Barriers to Equality in Healthcare Faced by Sex Workers: A Systematic Review

Background
Sex workers (SWs) are generally regarded as a vulnerable population which often suffer from poor health and unsuitable access to healthcare. This paper aims to understand barriers to healthcare faced by SWs in the UK and has therefore focused on ‘Western’ cultures.

 Methods
A search of PubMed, Embase, Web of Science and the International Journal of Equity in Health and reference/citation searches were conducted. The search focused on papers assessing barriers to healthcare experienced by SWs that met the following parameters: were published between 2015 and the present, focused on ‘Western’ cultures and were published in English. The barriers identified were classified using the Health Care Access Barriers (HCAB) Model and thematic analysis was then performed as described by Higginbottom et al.

 Results
The search identified 29 paper originating from 11 countries and assessed female sex workers (FSW), male sex workers (MSW) and transgender sex workers (TSW) from a range of sexualities, ethnicities and migrant status’. Overwhelmingly, the most frequently identified barrier was occupational stigma (OS). Poor professional practise, mistrust of healthcare professionals, structural barriers within healthcare, health illiteracy and fears associated with seeking healthcare were also identified.

Key messages

Based on this review, this paper concludes that focusing on anti-discrimination training targeted at healthcare professionals will hopefully encourage the delivery of high-quality care that maximises respect for autonomy and positive health outcomes for SWs.