Urgent need to address mental health among women who sell sex

22 October 2020

Women who sell sex are experiencing high levels of mental health issues, reveals a groundbreaking evidence review.

Women supporting one another

The first global evidence review of its kind has found women who sell sex in low- and middle-income countries are experiencing high levels of mental health issues – yet mental health services for sex workers are lacking.

The review of 56 studies involving 25,000 women who sell sex found around 40% had depression or were psychologically distressed. Around 20% had anxiety, post-traumatic stress disorder (PTSD) or suicidal thoughts, and 6% had recently attempted suicide.  

Previous evidence suggests women who sell sex face an increased risk of poor mental health linked to factors such as bad housing, money worries, violence, stigma and discrimination. The review echoes this, finding that sex workers with a mental health issue are more likely to have experienced violence, drugs or alcohol misuse, condomless sex with clients, or be living with HIV.

Despite the alarming levels of mental health issues found by the review, researchers could find no studies describing mental health support for women who sell sex. This suggests there is an urgent need for interventions to address the issue. Understanding how factors such as violence affect mental health will be crucial to designing effective solutions.

The strong association between poor mental health and reduced condom use with clients, and between mental health and living with HIV, suggest that addressing mental health issues may also improve the sexual and reproductive health of both women who sell sex and their clients. Mental health interventions can also support women who sell sex who are living with HIV to stay on treatment, protecting their health and the health of others.

The review’s authors call for mental health interventions to be embedded within existing HIV services. Strategies could include training peers to support other sex workers who are at increased risk of mental health issues and providing counselling to address alcohol and drug misuse and experiences of violence.

It is worth noting that only 14 of the 56 studies reviewed were considered to be of high quality. There is also a lack of long-term research (necessary to assess cause and effect) among the studies reviewed. The studies also use a wide range of measurement tools and cut-off scores to assess mental health issues and risk factors, making it difficult to compare studies.

Future studies should address these research issues to generate evidence that is needed to better understand and address mental health issues among women who sell sex.

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Written by Hester Phillips