title: Care seeking behaviour and barriers to accessing services for sexually transmitted infections among female sex workers in Laos: a cross-sectional study.
abstract: BACKGROUND
  Prompt, correct diagnosis and treatment with health information are essential components of reproductive tract infection (RTI) and sexually transmitted infection (STI) services. This study aims to describe care seeking behaviour and barriers to accessing RTI/STI services among female sex workers (FSWs) in Laos.
  
  
  METHODS
  A cross-sectional survey using closed and open-ended questions was performed in six districts along Road 9, traversing Savannakhet province from Thailand to Vietnam. In total, 407 FSWs were interviewed. The data were analyzed and presented descriptively. Multiple logistic regression analysis was applied to assess associations between respondents' background characteristics and care seeking behaviour.
  
  
  RESULTS
  About half of the respondents (49%) were less than or equal to 19 years of age, and 50% had started or completed secondary school. Fifty-eight percent had been engaged in sex work for less than 1 year. Eighty-six percent of the respondents reported RTI/STI signs or symptoms currently or in the last 3 months but only two-thirds of those with symptoms sought treatment. Source of treatment for the last RTI/STI episode was the drop-in centre (53%) followed by a public hospital (23%), private clinic (12%), private pharmacy (9%), and herbalist (2%). The main barriers to service use were long waiting time, inconvenient location of the clinic, not knowing where to get the services needed, and negative attitudes among healthcare providers. Care seeking behaviour was associated with longer duration of sex work (OR = 2.6, 95%CI 1.52-5.36). Forty-four percent received health information from peer educators, 34% from fellow friends, 26% from a pimp, and 26% had received information from a healthcare provider during the visit.
  
  
  CONCLUSIONS
  There were several barriers to accessing RTI/STI services and they were related to both structural and individual factors. Innovative STI service strategies to inform FSWs about the importance of early diagnosis and treatment should be established. Continuous training for STI service providers focusing on counseling skills and awareness of the sexual health care needs for FSWs is recommended in order to minimize the barriers experienced by FSWs in this particular setting.
authors.affiliation: Faculty of Postgraduate Studies, University of Health Sciences, Vientiane, Lao PDR. ketkesone@hotmail.com
authors.forename: Ketkesone
authors.initials: K
authors.lastname: Phrasisombath
authors.forename: Sarah
authors.initials: S
authors.lastname: Thomsen
authors.forename: Vanphanom
authors.initials: V
authors.lastname: Sychareun
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Faxelid
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003153:Community Health Services / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D005260:Female; D006297:Health Services Accessibility / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D007812:Laos; D016015:Logistic Models; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D011785:Quality Assurance, Health Care; D060737:Reproductive Tract Infections / Q000628:therapy*; D060386:Sex Workers / Q000523:psychology* / Q000706:statistics & numerical data; D012749:Sexually Transmitted Diseases / Q000628:therapy*; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014850:Waiting Lists; D000078329:Workforce