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Bronfenbrenner U. But in the Netherlands, Prostitutes Tokar was much stricter and doctors all follow the same protocol. Eleven Prostitutes Tokar reported how limited healthcare funding decreased HIV testing [ 192024263236414850 — 52 ].

At leastno one else. And in our country they understand our language…it is easier. Moreover, one woman reported that the absence of out-of-pocket payments and ability to choose your doctor reduces her trust in Dutch health care. In Ukraine, paying high out-of -pocket fees made her comfortable as it gave her a feeling of control Prostitutes Tokar the situation Prostitutes Tokar well as the assurance that she has chosen the best doctor which correlated with high costs.

It was also possible to go to another doctor if she was not satisfied with the first one. But in the Netherlands, it was much stricter and doctors all follow the same protocol. You know they [Dutch health workers] will always give you here paracetamolif you have pain in the knee or something Prostitutes Tokarthey give paracetamol.

Issues of the stigma attached to sex workers and migrants were mentioned by most participants. For example, Prostitutes Tokar participant said that nowadays even Prostitutes Tokar sex workers prefer not to go to a family doctor because of the persistent social stigma facing sex workers.

Moreover, some participants connected greater stigma with perceptions in Dutch society, partly formed by Prostitutes Tokar dominant media discourse that the majority of sex Prostitutes Tokar are non-Dutch citizens, and victims of trafficking, who were coerced into sex work, and that their experience is horrific:.

Soyou must have had a lot of adventures and met so many interesting people! You Prostitutes Tokar have seen a lot of horrible things! It must have been really terrible! How did you end up there? Director, activist. Thus, sex workers prefer to hide their identity or to go to specialized clinics, where they will not be treated as victims.

Topics of the victimization of sex workers and placing all migrant sex workers under Prostitutes Tokar of having been Prostitutes Tokar are major issues for sex workers, as they are not allowed to self-identify. Thus, in most cases even when women do not recognize themselves as victims, they would be seen as such according Prostitutes Tokar the law and the way this law is interpreted and applied in practice:.

If they tell me stories like Prostitutes Tokarsomebody paid half-price for the ticketsomebody arranged this Prostitutes Tokaror hotel or half-price of it. And how do they get the money from your sexual services? Sosomebody is profiting from your work and do you know what the debt is? Who will pay extra money for such dirty stinkers? I am not a dirty stinkerI am not like themand they are infected and ill. All women interviewed as well as some stakeholders talked about the time and transport costs as a potential barrier to accessing HIV testing:.

If you do not have an appointment you will not get medical services … And if you have your appointment at Once I was in a traffic jamI was eight Prostitutes Tokar late and they did not let me have my appointment. Moreover, one stakeholder described a pilot project where a self-testing approach was used.

Although there were some concerns regarding the link to treatment and HIV care, the ability to pay for self-testing kits, and possible misuse or misinterpretation of test results, some individuals appreciated this approach as it was fast, easy to perform and could be done without involving anyone else. This is often associated with a trend in which policy and law in relation to prostitution become increasingly strict and therefore have increasingly repressive effects on non-legal migrant female sex workers from Prostitutes Tokar, non-EU countries.

For example, one of the social nurses experienced the separation between legal and non-legal prostitution as a barrier to doing Prostitutes Tokar work:. I feel that the non-legal sector is much Prostitutes Tokar easy to access than the legal sector. Soif the non-legal sector becomes legalit would be much easier to access them [sex workers].

Prostitution will always existno matter if it is legal or non-legalbut the accessibility for healthcare providers becomes less if it is non-legal. One participant questioned a definition of the voluntary nature of sex work and thought that many legal sex workers do not voluntarily choose this work, while the government pretends that they have freely chosen to be a sex worker:. It is suggested that exploitation of women [who are SWs] can be eradicated if you only allow sex workers to work when they have self-chosen for prostitution.

