An explorative qualitative study of barriers to the use of health and mental health services among migrant female sex workers in Germany and needs for action.

BACKGROUND

Migrant female sex workers (MFSWs) can be exposed to various health risks due to their occupation, including mental and physical health, substance use, and experience of violence. However, they face substantial barriers to accessing healthcare services. The inadequate access to medical care for migrant female sex workers poses a challenge to the German healthcare system.

RESEARCH AIMS: This qualitative study aimed to identify and analyze the barriers to the use of health and mental health services by migrant female sex workers in Berlin and what should be done to improve the access to healthcare and to make it easier to use health and mental health services for migrant female sex workers. The data collected can be used to derive overarching recommendations and strategies for action.

METHODS

Semi-structured, guided interviews were conducted with 10 migrant female sex workers in Berlin, Germany. The interviews were audio recorded, and the content of the transcribed interviews was analyzed. A structuring qualitative content analysis, according to Kuckartz, with deductive-inductive category formation was conducted in MAXQDA 2022.

RESULTS

Barriers were analyzed at three levels: patient, provider, and system. The patient level was related to the patient characteristics: social structure variables, health beliefs and attitudes, personal enabling resources, community enabling resources, perceived illness, and personal health practices. The provider level was related to the provider characteristics: skills and attitudes. The system level was related to the system characteristics: the organization of the healthcare system on local and national levels. Moreover, needs for actions were identified, which can be used for deriving recommendations for the improvement of healthcare situation of migrant sex workers living in Berlin.

CONCLUSION/DISCUSSION: Health services and future intervention studies should consider barriers identified in this study to improve the health services utilization and health of sex workers as part of the effort to protect the right of humans to health.