title: Where Do Female Sex Workers Seek HIV and Reproductive Health Care and What Motivates These Choices? A Survey in 4 Cities in India, Kenya, Mozambique and South Africa.
abstract: BACKGROUND
  A baseline cross-sectional survey among female sex workers (FSWs) was conducted in four cities within the context of an implementation research project aiming to improve FSWs' access to HIV, and sexual and reproductive health (SRH) services. The survey measured where FSWs seek HIV/SRH care and what motivates their choice.
  
  
  METHODS
  Using respondent-driven sampling (RDS), FWSs were recruited in Durban, South Africa (n = 400), Tete, Mozambique (n = 308), Mombasa, Kenya (n = 400) and Mysore, India (n = 458) and interviewed. RDS-adjusted proportions were estimated by non-parametric bootstrapping, and compared across cities using post-hoc pairwise comparison tests.
  
  
  RESULTS
  Across cities, FSWs most commonly sought care for the majority of HIV/SRH services at public health facilities, most especially in Durban (ranging from 65% for condoms to 97% for HIV care). Services specifically targeting FSWs only had a high coverage in Mysore for STI care (89%) and HIV testing (79%). Private-for-profit clinics were important providers in Mombasa (ranging from 17% for STI care and HIV testing to 43% for HIV care), but not in the other cities. The most important reason for the choice of care provider in Durban and Mombasa was proximity, in Tete 'where they always go', and in Mysore cost of care. Where available, clinics specifically targeting FSWs were more often chosen because of shorter waiting times, perceived higher quality of care, more privacy and friendlier personnel.
  
  
  CONCLUSIONS
  The place where care is sought for HIV/SRH services differs substantially between cities. Targeted services have limited coverage in the African cities compared to Mysore. Convenience appears more important for choosing the place of care than aspects of quality of care. The best model to improve access, linking targeted interventions with general health services, will need to be tailored to the specific context of each city.
authors: International Centre for Reproductive Health, Ghent University, Gent, Belgium.
authors: Yves
authors: Y
authors: Lafort
authors: MatCH Research (Maternal, Adolescent and Child Health Research) Unit, University of the Witwatersrand, Durban, South Africa.
authors: Ross
authors: R
authors: Greener
authors: Ashodaya Samithi, Mysore, India.
authors: Anuradha
authors: A
authors: Roy
authors: MatCH Research (Maternal, Adolescent and Child Health Research) Unit, University of the Witwatersrand, Durban, South Africa.
authors: Letitia
authors: L
authors: Greener
authors: International Centre for Reproductive Health-Kenya, Mombasa, Kenya.
authors: Wilkister
authors: W
authors: Ombidi
authors: International Centre for Reproductive Health-Mozambique, Maputo, Mozambique.
authors: Faustino
authors: F
authors: Lessitala
authors: Institute for Global Health, University College London, London, United Kingdom.
authors: Hassan
authors: H
authors: Haghparast-Bidgoli
authors: MatCH Research (Maternal, Adolescent and Child Health Research) Unit, University of the Witwatersrand, Durban, South Africa.
authors: Mags
authors: M
authors: Beksinska
authors: International Centre for Reproductive Health, Ghent University, Gent, Belgium.|International Centre for Reproductive Health-Kenya, Mombasa, Kenya.|University of Nairobi, Nairobi, Kenya.
authors: Peter
authors: P
authors: Gichangi
authors: Ashodaya Samithi, Mysore, India.|University of Manitoba, Winnipeg, Canada.
authors: Sushena
authors: S
authors: Reza-Paul
authors: MatCH Research (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: Jenni A
authors: JA
authors: Smit
authors: 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: Matthew
authors: M
authors: Chersich
authors: 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.|Rega Institute for Medical Research, KU Leuven, Leuven, Belgium.
authors: Wim
authors: W
authors: Delva
mesh_terms: D000328:Adult; D002755:Choice Behavior; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000523:psychology* / Q000821:virology; D015497:HIV-1 / Q000302:isolation & purification; D006801:Humans; D007194:India / Q000453:epidemiology; D007630:Kenya / Q000453:epidemiology; D009042:Motivation; D009073:Mozambique / Q000453:epidemiology; D010342:Patient Acceptance of Health Care; D034121:Reproductive Health Services / Q000706:statistics & numerical data*; D060386:Sex Workers / Q000523:psychology*; D012725:Sexual Behavior / Q000523:psychology*; D013019:South Africa / Q000453:epidemiology; D055815:Young Adult