Table 1 Examples of meaning units, summarized meaning units, sub-theme and theme

I visited a social hygiene clinic 3 years ago. The staff there probably suspected that I was a sex worker, because they were rude and spoke to me in harsh reprimanding voices. I felt humiliated. I definitely won’t go there again.

Negative experience

Experienced stigma

Experience of stigma in the health care setting

I was so scared and worried about being humiliated when I first sought help for STDs. I wore a mask and big sunglasses when I visited the clinic. As soon as I had completed my medical consultation, I ran away like “a rat scampering in the street.

Worried about being humiliated

Anticipated stigma

It would be embarrassing to bump into acquaintances at the social hygiene clinics. I won’t seek help from public health services or social hygiene clinics.

Being witnessed in the public health sector cause stress

Internalized stigma

I can be a housewife or a manager in a company. It is not necessary to tell health care workers the truth about my work when seeing a doctor. Even if I get HIV, it does not mean that I necessarily got it from my sex work. Everyone has a chance to become infected.

Hide private information and to set boundaries with health care providers

Concealment of sex worker identity

Coping with the stigma of sex work

I would go to the local NGOs for regular STDs tests. Because it is a sex worker-friendly organization, I feel safe and be respected there.

Choose stigma-free alternative services

Avoidance of stigmatizing situations

I understand that not everyone accept sex workers. Therefore, I pay more attention to the disease treatment than the attitudes of the health care provider. Their perception of me would not affect my life

Normalize others’ negative attitudes

Ignore the stigma

We could receive more comprehensive and necessary diagnostic tests and treatments if we disclose our sex work at the social hygiene clinic. Besides blood tests, they also offer a saliva test and a Pap smear test

Analyze the risks and benefits

Selective disclosure of sex worker identity

Women engage in sex work for various reasons, many FSWs scarify their pride and dignity for their family. I need to pay for the rent, the tuition fee of my son, and the living expenses. Sex work is the only way for me to make a living and be a responsible mother. The health care providers could not imagine how difficult for a single mother living in Hong Kong. They should not judge me based on the sex work I do

Use poverty as an excuse of sex work

Justification of sex work

My peers gave me great support. They encouraged me to have routine STDs tests and even accompanied me to the hospitals. This makes me feel less stressed when visiting the doctor.

Handle stress with social support networks

Seek out social support

When I feel sad or unhappy, I will go out with friends and drown my sorrows with alcohol.

Understand the complex needs

Multiple health care needs beside STDs

The call for non-judgmental holistic health care

Only if health care providers have a good understanding of the sex industry and our work environment would they understand our occupational risks and be more sensitive to our multiple health care needs. They would also understand our fears, sorrows, and depression beyond those related to the contraction of STDs.

Suggest for better health care services

Expand the scope of services