Exploring Perspectives on Access to Cervical Cancer Screening for Female Sex Workers in Nigeria

Abstract Cervical cancer remains a leading cause of cancer-related deaths among women in low- and middle-income countries, with Nigeria bearing a significant burden. Female sex workers (FSWs), due to heightened exposure to HPV and other risk factors, represent a high-priority group for prevention. Yet, in Nigeria, their access to screening and treatment remains constrained by structural, social, and systemic barriers. Using a constructivist grounded theory methodology, data were collected from a total of 35 participants. Focus group discussions were conducted with 21 female sex workers recruited from brothels in Lagos State, while in-depth interviews were held with 2 healthcare providers, 5 representatives from civil society organizations, and 7 policymakers from both state and federal levels. The findings were grouped under four major thematic categories: knowledge, attitudes and practices; socio-cultural and psychological factors; healthcare systems and services; and past experiences of care. Despite being at elevated risk, FSWs often delayed or avoided screening due to mistrust in public health institutions, shame, and competing economic priorities. However, many participants expressed strong willingness to engage with services if they were respectful, accessible, affordable, and non-judgmental. Recommendations from participants included decentralised, brothel-based screening; use of peer educators; increased awareness campaigns; and the provision of incentives to offset opportunity costs. Complementary perspectives from policymakers and providers revealed misalignments between policy intentions and service delivery realities, especially the lack of targeted programming for FSWs. The study concludes that equitable access to cervical cancer screening for FSWs is not merely a technical challenge but a moral imperative. Addressing this gap requires policies that prioritise structural inclusion, stigma reduction, and community co-design. Key messages • This study explored several barriers to accessing cervical cancer services by FSWs in Nigeria. • This study identifies gaps and opportunities to make Nigeria’s cervical cancer screen and treat policy more responsive to address the gaps for marginalised populations like FSWs.