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Barriers to Accessing Sexual Health Services for Transgender and Male Sex Workers: A Systematic Qualitative Meta-summary

  • Samuel BrookfieldEmail author
  • Judith Dean
  • Candi Forrest
  • Jesse Jones
  • Lisa Fitzgerald
Substantive Review

Abstract

Access to safe and effective sexual healthcare services for transgender and male sex workers (TMSW) is a human right. Globally, TMSW experience a higher prevalence of human immunodeficiency virus (HIV) and sexually transmitted infections than the general population or other sex workers, suggesting the existence of unique challenges for this group when accessing healthcare. A systematic database search identified 22 qualitative papers addressing barriers to accessing sexual healthcare services for TMSW. These papers were critically evaluated for adherence to best practice standards for qualitative research and research with sex workers. A coding process identified five themes. Stigma was the predominant barrier, and was divided into stigma related to sexuality, gender identity, HIV status, sex worker status, and internalised stigma. Other barriers were confidentiality concerns, sexual health literacy, fatalism, and structural barriers. Each of these themes were informed by the wider context of stigma. The literature presents a complex syndemic of social disadvantage and exclusion acting to produce and reinforce health disparities related to sexual health and access to screening and treatment for TMSW.

Keywords

Sex work Transgender Male sex work Sexual health Systematic review 

Notes

Funding

All funding for this review was provided by the HIV Foundation, Queensland.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

This research received ethical approval under the University of Queensland Human Research Ethics Committee (Approval Number #2016001287).

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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.School of Public Health, Faculty of MedicineUniversity of QueenslandBrisbaneAustralia
  2. 2.Respect Inc.BrisbaneAustralia

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