Medical Students’ Knowledge and Attitudes Toward Female Sex Workers and Their Occupational Risk Factors
Keywords:Students, Medical, Attitude of Health Personnel, Sex Workers, Social Determinants of Health, Reproductive Rights
Background: The tendency for female sex workers to seek health care is highly influenced by physician attitudes and behavior. By identifying medical students' attitudes toward female sex workers and assessing their knowledge of barriers to seeking care, we can focus medical training and advocacy efforts to increase access to care and improve public health outcomes. Methods: In this cross-sectional study, medical students from various countries were invited to participate in an online survey with close-ended questions and Likert scale statements. Responses were quantified and knowledge and attitude scores were assigned based on knowledge of barriers to seeking care and agreement with positive and negative attitude statements. Results: A total of 292 medical students from 56 countries completed the survey, of whom 98.3% agreed that it will be their job to provide treatment to patients regardless of occupation. Self-identified religious students conveyed more negative attitudes toward female sex workers compared to those who did not identify themselves as religious (p<0.001). Students intending to practice in countries where prostitution is legal conveyed more positive attitudes compared to those intending to practice in countries where prostitution is illegal (p<0.001). Conclusion: Medical students largely agreed on the importance of providing care to female sex workers as a vulnerable group. In addition to addressing knowledge gaps in medical education, more localized studies are needed to understand the religious and legal influences on attitudes toward female sex workers. Such information can help focus the efforts in both medical education and communication training to achieve the desired behavioral impacts, reconciling the future generations of health care providers with the needs of female sex workers.
2. Rusch ML, Brouwer KC, Lozada R, Strathdee SA, Magis-Rodriguez C, et al. Distribution of Sexually Transmitted Diseases and Risk Factors by Work Locations Among Female Sex Workers in Tijuana, Mexico. Sex Transm Dis. 2010 Oct;37(10):608-14.
3. Wolffers I, Van Beelen N. Public Health and the Human Rights of Sex Wor¬kers. Lancet. 2003 Jun 7;361(9373):1981.
4. Baldwin S, Eisenman DP, Sayles JN, Ryan G, Chuang KS. Identification of Human Trafficking Victims in Health Care Settings. Health Hum Rights. 2011 Jul 14;13(1):1-14.
5. Dovydaitis T. Human Trafficking: The Role of the Healthcare Provider. J Midwifery Womens Health. 2011 Sep-Oct; 55(5):462-7.
6. Zimmerman C, Hossain M, Yun K, Gajdadziev V, Guzun N, et al. The Health of Trafficked Women: A Survey of Women Entering Posttrafficking Services in Europe. Am J Public Health. 2008 Jan;98(1):55-59.
7. Baral S, Beyrer C, Muessig K, Poteat T, Wirtz AL, et al. Burden of HIV Among Female Sex Workers in Low-income and Middle-income Countries: A Systema¬tic Review and Meta-analysis. Lancet Infect Dis. 2012 Jul;12(7):538-49.
8. Ahmad K. Call for Decriminalization of Prostitution in Asia. Lancet. 2001 Aug 25;358(9282):643.
9. Gupta J, Raj A, Decker MR, Reed E, Silverman JG. HIV Vulnerabilities of Sex-trafficked Indian Women and Girls. Int J Gynaecol Obstet. 2009 Oct;107(1):30-4.
10. Lieber E, Li L, Wu Z, Rotheram-Borus MJ, Guan J. HIV/STD Stigmatization Fears as Health-Seeking Barriers in China. AIDS Behav. 2006 Sep;10(5):463-71.
11. Rosenheck R, Ngilangwa D, Manongi R, Kapiga S. Treatment-seeking Beha¬vior for Sexually Transmitted Infections in a High-risk Population. AIDS Care. 2010 Nov;22(11):1350-8.
12. Shannon K, Strathdee SA, Shoveller J, Rusch M, Kerr T, et al. Structural and Environmental Barriers to Condom Use Negotiation with Clients Among Female Sex Workers: Implications for HIV-Prevention Strategies and Policy. Am J Public Health. 2009 Apr;99(4):659-65.
13. Vijeyarasa R, Stein RA. HIV and Human Trafficking-Related Stigma: Health Interventions for Trafficked Populations. JAMA. 2010 Jul 21;304(3):344-5.
14. Wawer MJ, Podhisita C, Kanungsukkasem U, Pramualratana A, McNamara R. Origins and Working Conditions of Female Sex Workers in Urban Thailand: Consequences of Social Context for HIV Transmission. Soc Sci Med. 1996 Feb;42:453–62.
15. Sanders T. Protecting the Health and Safety of Female Sex Workers: The Responsibility of All. BJOG. 2007 Jul;114(7):791-3.
16. Mardh PA, Shoubnikova M, Genc M, Chaplinkas S, Unzeitig V. Health Care of Female Commercial Sex Workers. Eur J Contracept Reprod Health Care. 1999 Sep;4(3):165-80.
17. Rekart ML. Sex Work Harm Reduction. Lancet. 2005 Dec 17;336(9503):2123-34.
18. Goodyear M, Cusick L. Protection of Sex Workers. BMJ. 2007 Jan 13;334(7584):52-3.
19. Boynton P, Cusick L. Sex Workers to Pay the Price. BMJ. 2006 Jan 26;332(7535):190-1.
20. Phrasisombath K, Thomsen S, Hagberg J, Sychareun V, Faxelid E. Knowle¬dge About Sexually Transmitted Infections and Attitudes Toward Female Sex Workers with STI Symptoms Among Health Care Providers in Laos. Asia Pac J Public Health. 2012 Nov;24(6):940-52.
21. Phrasisombath K, Thomsen S, Sychareun V, Faxelid E. Care Seeking Beha¬viour and Barriers to Accessing Services for Sexually Transmitted Infections Among Female Sex Workers in Laos: A Cross-sectional Study. BMC Health Services Research. 2012 Feb 14;12:37.
22. Nuttbrock LA, Rosenblum A, Magura S, Villano C, Wallace J. Linking Fema¬le Sex Workers with Substance Abuse Treatment. J Subst Abuse Treat. 2004 Oct;27(3):233-9.
23. Alexander P. Key Issues in Sex Work-related HIV/AIDS/STD Prevention In¬terventions. AIDS Health Promotion Exchange; 1992;1:4-6.
24. DiClemente RJ, Crosby RA, Kegler MC. Emerging Theories in Health Pro¬motion, Practice and Research. John Wiley and Sons, Inc. Jossey-Bass: San Francisco. 2012.
25. Daaleman TP, Frey B. Spiritual and Religious Beliefs and Practices of Fami¬ly Physicians. J Fam Pract. 1999 Feb;48(2):98-104.
26. Beach MC, Meredith LS, Halpern J, Wells KB, Ford DE. Physician Concep¬tions of Responsibility to Individual Patients and Distributive Justice in Health Care. Ann Fam Med. 2005 Jan-Feb;3(1):53-9.
27. Jotkowitz AB, Glick S, Porath A. A Physician Charter on Medical Professio¬nalism: A Challenge for Medical Education. Euro J Int Med. 2004 Feb;15(1):5-9.
28. Ramalah KD, Vijay-Kumar KN, Hosein E, Krishnamoorthy P, Augustin DJ, et al. A Campaign of ‘Communication for Behavioural Impact’ to Improve Mass Drug Administrations Against Lymphatic Filariasis: Structure, Implementa¬tion, and Impact on People’s Knowledge and Treatment Coverage. Ann Trop Med Parasitol. 2006 Jun;100(4):345-61.
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