Posttraumatic stress disorder among female street-based sex workers in the greater Sydney area, Australia.
BACKGROUND
This paper examines rates of exposure to work-related violence and other trauma, and the prevalence of lifetime and current posttraumatic stress disorder (PTSD) among female street-based sex workers. It also investigates associations between current PTSD symptoms and: demographic characteristics, psychiatric comorbidity, injecting and sex risk behaviours, and trauma history.


METHODS
Cross sectional data collected from 72 women via face to face structured interviews. The interview included structured diagnostic assessment of DSM-IV PTSD; drug dependence; depression; experience of childhood trauma; and an assessment of sex working history.


RESULTS
All but one of the women interviewed reported experiencing trauma, with the majority reporting multiple traumas that typically began in early childhood. Child sexual abuse, adult sexual assault and work related violence were commonly reported. Just under half of the women met DSM-IV criteria for PTSD and approximately one-third reported current PTSD symptoms. Adult sexual assault was associated with current PTSD symptoms. Depression and drug dependence were also highly prevalent; cocaine dependence in particular was associated with elevated rates of injecting risk and sexual risk behaviours.


CONCLUSIONS
These women reported complex trauma histories and despite ongoing opportunities for clinical intervention, they continued to experience problems, suggesting that current models of treatment may not be appropriate. More targeted interventions, and integrated mental health and drug treatment services are needed to address the problems these women are experiencing. Outreach services to these women remain a priority. Education strategies to reduce risky injecting and sexual behaviours among sex workers should also remain a priority.
Roxburgh
Amanda
A
National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia. a.roxburgh@unsw.edu.au
Degenhardt
Louisa
L
Copeland
Jan
J
D000328:Adult; D001315:Australia / Q000453:epidemiology; D002648:Child; D002650:Child Abuse, Sexual / Q000523:psychology / Q000706:statistics & numerical data; D015897:Comorbidity; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008016:Life Change Events; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology; D009784:Occupational Diseases / Q000175:diagnosis / Q000453:epidemiology; D015995:Prevalence; D011569:Psychiatric Status Rating Scales; D011902:Rape / Q000523:psychology / Q000706:statistics & numerical data; D012309:Risk-Taking; D011477:Sex Work / Q000523:psychology / Q000706:statistics & numerical data*; D012725:Sexual Behavior / Q000523:psychology; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D015819:Substance Abuse, Intravenous / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D014505:Urban Population / Q000706:statistics & numerical data; D014754:Violence / Q000523:psychology / Q000706:statistics & numerical data