Self-reported experiences of health services among female street-based prostitutes: a cross-sectional survey.

BACKGROUND: Previous studies show that women working in prostitution do not use routine health services appropriately. Little is known about the nature and frequency of service contacts or barriers to access. This information is needed if use of current services by this group is to improve. AIM: To identify barriers reducing access to health services by street prostitutes, and to identify current patterns of use. DESIGN OF STUDY: Cross-sectional survey.
SETTING: Inner-city Bristol.
METHOD: Seventy-one female street-based prostitutes were interviewed about their experiences of health services.
RESULTS: The women had frequent contacts with healthcare providers. The general practitioner (GP) was the main source of all types of care. Although 83% (59/71) were registered with a GP, 62% (36/59) had not disclosed their work. Only 46% (33/71) had been screened for sexually transmitted infection in the previous year and 24% (17/71) were vaccinated against hepatitis B, a national recommendation for sex workers. Only 38% (25/65) had had cervical smears according to screening guidelines. Opportunistic screening and care was important. While pregnant with their last child, only 30% (14/47) booked in the first trimester and attended all antenatal appointments, with 13% (6/47) receiving no antenatal care until admitted in labour. Appointments, waiting times, and fear of judgement and other patients staring, were considered significant barriers to service use. The model suggested by the women was an integrated service providing basic living needs alongside health care.
CONCLUSION: Non-disclosure and poor attendance for follow-up make appropriate care difficult, and may contribute to poor health. Despite frequent service contacts, opportunities for care are being missed.