Facilitators and barriers to linkage to HIV care and treatment among female sex workers in a community-based HIV prevention intervention in Tanzania: A qualitative study

PLoS One. 2019 Nov 19;14(11):e0219032. doi: 10.1371/journal.pone.0219032. eCollection 2019.


Background: HIV-infected female sex workers (FSWs) have poor linkage to HIV care in sub-Sahara Africa.

Methods: We conducted 21 participatory group discussions (PGDs) to explore factors influencing linkage to HIV care among FSWs tested for HIV through a comprehensive community-based HIV prevention project in Tanzania.

Results: Influences on linkage to care were present at the system, societal and individual levels. System-level factors included unfriendly service delivery environment, including lengthy pre-enrolment sessions, concerns about confidentiality, stigmatising attitudes of health providers. Societal-level factors included myths and misconceptions about ART and stigma. On the individual level, most notable was fear of not being able to continue to have a livelihood if one's status were to be known. Facilitators were noted, including the availability of transport to services, friendly health care providers and peer-support referral and networks.

Conclusion: Findings of this study underscore the importance of peer-supported linkages to HIV care and the need for respectful, high-quality care.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Community Health Services
  • Female
  • Focus Groups
  • HIV Infections / diagnosis
  • HIV Infections / prevention & control*
  • HIV Infections / therapy
  • Health Personnel
  • Health Services Accessibility
  • Humans
  • Peer Group
  • Preventive Health Services
  • Qualitative Research
  • Sex Workers*
  • Social Stigma
  • Tanzania
  • Young Adult

Grants and funding

This study was funded by USAID under Cooperative Agreement No: AID-621-A-15-00003 to MW. However, the funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.