的转录文本被导入NVivo以支持数据分析。转录文本进行了主题分析，并根据改编后的医疗服务利用安徒生模型进行了演绎映射。
从访谈分析中解读出的主题涉及医疗保健需求、促成因素、服务提供以及获取服务的障碍。另外归纳出一个“在理想世界”的类别，反映了当前医疗服务提供和获取方面的差距。主题包括：对评判和污名的恐惧；社会禁忌；感觉未被倾听且被服务部门忽视（错过参与机会）；评判性的服务提供；以及提供量身定制的服务和训练有素的工作人员。
许多性工作者的经历因频繁遭受心理和身体创伤及暴力而受到影响，这些创伤和暴力与一生的经历、作为性工作者的经历以及与医疗保健或支持服务的接触有关。许多性工作者相互交织的边缘化身份也是他们遭受创伤以及与医护人员互动的一个特征。建议包括创建整体服务；培训有洞察力、能理解性工作复杂性以及性工作者所面临多重边缘化交织情况的非评判性工作人员；对法定服务部门的工作人员，如全科医生（GP）初级医疗实践进行适当培训；训练有素的联络点人员，他们能够在各自的服务范围内进行倡导和教育；提供同伴支持；整合服务途径，纳入合作组织之间的“快速通道”转诊系统。
