Health Services Use and HIV Prevalence Among Migrant and National Female Sex Workers in Portugal: Are We Providing the Services Needed?

Abstract

This cross-sectional bio-behavioral survey conducted with 853 female sex workers (FSW) aimed to examine differences in use of HIV health services, testing and prevalence among migrant and national FSW. A quarter of undocumented FSW had never used National Health Service (NHS) and 15 % never tested for HIV, significantly more than nationals (p < 0.001 and p = 0.024, respectively). HIV infection was self-reported by 11.9 % of nationals, 1.8 % of documented and 0.8 % of undocumented migrants (p < 0.001). The HIV rapid test was reactive in 13.6 % of undocumented, 8.0 % of nationals and 2.3 % of documented. A higher proportion of migrants were unaware of their positive serostatus compared to nationals. Ever had HIV testing was less likely among undocumented, who never used the NHS and who didn’t know where to go if suspected being HIV-infected. Promoting early diagnosis with linkage to care among migrant FSW should be supported, while developing health services better tailored to their needs.

Resumen

Una encuesta transversal biocomportamental fue realizada con una muestra de 853 trabajadoras sexuales (TS) con el objetivo de examinar diferencias en el uso de servicios de salud del VIH, test y prevalencia entre TS migrantes y nacionales. Un cuarto de las TS indocumentadas nunca utilizaron el Servicio Nacional de Salud (SNS) y el 15 % nunca fueron testadas respecto al VIH, porcentajes significativamente superiores a las observadas para las nacionales (p < 0.001 y p = 0.024, respectivamente). La infección por VIH fue auto reportada por 11.9 % de las nacionales, 1.8 % de las migrantes documentadas y 0.8 % de las indocumentadas (p < 0.001). El test rápido del VIH fue reactivo para un 13.6 % de las indocumentadas, 8.0 % de las nacionales y 2.3 % de las documentadas. Una proporción mayor de migrantes desconocía su serostatus positivo en comparación con las nacionales. El test del VIH fue menos frecuente entre las indocumentadas, quien nunca utilizó el SNS y quien no sabía dónde recurrir si sospechaba estar infectada por el VIH. Promover un diagnóstico precoz en conexión con los cuidados en TS migrantes debe ser respaldado mientras se desarrollan servicios de salud mejor adaptados a sus necesidades.

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References

  1. 1.

    Baral S, Beyrer C, Muessig K, et al. Burden of HIV among female sex workers in low-income and middle-income countries: a systematic review and meta-analysis. Lancet Infect Dis. 2012;12(7):538–49.

    Article  PubMed  Google Scholar 

  2. 2.

    Bridge J, Lazarus JV, Atun R. HIV epidemics and prevention responses in Asia and Eastern Europe: lessons to be learned? AIDS. 2010;24(Suppl 3):S86–94.

    Article  PubMed  Google Scholar 

  3. 3.

    ECDC. Thematic report: sex workers. Monitoring implementation of the Dublin Declaration on Partnership to Fight HIV/AIDS in 2012. Stockholm: ECDC; 2012.

  4. 4.

    UNAIDS. Global report: UNAIDS report on the global AIDS epidemic in 25 European countries. Geneva: UNAIDS; 2012.

  5. 5.

    TAMPEP. Sex work in Europe: a mapping of the prostitution scene Europe and Central Asia. Progress report. Amsterdam: TAMPEP; 2009.

    Google Scholar 

  6. 6.

    Platt L, Grenfell P, Bonell C, et al. Risk of sexually transmitted infections and violence among indoor-working female sex workers in London: the effect of migration from Eastern Europe. Sex Transm Infect. 2011;87(5):377–84.

    Article  PubMed  Google Scholar 

  7. 7.

    Richter M, Chersich MF, Vearey J, et al. Migration status, work conditions and health utilization of female sex workers in three South African cities. J Immigr Minor Health. 2014;16(1):7–17.

    Article  PubMed  Google Scholar 

  8. 8.

    Platt L, Grenfell P, Fletcher A, et al. Systematic review examining differences in HIV, sexually transmitted infections and health-related harms between migrant and non-migrant female sex workers. Sex Transm Infect. 2013;89(4):311–9.

    Article  PubMed  Google Scholar 

  9. 9.

    Blondell SJ, Kitter B, Griffin MP, et al. Barriers and facilitators to HIV testing in migrants in high-income countries: a systematic review. AIDS Behav. 2015;19(11):2012–24.

    Article  PubMed  Google Scholar 

  10. 10.

    Dias SF, Severo M, Barros H. Determinants of health care utilization by immigrants in Portugal. BMC Health Serv Res. 2008;8:207.

    Article  PubMed  PubMed Central  Google Scholar 

  11. 11.

    Dias S, Gama A, Severo M, et al. Factors associated with HIV testing among immigrants in Portugal. Int J Public Health. 2011;56(5):559–66.

    Article  PubMed  Google Scholar 

  12. 12.

