Exploration of female sex workers' experiences and perceptions with accessing healthcare in Malawi : a qualitative study

Exploration of female sex workers' experiences and perceptions with accessing healthcare in Malawi: a qualitative study Female sex workers (FSWs) in Malawi, like other similar settings, face major challenges accessing healthcare services including those provided by public and non-governmental organisations (NGOs). Understanding FSWs' experiences and perceptions of accessing healthcare could improve service delivery to this vulnerable group of women by enhancing service utilisation and reducing their potential of being infected with Human Immunodeficiency Virus (HIV) and sexual transmitted infections (STIs) thus reducing transmission. Study 1 explored FSWs' positive experiences with access to healthcare and Study 2 explored a wider range of FSWs' experiences and perceptions of accessing healthcare services provided by public and non-governmental organisations in Malawi. Qualitative methods were employed to explore FSWs' experiences and perceptions of accessing healthcare services in Malawi. Study 1 collected data, using face-to-face semi-structured interviews from 45 FSWs, 10 healthcare professionals (HCPs) and six service providers from Theatre for a Change and Family Planning Association of Malawi. Three main themes emerged from data of Study 1: (1) Approaches to improving access to healthcare, (2) Effects of the NGOs on provision of healthcare services to FSWs, and (3) Professionals' awareness of FSWs' needs. Three main themes also emerged from the data of Study 2: (1) Enduring structural violence; (2) Enduring direct violence; (3) Combating structural violence. The empirical evidence derived from these studies about positive experiences with access to healthcare and structural determinants of negative experiences and perceptions of accessing healthcare, particularly in public health facilities and the preference for provision of services in 'Hotspots' could be used, along with other evidence to review current policy and inform future plans. Development should be aimed at improving HCPs' awareness of the needs of FSWs while making services more acceptable and approachable in Malawi for this high risk population.