Female sex workers FSWs are disproportionately affected by the epidemic. However, to date little work has been done with FSWs in Zambia, and little is known about barriers and facilitators to HIV testing in this population. Emerging themes demonstrated barriers and facilitators to HIV testing occurring at multiple levels, including individual, social network, and structural. Stigma and discrimination, including healthcare provider stigma, were a particularly salient barrier.
Improving knowledge, social support, and acknowledgment of FSWs and women's role in society emerged as facilitators to testing. Interventions to improve HIV testing among FSWs in Zambia will need to address barriers and facilitators at multiple levels to be maximally effective.
FSWs face multilevel barriers to accessing healthcare services, which can limit HIV testing coverage. Diverse barriers to accessing HIV testing have been noted, such as criminalization of sex work, healthcare provider stigma, distance or time required to go to a clinic, and fear of testing.
Stigma can be experienced as enacted explicit actions against an individual , perceived such as the expectation that enacted stigma will occur , or internalized or self-stigma the internalization of enacted and perceived stigma that results in negative attitudes about the self.
Correspondingly, HIV prevalence is thought to be higher among Zambian FSWs than among the general population, but limited evidence exists. Primary reasons for not testing for HIV were reported to be anticipated fear related to testing and not wanting to know status. Further, the lack of sex worker organizations currently operating in Zambia means that there is little advocacy for development of competent care for this population. The aim of this formative research was to gain a more in-depth understanding of perceived barriers and facilitators of HIV testing among FSWs.
