Healthcare for sex workers—access, barriers, and needs

Stigma has a significant impact on the health of different societal groups and contributes to inequalities in healthcare. Sex work is associated with significant social stigma, which has detrimental effects on sex workers’ access to healthcare. This exploratory study gives first insights into the perspectives of sex workers and counselors in Germany on sex workers’ access, needs, and barriers with respect to healthcare. We focused on an established network of services for sex workers in Bochum.

We conducted in-depth guideline-based interviews with four counselors at centers that provide social and medical support for sex workers and three sex workers who use these services. Interviews were analyzed using qualitative content analysis.

The main barriers reported with respect to sex workers’ access to healthcare were health insurance, language barriers, bureaucracy, mobility, and discrimination. Sex work stigma within healthcare was reported to intersect with other forms of discrimination, such as racism. Specific needs and barriers were reported regarding mental health, which emerged as an important topic for sex workers. Free and anonymous healthcare offers were evaluated positively. Interviewees noted a lack of services that address the needs of sex workers beyond sexually transmitted infections, such as mental healthcare.

Several barriers to accessing healthcare remain for sex workers, many of which are particularly relevant for migrant sex workers from Eastern European countries. The development of additional antidiscriminatory healthcare services is necessary and should give priority to sex workers’ perspectives.