Why do female sex workers disengage from targeted reproductive and sexual health services? Experiences from the Sisters with a Voice programme in Zimbabwe
Abstract Background The Sisters programme provides HIV and sexual and reproductive health services for female sex workers (FSW) in Zimbabwe. Many engage with these services only once, while others disengage after repeated visits. Little is known about reasons for disengagement and the extent of serv...
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2025-07-01
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| Online Access: | https://doi.org/10.1186/s12913-025-12870-y |
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| author | Fortunate Machingura Thomas Hartney Galven Maringwa Jasper Maguma Sikhululiwe Mkwananzi Rumbidzai Chipwere Tariro Chinozvina Primrose Matambanadzo Gracious Madimutsa Memory Makamba Jeffrey Dirawo M. Sanni Ali Sarah Bourdin Triantafyllos Pliakas Amon Mpofu Owen Mugurungi Brian Rice Andrew Phillips James R. Hargreaves Frances M. Cowan |
| author_facet | Fortunate Machingura Thomas Hartney Galven Maringwa Jasper Maguma Sikhululiwe Mkwananzi Rumbidzai Chipwere Tariro Chinozvina Primrose Matambanadzo Gracious Madimutsa Memory Makamba Jeffrey Dirawo M. Sanni Ali Sarah Bourdin Triantafyllos Pliakas Amon Mpofu Owen Mugurungi Brian Rice Andrew Phillips James R. Hargreaves Frances M. Cowan |
| author_sort | Fortunate Machingura |
| collection | DOAJ |
| description | Abstract Background The Sisters programme provides HIV and sexual and reproductive health services for female sex workers (FSW) in Zimbabwe. Many engage with these services only once, while others disengage after repeated visits. Little is known about reasons for disengagement and the extent of service needs after disengaging. Methods Programme staff used site- and age-stratified random sampling to identify 1,200 programme records of FSWs who attended one of four Sisters clinics at least once between January 2018 and June 2019, and had no evidence of a further visit before September 2020. Outreach workers attempted to contact these FSWs via home visits, phone tracing and contacting peer educators. We calculated the proportion of FSWs successfully contacted, the level of ongoing engagement in sex work, expressed unmet need for Sisters services and the proportion of FSWs who subsequently made a return visit to the programme. We explored sociodemographic factors associated with these outcomes. Results Of 1169 FSWs for whom contact was attempted, peer educators or others provided evidence in relation to 16 FSWs thought to have died. Of the 45% (504/1169) of FSWs who were successfully contacted, 37% (188/504) were no longer engaged in sex work, although 83% (156/188) reported that they were still in need of services. Reasons given for disengaging included having migrated (40%; 200/504); work commitments (16%; 79/504) and accessing services elsewhere (10%; 51/504). 62% of FSWs (313/504) said they were still active in sex work, among whom 23% (73/313) revisited the programme within 3 months of contact. FSWs living with HIV were less likely to re-engage with the programme (adjusted odds ratio 0.41, 95% CI 0.20–0.83). Age and site were associated with no longer being in sex work, while other factors showed no strong association. Conclusions These findings highlight the need for robust outreach and re-engagement strategies that accommodate the mobility and evolving circumstances of FSWs. In particular, programmes that promote peer-led, community-based microplanning—supported by integrated data management systems—can help address stigma, frequent relocation, and financial constraints that hinder continuous care. By tailoring services to both active and former FSWs, health systems can ensure that essential sexual and reproductive health services remain accessible, even when FSWs exit sex work. Such differentiated approaches ultimately strengthen continuity of care, reduce service gaps, and support broader public health goals by improving health equity and outcomes for this high-risk population. |
| format | Article |
| id | doaj-art-653b7d5f45e5449688cc97fa81daa2d8 |
| institution | Kabale University |
| issn | 1472-6963 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | BMC |
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| series | BMC Health Services Research |
| spelling | doaj-art-653b7d5f45e5449688cc97fa81daa2d82025-08-20T03:37:23ZengBMCBMC Health Services Research1472-69632025-07-0125111210.1186/s12913-025-12870-yWhy do female sex workers disengage from targeted reproductive and sexual health services? Experiences from the Sisters with a Voice programme in ZimbabweFortunate Machingura0Thomas Hartney1Galven Maringwa2Jasper Maguma3Sikhululiwe Mkwananzi4Rumbidzai Chipwere5Tariro Chinozvina6Primrose Matambanadzo7Gracious Madimutsa8Memory Makamba9Jeffrey Dirawo10M. Sanni Ali11Sarah Bourdin12Triantafyllos Pliakas13Amon Mpofu14Owen Mugurungi15Brian Rice16Andrew Phillips17James R. Hargreaves18Frances M. Cowan19Centre for Sexual Health and HIV/AIDS Research Zimbabwe (CeSHHAR Zimbabwe)London School of Hygiene and Tropical MedicineCentre for Sexual Health and HIV/AIDS Research Zimbabwe (CeSHHAR Zimbabwe)Centre for Sexual Health and HIV/AIDS Research Zimbabwe (CeSHHAR Zimbabwe)Centre for Sexual Health and HIV/AIDS Research Zimbabwe (CeSHHAR Zimbabwe)Centre for Sexual Health and HIV/AIDS