Health needs, utilization, and barriers in a sample of drug involved African American female sex workers in Miami

Background: African American street sex workers are a vulnerable population for health problems, yet contact with health services are inconsistent, especially for preventive care. Objective: Describe and examine health needs, utilization, and barriers among a sample of drug involved African American female sex workers in Miami. Methods: Data were drawn from baseline interviews from an ongoing intervention trial testing case management approaches for increasing health services linkages. Data collection commenced May, 2007 and 502 women are currently enrolled. Results: Mean age of the sample is 39.1 years. Barriers to health care utilization were common: 46.8 % reported current homelessness; 23.1% lacked identification; and 62.9 % lacked health insurance, 62.4% reported public transportation as their main source of travel. Participants reported substantial levels of health problems: 46.3% reported significant physical health problems, 54.7% did not receive care; 19.7% reported being HIV positive, and 26% of these reported not receiving care; 60.3% reported significant mental health problems, 71.1% did not receive care; and 90% met criteria for substance dependence. 43.6% do not have a regular source of medical care. Predictors of no regular source of care are: uninsured, HIV negative, homeless in the last 90 days, lower social support, and higher mental distress. Discussion: Lack of insurance was a primary predictor of health care stability in this high risk sample. Homelessness, mental health, and social support must be considered when addressing the insurance and health needs in this population.