Howeverthese measures are not solving Prostitutes Tokar believe that if a person wants to sell his or her own bodysome kind of damage has probably occurred in the past.

Sowhat is being meant with self-chosen prostitution? Healthcare provider. For example, the programme manager prostitution stated that this combination is not always easy to apply:. Prostitutes Tokar a situation where a healthcare providerwho has a confidential relationship Prostitutes Tokar a sex workeris confronted Prostitutes Tokar human trafficking of that sex workerthe connection with the police needs to be made.

Howeverthis would damage the confidential relationship with that sex worker; we do not want that. Programme manager prostitution. The physician pointed to the discouraging effects of the municipal prostitution policy to focus on non-legal migrant female sex workers from EE, Prostitutes Tokar countries:.

If you are not being supported Prostitutes Tokar your own municipalityit feels like a barrier to focus our efforts more Prostitutes Tokar non-legal sex workers … that is actually really weird from a public health perspective. However, the allocation of financial resources also determined the focus of the municipal health services:. Our core business is the legal sector because that is being financed. Although human rights aspects, such as universal access to comprehensive prevention programmes, treatment, care and support, constitute a fundamental principle and were introduced in the Netherlands long ago, some stakeholders as well as all female sex workers interviewed had fragmented knowledge about whether and how ART treatment would be Prostitutes Tokar for non-EU female sex workers.

To address this issue, one NGO has developed various educational materials and training aimed at health professionals. One NGO Prostitutes Tokar described a specific case of a Ukrainian woman who was pregnant and was diagnosed HIV-positive, and all the difficulties they faced in helping her with beginning ART, as she also had other health problems, which involved additional costs to cover the necessary analysis, tests, and visits to health specialists.

Even though the NGO managed to provide some support, which took several months of hard work, at some point the woman returned to Ukraine:. She could access [treatment] as an exceptional casewe did itwe found a specialist Prostitutes Tokar, because she needed more than just ART.

We heard from her mother […] the grandmother of the childthat she moved to Israel for work. Director, NGO. This paper sought to examine the context-specific vulnerabilities of non-EU migrant female sex workers and to describe their experiences and perceptions of existing HIV testing services in Amsterdam.

In summary, the analysis highlights six barriers to HIV testing most Prostitutes Tokar reported by research participants: 1 migration Prostitutes Tokar sex-work policies; 2 stigma, including self-stigmatization; 3 lack of trust in healthcare providers or social workers; 4 Prostitutes Tokar levels of Dutch or English languages; 5 negative experience in accessing healthcare services in the home country; and 6 low perceived risk and HIV-related knowledge. Having a family and children, social support and working at the licensed sex-work venues could facilitate HIV testing among migrant female sex workers in Amsterdam.

Moreover, this research adds the voices of EE, non-EU women involved in escort services, which often remain inaudible to research, health providers Prostitutes Tokar the public [ 1 ]. Despite the fact that sex work is legalized in the Prostitutes Tokar, migrant non-EU female sex workers are not eligible to apply for a work permit to be employed as sex workers [ 7 ]. Moreover, the contradictory tasks Prostitutes Tokar government organizations, which involve a combination of providing health care and various control measures, may further limit the accessibility of health services for migrant female sex workers.

It does, however, raise a number of concerns: 1 high administrative costs needed to cover regular check-ups of licensed sex-work venues; 2 poor quality of health services provided onsite, lack of confidentiality and insensitive treatment of sex workers; and 3 not being effective for unlicensed sex-work venues [ 28 ]. Moreover, there are sound arguments against formally involving governments in the organization of sex work through licensing or registration [ 40 ].

On the other hand, the decriminalization of sex work may bring the greatest benefit to sex workers and broader community, provided that effective laws against sexual abuse, exploitation, coercion Prostitutes Tokar trafficking of minors and adults are in place [ 28 Prostitutes Tokar. While working at a licensed sex-work venue could promote the uptake of health services, including HIV testing, unlicensed venues such as online escort agencies may impede it.

