Young female sex workers lived experiences of selling sex and accessing sexual and reproductive health services in Tanzania: implications for HIV prevention

Résumé

Background: Adolescent girls and young women who sell sex are at a heightened risk of acquiring HIV compared to those who do not. Their access to Sexual and Reproductive Health (SRH) services is also limited. This study explored the context of sex work for young female sex workers (YFSWs) and how they accessed sexual and reproductive health (SRH) services, including HIV services, to gain insights for enhancing demand for and access to these services. Methods: This study utilized an ethnographic research design involving 38 in-depth interviews and photovoice with YFSWs aged 18-24 years and six SRH program implementers. Thematic analysis was conducted with the aid of NVIVO software. Results: Five themes emerged: (1) "Selling sex in a setting where it is illegal"; (2) Nature of SRH services available to YFSWs; (3) Stigma as a barrier to accessing services; (4) Preference for differentiated type of SRH services; and (5) Peer influencers in creating demand for SRH services. Participants reported that sex work was illegal in Tanzania and highly stigmatized. YFSWs operated discreetly for fear of police arrests, and stigma and discrimination. Stigma and discrimination hindered access to SRH services. Peers were important in influencing YFSWs' decision on whether to use or not and where and how to access the SRH services. Conclusion: YFSWS operate under stressful conditions and had limited access to SRH services. Peers of YFSWs played a key role in access to and use of SRH services. There is a need for differentiated care for YFSWs and building an enabling environment to motivate YFSW to access SRHs. Given the numerous challenges faced by YFSWs in accessing SRH services, interventions targeted at this group should focus on multi-level barriers: (a) at health facility level, provide differentiated SRH care/services that are friendly and trusted; (b) at community level, address stigma and social norms that promote gender inequalities; (c) at individual level, provide SRH knowledge and livelihood options and; and finally, (d) at policy level, address policies that criminalize sex work.

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