Structural Barriers to Receiving Health Care Services for Female Sex Workers in Russia

Abstract

Female sex workers in Russia have been particularly vulnerable to recent social, political, and economic changes. In this article, we describe the facilitators and barriers for sex workers receiving health care services in St. Petersburg, Russia. We conducted observations at medical institutions and nongovernmental organizations and in-depth interviews with 29 female sex workers. We identified the following barriers: poverty, not having documents, lack of anonymity in testing, and the official registration system. We identified the following facilitators: intervention by family members, social connections within the health care system, and referral services from a nongovernmental organization. Our findings indicate a need for reassessing policies and designing programs that better facilitate the use of health care services for the most vulnerable populations. This should include the expansion of support systems and outreach services designed to help female sex workers navigate the health care system.

HIV Testing and Counseling Among Female Sex Workers: A Systematic Literature Review

“…About half of the articles reviewed assessed how FSWs’ social interactions influenced their decision to test for HIV [18–20, 24, 26, 29, 34, 38, 40, 41, 43, 45, 47–51]. Positive attitudes and support from peers, family and partners facilitated HIV testing [19, 20, 24, 26, 29, 34, 40, 41, 45, 48–51].…”

“…Positive attitudes and support from peers, family and partners facilitated HIV testing [19, 20, 24, 26, 29, 34, 40, 41, 45, 48–51]. In China, women were more likely to test if accompanied by peers [19, 20].…”

“…In China, women were more likely to test if accompanied by peers [19, 20]. In Russia, family support was an important condition for accessing healthcare, including HIV testing, as women could rely on their family financially and emotionally [24]. Participation in self-support groups in India [18] and Uganda [51] and receiving condoms from HIV prevention programs in China [38] facilitated testing.…”

“…A total of fourteen articles focused on stigma and discrimination of HIV+ people and/or sex workers [20, 24, 26, 29, 31, 34, 36, 41, 46–52]. Fears of being identified as HIV+ [24, 26, 31, 34, 36, 41, 47–51] or as a sex worker [20, 26, 31, 34, 41, 46–52] were reported as barriers to testing in a number of studies.…”

“…Fears of being identified as HIV+ [24, 26, 31, 34, 36, 41, 47–51] or as a sex worker [20, 26, 31, 34, 41, 46–52] were reported as barriers to testing in a number of studies. FSWs could refuse HIV testing [29, 36, 41, 48, 50, 52] or fail to collect test results [48] if afraid of receiving an HIV+ diagnosis.…”