This should be considered as dual process: from one perspective, the unlicensed sector is difficult to reach and is not considered to be a priority for local healthcare providers as there Prostitutes Tokar no rigorous data proving that there is such a need. From a Prostitutes Tokar perspective, sex workers in the unlicensed sector may avoid any contact with officialdom, including health workers. Local health facilities employ the paradigm of licensed windows, and brothels located in a specific Prostitutes Tokar, like the Red Light districts.

So, they can enumerate all the venues, ask for their registration number from the City Council and then, safeguarded by the sex-work policy, knock on their door to gain physical Prostitutes Tokar to sex workers. Prostitutes Tokar, very little attention is paid to the online sex-work agencies and individuals working without a license.

Prostitutes Tokar may be the consequence of a municipal prostitution Prostitutes Tokar and allocation of resources, but also of the absence of rigorous evidence regarding size of the Prostitutes Tokar sex-work sector, including online-based sex work, Prostitutes Tokar the difficulty in reaching female sex workers using the internet.

There is limited evidence on how migrant sex work operates through numerous online platforms and social media [ 1 ], although this form of sex work is likely to increase in the future.

Consequently, unlicensed sex-work spaces fell below the radar as they were classified as criminalized forms that cannot be incorporated with a legal framework. We call for a broader understanding of sex-work identities, practices and lived experiences, suggesting that any Prostitutes Tokar female sex worker could combine multiple geographies of sex work based on migration status, legal definition of sex-work space, licensing system, continuity and regularity of engagement in sex work throughout her life.

This study also highlights that having a relationship of trust with healthcare providers can facilitate HIV testing. In addition, we observed how trust is related to other factors e.

The building of trust can be described as both a process in the establishment of a caring relationship between the healthcare provider and the patient and an outcome of that relationship[ 41 ].

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This involves the ability to relate to each other and to be mutually interested in having a meaningful social Prostitutes Tokar 4243 ]. In addition, profound knowledge of the culture of internet-based sex workers, including their self-definitions, may play a crucial role in designing strategies which aim to build trusting relationships with these sex workers.

We have described experiences of internet-based escort-agency female sex workers, who travelled as tourists across several EU countries, and women who had valid residence and work permit and worked in a club. In both cases, however, women preferred not to report their sex work to doctors, friends, neighbours and their family.

In line with previous studies, we found that the stigma associated with sex work, including self-stigmatization and HIV- and AIDS-related stigma, is a barrier to accessing health services, including HIV testing. We suggest considering both sex work and HIV- and AIDS-related stigma not as Prostitutes Tokar matter of Prostitutes Tokar processes, experiences or perceptions, but rather as a social process linked to power, inequality and exclusion [ 4445 ].

So, in order to combat stigma, we have to think about Prostitutes Tokar and environmental interventions aimed at transforming the local contexts in which migrant sex workers face double or even triple stigma.

While community mobilization, empowerment, advocacy, and a rights-based approach were among most common strategies used to address sex work and HIV- and AIDS-related stigmas and promote the uptake of services [ 46 — 48 ], it is not clear if the same strategies would be as effective with highly mobile migrant sex workers. Nevertheless, we believe that existing local networks, unions and community-led organizations of sex workers in their home countries, especially in Prostitutes Tokar of circular migration of EE, non-EU migrant female sex workers across multiple EU Prostitutes Tokar, might serve Prostitutes Tokar a potential bridge between women and health professionals in destination countries.

Moreover, networks, unions and organizations of sex workers, as well as organizations representing migrant sex workers, Prostitutes Tokar be included in the policy process regarding sex work, migration and trafficking issues. Similar to the results reported in Prostitutes Tokar literature, we observed that the social support of Prostitutes Tokar, family, friends and escort agency owners Prostitutes Tokar assist women in accessing health services [ 4649 — 56 ].

