Sexual violence against female sex workers in The Gambia: a cross-sectional examination of the associations between victimization and reproductive, sexual and mental health

Abstract

BackgroundFemale sex workers (FSW) are a vulnerable population for sexual violence and poor sexual and reproductive health outcomes. Sexual violence against FSW has not been widely studied in The Gambia. This study will report the prevalence of and evaluate the health issues correlated with forced sex perpetrated by clients against FSW in The Gambia, and will secondly aim to inform future research and efforts to improve health outcomes for survivors of violence.MethodsA cross-sectional survey was administered among 251 FSW accrued through a combination of chain referral and venue-based sampling in The Gambia. Eligibility criteria included being over 16 years old and having exchanged sex for money, goods, or favors in the past 12 months.ResultsThere is a high prevalence of sexual violence against FSW in The Gambia, with 29% (n = 70) of participants reporting a client forced them to have sex in their lifetime. Women who reported forced sex by a client were more likely to report symptoms of depression (aOR 2.15, CI: 1.10 – 4.16 p < 0.05), unwanted pregnancy (aOR: 2.69, CI: 1.12 – 6.49 p < 0.05) and report “no”, “difficult” or “somewhat difficult” access to condoms (aOR: 3.31, CI: 1.76 – 6.26 p < .01) compared to women who did not report forced sex. Client-perpetrated forced sex was also negatively associated with receiving any sexually transmitted infection (STI) test in the past 12 months (aOR: 0.49, CI: .26 – .91 p < .05).ConclusionFSW who experience sexual violence by a client are more likely to experience poor sexual, reproductive and mental health outcomes. Responding to sexual violence among FSW, including providing survivors with access to post-exposure prophylaxis, emergency contraception, and mental health services, must be a priority given the prevalence of forced sex and links with poor health outcomes. Efforts to reduce sexual violence against FSW is a vital strategy to improve the health and safety of FSW as well as impact the spread of HIV/STIs in The Gambia.

HIV risks and needs related to the Sustainable Development Goals among female sex workers who were commercially sexually exploited as children in Lesotho

“…Targets Indicators Related Survey Questions The survey was adapted from studies with FSW across sub-Saharan Africa [16,[33][34][35][36][37] and pre-tested with FSW community members to ensure that questions were understood in English and Sesotho. Topics included socio-demographic characteristics, human rights violations, sexual behaviour, health service access, mental health, social capital, and reproductive health.…”

Meeting the Reproductive Health Needs of Female Key Populations Affected by HIV in Low‐ and Middle‐Income Countries: A Review of the Evidence

“…A study in India showed that fear of violence from both noncommercial partners and clients can deter sex workers from negotiating condom use and accessing STI services for testing and treatment (Deering ). In Gambia, one study found strong linkages between coerced sex/sexual violence and decreased condom use and unintended pregnancy (Sherwood ). Similarly, a study in Uganda revealed that the forced sex, rape, and other forms of physical and sexual violence experienced by FSWs has resulted in an urgent need for safe abortion services in a country where the practice of unsafe abortion is common (Marlow et al.…”

Depression and HIV Risk Behaviors among Female Sex Workers in Guangdong, China: A Multicenter Cross-Sectional Study

“…Globally, literature has revealed that HIV/STDs risk factors such as work-related violence [11], unwanted pregnancy [12], and condomless sex [13] were associated with mental health problems, and mental health problems in turn may increase the spread of HIV/STDs among FSWs since FSWs with high level of depression symptoms were less likely to use condom consistently or properly [8]. FSWs with mental health problem are more likely to have suicide ideation and attempt [11–14].…”