Peers reaching peers: a case study on expanding contraceptive access for female sex workers in Uganda

Background Female sex workers (FSWs) face disproportionately high rates of unintended pregnancy and unmet family planning needs. Peer-led interventions offer a promising strategy to expand access to contraceptives for populations such as FSWs that are routinely stigmatized or otherwise left behind by traditional healthcare facilities. Methods We trained 50 peer educators across four divisions of Nansana Municipality in Uganda to deliver contraceptive education and provide free short-acting contraceptives directly to FSWs. Peer educators also facilitated referrals as needed to a stigma-free clinic offering long-term contraceptives, and comprehensive sexual and reproductive health services. Peer educators were trained in destigmatizing sexual and reproductive health service provision for FSWs specifically. Providing these services at a designated clinic minimized structural barriers, such as stock-outs and disrespectful provider attitudes, enabling effective referrals and service uptake. Results Over 12 months, 787 FSWs received contraceptive education: 5420 male and 510 female condoms were distributed, 232 FSWs accepted oral contraceptives, and 179 were referred for and received long-acting methods, with 74 receiving injectables and 105 implants or intrauterine devices. Conclusions Peer-led models can expand contraceptive access among FSWs in designated stigma-free facilities with reliable supply chains. To achieve sustainable contraceptive access among FSWs more broadly, this approach should be integrated into government sexual and reproductive health systems.