title: Suboptimal access to primary healthcare among street-based sex workers in southwest Switzerland.
abstract: OBJECTIVE
  Street-based sex workers (SSWs) in Lausanne, Switzerland, are poorly characterised. We set out to quantify potential vulnerability factors in this population and to examine SSW healthcare use and unmet healthcare requirements.
  
  
  METHODS
  We conducted a cross-sectional questionnaire-based survey among SSWs working in Lausanne's red light district between 1 February and 31 July 2010, examining SSW socio-demographic characteristics and factors related to their healthcare.
  
  
  RESULTS
  We interviewed 50 SSWs (76% of those approached). A fifth conducted their interviews in French, the official language in Lausanne. 48 participants (96%) were migrants, of whom 33/48 (69%) held no residence permit. 22/50 (44%) had been educated beyond obligatory schooling. 28/50 (56%) had no health insurance. 18/50 (36%) had been victims of physical violence. While 36/50 (72%) had seen a doctor during the preceding 12 months, only 15/50 (30%) were aware of a free clinic for individuals without health insurance. Those unaware of free services consulted emergency departments or doctors outside Switzerland. Gynaecology, primary healthcare and dental services were most often listed as needed. Two individuals (of 50, 4%) disclosed positive HIV status; of the others, 24/48 (50%) had never had an HIV test.
  
  
  CONCLUSIONS
  This vulnerable population comprises SSWs who, whether through mobility, insufficient education or language barriers, are unaware of services they are entitled to. With half the participants reporting no HIV testing, there is a need to enhance awareness of available facilities as well as to increase provision and uptake of HIV testing.
authors.affiliation: Infectious Diseases Service, Centre Hospitalier Universitaire Vaudois,Rue du Bugnon 46, Lausanne, Switzerland. Katharine.Darling@chuv.ch
authors.forename: Katharine Elizabeth Anna
authors.initials: KE
authors.lastname: Darling
authors.forename: Elodie
authors.initials: E
authors.lastname: Gloor
authors.forename: Anne
authors.initials: A
authors.lastname: Ansermet-Pagot
authors.forename: Paul
authors.initials: P
authors.lastname: Vaucher
authors.forename: Sophie
authors.initials: S
authors.lastname: Durieux-Paillard
authors.forename: Patrick
authors.initials: P
authors.lastname: Bodenmann
authors.forename: Matthias
authors.initials: M
authors.lastname: Cavassini
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D006679:HIV Seropositivity / Q000453:epidemiology*; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006301:Health Services Needs and Demand; D006305:Health Status Indicators; D006801:Humans; D007348:Insurance, Health; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000458:organization & administration; D060386:Sex Workers / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D013557:Switzerland / Q000453:epidemiology; D063106:Transgender Persons / Q000706:statistics & numerical data; D014171:Transients and Migrants / Q000706:statistics & numerical data; D035862:Vulnerable Populations; D016387:Women's Health / Q000592:standards; D008297:Male