Background In Benin, HIV/STI clinical and prevention services (based on community mobilisation activities) for female sex worker (FSWs) were extended throughout the country. However, the attendance of clinical services remains very low. Most of the FSW-dedicated clinics are not functional.

Objective This study explores factors related to low functionality and sub-optimal attendance of clinical services by FSWs.

Methods Individual interviews and/or focus groups were conducted with 35 FSWs, 50 health care providers, 70 stakeholders from NGOs and 18 departmental heads of the National AIDS Program in 9 of the 12 regions of the country. Interview guides were developed using a conceptual framework describing actors, implications and issues of implementation activities. Direct observations in the field and analysis of activity reports were also conducted. Data from various sources were triangulated and validated with stakeholders.

Results Several factors have undermined regular STI services utilisation by FSW, encompassing: (i) incomplete and insufficient package of services, with lack of integration of programme components, irregular and insufficient supervision, recurrent shortages of STI drugs and supplies; (ii) limited involvement of FSWs in the programme design, implementation and service organisation; (iii) police repression resulting in dispersion of FSWs, lack of empowerment activities (structural factors); (iv) fear of stigma, little motivation of some health provider to respond to FSWs needs; (v) dysfunctional referral between community level work and STI clinics. In addition poor planning that does not take into account local needs (size, diversification of sex work typologies) also contributes to the non-functionality of the FSW-dedicated clinical services.

Conclusion The results of this study suggest that innovative service delivery models that maximise the synergy between community level work, and uptake of health services need to be designed, implemented and evaluated. Clinical and community level work should also be complemented by appropriate structural interventions.