The stigma of sex work and associated health care services from the perspectives of sex workers, nurses, and nursing students in Hong Kong : the development of an intervention to reduce stigma towards sex workers among nurses

Abstract

Background: Timely and equal access to health is considered as a basic human right. Despite multiple healthcare needs and free sexual and reproductive health care services in Hong Kong, many sex workers remain reluctant to seek timely treatment. A synthesis of the relevant literature suggests that multiple barriers could hinder sex workers from accessing health care services, and the negative attitudes of healthcare providers are a major deterrent to sex workers in accessing health care services. However, there has been no study focusing on the experiences of sex workers with accessing health care services in Hong Kong. Also, there is little understanding of the perceptions of nurses and nursing students in of their role in providing non­discriminatory care to sex workers. Aims: The study aimed to explore the stigma of sex work and associated health care services from the perspectives of sex workers, nurses, and nursing students in Hong Kong, and to develop an intervention to reduce stigma towards sex workers among nurses. Methods: A series of studies were conducted to identity the stigma of sex work and associated health care services from the perspectives of sex workers, nurses, and nursing students. It contained three components: 1) semi-structured focus group discussions with nurses; 2) semi-structured individual interviews with female sex workers (FSWs); 3) a cross-sectional survey among undergraduate nursing students. Based on the review of the literature and the local evidence, the Medical Research Council (MRC) framework guided the development of a preliminary conceptual framework and a complex intervention to reduce stigma towards sex workers among nurses in Hong Kong. Results: Overall, the female sex workers could access to the health care services in Hong Kong. However, stigma remains the key barrier to their seeking timely professional help, fully disclosing their secret of being involved in sex work, and receiving comprehensive health care services. Meanwhile, given that sex-related topics are still a taboo in Chinese communities, the health needs and stigmatization of sex workers are not topics that have been included in nursing education and clinical practices in Hong Kong. The findings from qualitative interview study of 36 nurses and a cross-sectional study of 317 nursing students suggest that nurses and nursing students have insufficient knowledge or are misinformed about sex workers and the sex industry, and hold prejudicial attitudes toward sex workers. But they will comply with the professional code of ethics in providing care to patients whom they suspect to be sex workers. Conclusion: This study contributes to a better understanding of the stigma of sex work and associated health care services in Hong Kong. Nurses and nursing students held strong, but ambivalent, personal attitudes toward sex workers. This study also contributes to increasing awareness of, and respect for, the human right of FSWs to receive non-discriminatory health services. Reducing sex work-related stigma among healthcare providers, including nursing professionals and students, is critical to addressing health disparities between sex workers and the general population.