title: Barriers to HIV and sexual and reproductive health care for female sex workers in Tete, Mozambique: results from a cross-sectional survey and focus group discussions.
abstract: In the context of an operational research project in Tete, Mozambique, use of, and barriers to, HIV and sexual and reproductive health (HIV/SRH) commodities and services for female sex workers (FSWs) were assessed as part of a baseline situational analysis.
  
  
  
  In a cross-sectional survey 311 FSWs were recruited using respondent driven sampling and interviewed face-to-face, and three focus group discussions were held with respectively 6 full-time Mozambican, 7 occasional Mozambican and 9 full-time Zimbabwean FSWs, to investigate use of, and barriers to, HIV/SRH care.
  
  
  
  The cross-sectional survey showed that 71 % of FSWs used non-barrier contraception, 78 % sought care for their last sexually transmitted infection episode, 51 % of HIV-negative FSWs was tested for HIV in the last 6 months, 83 % of HIV-positive FSWs were in HIV care, 55 % sought help at a health facility for their last unwanted pregnancy and 48 % after sexual assault, and none was ever screened for cervical cancer. Local public health facilities were by far the most common place where care was sought, followed by an NGO-operated clinic targeting FSWs, and places outside the Tete area. In the focus group discussions, FSWs expressed dissatisfaction with the public health services, as a result of being asked for bribes, being badly attended by some care providers, stigmatisation and breaches of confidentiality. The service most lacking was said to be termination of unwanted pregnancies.
  
  
  
  The use of most HIV and SRH services is insufficient in this FSW population. The public health sector is the main provider, but access is hampered by several barriers. The reach of a FSW-specific NGO clinic is limited. Access to, and use of, HIV and SRH services should be improved by reducing barriers at public health facilities, broadening the range of services and expanding the reach of the targeted NGO clinic.
authors.affiliation: International Centre for Reproductive Health, Ghent University, Gent, Belgium. yves.lafort@ugent.be.
authors.forename: Yves
authors.initials: Y
authors.lastname: Lafort
authors.affiliation: International Centre for Reproductive Health-Mozambique, Maputo, Mozambique.
authors.forename: Faustino
authors.initials: F
authors.lastname: Lessitala
authors.affiliation: Direcção Provincial de Saúde de Tete, Tete, Mozambique.
authors.forename: Balthazar
authors.initials: B
authors.lastname: Candrinho
authors.affiliation: MatCH Research Unit (Maternal, Adolescent and Child Health Research Unit), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa.
authors.forename: Letitia
authors.initials: L
authors.lastname: Greener
authors.affiliation: MatCH Research Unit (Maternal, Adolescent and Child Health Research Unit), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa.
authors.forename: Ross
authors.initials: R
authors.lastname: Greener
authors.affiliation: MatCH Research Unit (Maternal, Adolescent and Child Health Research Unit), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa.
authors.forename: Mags
authors.initials: M
authors.lastname: Beksinska
authors.affiliation: MatCH Research Unit (Maternal, Adolescent and Child Health Research Unit), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa.|Discipline of Pharmaceutical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
authors.forename: Jenni A
authors.initials: JA
authors.lastname: Smit
authors.affiliation: International Centre for Reproductive Health, Ghent University, Gent, Belgium.|Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Matthew
authors.initials: M
authors.lastname: Chersich
authors.affiliation: International Centre for Reproductive Health, Ghent University, Gent, Belgium.|The South African DST/NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), University of Stellenbosch, Stellenbosch, South Africa.|Center for Statistics, Hasselt University, Diepenbeek, Belgium.
authors.forename: Wim
authors.initials: W
authors.lastname: Delva
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data; D003268:Contraception Behavior / Q000523:psychology; D003430:Cross-Sectional Studies; D005260:Female; D017144:Focus Groups; D015658:HIV Infections / Q000523:psychology; D006297:Health Services Accessibility; D006801:Humans; D009073:Mozambique; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D011247:Pregnancy; D011275:Pregnancy, Unwanted / Q000523:psychology; D034121:Reproductive Health Services / Q000706:statistics & numerical data*; D012742:Sex Offenses / Q000523:psychology; D060386:Sex Workers / Q000523:psychology*; D012725:Sexual Behavior / Q000523:psychology*; D012749:Sexually Transmitted Diseases / Q000523:psychology; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Care seeking; Female sex workers; HIV; Mixed methods; Mozambique; Sexual and reproductive health