Resumen de Hiv testing among eastern european migrant female sex workers: experiences from countrv of oriqin (ukraine) and countrv of destination (the netherlands)
Earlier HIV diagnosis continues to be a public health priority in the European Union, especially among populations facing overlapping vulnerabilities and multiplying stigmas (e.g. migrants, sex workers, people who use drugs, and men who have sex with men). Since 1991, after the Soviet Union dissolution, increased numbers of male and female sex workers, from Central and Eastern European countries were reported in many European Union member states. Further expansion of the European Union might coincide with growths of migration flows from Eastern Europe to Western Europe.
The aim of this study was to 'unpack' context-specific vulnerabilities of migrant female sex workers from Eastern European, non-EU countries (namely, Belarus, Moldava, Russia and Ukraine), and to describe whether and how these affect access to health services, including access to HIV testing in the Netherlands.
The research took place in two different European settings: a country of origin (Ukraine) and a country of destination (the Netherlands).
In this thesis, I employed both qualitative and quantitative methods. To answer the different research questions, I conducted five studies. I started with a systematic literature review (study 1/ chapter 4), which facilitated further development of the research design. The context of the country of origin (Ukraine) was assessed on the basis of an integrated bio-behavioural survey (IBBS, 2013-2014) among female sex workers in the country (study 2/Chapter 5) and policy gap analysis (study 3/Chapter 6). To examine barriers and facilitators of HIV testing among Eastern European, nonEU female sex workers in the context of the destination country (Amsterdam, the Netherlands) a qualitative study was conducted among key stakeholders (study 4/Chapter 7). I also summarized ethical and methodological considerations when conducting research among migrant female sex workers using the experiences gained in study 4 (Chapter 8).
Overall, HIV testing remains insufficient among EE, non-EU fema le sex workers, both in the country of origin and in the country of destination. It is essential to facilitate HIV testing in this group across both contexts as Eastern Europe and Central Asia remains the only region in the world where HIV incidence continues to rise, with an alarming increase of 60% between 2010 and 2016. Macro-level factors, including, sex work, migration and HIV testing and treatment policies, shape local contexts, define priorities for local healthcare programs and allocation of financia! resources, fuel sex worker-and HIV-associated stigma, influence trust and affect health-seeking of heafthcare services in both countries. On the contrary, social support of peers, manager, family and friends is a main facilitator of HIV testing among migrant women. Our findings also highlight the importance of a self-testing approach.
Key words HIV, HIV testing, female sex workers (FSWs), migration, Eastern Europeans, Ukraine, Netherlands behaviour of women. These factors should, thus, be seen as key barriers to utilization
