Influence of traumatic experiences on female sex workers' mental health in Burkina Faso

Background:

Female sex workers (FSW) are regularly exposed to risks of psychological and physical trauma.  There remains substantial gaps in programming for FSWs, given HIV prevalence has been little impacted by ongoing programming for  FSW in recent years.

Methods:

This design permits an in-depth exploration of the contexts and social perceptions of violence and mental health impacts on FSW. Both quantitative and qualitative methods were conducted simultaneously and individuals were allowed to participate in one or both activities. 

Results:

A total of 696 FSW were recruited and enrolled into the study in Ouagadougou and Bobo Dioulasso, Burkina Faso.  77.4% of respondents reported experiencing physical violence after initiating sex work.  Forty percent of participants (40.9%) reported rape or forced sex, the majority of which occurred after initiating sex work (73.0%).  Perpetrators: regular and new clients, intimate partners, strangers and uniformed officers.

Some 41.8% of quantitative participants reported ever having feelings of depression and 90.6% of these reported experiencing these emotions within the last 3 months.

Discussion:

In some cases, the male perpetrator used physical force to force nonconsensual sex. Forced nonconsensual sex was often without condom use.  Several participants described methods to avoid violence and to promote social protection among FSW, such as “beeping” each other via mobile phone.   Participants reported feelings of depression, alienation and disillusionment.  Our findings suggest that stigma, physical and sexual abuse  are prevalent among FSW.  Within this context of sex work, lifetime experiences of physical and sexual violence were highly correlated with self-reported mental health symptoms.