Lockdown worsens mental health of sex workers

For many South Africans going on lockdown meant staying at home with family while those who had to work did so virtually in most cases.

But for street-based Cape Town sex worker Nicky her life was the complete opposite. Not only did she give up seeing her two-year-old daughter for the fear of exposing her to Covid-19, but as a homeless sex worker the lockdown was characterised by verbal abuse and constant harassment, mostly from the police and other law enforcement officers, including security guards.

“Many times I felt so humiliated as I had to go knock on people’s doors to ask for food. Having no source of income at all was horrible. Begging for food is not something that I’m used to as I’m used to making my own money and supporting myself and my daughter.”

Notwithstanding her financial difficulties, having to face confrontations with law enforcement officers made her life under lockdown even more challenging, adding to her mental health problems.

“It was even difficult to walk in the streets as the police know who we are and targeted us even when going to the shop. I remember one time having a panic attack and passing out during a confrontation with the law enforcement officers who were confiscating my blankets and the groceries that I just got from a family nearby.

“I remember going back to the house to report that my food has been confiscated by the police and the family didn’t believe me and thought that I sold the food for drugs. I was so humiliated by the experience.”

New research, done by the London School of Hygiene and Tropical Medicine and published in Plos One, found that female sex workers in the developing world are at greater risk of mental health problems compared to the general population.

The systematic review of 56 studies, which sampled about 25,000 female sex workers in more than 60 countries, including Africa, Eastern Europe, the Middle East, Asia and the Caribbean, is the first globally to estimate the prevalence of mental health problems among female sex workers in the developing world and to examine associations between poor mental health and other risk factors common in sex workers’ lives.

Researchers who analysed the magnitude of mental health problems and sex workers’ experience of violence, alcohol and drug use, “demonstrate that mental health problems are an important burden of disease experienced by many female sex workers in lower and middle-income countries”.

Lead researcher Dr Tara Beattie and colleagues noted that sex workers with mental health problems were more likely to have experienced violence, to report harmful alcohol or drug use, to report inconsistent condom use with clients, and to be HIV-positive compared with sex workers who did not have a mental health problems.

Female sex workers experienced a high burden of depression, anxiety, post traumatic stress disorder, psychological distress, and suicidal behaviours.

Gulam Petersen, a transgender woman sex worker from Observatory in Cape Town, admits that due to criminalisation of sex work in the country, she and fellow sex workers had to go even more underground and sometimes engaged in riskier sex just to put food on the table.

“We had to go underground because we still have clientele to service, even though this was at a much smaller scale. Because of the fear of being arrested we sometimes used escape routes that were not safe just to reach clientele.

“Offering the service became very dangerous. During the lockdown I lost four phones as I either got robbed or had my belongings confiscated by the police. You constantly had to look over your shoulder and that constant worry contributes to mental health problems too. It was a very stressful time for us, so much so that I ended up smoking tea bags just to take the edge off as there were no cigarettes or wine during the hard lockdown,” she said.

Megan Lessing, media advocacy officer at Sex Work Education and Advocacy Taskforce (Sweat), said during the lockdown the organisation has been inundated by calls from sex workers needing support, including food, legal advice and counselling.

“We've had sex workers who have been kicked out of their accommodation because they could no longer afford the daily rates that they used to pay. Most ended up in the streets and at least one has died of pneumonia as she had to spend cold winter day outside. In some instances sex workers don't even have blankets as their belongings are often confiscated by the police. As a result of police harassment they end up in very harsh environments, and that contributes to their mental health problems,” she said.

“Due to the financial struggles that they've experienced during the lockdown we fear that sex workers might be engaging in more riskier behaviour as the lockdown eases up, as many are desperate for money in order to support their families,” Lessing said.

Researchers said the latest findings highlight the urgent need for interventions designed to improve the mental health and wellbeing of sex workers and to address the current treatment gap. “The prevention and treatment of key risk factors such as violence and harmful alcohol and drug use would also help improve the mental health of female sex workers.”

Strategies to prevent suicide could include promoting mental health, limiting access to the means for suicide, reducing harmful alcohol use and violence experience, and training “gatekeepers” to support women at increased risk, researchers noted.

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