Attracting female sex workers to HIV testing and counselling in Ethiopia: a qualitative study with sex workers in Addis Ababa.

Despite growing efforts to increase HIV testing and counselling (HTC) services for most at risk populations in Ethiopia, the use of these services by female sex workers (FSWs) remains low. With rising numbers of FSWs in Addis Ketema and concerns about their high risk behaviours, exploring and addressing the barriers to uptake is crucial. This qualitative study explores the barriers to utilising HTC facilities and identifies the motives and motivations of FSWs who seek HTC through in-depth and semi-structured interviews with female sex workers, healthcare workers and key informants. Results indicate that FSWs face numerous barriers including inability to seek treatment if found to be positive due to the requirement of an identity (ID) card many do not own. Many FSWs reported discriminatory behaviour from healthcare workers and a lack of dedicated services. What is clear from the findings is that distinct strategies, which differ from those of the broader population, are required to attract FSWs--strategies which take into account the barriers and maximise the reported motives and motivations for testing.