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Postgrad Med J doi:10.1136/postgradmedj-2012-131001
  • Original article

Suboptimal access to primary healthcare among street-based sex workers in southwest Switzerland

  1. Matthias Cavassini1
  1. 1Infectious Diseases Service, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
  2. 2Faculty of Biology and Medicine of the University of Lausanne, Switzerland
  3. 3Association Fleur de Pavé, Lausanne, Switzerland
  4. 4Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland
  5. 5Migrant Health Program, Department of Community Medicine and Primary Care, Geneva University Hospitals, Geneva, Switzerland
  1. Correspondence to Dr Katharine Darling, Infectious Diseases Service, Centre Hospitalier Universitaire Vaudois, Rue du Bugnon 46, Lausanne 1011, Switzerland; Katharine.Darling{at}chuv.ch
  • Received 12 April 2012
  • Accepted 13 October 2012
  • Published Online First 13 November 2012

Abstract

Objectives Street-based sex workers (SSWs) in Lausanne, Switzerland, are poorly characterised. We set out to quantify potential vulnerability factors in this population and to examine SSW healthcare use and unmet healthcare requirements.

Methods We conducted a cross-sectional questionnaire-based survey among SSWs working in Lausanne's red light district between 1 February and 31 July 2010, examining SSW socio-demographic characteristics and factors related to their healthcare.

Results We interviewed 50 SSWs (76% of those approached). A fifth conducted their interviews in French, the official language in Lausanne. 48 participants (96%) were migrants, of whom 33/48 (69%) held no residence permit. 22/50 (44%) had been educated beyond obligatory schooling. 28/50 (56%) had no health insurance. 18/50 (36%) had been victims of physical violence. While 36/50 (72%) had seen a doctor during the preceding 12 months, only 15/50 (30%) were aware of a free clinic for individuals without health insurance. Those unaware of free services consulted emergency departments or doctors outside Switzerland. Gynaecology, primary healthcare and dental services were most often listed as needed. Two individuals (of 50, 4%) disclosed positive HIV status; of the others, 24/48 (50%) had never had an HIV test.

Conclusions This vulnerable population comprises SSWs who, whether through mobility, insufficient education or language barriers, are unaware of services they are entitled to. With half the participants reporting no HIV testing, there is a need to enhance awareness of available facilities as well as to increase provision and uptake of HIV testing.