Lifetime experiences of gender-based violence, depression and condom use among female sex workers in Cameroon

Abstract

Background: In general populations, consistent data highlight the relationships among violence, HIV risk behavior and depression; however, these patterns are not well understood among female sex workers (FSWs). We examined the relationship between FSWs’ experiences with sexual violence and consistent condom use as a key HIV risk behavior and explored mental health as a potential mediator. Methods: In total, 2,165 FSWs were recruited via respondent-driven sampling in Cameroon in 2016. The women answered questions about violence, condom use and mental health. Results: Inconsistent condom use with clients was reported by 23.5% of participants (508/2,165). Lifetime sexual violence was prevalent with 33.0% (713/2,163) of participants. Almost 50% (1,067/2,143) of respondents had some level of depression. Sexual violence was significantly associated with inconsistent condom use (adjusted risk ratio (aRR) 1.4, 95% confidence interval (CI) (1.2–1.6)). Of FSWs with no depression, 24.9% (267/1,071) reported sexual violence, versus 56.1% (32/57) of respondents with severe depression ( p < .01). Severe depression significantly increased risk of condomless sex (aRR 1.8, 95% CI (1.3–2.6)); in mediation analysis, both sexual violence and severe depression remained significant predictors of condomless sex (aRR 1.4, 95% CI (1.2, 1.6) and aRR 1.7, 95% CI (1.2–2.4), respectively). Depression did not mediate the relationship between sexual violence and condom use. Conclusion: Sexual violence and depression are prevalent and independently associated with condom nonuse with clients among FSWs in Cameroon. Results highlight the need for interventions to address mental health as well as gender-based violence for FSWs.

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

“…Nine studies reported on mental health problems and condom use with clients and regular partners [ 24 , 53 , 56 , 60 , 62 , 68 , 71 , 80 , 84 ]. Condom use measurement varied with studies either reporting frequency of condom use (always versus not always) or condom use at last sex (yes/no).…”

Unmet Need for Family Planning and Experience of Unintended Pregnancy Among Female Sex Workers in Urban Cameroon: Results From a National Cross-Sectional Study

“…There is substantial evidence from Cameroon and further abroad that pervasive structural factors, such as violence, stigmatization, price premiums for condomless sex, legal status, and policing, as well as social considerations, undermine FSWs agency to negotiate condom use consistently. 46,48,65 Although current fertility intentions were not known, half of women were susceptible to pregnancy due to inadequate contraceptive use. Access to contraceptive choice and counseling is an essential part of sexual and reproductive health services.…”

“…46,47 Earlier work has demonstrated that physical and sexual violence as well as depression are prevalent among FSWs in Cameroon and associated with condom nonuse, being offered more money for condomless sex, and condom failure. 46,48 These circumstances may similarly affect risk of unintended pregnancy. However, there are limited studies evaluating unintended pregnancy, pregnancy outcomes, or related consequences with the majority of studies focused on HIV risks.…”

Unmet contraceptives needs among Female Sex Workers (FSWs) in semi urban Blantyre, Malawi

“…In qualitative studies done elsewhere FSWs reported not using a condom with their boyfriends and/or steady partners re ects intimacy and trust which contributes to stronger relationship [24,[41][42][43][44][45][46]. Inconsistent condom use, condom failure and considerations for income were reported as prevalent issues in many study settings [47][48][49]. These ndings highlight a critical need to provide education to improve condoms uptake services provision among FSWs and also suggests a need to improve the knowledge, attitudes and counseling skills of health providers.…”