Intersections of Sex Work, Mental Ill-Health, IPV and Other Violence Experienced by Female Sex Workers: Findings from a Cross-Sectional Community-Centric National Study in South Africa

Abstract

Female sex workers (FSWs) are at increased risk of mental health problems, including mood disorders and substance abuse, and we need to understand the origins of these to treat and prevent them, and particularly understand how the context in which they sell sex impacts their mental health. We conducted a multi-stage, community-centric, cross-sectional survey of 3005 FSWs linked to SW programmes in twelve sites across all nine provinces of South Africa. We interviewed adult women who had sold sex in the preceding six months, who were recruited via SW networks. We found that FSWs have very poor mental health as 52.7% had depression and 53.6% has post-traumatic stress disorder (PTSD). The structural equation model showed direct pathways from childhood trauma and having HIV+ status to mental ill-health. Indirect pathways were mediated by food insecurity, controlling partners, non-partner rape, harmful alcohol use, substance use to cope with SW, indicators of the circumstances of SW, i.e., selling location (on streets, in taverns and brothels), frequency of selling and experiencing SW stigma. All paths from childhood trauma had final common pathways from exposure to gender-based violence (non-partner rape or intimate partner violence) to mental ill-health, except for one that was mediated by food insecurity. Thus, FSWs’ poor mental health risk was often mediated by their work location and vulnerability to violence, substance abuse and stigma. The potential contribution of legal reform to mitigate the risks of violence and mental ill-health are inescapable. Treatment of mental ill-health and substance abuse should be an essential element of FSW programmes.

Temporomandibular Disorders and Bruxism among Sex Workers—A Cross Sectional Study

“…Female sex workers comprise 0.4-4.3% if the population in sub-Saharan Africa, 0.2-2.6% in Asia, 0.1-1.5% in the ex-Russian Federation, 0.4-1.4% in East Europe, 0.1-1.4% in West Europe and 0.2-7.4% in Latin America [23]. This huge population suffers (among other problems) from poor mental health and high incidence of depression and post-traumatic stress disorder [28]. Regretfully, as a result of the stigma experienced by sex workers, health and social care supplied to this group are not always adequate and/or satisfactory.…”

“…The stigma may result in increased stress, mental health problems, feelings of isolation and social exclusion [26]. Sex workers (SW) tend to experience high levels of violence which in turn may lead to high rates of anxiety, stress and post-traumatic stress disorder [27,28]. All of the above may influence the onset of both TMD and bruxism.…”

“…A comprehensive cross-sectional study on female SW showed that about 72% drink alcohol, with many consuming very large quantities. About 20-30% of the female SW use drugs and/or alcohol to help them cope with being SW [28]. Long-term drug abuse leads to a high prevalence of oral motor behavior and signs/symptoms of TMD [29], while smoking affects the painful perception of TMD patients and influences co-morbid aspects such as fatigue worsening, pain control, sleep quality and psychological distress [30].…”

Differentiating the incidence and burden of HIV by age among women who sell sex: a systematic review and meta‐analysis

“…Targeted key population programmes have historically focused on providing services for adults ages 18 years and older without a specific focus on younger adults or inclusion of those under 18, although in some settings have expanded to offer tailored HIV programming for adolescent girls and young women. YWSS face intersectional challenges and needs related to both age and being a woman who sells sex, including not only HIV prevention and treatment, but also gender-based violence, economic challenges, mental health, housing, education and parenting needs [5,29,[54][55][56]. Needs vary tremendously during the transitional period of adolescence and young adulthood, and services designed for adults will not meet all of these varied and dynamic needs.…”

Younger age of initiation of selling sex and depressive symptoms among female sex workers in Eswatini

“…6,23 Behavioral risk factors, including not carrying condoms 5,24 and reporting condom use errors such as slipping and breaking 25,26 are related to both depression and underage initiation of selling sex. Both FSW with depression and FSW who started selling sex as minors report a longer length of time in the sex trade 8,27 and greater frequency of selling sex 28,29 compared to FSW who are not depressed and FSW who started selling sex as adults.…”