The role of health and advocacy organisations in assisting female sex workers to gain access to health care in South Africa

Abstract

BackgroundGlobally, 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.MethodsEleven 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.ResultsThe 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.ConclusionThis 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.

Women Who Sell Sex in Eastern and Southern Africa: A Scoping Review of Non-Barrier Contraception, Pregnancy and Abortion

“…Makhakhe and colleagues [ 29 ] report a similar finding concerning targeted services in South Africa. Participants felt that they could not consult public SRH services because of stigma.…”

“…Fourteen of the studies were conducted in Kenya [ 10 – 23 ], eight in South Africa [ 13 , 14 , 24 – 29 ], eight in Uganda [ 30 – 37 ], six in Mozambique [ 13 , 14 , 38 – 40 ], five in Tanzania [ 41 – 45 ], three in Eswatini [ 46 – 48 ] and in Malawi [ 49 – 51 ], two in Ethiopia [ 52 , 53 ], in Zambia [ 54 , 55 ], and in Zimbabwe [ 56 , 57 ] and one each in Democratic Republic of Congo [ 58 ], Lesotho [ 59 ], Rwanda [ 60 ], and online (Australia, Brazil, El Salvador, France, Kenya, Malawi, Russia, South Korea, Spain, Tanzania, the United States of America, and Zimbabwe) [ 56 ]. Thus, knowledge production concerning WSS in relation to non-barrier contraception, pregnancy and abortion is dominated by studies conducted in Kenya.…”

“…A number of barriers to contraceptive services were identified in the studies. These include: long clinic wait times [ 22 ]; having to pay medical fees [ 22 , 28 ]; being asked for bribes [ 38 ]; inconvenient clinic operating hours [ 22 , 42 ]; perceived compulsory HIV testing at clinics [ 22 ]; discriminatory provider-client interactions [ 22 ]; inadequate care [ 38 , 58 ]; paucity of available services [ 58 ]; stigmatisation [ 29 , 38 , 42 ]; breaches in confidentiality [ 38 ]; lack of transport [ 28 ]; negative partner influences [ 22 , 28 ].…”

Determinants of intention to use pre-exposure prophylaxis and condom use among cisgender female sex workers in Madrid, Spain

“…This finding is in alignment with higher PrEP uptake by FSWs in South Africa at mobile clinics compared to fixed clinics (Pillay et al 2020). FSWs in this setting report that their preference for mobile clinics is based on appreciation for peer approach and tailored services that promote trust and reduce stigma, compared to fixed clinics (Makhakhe et al 2019).…”

HIV- and sex work-related stigmas and quality of life of female sex workers living with HIV in South Africa: a cross-sectional study

“…Additionally, sex work stigma stems from multiple levels and manifests in forms such as policy, laws, and the public [ 54 , 55 ], all of which can impact sex worker spaces. The lack of an association between enacted sex work stigma and environmental QoL may be attributed to local non-governmental organizations’ advocacy for FSW rights [ 56 ], as well as the study participants’ involvement with sex work venues. Social support from FSW peers may lessen the impact of enacted sex work stigma [ 47 ].…”