Mental ill health experiences of female sex workers and their perceived risk factors: A systematic review of qualitative studies

Abstract

Aim: To provide in-depth insights into the lived experience of sex workers’ mental ill health. Background: Female sex workers globally are vulnerable to significant mental health challenges due to social inequalities, including classism, gender inequality, discrimination and criminalisation, coupled with stigma and violence. Understanding the mental ill health experiences of female sex workers is crucial for developing effective tailored interventions. Design: A systematic qualitative literature review. Methods: Searches across ten databases, including CINAHL Plus, Cochrane Library, Medline (1949 to current date 2022), ProQuest, PTSDPubs, PsycINFO, EMBASE, Web of Science (Core Collection), AMED, and Google Scholar. Included studies were assessed for quality using the Critical Appraisal Skills Programme (CASP) Qualitative Studies Checklist and subsequently thematically analysed. Results: Seventeen studies were included revealing five interconnected themes. Female sex workers frequently experience anxiety, depression and suicidal ideation, at times exacerbated by addiction as a coping mechanism. Stigma from society, family and healthcare providers leads to isolation and hindered access to care. The normalisation of violence both from clients and law enforcement contributes to severe mental health issues including Post Traumatic Stress Disorder (PTSD). Despite these challenges, Female Sex Workers employ various coping mechanisms such as rationalising their work, community mobilisation and strategic risk navigation. Conclusions: Female sex workers face multifaceted mental health challenges, significantly influenced by societal stigma and violence. Comprehensive support systems including mental health services, addiction support, and efforts to combat stigma and violence are essential to improving the wellbeing of female sex workers. Addressing these issues can lead to better mental health and overall wellbeing for female sex workers, creating a safer and more supportive environment. Policymakers and healthcare professionals need to collaborate to implement strategies that address these challenges and promote the wellbeing of female sex workers.