Knowledge, Attitudes, and Perceptions of Sex Workers in Substance Abuse Recovery on Women’s Health

Purpose: Street sex worker populations are underrepresented in women’s health research. Of the few studies, women moving in and out of the criminal justice system demonstrate higher prevalence of co-occurring substance use disorders, poor reproductive outcomes, and cervical cancers compared to other women. Barriers to healthy screening behaviors include access, experience of discrimination and/or stigmatization, and competing priorities. This study sought to examine whether knowledge, perceptions and attitudes would affect the uptake of well woman exams in this underserved population. Methods: A cross-sectional study was conducted among women diverted through the Prostitute Diversion Initiative and into substance abuse recovery in lieu of jail. Trauma-sensitive cancer prevention education was conducted prior to a well woman exam (2012-2017). Self-administered baseline assessments of 36 items measured on the Likert-scale was used to assess baseline knowledge (n=14), attitudes (n=4), and perceptions (n=18) about well woman exams. Statistical analysis was performed using SAS statistical software to assess difference overall, and by age, education and history of trauma. Results: Only 32% of 219 women believed they were at increased risk of cervical cancer. The majority (92%) knew well woman exams were important even if asymptomatic, but fewer (58%) knew when their daughters should initiate exams. Knowing someone with cervical cancer was significantly associated with uptake (p Conclusions: Although knowledge about cervical cancer screenings was relatively high, and attitudes mostly encouraging, there remains misconceptions about risk and perceived barriers like provider’s gender and anxiety waiting for results that needs to be addressed to scale up cervical screening uptake rates in this underserved population.