Only 5% of female sex workers get screened for cervical cancer, study finds

Dar es Salaam. Less than five percent of female sex workers get screened for cervical cancer, despite being among the groups most vulnerable to the disease, new research reveals.

The study, titled “Female Sex Workers and Cervical Cancer Screening in Kilimanjaro Region: Uptake and Behavioural Determinants in Health Belief Model Perspectives,” found that only 4.8 percent of the women surveyed had ever been screened.

The stark figure emerges from a paper quietly published last month in BMJ Public Health—the first to examine cervical cancer screening habits among female sex workers in Tanzania.

Researchers from the Kilimanjaro Christian Medical Centre spent three months tracking down 351 women aged 25 to 49, following chains of trust from bar to brothel, from urban alley to rural roadside.

Their findings paint a troubling picture of how stigma, poor access, and weak health communication keep one of Tanzania’s most at-risk groups from lifesaving preventive care.

One of the study’s authors, Mr. Gumbo Silas, said the result was surprisingly low, especially considering that 89 percent of the sex workers were aware of the availability of screening services.

“This means that despite high awareness, very few take the step to get screened, showing a critical gap between knowledge and action,” he said.

Cervical cancer is a consequence of long-term infection with the human papillomavirus (HPV). Tanzania is reported to be among the five countries with the highest rates of cervical cancer in Africa, with more than 7,000 women diagnosed each year—58 percent of whom die from the disease.

The Kilimanjaro study found that most respondents had heard of cervical cancer but lacked accurate knowledge about its causes and prevention.

“Awareness alone doesn’t guarantee behavior change. It creates knowledge, but behavior change requires motivation and support. Behavioral factors are what drive an individual to accept or adhere to a recommended health action,” said Mr. Silas.

Most screening in Tanzania is conducted through public maternal and child health clinics, where services are geared toward married women and mothers.

Female sex workers, who often operate informally and lack health insurance, rarely visit these facilities. Many work at night, move frequently between towns, or fear being identified by health workers.

Medical doctor and research scientist at the Kilimanjaro Clinical Research Institute (KCRI), Dr. Innocent Peter Uggh, highlighted that the main reason female sex workers are not getting screened is not due to practical obstacles, but rather a fundamental lack of belief that they are personally at risk.

“Almost all—99 percent—of participants reported no major barriers preventing them from going for screening,” Dr. Uggh said. “Instead, they believed they were healthy and didn’t need screening, reflecting a low perceived susceptibility to cervical cancer.”

Using the Health Belief Model, the researchers suggest that meaningful change occurs only when health programs move beyond simple information-sharing and address an individual’s personal conviction about the disease.

Their findings identified four specific behavioral factors—far more influential than awareness—that determine whether a woman’s intention turns into an actual clinic visit.

When women in high-risk environments are left behind, it raises questions about whether the country’s target to screen 60 percent of the female population can realistically be achieved.

“To close this gap, there is an urgent need for tailored, inclusive strategies that address both behavioral and structural barriers,” Dr. Uggh said.

Participants who had a strong belief in the protective power of screening were more than three times as likely to get screened. Similarly, female sex workers with high self-efficacy—the confidence to take action—were about 3.6 times more likely to undergo screening.

The researchers also emphasized the importance of “cues to action,” or external prompts that trigger behavior change. This could include a reminder from a peer educator or encouragement from a trusted health worker.

“Policymakers should design community-based, behaviorally informed interventions that strengthen women’s perception of cervical cancer severity and the benefits of screening,” Dr. Uggh said.

“This confidence should be reinforced through triggers like recommendations and encouragement from health workers and the media.”

The study showed that women who received regular cues to action were also 3.6 times more likely to move from passive intention to active participation in screening