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Determinants of access to HIV testing and counselling services among female sex workers in sub-Saharan Africa: a systematic review

Journal Article
(Published January, 2019)
Nnko, S. (Author),
Kuringe, E. (Author),
Nyato, D. (Author),
Drake, M. (Author),
Casalini, C. (Author),
Shao, A. (Author)
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HIV testing and counselling (HTC) is an essential component for HIV prevention and a critical entry point into the HIV continuum of care and treatment. Despite the importance of HTC for HIV control, access to HTC services among female sex workers (FSWs) in sub-Saharan Africa (SSA) remains suboptimal and little is
known about factors influencing FSWs’ access to HTC. Guided by the client-centred conceptual framework, we conducted a systematic review in MEDLINE, POPLINE and Web of Science databases for literature published between Jan 2000 - July 2017 to understand the facilitators and barriers influencing FSWs in SSA to access HTC services. This review shows that factors related to approachability, acceptability, availability, affordability and appropriateness of the services are crucial in influencing access to HTC services among FSWs in SSA. These factors were mediated by individual attributes such as HIV risk perceptions, awareness of the availability of HTC, and perceptions of the importance and quality of HTC services. The decision to utilise HTC was predominantly
hampered by discriminatory social norms such as HIV stigma and criminalisation of sex work.
Conclusions: FSWs’ access to HTC is facilitated by multiple factors, including individual awareness of the availability of HTC services, and perceived quality of HTC especially with regard to assured confidentiality. Concerns about HIV stigma and fear about discrimination due to community intolerance of sex work acted as major barriers for FSWs to seek HTC services from the facilities offering health services to the general population.

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Citation: 
31. Nnko S, Kuringe E, Nyato D, Drake M, Casalini C, Shao A, et al. Determinants of access to HIV testing and counselling services among female sex workers in sub-Saharan Africa: a systematic review. BMC public health. 2019;19(1):15.