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.

Depression and Post Traumatic Stress amongst female sex workers in Soweto, South Africa: A cross sectional, respondent driven sample

“…The prevalence of depression amongst FSWs in Soweto was also higher than those documented in South Africa, with more than two thirds of FSW in Soweto suffering from depression as compared with 4.9% in the total adult population [ 17 ]. While the prevalence of depression in our study was slightly lower than that recorded amongst SWs in KwaZulu Natal (66.3% versus 78.4%) [ 9 ], we note that the KwaZulu Natal study drew from a subset of SWs who were already attending a support group which may have biased the sample. Our findings are almost 10% higher than those found amongst young women in an informal settlement in South Africa [ 18 ].…”

“…Approaches to healthcare access which are cognizant of the mental health needs of this population, and which are more holistic in nature, may be important to meeting the overall needs of the population. The criminalisation of sex work has been documented to force SWs to conceal their identities [ 9 ], and the negative social views on SW often lead to SWs feeling isolated and to increasing levels of discrimination being enacted by family, community and public protectors such as health and policing officials [ 5 , 54 , 55 ]. Legislative frameworks and policies which not only contradict South Africa’s Constitution, but further the vulnerability of FSWs while stifling their mental health needs, must be revised by the South African Government.…”

“…Yet very few studies address the mental health needs of SWs in South Africa. A 2017 study of SWs attending a support group in KwaZulu Natal, South Africa (n = 155), found that 78.4% of their sample suffered from depression and anxiety, while 80% engaged in binge drinking [ 9 ]. This study aims to describe the prevalence and severity of both depression and PTSD, and their risk factors amongst FSWs in Soweto, South Africa.…”

Mental health problems among female sex workers in low- and middle-income countries: A systematic review and meta-analysis

“…Measures of violence varied by timeframe (recent versus ever), typology (physical, sexual, emotional) and perpetrator (client, intimate partner, etc.). Overall, 13 studies reported associations between depression and violence [34,37,39,43,44,46,49,52,53,59,79,83], with 7 studies included in the meta-analyses (S1 Fig). The pooled unadjusted OR of depression and violence experience (ever or recent) is 2.2 (1.4-3.3), p < 0.001 (n = 7 studies), and the pooled unadjusted OR of depression and recent violence experience is 2.3 (1.3-4.2), p = 0.005 (n = 5 studies).…”

Mental Health and its Relationship With Social Support in Iranian Women With High-Risk Sexual Behaviors

“…Polia et al investigated anxiety, depression, and drug use in the female sex workers. Anxiety and depression were reported as 78% and 80% in the female sex workers, respectively (19). The study of Patel et al showed that depression and anxiety were common in the female sex workers and severity of depression had a significant relationship with violence, disease, and income level (20).…”