Moreover, self-medication and travelling back to their home country were most common health-seeking strategies. These involve questions of language, Prostitutes Tokar and perceived control over the situation, which should be explored in future studies.

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In this situation, we suggest considering self-testing [ 5160 ] and promoting it online in close cooperation with EE sex-work activists, Prostitutes Tokar and networks, in ways that are consistent with cultural traditions. Thus, future research should address factors mediating access to health services across different stages of the migration cycles Prostitutes Tokar EE, non-EU migrant female sex workers.

As with all studies that collect self-reported data, there was a risk of respondents giving socially desirable answers. In order to minimize this risk, taking account of the sensitivity of the research topic, we reassured all participants that any information they provide would remain confidential; if participants preferred, their Prostitutes Tokar was not recorded. A major limitation is the small number of migrant female sex workers interviewed.

Even though we cooperated with local NGOs, we could obtain access only women living and working legally in Amsterdam. Prostitutes Tokar, we had to contact an escort agency and gain its trust, which was a slow and time-consuming process. Due to the small number of migrant female sex workers interviewed, we are uncertain whether data saturation Prostitutes Tokar been realized. In this respect, we mean simply the ability to speak and understand Russian, and refer to the shared history of the Soviet Union.

We call for scaling up outreach interventions that focus on female sex workers and migrant female sex workers working online, who remain an invisible part of the sex-work industry. Having Prostitutes Tokar of trust with women sex workers, and providing social support, may facilitate HIV testing among migrants. In this regard, Prostitutes Tokar is important that networks, unions and organizations of sex workers and migrant sex workers play a fundamental role in the formulation of sex work and migration policies as well as programme delivery.

Future studies may usefully examine new sex-work geographies among EE, non-EU migrant sex workers. We are grateful to the people who participated for sharing their stories.

We are thankful to Mrs Deborah Eade for English language editing. We are thankful to Maria Roura for supporting the idea of Prostitutes Tokar study. Browse Subject Areas? Click through the PLOS taxonomy to find articles in your field.

Abstract Historically, the Netherlands has hosted a large number of migrant sex Prostitutes Tokar. Download: PPT. Phase 3: Finding ways forward. Results Context of sex work among EE, non-EU migrant women in Amsterdam Overall, most of the Prostitutes Tokar participants suggested that because of legal restrictions it is very difficult for non-EU residents Prostitutes Tokar a valid residence and work permit to be employed as a sex worker in Amsterdam, but several strategies for how to overcome this barrier were reported.

Micro-level factors a Socio-demographic characteristics. Yet, several participants reported that age was often misreported as women tried to attract Prostitutes Tokar clients: Yesthat's interestingbecause they are not that young as you expect. Female sex worker Most of the participants linked youth with a lack of HIV-related knowledge, knowledge of local policies and low self-perceived risk.

City council representative There is a group who does sex workbut they do Prostitutes Tokar think they do it. Interviewer : Why have you mentioned language? SoI think especially in sex workwhere it is quite difficult to understand tax payingand the permits … even for me it's not very easy to understand … Police Prostitutes Tokar Moreover, in some cases female sex workers fully relied on a third person operator whom they hire for security and language purposes.

For example, a client described this situation as follows: Nowwhat went completely wrong—the communication. Female sex worker Those who came as tourists avoided using any medical services even when they had pre-paid tourist medical insurance and even when they were feeling sick as they were afraid to be identified as a sex worker by the police.

The educational component in Russian was a welcomed improvement to the programme: You should look at the level of education. Female sex worker Interviewer : Why do you test? Meso-level factors a Sex-work venue. Female sex worker Moreover, one woman reported that the absence of out-of-pocket payments and ability to Prostitutes Tokar your doctor reduces Prostitutes Tokar trust in Prostitutes Tokar health care. Director, activist Prostitutes Tokar, sex workers prefer to hide their identity or to go to specialized clinics, where they will not be treated as victims.

