People in situations prostitution Qualitative study on expectations and experiences of primary care

Background. If the health needs of sex workers and their difficulties in accessing healthcare are well documented, there are no studies exploring their representations and feelings about primary healthcare.Aim. To identify the health care expectations of sex workers in a general practice consultation.Methods. A qualitative study using grounded theory was carried out in Bordeaux from September 2018 to May 2019 among sex workers recruited through field associations. The semi-structured interviews were recorded, transcribed, then two researchers coded and analysed the verbatims.Results. 17 women were interviewed aged 19 to 60 of six different nationalities. The general practitioner (GP) was recognized as a privileged health interlocutor because of his accessibility, the follow-up provided and the plurality of his skills. The care pathway was conditioned by people's social situation. Patients expected from the practitioner a global approach (with medical, psychological and social dimension) as well as relational and communication skills: kindness, non-judgement, empathy, active and accurate listening. Talking about prostitution in a medical consultation was difficult, due to fear of being stigmatized and to practising activity considered shameful by wo-men. However it was found necessary in order to provide care adapted to the health situations encountered. The GP had a role in initiating a dialogue and in allowing the patient to speak openly.Conclusion. Promoting a "patient-centred approach" favors satis factory healthcare and access to care for sex workers. Promoting the opening of a dialogue in a medical consultation is beneficial in order to obtain adapted support for patients and to deliver prevention messages.