Abstract
BackgroundWomen involved in both street-level and off-street sex work face disproportionate health and social inequities compared to the general population. While much research has focused on HIV and sexually transmitted infections (STIs) among sex workers, there remains a gap in evidence regarding the broader health issues faced by this population, including mental health. Given limited evidence describing the mental health of women in sex work, our objective was to evaluate the burden and correlates of mental health diagnoses among this population in Vancouver, Canada.MethodsAn Evaluation of Sex Workers Health Access (AESHA) is a prospective, community-based cohort of on- and off-street women in sex work in Vancouver, Canada. Participants complete interviewer-administered questionnaires semi-annually. We analyzed the lifetime burden and correlates of self-reported mental health diagnoses using bivariate and multivariable logistic regression.ResultsAmong 692 sex workers enrolled between January 2010 and February 2013, 338 (48.8%) reported ever being diagnosed with a mental health issue, with the most common diagnoses being depression (35.1%) and anxiety (19.9%). In multivariable analysis, women with mental health diagnoses were more likely to identify as a sexual/gender minority (LGBTQ) [AOR=2.56, 95% CI: 1.72—3.81], to use non-injection drugs [AOR=1.85, 95% CI: 1.12—3.08], to have experienced childhood physical/sexual trauma [AOR=2.90, 95% CI: 1.89—4.45], and work in informal indoor [AOR=1.94, 95% CI: 1.12 – 3.40] or street/public spaces [AOR=1.76, 95% CI: 1.03–2.99].ConclusionsThis analysis highlights the disproportionate mental health burden experienced by women in sex work, particularly among those identifying as a sexual/gender minority, those who use drugs, and those who work in informal indoor venues and street/public spaces. Evidence-informed interventions tailored to sex workers that address intersections between trauma and mental health should be further explored, alongside policies to foster access to safer workspaces and health services.
Highlights
Women involved in both street-level and off-street sex work face disproportionate health and social inequities compared to the general population
One third (36.3%) of women were Indigenous, 25.6% identified as a sexual/gender minority, and 11.3% were living with Human Immunodeficiency Virus (HIV) (Table 1)
The median age was 34, with no significant differences based on reported mental health diagnoses
Summary
Women involved in both street-level and off-street sex work face disproportionate health and social inequities compared to the general population. Women involved in sex work face disproportionate social and health inequities compared to the general population, including high rates of violence, poor sexual health, and vulnerabilities to HIV and STIs [1,2,3,4,5,6,7,8,9]. Nemoto et al discovered that almost half their population of trans female sex workers in the Bay Area had high depression scores, which were correlated with frequent transphobia experiences and lower income and education [19] From these early studies, it is apparent that women in sex work are at risk of mental illness that is linked to traumatic experiences, and that the subpopulation of women who identify as sexual/gender minorities may have discrimination related contributors
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