ArticleReproductive health2019
Antenatal care presentation and engagement in the context of sex work: exploring barriers to care for sex worker mothers in South Africa.
Article in Reproductive health, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers.
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Who cites it
14 citing papers in PubMed, 19 citations in OpenAlex.
- Health inequities faced by sex workers.The Lancet. Public health · 2026Review
- Maternal Health of Female Sex Workers in Six Low- and Middle-Income Countries.International journal of women's health · 2026Article
- Uptake and Timing of Viral Load Testing and Frequency of Viraemic Episodes During Pregnancy in South Africa.HIV/AIDS (Auckland, N.Z.) · 2026Article
- Causes of death among young children of female sex workers in three sub-Saharan African countries: a cross-sectional exploratory investigation.Frontiers in public health · 2025Article
- Reproductive healthcare utilization for women in the sex trade: a qualitative study.Israel journal of health policy research · 2024Article
- Article
- Care and support during maternity for mothers affected by modern slavery: A scoping review.International journal of nursing studies advances · 2023Article
- Impact and cost-effectiveness of the national scale-up of HIV pre-exposure prophylaxis among female sex workers in South Africa: a modelling analysis.Journal of the International AIDS Society · 2023Article
- Causes of mortality among female sex workers: Results of a multi-country study.EClinicalMedicine · 2022Article
- Article
- Barriers and facilitators for access and utilization of reproductive and sexual health services among Female Sex Workers in urban and rural Maharashtra, India.Frontiers in public health · 2022Article
- Women Who Sell Sex in Eastern and Southern Africa: A Scoping Review of Non-Barrier Contraception, Pregnancy and Abortion.Public health reviews · 2022Article
- Effective integration of sexual reproductive health and HIV prevention, treatment, and care services across sub-Saharan Africa: where is the evidence for program implementation?Reproductive health · 2019Article
- Maternal health and maternal health service utilization among female sex workers: A scoping review.Women's health (London, England)Article
Corrections and comments
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Authors and funding
10 authors at 4 institutions in 2 countries.
Funding
Abstract
backgroundLate presentation combined with limited engagement in antenatal care (ANC) increases risk of vertical transmission among mothers living with HIV. Female sex workers (FSW) have more than four times greater burden of HIV than other women of reproductive age in South Africa and the majority of FSW are mothers. For mothers who sell sex and are at increased HIV acquisition risk, timely and routine ANC seeking is especially vital for prevention of vertical transmission. This study represents a mixed-methods study with FSW in Port Elizabeth, South Africa, to characterize factors influencing ANC seeking behaviors in a high HIV prevalence context.
methodsFSW (n = 410) were recruited into a cross-sectional study through respondent-driven sampling between October 2014 and April 2015 and tested for HIV and pregnancy. A sub-sample of pregnant and postpartum women (n = 30) were invited to participate in in-depth interviews (IDIs) to explore their current or most recent pregnancy experiences. IDIs were coded using a modified grounded theory approach and descriptive analyses assessed the frequency of themes explored in the qualitative analysis among the quantitative sample.
resultsIn the quantitative survey, 77% of FSW were mothers (313/410); of these, two-thirds were living with HIV (212/313) and 40% reported being on antiretroviral therapy (ART) (84/212). FSW in the qualitative sub-sample reported unintended pregnancies with clients due to inconsistent contraceptive use; many reported discovering their unintended pregnancies between 4 and 7 months of gestation. FSW attributed delayed ANC seeking and ART initiation in the second or third trimesters to late pregnancy detection. Other factors limiting engagement in ANC included substance and alcohol use and discontent with previous healthcare-related experiences.
conclusionsLate pregnancy discovery, primarily because pregnancies were unplanned, contributed to late ANC presentation and delayed ART initiation, increasing risks of vertical HIV transmission. Given limited ART coverage among participants, addressing the broader sexual and reproductive health and rights needs of mothers who sell sex has important implications for preventing vertical transmission of HIV. Integrating comprehensive family planning services into FSW programming, as well as providing active linkage to ANC services may reduce barriers to accessing timely ANC, decreasing risks of vertical transmission.
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