The Socio-Ecological Model Approach to Understanding Barriers and Facilitators to the Accessing of Health Services by Sex Workers: A Systematic Review

August 2017 - Structural Prevention

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Ma, P.H.X., Chan, Z.C.Y., and Loke, A.Y. AIDS and Behavior (June 2017), doi:10.1007/s10461-017-1818-2.

The authors of this review applied the socioecological model to examine behaviors associated with accessing health services among sex workers (SWs) globally. The 30 eligible papers identified barriers at several levels that kept SWs from accessing health services, along with factors that facilitated access at each level:

  • Interpersonal: Barriers included insufficient information, cost, lack of social support, and fears about the consequences of a positive diagnosis. Facilitators included health knowledge including the benefits of treatment, perceptions of personal risk, social support, and peer support.
  • Institutional: Barriers included poor perceived quality of care, poor staff attitudes, confidentiality breaches, services that did not attend to their multiple health needs, and inconvenient hours and locations. Facilitators included perceived high-quality, convenient, and stigma-free care from health care workers.
  • Community: Barriers included stigma related to HIV, drug use, or sex work. Facilitators included nongovernmental advocacy groups that help SWs overcome health access barriers.
  • Policy: Barriers included criminalization and citizenship status requirements. Facilitators included government health care subsidies for SWs.

The authors called for interventions to address multilevel barriers and continue developing facilitating elements to improve health care access for SWs.

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