Silent killer of the night: a feasibility study of an outreach well-women clinic for cervical cancer screening in female sex workers in Hong Kong

Abstract

The purpose of this study was to see if an outreach model could be a feasible option for early detections of preinvasive cervical cancer in women with double identities of female sex workers (FSW) and illegal migrant workers in Hong Kong who most needed cervical screening but were often deprived of such a service. High turnover rates, acceptability, and compliance for follow-ups could potentially render such a clinical model unsuccessful. A total of 245 FSW were screened at the outreach clinic from January 2004 to December 2005, which was set up in a nongovernmental organization in a red light district. A questionnaire regarding their lifestyles and demographic details was used before a gynecological history, Papanicolaou (PAP) smear, and other health checkup were conducted. Chi-square test and multinomial logistic regression were used to analyze the results. Of 235 women tests, 9.8% of them had CIN I-III, and places of origin were found to be important risk factors for abnormal PAP smears. The nonlocal workers were significantly more likely to have abnormal PAP smears (chi(2)= 10.55, P= 0.04). Among the women, 88.1% of them who had the tests returned for follow-up with poorer compliance among those with an abnormal result. We conclude that an outreach well-women clinic seems to be an acceptable option for these women and an effective way for the early detection of cervical cancer.

Systematic review examining differences in HIV, sexually transmitted infections and health-related harms between migrant and non-migrant female sex workers

“…The remaining 13 studies focussed on international or intracontinental migration moving from low-income or middle-income to high-income countries. Destination countries included Australia,23 37 Spain,29 30 Portugal,31 Italy,34 35 the Netherlands,36 UK,33 Hong Kong42 43 and Turkey 28…”

“…Prevalence of an acute STI was consistently higher among migrants compared to non-migrants. The most frequently measured risk behaviour was condom use 23 25 33 37 42 43 46 47. Other outcomes relating to sexual behaviours included: practising of anal sex with clients47 and accepting of extra money for unprotected sex 47.…”

“…Other outcomes relating to sexual behaviours included: practising of anal sex with clients47 and accepting of extra money for unprotected sex 47. Three studies measured broader sexual and reproductive health-related outcomes, including vaginal douching with an over-the-counter medication,42 43 undergoing a cervical smear test,42 43 termination and use of contraceptives 33. Four studies examined use of alcohol or illegal drugs33 42 46 47 but just one examined experience of violence 33.…”

Prevalence of abnormal Papanicolaou smears in female sex workers in Hong Kong

“…According to our current study, the prevalence of abnormal Pap smears in the general population was very similar to that reported in 1999 in our previous study. 5 In another study we conducted, 4 based on a smaller sample of 235 subjects, the prevalence of cervical intraepithelial neoplasia of all grades (I-III) combined in female sex workers was 9.8%. While in the current study, the prevalence in this group was 5.67% (LSIL + HSIL).…”

“…Based on a much smaller data set, our previous study showed that the point prevalence of Pap smear-diagnosed cervical intraepithelial neoplasia of all grades (I-III) in female sex workers in Hong Kong was 9.8%. 4 We had also reported a corresponding prevalence in our general population (estimated over a 6-month period…”