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. 2023 Jun 26:14:1048703.
doi: 10.3389/fpsyt.2023.1048703. eCollection 2023.

The relationship between underage initiation of selling sex and depression among female sex workers in Eswatini

Ashley Grosso  1   2 , Rebecca Fielding-Miller  3 , Sindy Matse  4 , Bhekie Sithole  5 , Stefan Baral  6
Affiliations

The relationship between underage initiation of selling sex and depression among female sex workers in Eswatini

Ashley Grosso et al. Front Psychiatry. .

Abstract

Background: Minors who sell sex are likely to have complex mental health needs that may persist into adulthood. This topic is understudied in sub-Saharan Africa. This study hypothesized that adult female sex workers in Eswatini who started selling sex as minors have a higher prevalence of depression than those who started as adults. We also examined correlates of depression and underage initiation of selling sex, including stigma and condom-related behaviors.

Methods: From October-December 2014, women aged 18 or older who sold sex in the past 12 months in Eswatini were recruited through venue-based sampling. Participants completed a survey including the 9-item Patient Health Questionnaire (PHQ-9) and a question about the age at which they first sold sex for money. T-tests, χ2 tests and multivariable logistic regression were used to assess associations.

Results: Overall, 43.1% of participants (332/770) had probable depression, and 16.6% (128/770) started selling sex as minors under the age of 18. Over half (55.5%, 71/128) of those who started selling sex as minors had depression. This was significantly higher than the 40.7% (261/642) prevalence of depression among participants who started selling sex as adults (p = 0.002). After adjusting for confounders, female sex workers who started selling sex as minors had higher odds of depression than those who started as adults (adjusted odds ratio [aOR] 1.70, 95% confidence interval 1.11-2.60).

Conclusion: Results highlight the need for trauma-informed and adolescent-friendly mental health services in settings free of stigma toward female sex workers in Eswatini.

Keywords: Eswatini; adolescent; barriers to care; depression; sex workers.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Depression severity by younger or older initiation of selling sex among female sex worker study participants in Eswatini, 2014.
Figure 2
Figure 2
If you are having any of the problems above, how difficult have these problems made it for you to do your work, take care of things at home, or get along with other people?
See this image and copyright information in PMC

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