Depression, anxiety symptoms and substance use amongst sex workers attending a non-governmental organisation in KwaZulu-Natal, South Africa

Abstract

Background: Sex work is a high-risk occupation for mental health problems as sex workers are vulnerable to high rates of violence, sexual coercion, stigma and HIV.
 
 Aim: To determine the prevalence of depressive and anxiety symptoms and substance use in sex workers.Method: A crosssectional questionnaire survey of all men and women attending the Sisonke health initiative, a non-profit non-governmental organisation (NGO), for sex workers was conducted over three months. A socio-demographic questionnaire, the Self Reporting Questionnaire (SRQ 20), the Patient Health Questionnaire (PHQ 9) and the WHO Alcohol, Smoking and Substance Involvement Screening Test (ASSIST V3.0) were administered.
 
 Results: A total of 155 participants were surveyed. The prevalence of anxiety and depressive symptoms on the SRQ 20 and PHQ 9 total scores were 78.4% and 80.9% respectively. Some 40% of sex workers reported suicidal ideation in the year preceding the study. High rates of violence (n = 112, 72%) and childhood abuse (n = 107, 69%) were reported. The prevalence of HIV was 76.1%. The lifetime prevalence of substance use for nicotine (87.8%), alcohol (87.8%) and cannabis (87.7%) was high. Despite the high prevalence of psychiatric symptoms reported, only 15 (9.7%) participants were receiving psychiatric treatment at the time of the survey.
 
 Conclusions: The high prevalence of anxiety, depression, suicidal ideation, substance use and co-morbid HIV infection reported by sex workers and the significant treatment gap suggests an urgent need to provide an integrated health service that targets physical and mental health in sex workers.
 
 (Full text of the research articles are available online at www.medpharm.tandfonline.com/ojfp)
 
 S Afr Fam Pract 2017; DOI: 10.1080/20786190.2016.1272247

Key risk factors for substance use among female sex workers in Soweto and Klerksdorp, South Africa: A cross-sectional study

“…In addition to alcohol, studies have shown a high prevalence of substance use (alcohol and other drug use) amongst sex workers, both globally and in South Africa [9,10]. A 2015 study of FSWs in KwaZulu-Natal found that 83.2% of respondents admitted to lifetime substance use [11]. Across the country, the use of opioids such as heroin, codeine, and Nyaope (antiretroviral therapy [ART] medication mixed with detergent, rat poison, marijuana, and/or methamphetamine) has been increasing [12,13].…”

“…Almost 86.6% of FSWs reported experiencing some form of violence in their lifetime [25]. The increased prevalence of substance use that FSWs face may account for the higher prevalence of mental health issues compared to the general population [11]. Findings from previous research highlight a high prevalence of depressive symptoms amongst FSWs, with more than two thirds of FSWs in Soweto experiencing symptoms suggestive of severe depression, and more than a third suggestive of post-traumatic stress disorder (PTSD) [7].…”

“…High levels of alcohol consumption are a contributing factor for risky sexual behaviours and HIV acquisition among women in South Africa [30]. Furthermore, depressive symptoms, violence, and substance use are all associated with a poor adherence to ART among people living with HIV infection [11,31,32]. Given the goal to achieving the United Nations 95:95:95 targets by 2030 [33], and in a key population where HIV prevalence has been recorded to range between 34-90%, factors influencing poor adherence to ART can be problematic and directly impact viral suppression [6,24,34,35].…”

Prevalence and correlates of anxiety and depression among female sex workers in Dire Dawa city Administration, Eastern Ethiopia

“…In the global literature different anxiety and depression prevalence rates were reported among FSWs where some were higher, others comparable and some others were lower than the rate found in our study. For instance, the rates of depression levels range from 9% among FSWs in China (Tam et al, 2022) to 80.9% among FSWs in South Africa (5).…”

Effectiveness of the HEART Program in Reframing the Needs and Aspirations of Commercial Sex Workers

“…Due to a dearth of study on relevant services which focused on the needs and aspirations of CSWs, the number of CSWs continues to rise over the world, owing to the high frequency of violence and the resulting reproductive and mental health difficulties (Poliah and Paruk, 2017;Wong, 2009). According to World Health Organization (2018), over 376 million new infections among CSWs and more than 1 million Sexually Transmitted Infections (STIs) occurring each day globally.…”