Sexual and reproductive health services utilization by female sex workers is context-specific: results from a cross-sectional survey in India, Kenya, Mozambique and South Africa

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dc.contributor.author Lafort, Yves
dc.contributor.author Greener, Ross
dc.contributor.author Roy, Anuradha
dc.contributor.author Greener, Letitia
dc.contributor.author Ombidi, Wilkister
dc.contributor.author Lessitala, Faustino
dc.contributor.author Skordis-Worrall, Jolene
dc.contributor.author Beksinska, Mags
dc.contributor.author Gichangi, Peter
dc.contributor.author Reza-Paul, Sushena
dc.contributor.author Smit, Jenni A
dc.contributor.author Chersich, Matthew
dc.contributor.author Delva, Wim
dc.date.accessioned 2017-01-20T18:30:32Z
dc.date.available 2017-01-20T18:30:32Z
dc.date.issued 2017-01-19
dc.identifier.citation Reproductive Health. 2017 Jan 19;14(1):13
dc.identifier.uri http://dx.doi.org/10.1186/s12978-017-0277-6
dc.identifier.uri http://hdl.handle.net/1993/32062
dc.description.abstract Abstract Background Female sex workers (FSWs) are extremely vulnerable to adverse sexual and reproductive health (SRH) outcomes. To mitigate these risks, they require access to services covering not only HIV prevention but also contraception, cervical cancer screening and sexual violence. To develop context-specific intervention packages to improve uptake, we identified gaps in service utilization in four different cities. Methods A cross-sectional survey was conducted, as part of the baseline assessment of an implementation research project. FWSs were recruited in Durban, South Africa (n = 400), Mombasa, Kenya (n = 400), Mysore, India (n = 458) and Tete, Mozambique (n = 308), using respondent-driven sampling (RDS) and starting with 8-16 ‘seeds’ identified by the peer educators. FSWs responded to a standardised interviewer-administered questionnaire about the use of contraceptive methods and services for cervical cancer screening, sexual violence and unwanted pregnancies. RDS-adjusted proportions and surrounding 95% confidence intervals were estimated by non-parametric bootstrapping, and compared across cities using post-hoc pairwise comparison tests with Dunn–Šidák correction. Results Current use of any modern contraception ranged from 86.2% in Tete to 98.4% in Mombasa (p = 0.001), while non-barrier contraception (hormonal, IUD or sterilisation) varied from 33.4% in Durban to 85.1% in Mysore (p < 0.001). Ever having used emergency contraception ranged from 2.4% in Mysore to 38.1% in Mombasa (p < 0.001), ever having been screened for cervical cancer from 0.0% in Tete to 29.0% in Durban (p < 0.001), and having gone to a health facility for a termination of an unwanted pregnancy from 15.0% in Durban to 93.7% in Mysore (p < 0.001). Having sought medical care after forced sex varied from 34.4% in Mombasa to 51.9% in Mysore (p = 0.860). Many of the differences between cities remained statistically significant after adjusting for variations in FSWs’ sociodemographic characteristics. Conclusion The use of SRH commodities and services by FSWs is often low and is highly context-specific. Reasons for variation across cities need to be further explored. The differences are unlikely caused by differences in socio-demographic characteristics and more probably stem from differences in the availability and accessibility of SRH services. Intervention packages to improve use of contraceptives and SRH services should be tailored to the particular gaps in each city.
dc.title Sexual and reproductive health services utilization by female sex workers is context-specific: results from a cross-sectional survey in India, Kenya, Mozambique and South Africa
dc.type Journal Article
dc.language.rfc3066 en
dc.rights.holder The Author(s).
dc.date.updated 2017-01-19T17:02:28Z

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