Abstract

There is limited information on contraceptive values and preferences of sex workers. We conducted a mixed-method study to explore contraceptive values and preferences among sex workers. We conducted an online survey with individuals from 38 countries (n = 239), 6 focus group discussions (FGD, n = 68) in Zimbabwe, and 12 in-depth phone interviews (IDI) across 4 world regions, in June and July of 2019. Participants were asked about awareness of contraceptives, methods they had used in the past, and the determinants of their choices. Differences between respondents from high-, low- and middle- income countries were examined. Qualitative data were analysed thematically. Survey participants reported an awareness of modern contraceptive methods. FGDs found that younger women had lower awareness. Reports of condomless sex were common and modern contraceptive use was inconsistent. Determinants of contraceptive choices differed by setting according to results of the survey, FGD, and IDI. Regardless of country income level, determinants of contraceptive choices included ease of use, ease of access to a contraceptive method, and fewer side effects. Healthcare provider attitudes, availability of methods, and clinic schedules were important considerations. Most sex workers are aware of contraceptives, but barriers include male partners/clients, side effects, and health system factors such as access and clinic attitudes towards sex workers.

摘要

关于性工作者的避孕价值观和偏好的信息有限。我们进行了一项混合方法研究，以探讨性工作者的避孕价值观和偏好。我们对来自 38 个国家（n  = 239）的个人进行了在线调查，6 次焦点小组讨论（FGD，n = 68) 在津巴布韦，以及 2019 年 6 月和 7 月在世界 4 个地区进行的 12 次深度电话访谈 (IDI)。 参与者被问及避孕意识、他们过去使用的方法以及他们选择的决定因素. 研究了来自高收入、低收入和中等收入国家的受访者之间的差异。定性数据进行了专题分析。调查参与者报告了对现代避孕方法的认识。FGD 发现年轻女性的意识较低。无安全套性行为的报道很普遍，现代避孕药具的使用也不一致。避孕选择的决定因素因调查结果、FGD 和 IDI 的设置而异。无论国家收入水平如何，避孕选择的决定因素包括易用性、避孕方法的易用性和较少的副作用。医疗保健提供者的态度、方法的可用性和诊所时间表是重要的考虑因素。大多数性工作者都知道避孕药具，但障碍包括男性伴侣/客户、副作用和卫生系统因素，例如可及性和诊所对性工作者的态度。