Research Zimbabwe (CeSHHAR Zimbabwe)Centre for Sexual Health and HIV/AIDS Research Zimbabwe (CeSHHAR Zimbabwe)Centre for Sexual Health and HIV/AIDS Research Zimbabwe (CeSHHAR Zimbabwe)Centre for Sexual Health and HIV/AIDS Research Zimbabwe (CeSHHAR Zimbabwe)Centre for Sexual Health and HIV/AIDS Research Zimbabwe (CeSHHAR Zimbabwe)Centre for Sexual Health and HIV/AIDS Research Zimbabwe (CeSHHAR Zimbabwe)London School of Hygiene and Tropical MedicineLondon School of Hygiene and Tropical MedicineLondon School of Hygiene and Tropical MedicineNational AIDS CouncilMinistry of Health and Child CareUniversity of SheffieldUniversity College LondonLondon School of Hygiene and Tropical MedicineCentre for Sexual Health and HIV/AIDS Research Zimbabwe (CeSHHAR Zimbabwe)Abstract Background The Sisters programme provides HIV and sexual and reproductive health services for female sex workers (FSW) in Zimbabwe. Many engage with these services only once, while others disengage after repeated visits. Little is known about reasons for disengagement and the extent of service needs after disengaging. Methods Programme staff used site- and age-stratified random sampling to identify 1,200 programme records of FSWs who attended one of four Sisters clinics at least once between January 2018 and June 2019, and had no evidence of a further visit before September 2020. Outreach workers attempted to contact these FSWs via home visits, phone tracing and contacting peer educators. We calculated the proportion of FSWs successfully contacted, the level of ongoing engagement in sex work, expressed unmet need for Sisters services and the proportion of FSWs who subsequently made a return visit to the programme. We explored sociodemographic factors associated with these outcomes. Results Of 1169 FSWs for whom contact was attempted, peer educators or others provided evidence in relation to 16 FSWs thought to have died. Of the 45% (504/1169) of FSWs who were successfully contacted, 37% (188/504) were no longer engaged in sex work, although 83% (156/188) reported that they were still in need of services. Reasons given for disengaging included having migrated (40%; 200/504); work commitments (16%; 79/504) and accessing services elsewhere (10%; 51/504). 62% of FSWs (313/504) said they were still active in sex work, among whom 23% (73/313) revisited the programme within 3 months of contact. FSWs living with HIV were less likely to re-engage with the programme (adjusted odds ratio 0.41, 95% CI 0.20–0.83). Age and site were associated with no longer being in sex work, while other factors showed no strong association. Conclusions These findings highlight the need for robust outreach and re-engagement strategies that accommodate the mobility and evolving circumstances of FSWs. In particular, programmes that promote peer-led, community-based microplanning—supported by integrated data management systems—can help address stigma, frequent relocation, and financial constraints that hinder continuous care. By tailoring services to both active and former FSWs, health systems can ensure that essential sexual and reproductive health services remain accessible, even when FSWs exit sex work. Such differentiated approaches ultimately strengthen continuity of care, reduce service gaps, and support broader public health goals by improving health equity and outcomes for this high-risk population.https://doi.org/10.1186/s12913-025-12870-yPreventive health servicesSex workersReproductive health servicesSexual healthZimbabweHIV |
| spellingShingle | Fortunate Machingura Thomas Hartney Galven Maringwa Jasper Maguma Sikhululiwe Mkwananzi Rumbidzai Chipwere Tariro Chinozvina Primrose Matambanadzo Gracious Madimutsa Memory Makamba Jeffrey Dirawo M. Sanni Ali Sarah Bourdin Triantafyllos Pliakas Amon Mpofu Owen Mugurungi Brian Rice Andrew Phillips James R. Hargreaves Frances M. Cowan Why do female sex workers disengage from targeted reproductive and sexual health services? Experiences from the Sisters with a Voice programme in Zimbabwe BMC Health Services Research Preventive health services Sex workers Reproductive health services Sexual health Zimbabwe HIV |
| title | Why do female sex workers disengage from targeted reproductive and sexual health services? Experiences from the Sisters with a Voice programme in Zimbabwe |
| title_full | Why do female sex workers disengage from targeted reproductive and sexual health services? Experiences from the Sisters with a Voice programme in Zimbabwe |
| title_fullStr | Why do female sex workers disengage from targeted reproductive and sexual health services? Experiences from the Sisters with a Voice programme in Zimbabwe |
| title_full_unstemmed | Why do female sex workers disengage from targeted reproductive and sexual health services? Experiences from the Sisters with a Voice programme in Zimbabwe |
| title_short | Why do female sex workers disengage from targeted reproductive and sexual health services? Experiences from the Sisters with a Voice programme in Zimbabwe |
| title_sort | why do female sex workers disengage from targeted reproductive and sexual health services experiences from the sisters with a voice programme in zimbabwe |
| topic | Preventive health services Sex workers Reproductive health services Sexual health Zimbabwe HIV |
| url | https://doi.org/10.1186/s12913-025-12870-y |
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