Psychological health and HIV transmission among female sex workers: a systematic review and meta-analysis

Abstract

Current HIV prevention interventions for female sex workers (FSWs) have tended to target the cognitive factors in changing their behaviors, yet little attention has been paid to the psychological factors that influence the behavior of women in sex work. This review aimed to explore the associations between the psychological health of FSWs and HIV risk. A total of eight studies published in English before July 2013 were identified and reviewed. FSWs had reported psychological issues, including depression, suicidal thoughts as well as lower quality of life, and the pooled prevalence of probable depression was as high as 62.4%. The majority of studies showed that higher scores in psychological health problems were associated with increased HIV risk behavior, in particular inconsistent condom use, or sexually transmitted infections. Among the five studies which measured symptoms of depression, four documented that higher depression scores were significantly associated with inconsistent condom use among FSWs with their clients and/or partners. Meta-analysis using a fixed-effects model was performed to examine the association between depression and inconsistent condom use and found that higher scores in depression were significantly associated with inconsistent condom use (odds ratio = 2.57, p < .001). This review contends that future HIV preventive interventions should take psychological health of FSWs into consideration.

The Impact of Violence, Perceived Stigma, and Other Work-Related Stressors on Depressive Symptoms Among Women Engaged in Sex Work

“…Contrary to previous evidence on sexual risk taking among women in sex work (Yuen et al, 2016), we found no statistically significant association with depressive symptoms. However, women in the high-risk group for depression reported more unprotected sex acts (32% vs. 19%) and more overall number of sex acts (89 vs. 61) with a paying partner in the last 3 months, suggesting important clinical significance for sexual risk.…”

“…However, the elevated percentage of women at risk for depression from the current study is consistent with other samples of women in sex work conducted elsewhere in Asia; about 53.9% in Hong Kong (Lau et al, 2010), 62.0% in China (Hong et al, 2007), 82.4% in Nepal (Sagtani et al, 2013), and 86% in India (Suresh et al, 2009) had depression or depressive symptoms. A recently-published systematic review on the psychological health of female sex workers globally reported a pooled prevalence of probable depression to be 62.4% (Yuen et al, 2016), nearly equivalent with the findings of this study. None of these studies (in Mongolia or elsewhere), however, utilized the BSI subscale on depressive symptoms, making direct comparisons difficult.…”

“…Women in sex work are at high risk for HIV and other STIs (Beyrer et al, 2015) and for experiencing gender-based violence (Deering et al, 2014), both related to their working status as well as their status as individuals in families and relationships. The few studies which exist on the mental health of those in sex work indicate high prevalence of depression and suicide associated with unique aspects of their employment such as number of paying partners, violence by paying partners, condom use and risk taking with clients, worries about making enough money, and longer duration of sex work (Hong, 2007, Le et al, 2010, Wang et al, 2007, Sagtani et al, 2013, Eller and Mahat, 2003, Nemoto et al, 2011, Pollock et al, 2009, Alegría et al, 1994, Yuen et al, 2016). …”

Personal and Financial Risk Typologies Among Women Who Engage in Sex Work in Mongolia: A Latent Class Analysis

“…A systematic review pertaining to the psychological health of women working in sex work globally reported the prevalence of depression at 62.4%. This systematic review also found a significant association between depression and sexual risk taking in four out of five studies included in the review (Yuen et al, 2016). The relationship between depression and HIV risk is more typically mediated by other HIV risk behaviors, including alcohol use.…”

Social and psychological correlates of unprotected anal intercourse among Hispanic-American women: implications for STI/HIV prevention

“…Psychological distress can be defined as negative feelings about oneself or one’s situation, such as feelings of depression, hopelessness and worthlessness (Kessler et al 2002; Radloff 1977). Psychological distress, particularly depression, is highly associated with increased HIV risk behaviours such as inconsistent condom use (Devieux et al 2015; Kennedy et al 1993; Yuen et al 2016). Researchers (Villegas et al 2013; Villegas-Rodriguez et al 2011) conducted a sexual risk reduction randomised controlled trial with 548 Hispanic women and found self-esteem and HIV knowledge to be significant predictors of self-efficacy for HIV prevention.…”