All women interviewed as well as some stakeholders talked about the time and transport costs as a potential barrier to accessing HIV testing: If you do not Prostitutes Tokar an appointment you will not get medical services … And if you have your appointment at Macro-level factors a Sex-work policies vs anti-migrant movement.

For example, one of the social nurses experienced the separation between legal and non-legal prostitution as a barrier to doing her work: I feel that the non-legal sector is much less easy to access than the legal sector. Social nurse One participant questioned a definition Prostitutes Tokar the voluntary nature Prostitutes Tokar sex work and thought that many legal sex workers do not voluntarily choose this work, while the government pretends that they have freely chosen Prostitutes Tokar be a sex worker: It is suggested that exploitation of women [who are SWs] can be eradicated if you only allow sex workers to work when they have self-chosen for prostitution.

For example, the programme manager prostitution stated that this combination is not always easy to apply: In a situation where a healthcare providerwho Prostitutes Tokar a confidential relationship with Prostitutes Tokar sex workeris confronted with human trafficking of that sex workerthe connection with the police needs to be made.

Programme manager prostitution The physician pointed to the discouraging effects of the municipal prostitution policy to Prostitutes Tokar on non-legal migrant female sex workers from EE, non-EU countries: If you are not being supported by your own municipalityit feels like a barrier to focus our efforts more on non-legal sex workers … that is actually Prostitutes Tokar weird from a public health perspective. However, the allocation of financial resources also determined the focus of the municipal health services: Our core business is the legal sector because that is being financed.

Even though the NGO managed to provide some support, which took several months of hard work, at some point the woman returned to Ukraine: She could access [treatment] Prostitutes Tokar an exceptional casewe did itwe found a specialistbecause she needed more than just ART. Discussion This Prostitutes Tokar sought to examine the context-specific vulnerabilities of non-EU migrant female sex workers and to describe their experiences and perceptions of existing HIV testing services in Amsterdam.

Prostitutes Tokar information. S1 Appendix.

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S2 Appendix. Annex 2: Interview guide for key stakeholders Phase 1. S3 Appendix. S4 Appendix. Annex 4: In-depth Interviews with stakeholders Phase 3.

S5 Appendix. Annex 5: Coding framework. Acknowledgments We are grateful to the people who Prostitutes Tokar for sharing their stories.

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References 1. Prostitutes Tokar R. Sociology of sex work. Annual Prostitutes Tokar of Sociology35, — View Article Google Scholar 2. Agustin L. Sex at the margins : Migrationlabour markets and the rescue industry. Wahab S. For their own good: Sex work, social control and social workers, a historical perspective. View Article Google Scholar 4. Shafer K. Jane Addams and social reform: A role model for the s. Social Work40 5— View Article Google Prostitutes Tokar 5.

Pisani E. Wisdom of whores. New York, NY: W. Hubbard P. Regulating sex work in the EU: Prostitute women Prostitutes Tokar the new spaces of exclusion. View Article Google Scholar 7. Outshoorn J. Policy change in prostitution in the Netherlands: From legalization to Prostitutes Tokar control.

Sexuality Research and Social Prostitutes Tokar9 23— View Article Google Scholar 8. Kilvington J. Prostitution policy in Europe. Feminist Review67 178— View Article Google Scholar 9. Sex work in Europe. A mapping of the prostitution scene in 25 European countries. Van Veen M. HIV and sexual risk behavior among commercial sex workers in the Netherlands. Archives of Sexual Behavior39, — Verscheijden M.

Sexually transmitted infections among female sex workers tested at STI Prostitutes Tokar in the Netherlands, — Emerging Themes in Epidemiology12 View Article Google Scholar De Coul E. PloS One10 7. Van Der Bij A. European Journal of Public Health18 4 Sethi G. HIV, sexually transmitted infections, and risk behaviours in male sex workers in London over a 10 year period.

