Strategies, programs and interventions implemented to improve sex workers’ access to health services in low- and middle-income countries: a scoping review

Sex workers (SWs) face complex health inequalities, including a relative risk of acquiring HIV nine times higher than the general population. Stigma and discrimination are major barriers, causing 26% of SWs to avoid seeking healthcare. This scoping review aimed to overview strategies, programs, or interventions implemented to improve adult SWs’ access to health services in low- and middle-income countries (LMICs). Following a registered protocol, 27 articles were selected from 1,994 initial records. The review focused on strategies for SWs aged 18 and above in LMICs, including studies published in English, Spanish, and Portuguese. Methodological quality was assessed according to JBI characteristics. Most studies were experimental (42.8%) and geographically concentrated in Africa and Asia (85.7%). Most (81.5%) reported improvements in proposed outcomes. Interventions were primarily educational (81.5%) and biomedical (e.g., HIV/STI testing, PrEP, condom distribution). Multi-component, peer-led, and community-based strategies were found to be particularly effective, leading to documented improvements in consistent condom use and HIV testing. Notably, SWs designed 37.0% of the interventions. Active SW participation enhances intervention, acceptability and sustainability in health processes. However, critical gaps persist, including the limited representation of Latin America and men/transgender participants, and a lack of strategies addressing online sex work. Structural barriers and stigma continue to constrain access. Future strategies must be integrated, sustained, and human-rights-based to holistically address critical dimensions like mental health, violence, and working conditions, moving beyond a proximal focus on behavior.