Female sex workers (FSWs) are individuals who consensually engage in sexual activities in exchange for money or other goods as a means of livelihood.

This profession can be categorised into two main groups: roamers, who are mobile and seek clients across different locations, and seaters, who work from fixed locations such as brothels or their own residences. In Ghana, FSWs face significant healthcare challenges due to their marginalized status.

Several healthcare challenges confront FSWs, including criminalization, family planning, HIV and STI prevention, stigmatization, knowledge of healthcare options, availability and access to care, and mental health and substance abuse issues.

This review explores the complex interplay of these factors, focusing on high HIV prevalence, barriers to healthcare access, and the impact of current interventions.

By providing a detailed analysis of these elements, the review aims to offer a comprehensive understanding of FSWs' healthcare needs and to identify strategies for improving their overall well-being.

The review calls for increased awareness of HIV prevalence and challenges, highlighting the urgent need to address the health needs of this vulnerable population and to promote equitable healthcare access.

HIV continues to be a critical public health issue in Ghana, with female sex workers (FSWs) experiencing a disproportionately high prevalence of the virus.

As of 2014, the HIV prevalence among FSWs was estimated at 11.1%, a stark contrast to the general population prevalence of 2.0% (Ghana AIDS Commission, 2014). Mobile FSWs, or roamers, face an even greater risk compared to their stationary counterparts, or seaters.

Despite governmental efforts to mitigate the spread of HIV through condom distribution programs, these initiatives have proven insufficient on their own.

A comprehensive approach to prevention, which includes the implementation of antiretroviral therapy (ART) and pre-exposure prophylaxis (PrEP), is crucial for the effective management of HIV and for preventing vertical transmission during unintended pregnancies (Dhana et al., 2014).

In addition to high HIV prevalence, there are significant gaps in knowledge and misconceptions about HIV transmission and sexually transmitted infections (STIs) among FSWs. Many sex workers possess inaccurate information, such as the belief that anal sex does not transmit HIV.

These misunderstandings often lead to self-medication and inadequate treatment, which exacerbate the health risks. Targeted educational interventions are essential to address these knowledge deficits, improve health outcomes, and reduce the transmission of HIV and other STIs (Awutu Senya East Municipality, 2023).

Access to healthcare remains a significant challenge for FSWs, impeded by concerns about confidentiality, high costs, and unsupportive healthcare environments. Fear of breaches in confidentiality and discrimination often leads FSWs to avoid seeking necessary care. Additionally, the high fees associated with private clinics can deter FSWs from accessing vital services. In response to these barriers, mobile health units and outreach programs have been established to deliver services in more accessible locations, aiming to mitigate these access issues and improve healthcare delivery for this vulnerable population (Wang et al., 2020; Slabbert et al., 2017).

The Ghana AIDS Commission (GAC) has implemented nationwide condom distribution programs aimed at high-risk populations, including female sex workers (FSWs).

These programmes distribute condoms through health facilities, community outreach initiatives, and brothels to reduce HIV and other sexually transmitted infections (STIs) by increasing condom use.

While the programs have successfully enhanced access to protective measures and improved overall condom usage, challenges persist due to inconsistent use influenced by various behavioral and contextual factors. Thus, while condom distribution has had a positive impact, it remains insufficient on its own, necessitating additional complementary prevention strategies (Dhana et al., 2014).

In response to the high HIV prevalence among FSWs, the government, in collaboration with international donors, has expanded access to antiretroviral therapy (ART) and pre-exposure prophylaxis (PrEP). ART is provided to individuals living with HIV to manage the disease and reduce transmission, while PrEP is offered to HIV-negative individuals at high risk of infection.

The availability of ART and PrEP has markedly improved health outcomes for FSWs by reducing viral loads and infection rates. ART has led to significant reductions in HIV-related morbidity and mortality, and PrEP has been effective in preventing new HIV infections among high-risk FSWs (Ghana AIDS Commission, 2014).

Non-governmental organizations (NGOs) such as the Ghana Network of Sex Workers (GNNSW) and the Centre for Popular Education and Human Rights (CEPHER) have developed health education and outreach programs focusing on HIV prevention, STI treatment, and reproductive health.

These initiatives aim to correct misconceptions and enhance knowledge among FSWs. Additionally, mobile health units operated by NGOs provide medical services directly within FSWs' communities, addressing barriers related to transportation and accessibility.

Despite their success in improving access to timely testing and treatment, challenges such as funding sustainability and limited coverage in remote areas remain.

Advocacy organisations like the Human Rights Advocacy Centre (HRAC) also work to combat stigma and advocate for FSWs' rights, contributing to increased awareness and legal support, though continued efforts are essential for achieving further legal reforms and improving societal attitudes towards sex work (Ryan & McGarry, 2022; Slabbert et al., 2017; Ghimire et al., 2011b).

Conclusion

Ghana has made significant progress in addressing the healthcare needs of female sex workers (FSWs) through various interventions such as condom distribution, antiretroviral therapy (ART), pre-exposure prophylaxis (PrEP), health education, and mobile health units. These efforts have led to improved health outcomes and greater access to care.

However, challenges persist, including stigma, fragmented service integration, and limited outreach, particularly in remote areas. Ongoing efforts to combat stigma, improve service integration, and expand outreach are crucial for further advancing the health rights of FSWs in Ghana.

References

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