Engaging female sex workers in their health care through stakeholder mapping and participatory analysis in Buenos Aires, Argentina
Date
2024-04
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Abstract
Cis and trans female sex workers (FSW) face marginalization and struggle to access sexual and reproductive health and rights (SRHR) services. The COVID-19 pandemic worsened these disparities.
January-April 2023, we conducted stakeholder mapping (SM) with SRHR policies and programs decision-makers, implementers and users in Buenos Aires, Argentina. This strategy aims to identify, classify and categorize stakeholders based on the power and agreement level of SRHR policies and plans implemented during the pandemic. A qualitative study was conducted through focus groups with FSW and interviews with healthcare providers analyzed with the DEPICT model (methodology for collaborative data interpretation with the community) to investigate facilitators and barriers from their perspectives.
Considering the challenges in identifying the appropriate stakeholders, this approach became crucial. The landscape is dynamic, influenced by the sociopolitical context, and recent shifts in government. Following SM, we categorized 147 stakeholders Supporters (68%) and promoters (16%) outnumbered blockers (10%), observers (3%) and neutral (3%) in implementing new policies aimed at SRHR services for FSW. The qualitative interviews revealed barriers including the pervasive impact of intersectional stigma and discrimination, violence, failures in intersectoral articulation and coordination, and difficulties in scheduling of appointments for SRHR services. Facilitators identified improvements in transgender healthcare services in the last decade and the emergence of community assets as pivotal, particularly during the pandemic.
SM was invaluable for identifying and characterizing the priorities of key stakeholders for designing policies affecting SRHR services. The inclusion of community perspective, while challenging, enriched our understanding of barriers and facilitators while empowering the community to express their needs. Despite structural barriers and challenges posed by the pandemic, community organizations have displayed resilience, emerging as a vital support system for FSW. We highlight the importance of collaborative efforts and comprehensive approaches in addressing the unique needs of FSW in Argentina and similar contexts.