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      Barriers to health service access among female migrant Ugandan sex workers in Guangzhou, China

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          Abstract

          Background

          Increased trade between China and Uganda has fueled trafficking of female Ugandans into China. These women may face challenges accessing health services. This study focused on examining barriers to health care access among female Ugandan sex workers in China.

          Methods

          In 2014, we undertook in-depth interviews with 19 female Ugandan sex workers in Guangzhou, China. Interviews focused on barriers to health service access and were analyzed using an a priori coding framework followed by open-coding to capture emergent themes.

          Results

          Out of 19 women, 12 women reported a history of being trafficked into China. None of the women had a valid Chinese visa. Fear of being arrested for lack of documentation discouraged women in this sample from accessing hospital services. Low pay, housing exploitation, and remittances contributed to participants’ lack of financial resources, which further inhibited their ability to access health services. Participants expressed feeling social isolation from the local community and reported mistrust of local individuals and organizations, including hospitals.

          Conclusion

          Ugandan sex workers in China faced substantial structural barriers that limited health service access. Policy changes and the development of new programs are urgently needed to ensure these women have improved access to health services.

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          Most cited references22

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          Organizational characteristics of HIV/syphilis testing services for men who have sex with men in South China: a social entrepreneurship analysis and implications for creating sustainable service models

          Background UNAIDS has called for greater HIV/syphilis testing worldwide just as local HIV/syphilis testing programs are cut or altered. New models are needed to make HIV/syphilis testing services sustainable while retaining their essential public health function. Social entrepreneurship, using business principles to promote a social cause, provides a framework to pilot programs that sustainably expand testing. Drawing on fieldwork in two South Chinese cities, we examined organizational and financial characteristics of current HIV/syphilis testing systems for men who have sex with men (MSM) in addition to new pilot programs focused on revenue-generation for sustainability. Methods We undertook a qualitative study to explore organizational and financial characteristics of HIV/syphilis testing for MSM. Data were collected from men who have sex with men and policy stakeholders in Guangzhou and Hong Kong. Framework analysis was used to identify themes and then code the data. Results Our qualitative research study included MSM and policy stakeholders (n = 84). HIV/syphilis testing services were implemented at a wide range of organizations which we grouped broadly as independent community-based organizations (CBOs), independent clinics, and hybrid CBO-clinic sites. From an organizational perspective, hybrid CBO-clinic sites offered the inclusive environment of an MSM CBO linked to the technical capacity and trained staff of a clinic. From a financial perspective, stakeholders expressed concern about the sustainability and effectiveness of sexual health services reliant on external funding. We identified four hybrid CBO-clinic organizations that launched pilot testing programs in order to generate revenue while expanding HIV testing. Conclusion Many MSM CBOs are searching for new organizational models to account for decreased external support. Hybrid CBO-clinic organizations create a strong foundation to increase HIV/syphilis testing using social entrepreneurship models in China. Electronic supplementary material The online version of this article (doi:10.1186/s12879-014-0601-5) contains supplementary material, which is available to authorized users.
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            Social Entrepreneurship for Sexual Health (SESH): A New Approach for Enabling Delivery of Sexual Health Services among Most-at-Risk Populations

            Joseph Tucker and colleagues argue for social entrepreneurship, a new approach to help improve delivery of sexual health services.
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              Incarcerated sex workers and HIV prevention in China: social suffering and social justice countermeasures.

              Sex workers in China are routinely coercively detained through administrative mechanisms outside of legal procedures, but very little is known about the anthropologic and public health context of these policies. This biosocial analysis of female Chinese sex worker detention uses ethnographic, legal, and public health data to describe social suffering and countervailing social justice responses among incarcerated sex workers (ISW) in China. Compared to sex workers not detained in China, ISW face substantive inequalities inscribed in physical and psychological suffering. Chinese sex worker detention camp practices may not only systematically increase HIV/syphilis risk among ISW, but also work to narrow women's social spheres of influence, a particularly cruel tragedy in a Chinese social system that highly values social and personal connections. A limited empiric analysis of Guangxi Province STI clinic data shows that cities detaining sex workers have higher mean HIV prevalence compared to cities that do not detain sex workers. While incipient medical and legal movements in China have generated momentum for expanding ISW services and resources, there is still substantial variation in the implementation of laws that ensure basic life-saving medical treatments. Post-incarceration social justice programs for sex workers linking women to essential STI/HIV resources, reconnecting broken social lives, and helping restore interpersonal relationships are urgently needed.
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                Author and article information

                Contributors
                646-774-6964 , ad3324@cumc.columbia.edu
                812-855-3627 , bmeyerso@indiana.edu
                919-962-8331 , aghaulor@email.unc.edu
                415-476-5192 , BrownK@obgyn.ucsf.edu
                +86-020-8725-5824 , redoakhope@gmail.com
                919-962-5059 , kate_muessig@med.unc.edu
                +86-020-8725-5824 , yanglg3@hotmail.com
                +86-1356-029-4997 , jdtucker@med.unc.edu
                Journal
                Int J Equity Health
                Int J Equity Health
                International Journal for Equity in Health
                BioMed Central (London )
                1475-9276
                14 October 2016
                14 October 2016
                2016
                : 15
                : 170
                Affiliations
                [1 ]HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality & Health, Columbia University and the New York State Psychiatric Institute, 1051 Riverside Dr, Unit 15, New York, NY 10032 USA
                [2 ]UNC-Project China, 2 Lujing Road, Guangzhou, China
                [3 ]Department of Applied Health Science, Indiana University School of Public Health-Bloomington, 1025 E 7th St. Rm PH116, Bloomington, IN 47405 USA
                [4 ]Rural Center for AIDS/STD Prevention, Indiana University School of Public Health-Bloomington, Bloomington, USA
                [5 ]School of Medicine, University of North Carolina-Chapel Hill, 321 S Columbia Street, Chapel Hill, NC 27516 USA
                [6 ]Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California-San Francisco, 505 Parnassus Avenue, Rm. 1483, San Francisco, CA 94143 USA
                [7 ]Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, 306 Rosenau, Campus Box 7440, Chapel Hill, NC 27599 USA
                [8 ]Guangdong Provincial STD Control Center, 2 Lujing Road, 11th Floor, Guangzhou, 510095 China
                Article
                453
                10.1186/s12939-016-0453-2
                5064915
                27741947
                f190bacc-acf7-46be-a54e-514faa3fcb42
                © The Author(s). 2016

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 25 May 2016
                : 26 September 2016
                Funding
                Funded by: FundRef http://dx.doi.org/http://dx.doi.org/10.13039/100000061, Fogarty International Center;
                Award ID: R25TW009340
                Funded by: FundRef http://dx.doi.org/10.13039/100000060, National Institute of Allergy and Infectious Diseases;
                Award ID: R01AI114310
                Award Recipient :
                Funded by: University of North Carolina CFAR
                Award ID: P30-AI50410
                Funded by: FundRef http://dx.doi.org/http://dx.doi.org/10.13039/100000025, National Institute of Mental Health;
                Award ID: T32MH019139
                Funded by: FundRef http://dx.doi.org/10.13039/100000873, Andrew W. Mellon Foundation;
                Categories
                Research
                Custom metadata
                © The Author(s) 2016

                Health & Social care
                health care access,female sex workers,migrants,china,uganda
                Health & Social care
                health care access, female sex workers, migrants, china, uganda

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