Female sex workers in Laos : perceptions, care seeking behaviour and barriers related to sexually transmitted infection services

Background: Sexually transmitted infections (STIs) cause health, social and economic burdens in both low- and high-income countries. Not only do STIs impact quality of life, reproductive health and child health, but they also play a crucial role in facilitating sexual transmission of human immunodeficiency virus (HIV). Prompt, correct diagnosis and treatment with health information are essential elements of STI and reproductive tract infection (RTI) services. In Laos, it is not known what makes female sex workers (FSWs) seek health care or what their priorities are when using public or private STI services. Other issues related to FSWs’ vulnerability, such as the social situation, work environment, and perceptions of health and ill-health are poorly understood and thus have rarely been considered when designing interventions. Aims: To explore FSWs’ perceptions of health/illness, and to assess their care seeking behaviours and risk perceptions as well as health care providers’ attitudes towards FSWs with STI symptoms in Savannakhet province in Laos. Methods: Semi-structured interviews regarding knowledge about STIs and attitudes towards FSWs with STI symptoms were performed with 244 health care providers (HCPs) providing STI services (I). Structured interviews about health seeking behavior were carried out with 407 FSWs (III). Both studies were carried out in 6 districts along Road 9, traversing Savannakhet province from Thailand to Vietnam. Descriptive statistics and chi-square test (I), and multiple multivariate logistic regression analyses were performed (III). Studies II and IV were conducted in Kaysone Phomvihan, the main district of Savannakhet province. Fifteen in-depth interviews were carried out with FSWs about what health and illness meant to them and what they believed signified good/bad health (II). Seven in-depth interviews and five focus group discussions were carried out with 39 FSWs (IV) about their working situation, risks related to their work, perc