    Wang Y, Li B, Zheng J, et al. Factors related to female sex workers’ willingness to utilize VCT service: a qualitative study in Jinan City, Northern China. AIDS Behav. 2009;13(5):866–72.

    Article  PubMed  Google Scholar 

  13. 13.

    Decker MR, Beyrer C, Sherman SG. Ending the invisibility of sex workers in the US HIV/AIDS surveillance and prevention strategy. AIDS. 2014;28(15):2325–7.

    Article  PubMed  PubMed Central  Google Scholar 

  14. 14.

    Dias S, Gama A. Community-based participatory research in public health: potentials and challenges. Rev Panam Salud Publica. 2014;35(2):150–4.

    PubMed  Google Scholar 

  15. 15.

    Dias S, Gama A, Fuertes R, et al. Risk-taking behaviours and HIV infection among sex workers in Portugal: results from a cross-sectional survey. Sex Transm Infect. 2015;91(5):346–52.

    Article  PubMed  Google Scholar 

  16. 16.

    Hong Y, Zhang C, Li X, et al. HIV testing behaviors among female sex workers in southwest China. AIDS Behav. 2012;16(1):44–52.

    Article  PubMed  Google Scholar 

  17. 17.

    Deblonde J, De Koker P, Hamers FF, et al. Barriers to HIV testing in Europe: a systematic review. Eur J Public Health. 2010;20(4):422–32.

    Article  PubMed  Google Scholar 

  18. 18.

    Beyrer C, Crago A-L, Bekker L-G, et al. An action agenda for HIV and sex work. Lancet. 2015;385(9964):287–301.

    Article  PubMed  Google Scholar 

  19. 19.

    Folch C, Esteve A, Sanclemente C, et al. Prevalence of human immunodeficiency virus, Chlamydia trachomatis, and Neisseria gonorrhoeae and risk factors for sexually transmitted infections among immigrant female sex workers in Catalonia, Spain. Sex Transm Dis. 2008;35(2):178–83.

    Article  PubMed  Google Scholar 

  20. 20.

    Vall-Mayans M, Villa M, Saravanya M, et al. Sexually transmitted Chlamydia trachomatis, Neisseria gonorrhoeae, and HIV-1 infections in two at-risk populations in Barcelona: female street prostitutes and STI clinic attendees. Int J Infect Dis. 2007;11(2):115–22.

    CAS  Article  PubMed  Google Scholar 

  21. 21.

    International HIV/AIDS Alliance. Behavioral monitoring and HIV infection prevalence among female sex workers as a component of second generation surveillance. Kyiv: Ukrainian AIDS Center; 2010.

    Google Scholar 

  22. 22.

    Uuskula A, Fischer K, Raudne R, et al. A study on HIV and hepatitis C virus among commercial sex workers in Tallinn. Sex Transm Infect. 2008;84(3):189–91.

    CAS  Article  PubMed  Google Scholar 

  23. 23.

    Zermiani M, Mengoli C, Rimondo C, Galvan U, Cruciani M, Serpelloni G. Prevalence of sexually transmitted diseases and hepatitis C in a survey of female sex workers in the north-east of Italy. Open AIDS J. 2012;6:60–4.

    Article  PubMed  PubMed Central  Google Scholar 

  24. 24.

    da Saúde Ministério. Programa Nacional de Prevenção e Controlo da Infeção VIH/SIDA 2012-2016. Lisboa: Ministério da Saúde; 2012.

    Google Scholar 

  25. 25.

    WHO. Consolidated guidelines on HIV testing services. Geneva: WHO; 2015.

  26. 26.

    Magnani R, Sabin K, Saidel T, et al. Review of sampling hard-to-reach and hidden populations for HIV surveillance. AIDS. 2005;19(Suppl 2):S67–72.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The study was partially financed by the ADIS/SIDA Program from the National Program for the Prevention and Control of HIV/AIDS Infection. AG has a Ph.D. Grant from Fundação para a Ciência e a Tecnologia (SFRH/BD/84259/2012). The authors would like to thank Gabriela Cohen, Inês Rego, Ricardo Fernandes, Ricardo Fuertes, Ricardo Rosa and Sara Trindade for their collaboration in the project implementation. The authors are also very grateful to all the community partners of the project. Special thanks to all the participants of this study. Finally, the project team are thankful to GHTM – UID/Multi/04413/2013.

Funding

This study was funded by ADIS/SIDA Program from the National Program for the Prevention and Control of HIV/AIDS Infection (grant number not applicable).

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Correspondence to Sónia Dias.

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All the authors declare that have no conflict of interest.

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All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

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Informed consent was obtained from all individual participants included in the study.

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Dias, S., Gama, A., Pingarilho, M. et al. Health Services Use and HIV Prevalence Among Migrant and National Female Sex Workers in Portugal: Are We Providing the Services Needed?. AIDS Behav 21, 2316–2321 (2017). https://doi.org/10.1007/s10461-016-1511-x

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Keywords

  • HIV infection
  • HIV testing
  • Health services use
  • Migrants
  • Sex workers