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

Abstract

Introduction Sex workers in South Africa experience high levels of trauma and mental health issues, but little is known about their drug and alcohol use. This study assessed the prevalence of substance use and its key risk factors amongst female sex workers (FSWs) at two sites in South Africa. Methods Two cross-sectional studies were conducted, in Soweto and Klerksdorp, South Africa. Using respondent-driven sampling (RDS) 508 FSWs in Soweto and 156 in Klerksdorp were enrolled. A study-specific survey was used to collect social and demographic information, substance use, mental ill-health, and HIV status. Raw and RDS-adjusted data were analyzed using Chi-squared tests of association. Weighted and unweighted Poisson regression models were used to assess key risk factors for alcohol and drug use at both univariate and multivariate levels. Results Of the 664 FSWs, 56.2% were binge drinkers and 29.4% reported using drugs within the last year. Living in a home with regular food (RR: 1.2597, 95% CI: 1.1009–1.4413) and being HIV positive (RR: 1.1678, 95% CI: 1.0227–1.3334) were associated with a higher risk of binge drinking. Having symptoms suggestive of post-traumatic stress disorder (RR: 1.1803, 95% CI: 1.0025–1.3895) and past year physical/sexual abuse from either intimate (RR: 1.3648, 95% CI: 1.1522–1.6167) or non-intimate partners (RR: 1.3910, 95% CI: 1.1793–1.6407) were associated with a higher risk of drug use. Discussion In conclusion, our findings demonstrate a high prevalence of alcohol and drug use among FSWs in Soweto and Klerksdorp with site-specific contextual dynamics driving substance use. Site differences highlight the importance of tailoring site-specific substance use harm mitigation for this key population.

Increasing age and duration of sex work among female sex workers in South Africa and implications for HIV incidence estimation: Bayesian evidence synthesis and simulation exercise

“…We included a total of 24 studies ( Black et al., 2015 ; Coetzee et al., 2017 ; Delva et al., 2011 ; DIFFER Project, 2018 ; Dunkle et al., 2005 ; Eakle et al., 2017 ; Gould and Fick, 2008 ; Lafort et al., 2016 , 2018 ; Luseno & Wechsberg, 2009 ; Milovanovic et al., 2021 ; Peltzer et al., 2004 ; Poliah & Paruk, 2017 ; Ramjee et al., 2005 ; Richter et al., 2013 ; Schwartz et al., 2017 ; Slabbert et al., 2017 ; Slabbert & Radebe, 2016 ; The Aurum Institute, Anova Health Institute, & UCSF, 2020 ; UCSF, Anova Health Institute, & WRHI, 2015 ; van Loggerenberg et al., 2008 ; Varga, 2001 ; Williams et al., 2000 ; Williams et al., 2003 ; Yeo et al., 2022 ), conducted between 1996 and 2019, covering all 9 South African provinces ( Table 1 ). Studies have recruited women from various settings such as female sex worker programmes, clinics, HIV counselling services, and outreach in known hotspots.…”

Polysubstance Use Profiles and HIV Viremia in a South African Cohort of Female Sex Workers: A Latent Class Analysis

“…8,9 FSW in South Africa reporting violence victimization histories and symptoms of post-traumatic stress disorder, for instance, are more likely to report higher-risk substance use. 10 Manifestations of financial instability, from food insecurity to homelessness, have also been linked to elevated substance use among women who sell sex. [11][12][13] The confluence of these forces can disrupt HIV self-management practices (ie, adherence to daily ART regimens) and HIV care continuity (ie, missed appointments, treatment attrition) for people living with HIV.…”

Epidemiology of alcohol use and alcohol use disorder among female sex workers in Mbeya City, Tanzania

“…Furthermore, individuals living in impoverished conditions and those who engage in alcohol consumption exhibit heightened vulnerability to risky behaviours [ 11 ]. It is crucial to acknowledge that alcohol consumption in these susceptible populations may exacerbate existing health-related challenges [ 8 , 12 ].…”