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Are HIV and reproductive health services adapted to the needs of female sex workers?: results of a policy and situational analysis in Tete, Mozambique

Yves Lafort UGent, Osvaldo Jocitala, Balthazar Candrinho, Letitia Greener, Mags Beksinska, Jenni A Smit, Matthew Chersich UGent and Wim Delva UGent (2016) BMC HEALTH SERVICES RESEARCH. 16.
abstract
Background: 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: 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. Results: 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. Conclusion: 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.
Please use this url to cite or link to this publication:
author
organization
year
type
journalArticle (original)
publication status
published
subject
keyword
CARE, PREVENTION, BURDEN, AFRICA, COTE-DIVOIRE, Availability, Mixed methods, Health services, Mozambique, Female sex workers, Reproductive health, HIV, COUNTRIES
journal title
BMC HEALTH SERVICES RESEARCH
BMC Health Serv. Res.
volume
16
article number
301
pages
9 pages
Web of Science type
Article
Web of Science id
000380645200003
JCR category
HEALTH CARE SCIENCES & SERVICES
JCR impact factor
1.827 (2016)
JCR rank
49/90 (2016)
JCR quartile
3 (2016)
ISSN
1472-6963
DOI
10.1186/s12913-016-1551-y
language
English
UGent publication?
yes
classification
A1
copyright statement
I have retained and own the full copyright for this publication
id
8080214
handle
http://hdl.handle.net/1854/LU-8080214
date created
2016-09-19 14:28:13
date last changed
2016-12-21 15:41:42
@article{8080214,
  abstract     = {Background: 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: 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. 
Results: 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. 
Conclusion: 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.},
  articleno    = {301},
  author       = {Lafort, Yves and Jocitala, Osvaldo and Candrinho, Balthazar and Greener, Letitia and Beksinska, Mags and Smit, Jenni A and Chersich, Matthew and Delva, Wim},
  issn         = {1472-6963},
  journal      = {BMC HEALTH SERVICES RESEARCH},
  keyword      = {CARE,PREVENTION,BURDEN,AFRICA,COTE-DIVOIRE,Availability,Mixed methods,Health services,Mozambique,Female sex workers,Reproductive health,HIV,COUNTRIES},
  language     = {eng},
  pages        = {9},
  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},
  url          = {http://dx.doi.org/10.1186/s12913-016-1551-y},
  volume       = {16},
  year         = {2016},
}

Chicago
Lafort, Yves, Osvaldo Jocitala, Balthazar Candrinho, Letitia Greener, Mags Beksinska, Jenni A Smit, Matthew Chersich, and Wim Delva. 2016. “Are HIV and Reproductive Health Services Adapted to the Needs of Female Sex Workers?: Results of a Policy and Situational Analysis in Tete, Mozambique.” Bmc Health Services Research 16.
APA
Lafort, Y., Jocitala, O., Candrinho, B., Greener, L., Beksinska, M., Smit, J. A., Chersich, M., et al. (2016). Are HIV and reproductive health services adapted to the needs of female sex workers?: results of a policy and situational analysis in Tete, Mozambique. BMC HEALTH SERVICES RESEARCH, 16.
Vancouver
1.
Lafort Y, Jocitala O, Candrinho B, Greener L, Beksinska M, Smit JA, et al. Are HIV and reproductive health services adapted to the needs of female sex workers?: results of a policy and situational analysis in Tete, Mozambique. BMC HEALTH SERVICES RESEARCH. 2016;16.
MLA
Lafort, Yves, Osvaldo Jocitala, Balthazar Candrinho, et al. “Are HIV and Reproductive Health Services Adapted to the Needs of Female Sex Workers?: Results of a Policy and Situational Analysis in Tete, Mozambique.” BMC HEALTH SERVICES RESEARCH 16 (2016): n. pag. Print.