HIV and STI prevention for female migrant sex workers challenges, strategies and research needs a qualitative study with expert interviews in Berlin

Background: Over the past few years there has been a constant increase of women migrating to Germany and other European countries to engage in sex work. With rising HIV rates among migrants in Germany and the vulnerable position of migrants in general and migrant sex workers specifically, HIV prevention for has become increasingly important. There is only limited research in Germany focusing on potential barriers to HIV/STI prevention among migrant sex workers. This study examines potential challenges and achievements of HIV/STI prevention for migrant sex workers in Berlin. The research further generates new approaches to HIV/STI prevention for the target group and seeks out additional research needs. Methods: 10 semi-structured interviews with representatives of NGOs and health authorities were conducted for data collection. Aspects of Grounded Theory and Schmidt's method of analyzing guided interviews were combined for data analysis. Findings: Experts named several barriers to effective HIV/STI prevention for migrant sex workers. Language and cultural issues made it difficult to reach the target group. A lack of knowledge of basic bodily functions among sex workers from Central Europe was described as problematic. Other challenges were based in working and living situations of migrant sex workers, including financial pressure and customers requesting condomless sex. Approaches suggested for improving HIV/STI prevention were rooted in a structural prevention perspective, including culturally appropriate services, clearly regulated working conditions for sex workers and providing interventions for sex workers' clients. Research needs focused on getting more demographic and cultural information about the target group. Discussion: In order to comprehensively address HIV/STI prevention for migrant sex workers, cultural appropriate interventions are necessary as well as strategies to enhance working conditions for sex workers in Germany, target johns with HIV/STI prevention and address issues of gender equality. Additionally, this implies advocating for sex workers rights and promoting the professionalization of sex work. Further research is needed to fully understand the needs of migrant sex workers in regards to HIV/STI prevention.