Background Syphilis is a significant disease from a public health perspective both historically and as a result of the serious consequences of infection. While studies have explored the epidemiology of syphilis among at-risk populations, limited information exists regarding women's preferences for STD testing and treatment services. The purpose of this study was to explore sex workers preferences for receiving sexual health services.

Methods A total of six groups of 4–7 sex workers each were recruited from local community-based organisations. The semi-structured interview guide included questions based on the Health Belief Model such as—1) cues to action—“Think back to the last time you received a female wellness exam or got tested for STD. What prompted you to schedule that appointment?” 2) Perceived susceptibility—“Describe what worries you most when you think about your health and how it's affected by being on the streets.” and 3) perceived barriers—“What are some of the reasons why women who are working the streets don't get tested for STD?” Focus groups lasted 1 h, were audio recorded, and transcribed. Preliminary codes were selected, applied to the transcripts, and key concepts that spanned groups were identified.

Results In general, most women used utilised health protective behaviours to mitigate health risks associated with sex work. However, these behaviours were context and partner specific. Participants were interested in having increased access to sexual health services. Primary themes regarding program development included—experiences with healthcare providers, types of services that would encourage uptake, mechanisms for service delivery and the importance of collaborating with law enforcement and other service providers. The participant's recommendations were organised into a model program with specific service delivery mechanisms for each key concept.

Conclusions These data suggest potential pathways STD control programs to intervene with hard-to-reach populations, like commercial sex workers. In this project, a participant-informed approach was utilised that should result in increased uptake and utilisation of sexual health services because participants provided key insights into the programmatic considerations necessary for STD prevention efforts to be most effective.