Yves Lafort 1, Ross Greener 2, Anuradha Roy 3, Letitia Greener 2, Wilkister Ombidi 4, Faustino Lessitala 5, Hassan Haghparast-Bidgoli 6, Mags Beksinska 2, Peter Gichangi 1 4 7, Sushena Reza-Paul 3 8, Jenni A Smit 2 9, Matthew Chersich 1 10, Wim Delva 1 11 12 13
Affiliations
- 1International Centre for Reproductive Health, Ghent University, Gent, Belgium.
- 2MatCH Research (Maternal, Adolescent and Child Health Research) Unit, University of the Witwatersrand, Durban, South Africa.
- 3Ashodaya Samithi, Mysore, India.
- 4International Centre for Reproductive Health-Kenya, Mombasa, Kenya.
- 5International Centre for Reproductive Health-Mozambique, Maputo, Mozambique.
- 6Institute for Global Health, University College London, London, United Kingdom.
- 7University of Nairobi, Nairobi, Kenya.
- 8University of Manitoba, Winnipeg, Canada.
- 9Discipline of Pharmaceutical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
- 10Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
- 11The South African DST/NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), University of Stellenbosch, Stellenbosch, South Africa.
- 12Center for Statistics, Hasselt University, Diepenbeek, Belgium.
- 13Rega Institute for Medical Research, KU Leuven, Leuven, Belgium.
PMID: 27494412 PMCID: PMC4975460
DOI: 10.1371/journal.pone.0160730
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.
Conclusion: 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.
Conflict of interest statement
Competing Interests: The authors have declared that no competing interests exist.
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