By Willa Dong

When the health needs of female sex workers (FSWs) are discussed, reproductive health and preventing HIV/AIDS are often the first things that are brought up. However, like any other person, a sex worker has a variety of health needs.

I became interested exploring these needs and trying to understand the extent to which  mental health is a priority for FSWs last September. Since then, I have looked at these issues in Shenzhen, China, through formal interviews with sex workers and also simply by spending time at a karaoke bar, beauty salons, and in neighborhoods, to get to know sex workers, mommies, and clients. I chose to do a smaller, qualitative study because it was important for me as a non-sex worker to understand the perspectives of sex workers, who already have a clear idea of their needs.

Though my interest is in the stories of sex workers, the statistics outlining the mental health situation for sex workers in China sustained my curiosity towards this issue. Recent research from Guangxi province found that 30 percent of FSWs reported high levels of depressive symptoms, and that 14.2 percent reported suicidal thoughts and 8.4 percent reported a suicide attempt in the past 6 months. For comparison, a study based in Beijing and Shanghai found that 3.1 percent of respondents had ever thought about suicide and one percent of respondents had ever attempted suicide in
their lifetimes.

Factors related to the social context surrounding sex work in China are linked to poor mental health. Sex workers who perceived high levels of stigma directed towards them were more likely to have elevated depressive symptoms, suicidal thoughts and suicide attempts than those who perceived low levels of stigma.

Mental health has also been linked to HIV-related risk behaviors among FSWs; those with high levels of depressive symptoms are less likely to report using condoms consistently and properly with clients than FSWs with low levels of depressive symptoms. For FSWs who are also injection drug users (IDUs), higher levels of hopelessness were associated with injecting with a syringe that had previously been used.

Because of the importance of mental health, future programs should aim to integrate mental health into HIV prevention efforts, such as providing access to sex worker and injection drug user-friendly psychological services. Additionally, promoting positive societal attitudes towards sex work and sex workers should be a priority. However, any research or programs aimed at improving mental health outcomes for FSWs must be carefully implemented with the partnership of FSWs and their allies, who already know what needs to be changed and are already advocating for these changes.

For promoting mental health especially, research and programs must be thoughtfully designed, as these issues have often been used to bolster support for the abolition of sex work. Public health work must clearly differentiate between sex work and the social context of sex work, such as the stigmatization and criminalization of sex workers and gender inequality. These underlying dynamics must be addressed to make real progress in promoting the health of sex workers.

Willa Dong is a public health master’s student at Johns Hopkins currently based in China.