Barriers and facilitators to access and utilisation of public sexual healthcare services for home-based Female Sex Workers (FSW) in The Netherlands: a qualitative study

An ongoing shift from indoor sex work venues to home-based sex work has resulted in challenges in the provision of sexual healthcare services (SHS) for female sex workers (FSW), such as sexually transmitted infection (STI) testing. The study aimed to explore self-identified characteristics of the home-based FSW population and barriers and facilitators to access and utilise the STI clinic’s SHS. For this qualitative study, semi-structured in-depth interviews were conducted with 29 home-based FSW in the Netherlands and thematically analysed using a hybrid of inductive and deductive coding using Atlas.ti 8. Home-based FSW valued autonomy and financial benefits but faced societal stigma, with experiences varying across clients. Main barriers to accessing and utilising SHS were mistrust due to legal concerns and fear of repercussions from authorities, fear of STI test results and concerns about cost, confidentiality, and anonymity of SHS. Main facilitators were direct telephone contact and building trust with STI clinic nurses, and increasing awareness of available SHS. Results highlight the importance of understanding FSW’s lived experiences and creating a supportive environment at SHS providers by building trust and offering non-stigmatising SHS. Addressing the identified barriers and facilitators is essential to improve access to and utilisation of SHS by home-based FSW.