'I don't want anyone to know': Experiences of obtaining access
to HIV testing by Eastern European, non-European Union sex
workers in Amsterdam, the Netherlands.
Historically, the Netherlands has hosted a large number
of migrant sex workers. Since sex work is considered a legal
profession it might serve as an example of better access to
health services, including HIV testing, at least for those
working within the legal framework. However, migrant sex
workers, especially non-European Union (EU) nationals, might not
be eligible to register for official employment and thus face
obstacles in obtaining access to health services, becoming
essentially invisible. This study examined context-specific
vulnerabilities of migrant female sex workers (FSWs) from
Belarus, Moldova, Russia and Ukraine, whether and how they have
access to HIV testing compared to other EE, non-EU migrant FSWs
in Amsterdam in the Netherlands. We conducted a
multi-stakeholder perspective study from November 2015 to
September 2017 in Amsterdam. The study comprised 1)
semi-structured interviews with key stakeholders (N = 19); 2)
in-depth interviews with Eastern European, non-EU migrant FSWs
(N = 5) and field observations of the escort agency working with
them; and 3) in-depth interviews with key stakeholders (N = 12).
We found six key barriers to HIV testing: 1) migration and
sex-work policies; 2) stigma, including self-stigmatization; 3)
lack of trust in healthcare providers or social workers; 4) low
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 might facilitate HIV testing. However, Internet-based sex
workers remain invisible in the sex-work industry. Our findings
indicate the importance of addressing women's diverse
experiences, shaped by intrapersonal, interpersonal, community,
network and policy-level factors, with stigma being at the core.
We call for the scaling up of outreach interventions focusing on
FSWs and, in particular, migrant FSWs working onlin