Prevalance and Risk Factors of Mental Health Problems, Substance Abuse and Coping Mechanisms of Street Based Female Sex Workers in Addis Ababa, Ethiopia

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Addis Ababa University


The purpose of the present study is to assess prevalance and risk facors of mental health problems, substance abuse and coping mechanisms among Addis Ababa Street based female sex workers. Mixed method explanatory research design was employed on 378 randomly selected street based sex workers in ten nominated hotspot areas in Addis Ababa. Mental Health Inventory (MHI)-38, simple screening instrument for substance abuse (SSI-SA) and Brief Coping-28 were employed for assessment. FGD and interviews were also utilized. Descriptive statistics, independent t-test, Pearson correlation and ANOVA were utilized to analyze the quantitative collected data. As a result, the general lifetime prevalence of psychological distress and substance abuse disorder among street based sex workers was 35.4% and 75.1% respectively. Among the dimensions of mental health index, depression, anxiety and loss of behavioral/emotional state was observed respectively. Even higher prevalence of psychological distress and substance abuse disorder was found among divorced, illiterates, lower income, rural born, adolescence and sex workers who had a forensic history. As the cause to join the sex work, peer pressure, to improve personal and family life situation, poverty and poor life situation of the families, to search for better life and better paying job, to failure to succeed in educational endeavors, unemployment, to get initial capital to start a business, success of others, failed marriage and other reasons were highly reported major multifaceted determinant factors for joining street based commercial sex worker. As contributing factors for psychological distress, forced self-degrading type of sex by clients, forced sex at knifepoint, physical assault, robbery, forced sex with multiple individuals at the same time. Sometimes clients refuse to pay for the service they received, insulting, some take them to an unknown place and torture them for more than 3 days while doing anything they want to them, and some injure them while they drunk were highly reported risk factors for developing psychosocial problem among street based sex workers. In this study, place of birth, forensic history, childhood history of sexual abuse, age, educational status, average monthly income and parent’s living arrangement had a statistically significant effect on mental health index of street based sex workers. Finally, the most frequently used adaptive coping mechanism by the sex workers were acceptance and religion respectively. Instrumental support, emotional support, planning, positive reframing, active coping and homer were also repeatedly reported adaptive coping mechanisms by sex workers in their due order. Concurrently, the most frequently used maladaptive coping mechanism by the sex workers were self-blame and substance use. Along with this, venting, Self-distraction, denial, behavioral disengagement were highly reported maladaptive coping mechanism by street based sex workers respectively. In conclusion, the life time prevalence rate of psychological distress and substance abuse disorder were very high. Therefore, mental health service providers shall consider in diagnosing and treating psychosocial problems of street based sex worker. Key Word: Psychological distress, Psychological Wellbeing, substance abuse, sex work



Psychological distress, Psychological Wellbeing, substance abuse, sex work