S exually Transmitted Infectionsand e Platt L. R isk of Prostitutes Tokar transmitted infections and violence among indoor-working female sex workers in London: The effect of migration from Eastern Europe. Sexually Transmitted Infections87 5 — Hamers F.

The changing face of the HIV epidemic in western Europe: What are the implications for public health policies? Prostitutes Tokar Lancet, 83— World Bank. Country Income Groups. Prostitutes Tokar F. Increased attendances of people of Eastern European origin at sexual health services in London. Sexually Transmitted Infections85 175— Sex work migration health. A report on the intersections of legislations and policies Prostitutes Tokar sex workmigration and health in Europe.

Barbone L. Vargas-Silva C. Geneva: WHO. Administrative codex of Ukraine. The Parliament of Ukraine. Accessed 18 April Prostitutes Tokar codex of Ukraine. Gruskin S. Government regulation of sex sexuality:in their own words. Reproductive Health Matters1— Rekart M. Sex-work harm reduction. The Lancet, — Harcourt C. Sex work and the law. Sexual Health2 3—8. Terminology guidelines. Prostitution in the Netherlands in Official website of Schengen visa information.

Green J. Bronfenbrenner U. The ecology of human development: experiments by nature and design. ISBN Bekker L. Combination HIV prevention for female sex workers: What is the evidence? The Lancet, 72— Baral S. Modified social ecological model: A tool to guide the assessment of the risks and risk contexts of HIV epidemics.

BMC Public Health13 1 Tokar A. We require Prostitutes Tokar to either 1 present written permission from the copyright holder to publish Prostitutes Tokar figures specifically under the CC BY 4. De Coul E. S2 Appendix: Annex 2: Interview guide for visit web page stakeholders Phase 1. Director, activist Thus, sex workers prefer to hide their identity or to go to specialized clinics, where they will not be treated as victims.

However, all 19 respondents Prostitutes Tokar mentioned the importance of civil society in Ukraine in implementing HIV policies and inspiring national policies.

In a situation where a Prostitutes Tokar providerwho has a confidential relationship with a sex workeris confronted with Prostitutes Tokar trafficking of that sex workerthe connection with the Prostitutes Tokar needs to be made. Respondents were recruited using a Prostitutes Tokar sampling strategy via web pages, where sex work is advertised Prostitutes Tokar Russian and English for Amsterdam Prostitutes Tokar via the Prostitutes Tokar NGOs providing services for female Prostitutes Tokar workers and migrant female sex workers in Amsterdam.

Soif the non-legal sector becomes legal Prostitutes Tokar, it would be much easier to access them [sex workers]. Most studies Prostitutes Tokar micro, or micro and meso levels of the SEM with predominance of Prostitutes Tokar factors.

In summary, the analysis highlights six barriers to HIV testing most commonly reported by research participants: Prostitutes Tokar migration and sex-work policies; 2 stigma, including self-stigmatization; Prostitutes Tokar lack of trust in healthcare providers or social workers; Prostitutes Tokar low levels of Dutch Prostitutes Tokar English languages; 5 negative experience in accessing healthcare services in the home country; and 6 low perceived risk and HIV-related Prostitutes Tokar.

Taylor S. Ameyan et al. The educational component in Russian was a welcomed improvement to Prostitutes Tokar programme:. Conducted online database searches and screened data: AT. I Prostitutes Tokar that the non-legal sector is much less easy to access than the legal sector.

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Thirteen articles reported that anticipated stigma and discrimination at health facilities hampered service utilization [ 19 , 20 , 24 , 26 , 29 , 37 , 41 , 46 , 48 , 49 , 50 , 51 , 52 ]. Please do not edit. Reviewer 1: This is an original publication of qualitative data exploring barriers and facilitators to HIV testing as a proxy for a wider range of HIV services available to migrant sex workers in the Netherlands.

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