{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T14:50:13Z","timestamp":1787064613760,"version":"build-2736575974"},"reference-count":52,"publisher":"MDPI AG","issue":"22","license":[{"start":{"date-parts":[[2021,11,15]],"date-time":"2021-11-15T00:00:00Z","timestamp":1636934400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001322","name":"South African Medical Research Council","doi-asserted-by":"publisher","award":["none"],"award-info":[{"award-number":["none"]}],"id":[{"id":"10.13039\/501100001322","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004440","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["214204\/A\/18\/Z"],"award-info":[{"award-number":["214204\/A\/18\/Z"]}],"id":[{"id":"10.13039\/100004440","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Department for Science and Innovation, South Africa","award":["None"],"award-info":[{"award-number":["None"]}]},{"DOI":"10.13039\/100004417","name":"Global Fund to Fight AIDS, Tuberculosis and Malaria","doi-asserted-by":"publisher","award":["46523"],"award-info":[{"award-number":["46523"]}],"id":[{"id":"10.13039\/100004417","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Female sex workers (FSWs) are at increased risk of mental health problems, including mood disorders and substance abuse, and we need to understand the origins of these to treat and prevent them, and particularly understand how the context in which they sell sex impacts their mental health. We conducted a multi-stage, community-centric, cross-sectional survey of 3005 FSWs linked to SW programmes in twelve sites across all nine provinces of South Africa. We interviewed adult women who had sold sex in the preceding six months, who were recruited via SW networks. We found that FSWs have very poor mental health as 52.7% had depression and 53.6% has post-traumatic stress disorder (PTSD). The structural equation model showed direct pathways from childhood trauma and having HIV+ status to mental ill-health. Indirect pathways were mediated by food insecurity, controlling partners, non-partner rape, harmful alcohol use, substance use to cope with SW, indicators of the circumstances of SW, i.e., selling location (on streets, in taverns and brothels), frequency of selling and experiencing SW stigma. All paths from childhood trauma had final common pathways from exposure to gender-based violence (non-partner rape or intimate partner violence) to mental ill-health, except for one that was mediated by food insecurity. Thus, FSWs\u2019 poor mental health risk was often mediated by their work location and vulnerability to violence, substance abuse and stigma. The potential contribution of legal reform to mitigate the risks of violence and mental ill-health are inescapable. Treatment of mental ill-health and substance abuse should be an essential element of FSW programmes.<\/jats:p>","DOI":"10.3390\/ijerph182211971","type":"journal-article","created":{"date-parts":[[2021,11,15]],"date-time":"2021-11-15T08:19:20Z","timestamp":1636964360000},"page":"11971","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":34,"title":["Intersections of Sex Work, Mental Ill-Health, IPV and Other Violence Experienced by Female Sex Workers: Findings from a Cross-Sectional Community-Centric National Study in South Africa"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4330-6267","authenticated-orcid":false,"given":"Rachel","family":"Jewkes","sequence":"first","affiliation":[{"name":"Gender & Health Research Unit, South African Medical Research Council, Pretoria 0001, South Africa"},{"name":"Office of the President, South African Medical Research Council, Tygerberg 7505, South Africa"},{"name":"Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Parktown, Johannesburg 2193, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4654-8755","authenticated-orcid":false,"given":"Minja","family":"Milovanovic","sequence":"additional","affiliation":[{"name":"Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa"},{"name":"African Potential Foundation, Menlo Park, Pretoria 0102, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7433-4383","authenticated-orcid":false,"given":"Kennedy","family":"Otwombe","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Parktown, Johannesburg 2193, South Africa"},{"name":"Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esnat","family":"Chirwa","sequence":"additional","affiliation":[{"name":"Gender & Health Research Unit, South African Medical Research Council, Pretoria 0001, South Africa"},{"name":"Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Parktown, Johannesburg 2193, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khuthadzo","family":"Hlongwane","sequence":"additional","affiliation":[{"name":"Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naomi","family":"Hill","sequence":"additional","affiliation":[{"name":"Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Venice","family":"Mbowane","sequence":"additional","affiliation":[{"name":"Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mokgadi","family":"Matuludi","sequence":"additional","affiliation":[{"name":"Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn","family":"Hopkins","sequence":"additional","affiliation":[{"name":"Sabin Vaccine Institute, Washington, DC 20037, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Glenda","family":"Gray","sequence":"additional","affiliation":[{"name":"Office of the President, South African Medical Research Council, Tygerberg 7505, South Africa"},{"name":"Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jenny","family":"Coetzee","sequence":"additional","affiliation":[{"name":"Gender & Health Research Unit, South African Medical Research Council, Pretoria 0001, South Africa"},{"name":"Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa"},{"name":"African Potential Foundation, Menlo Park, Pretoria 0102, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,11,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"979","DOI":"10.1038\/s41598-018-37791-1","article-title":"Spatial structure of depression in South Africa: A longitudinal panel survey of a nationally representative sample of households","volume":"9","author":"Cuadros","year":"2019","journal-title":"Sci. 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