title: Are HIV and reproductive health services adapted to the needs of female sex workers? Results of a policy and situational analysis in Tete, Mozambique.
abstract: In the context of an implementation research project aiming at improving use of HIV and sexual and reproductive health (SRH) services for female sex workers (FSWs), a broad situational analysis was conducted in Tete, Mozambique, assessing if services are adapted to the needs of FSWs.
  
  
  
  Methods comprised (1) a policy analysis including a review of national guidelines and interviews with policy makers, and (2) health facility assessments at 6 public and 1 private health facilities, and 1 clinic specifically targeting FSWs, consisting of an audit checklist, interviews with 18 HIV/SRH care providers and interviews of 99 HIV/SRH care users.
  
  
  
  There exist national guidelines for most HIV/SRH care services, but none provides guidance for care adapted to the needs of high-risk women such as FSWs. The Ministry of Health recently initiated the process of establishing guidelines for attendance of key populations, including FSWs, at public health facilities. Policy makers have different views on the best approach for providing services to FSWs-integrated in the general health services or through parallel services for key populations-and there exists no national strategy. The most important provider of HIV/SRH services in the study area is the government. Most basic services are widely available, with the exception of certain family planning methods, cervical cancer screening, services for victims of sexual and gender-based violence, and termination of pregnancy (TOP). The public facilities face serious limitations in term of space, staff, equipment, regular supplies and adequate provider practices. A stand-alone clinic targeting key populations offers a limited range of services to the FSW population in part of the area. Private clinics offer only a few services, at commercial prices.
  
  
  
  There is a need to improve the availability of quality HIV/SRH services in general and to FSWs specifically, and to develop guidelines for care adapted to the needs of FSWs. Access for FSWs can be improved by either expanding the range of services and the coverage of the targeted clinic and/or by improving access to adapted care at the public health services and ensure a minimum standard of quality.
authors.affiliation: International Centre for Reproductive Health, Ghent University, Ghent, 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: Osvaldo
authors.initials: O
authors.lastname: Jocitala
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), 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), 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), 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, Ghent, 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, Ghent, 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; D000553:Ambulatory Care / Q000458:organization & administration / Q000592:standards; D000554:Ambulatory Care Facilities / Q000458:organization & administration / Q000592:standards; D005260:Female; D015658:HIV Infections / Q000517:prevention & control*; D006291:Health Policy; D006801:Humans; D009073:Mozambique; D020380:Needs Assessment; D011050:Policy Making; D011247:Pregnancy; D060728:Reproductive Health; D034121:Reproductive Health Services / Q000458:organization & administration* / Q000592:standards; D060386:Sex Workers / Q000706:statistics & numerical data*; D012725:Sexual Behavior; D055815:Young Adult
keywords: Availability; Female sex workers; HIV; Health services; Mixed methods; Mozambique; Reproductive health