Integrating Sexual and Reproductive Health Services into HIV Programmes for Female Sex Workers in Hargeisa, Somaliland: A Cross-Sectional Study

Female sex workers in Somaliland experience a high burden of HIV and have substantial unmet sexual and reproductive health needs. Existing HIV programmes are frequently delivered separately from comprehensive sexual and reproductive health services, which limits access to holistic care. This study assessed the impact of integrating sexual and reproductive health services into established HIV programmes for female sex workers in Hargeisa, Somaliland. Its primary objectives were to evaluate changes in service uptake, the use of dual protection, and client satisfaction. A cross-sectional study was conducted among 350 female sex workers enrolled in an integrated HIV and sexual and reproductive health programme. Data were collected using structured questionnaires and clinical service records. Quantitative data were analysed using descriptive statistics and tests of association. Service integration was associated with a significant increase in the uptake of sexual and reproductive health services. The proportion of participants reporting consistent use of dual protection (condoms with another contraceptive method) rose from a baseline of 22% to 68% following integration. Over 90% of clients reported higher satisfaction with the integrated service model. Integrating sexual and reproductive health services into HIV programmes for female sex workers in Hargeisa is feasible and leads to improved service uptake and reported protective behaviours. This model addresses critical healthcare gaps for a key population. Programme planners and policymakers in similar contexts should adopt and fund integrated HIV and sexual and reproductive health service models for female sex workers. Provider training on delivering non-stigmatising, comprehensive care is essential. HIV, sexual and reproductive health, integration, female sex workers, Somaliland, cross-sectional study This original research provides the first empirical evidence from Somaliland on the impact of integrated HIV and sexual and reproductive health services for female sex workers, informing regional public health programming.