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Female sex workers FSW are a vulnerable population for sexual violence and poor sexual and reproductive health outcomes. This study will report the prevalence of and evaluate the health issues correlated with forced sex perpetrated by clients against FSW in The Gambia, and will secondly aim to inform future research and efforts to improve health outcomes for survivors of violence. A cross-sectional survey was administered among FSW accrued through a combination of chain referral and venue-based sampling in The Gambia.
Women who reported forced sex by a client were more likely to report symptoms of depression aOR 2. FSW who experience sexual violence by a client are more likely to experience poor sexual, reproductive and mental health outcomes.
Responding to sexual violence among FSW, including providing survivors with access to post-exposure prophylaxis, emergency contraception, and mental health services, must be a priority given the prevalence of forced sex and links with poor health outcomes. Multiple studies have demonstrated that sexual violence against FSW has been associated with decreased condom use [ 11 , 12 , 22 , 23 ], condom failure [ 24 ], HIV prevalence [ 13 , 25 ], and other STI symptoms [ 24 ].
Forced sex can also increase indirect risk for HIV by influencing future patterns of sexual risk taking including decreased condom use and increased substance use during sex [ 20 , 26 ]. Finally, forced sex has been associated with increased stigma and social vulnerability as well as decreased care-seeking for health issues, which may influence future HIV and STI care [ 30 ].
Female sex workers are subject to abuse by many types of perpetrators including police, pimps, partners and clients. While some reports do not specify type of perpetrator in data collection, where assessed, clients are often the predominant perpetrator of sexual violence [ 13 , 23 , 31 ].