“ My condition is my secret”: perspectives of HIV positive female sex workers on differentiated service delivery models in Kampala Uganda

Abstract

Background: Differentiated service delivery (DSD) models for female sex workers (FSWs) continue to be scaled up with the goal of expanding access to HIV services and treatment continuity. However, little is known about FSWs’ perspectives on their preferences, facilitators, and barriers to the effective utilization of various DSD models. Methods: We conducted 24 in-depth interviews among FSWs on antiretroviral therapy for at least one year in two drop-in centres and two public health facilities in Kampala, Uganda in January 2021. Results: The facility-based individual management model was most preferred, due to a wide array of comprehensive health services, privacy, and professional health workers. Community DSD models were physically accessible, but least preferred due to stigmatization and discrimination, lack of privacy and confidentiality, and limited health services offered. Conclusion: Targeted strategies to reduce stigma and discrimination and the provision of high-quality services have potential to optimise FSWs’ access to HIV services.