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Sex work is a high-risk occupation for mental health problems as sex workers are vulnerable to high rates of violence, sexual coercion, stigma and HIV.

Aim: To determine the prevalence of depressive and anxiety symptoms and substance use in sex workers.Method: A cross-sectional questionnaire survey of all men and women attending the Sisonke health initiative, a non-profit non-governmental organisation (NGO), for sex workers was conducted over three months. A socio-demographic questionnaire, the Self Reporting Questionnaire (SRQ 20), the Patient Health Questionnaire (PHQ 9) and the WHO Alcohol, Smoking and Substance Involvement Screening Test (ASSIST V3.0) were administered.

Results: A total of 155 participants were surveyed. The prevalence of anxiety and depressive symptoms on the SRQ 20 and PHQ 9 total scores were 78.4% and 80.9% respectively. Some 40% of sex workers reported suicidal ideation in the year preceding the study. High rates of violence (n = 112, 72%) and childhood abuse (n = 107, 69%) were reported. The prevalence of HIV was 76.1%. The lifetime prevalence of substance use for nicotine (87.8%), alcohol (87.8%) and cannabis (87.7%) was high. Despite the high prevalence of psychiatric symptoms reported, only 15 (9.7%) participants were receiving psychiatric treatment at the time of the survey.

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