title: Contraceptive service delivery in Kenya: A qualitative study to identify barriers and preferences among female sex workers and health care providers.
abstract: Female sex workers (FSWs) need access to contraceptive services, yet programs often focus on HIV prevention and less on the broader sexual and reproductive health needs of FSWs. We aimed to identify barriers to accessing contraceptive services among FSWs and preferences for contraceptive service delivery options among FSWs and health care providers (HCPs) in order to inform a service delivery intervention to enhance access to and use of contraceptives for FSWs in Kenya.
  
  
  
  Twenty focus group discussions were conducted with FSWs and HCPs in central Kenya.
  
  
  
  Three barriers were identified that limited the ability of FSWs to access contraceptive services: (1) an unsupportive clinic infrastructure, which consisted of obstructive factors such as long wait times, fees, inconvenient operating hours and perceived compulsory HIV testing; (2) discriminatory provider-client interactions, where participants believed negative and differential treatment from female and male staff members impacted FSWs' willingness to seek medical services; and (3) negative partner influences, including both nonpaying and paying partners. Drop-in centers followed by peer educators and health care facilities were identified as preferred service delivery options.
  
  
  
  FSWs may not be able to regularly access contraceptive services until interpersonal (male partners) and structural (facilities and providers) barriers are addressed. Alternative delivery options, such as drop-in centers coupled with peer educators, may be an approach worth evaluating.
  
  
  
  An unsupportive clinic infrastructure, discriminatory provider-client interactions and negative partner influences are barriers to FSWs accessing the contraception services they need. Alternative service delivery options, such integrating contraceptive service delivery at drop-in centers designed for FSWs and information delivery through peer educators, might provide improved access and better service quality to FSWs seeking contraception.
authors.affiliation: FHI 360, Durham, NC, United States. Electronic address: amy.corneli@duke.edu.
authors.forename: Amy
authors.initials: A
authors.lastname: Corneli
authors.affiliation: FHI 360, Durham, NC, United States.
authors.forename: Ansley
authors.initials: A
authors.lastname: Lemons
authors.affiliation: FHI 360, Nairobi, Kenya.
authors.forename: Rose
authors.initials: R
authors.lastname: Otieno-Masaba
authors.affiliation: Goldstar, Nairobi, Kenya.
authors.forename: John
authors.initials: J
authors.lastname: Ndiritu
authors.affiliation: FHI 360, Durham, NC, United States.
authors.forename: Catherine
authors.initials: C
authors.lastname: Packer
authors.affiliation: FHI 360, Durham, NC, United States.
authors.forename: Jesse
authors.initials: J
authors.lastname: Lamarre-Vincent
authors.affiliation: FHI 360, Durham, NC, United States.
authors.forename: Lisa
authors.initials: L
authors.lastname: Dulli
mesh_terms: D000293:Adolescent; D000328:Adult; D001291:Attitude of Health Personnel; D003267:Contraception / Q000706:statistics & numerical data*; D005260:Female; D017144:Focus Groups; D015658:HIV Infections / Q000517:prevention & control; D006282:Health Personnel; D006301:Health Services Needs and Demand; D006801:Humans; D007630:Kenya; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D057240:Patient Preference; D036301:Qualitative Research; D060386:Sex Workers; D012747:Sexual Partners; D055815:Young Adult
keywords: Africa; Contraceptives; Female sex workers; Service delivery