title: Psychological health and HIV transmission among female sex workers: a systematic review and meta-analysis.
abstract: Current HIV prevention interventions for female sex workers (FSWs) have tended to target the cognitive factors in changing their behaviors, yet little attention has been paid to the psychological factors that influence the behavior of women in sex work. This review aimed to explore the associations between the psychological health of FSWs and HIV risk. A total of eight studies published in English before July 2013 were identified and reviewed. FSWs had reported psychological issues, including depression, suicidal thoughts as well as lower quality of life, and the pooled prevalence of probable depression was as high as 62.4%. The majority of studies showed that higher scores in psychological health problems were associated with increased HIV risk behavior, in particular inconsistent condom use, or sexually transmitted infections. Among the five studies which measured symptoms of depression, four documented that higher depression scores were significantly associated with inconsistent condom use among FSWs with their clients and/or partners. Meta-analysis using a fixed-effects model was performed to examine the association between depression and inconsistent condom use and found that higher scores in depression were significantly associated with inconsistent condom use (odds ratio = 2.57, p < .001). This review contends that future HIV preventive interventions should take psychological health of FSWs into consideration.
authors.affiliation: a Department of Family Medicine and Primary Care , The University of Hong Kong , Hong Kong, Ap Lei Chau , Hong Kong.
authors.forename: Winnie Wing-Yan
authors.initials: WW
authors.lastname: Yuen
authors.affiliation: a Department of Family Medicine and Primary Care , The University of Hong Kong , Hong Kong, Ap Lei Chau , Hong Kong.
authors.forename: Lynn
authors.initials: L
authors.lastname: Tran
authors.affiliation: a Department of Family Medicine and Primary Care , The University of Hong Kong , Hong Kong, Ap Lei Chau , Hong Kong.
authors.forename: Carlos King-Ho
authors.initials: CK
authors.lastname: Wong
authors.affiliation: b School of Health Sciences , RMIT University , Melbourne , Victoria , Australia.
authors.forename: Eleanor
authors.initials: E
authors.lastname: Holroyd
authors.affiliation: c Department of Psychology, Faculty of Arts and Social Sciences , National University of Singapore , Singapore.
authors.forename: Catherine So-Kum
authors.initials: CS
authors.lastname: Tang
authors.affiliation: a Department of Family Medicine and Primary Care , The University of Hong Kong , Hong Kong, Ap Lei Chau , Hong Kong.
authors.forename: William Chi-Wai
authors.initials: WC
authors.lastname: Wong
mesh_terms: D017280:Condoms / Q000706:statistics & numerical data; D003863:Depression / Q000175:diagnosis; D005260:Female; D015658:HIV Infections / Q000523:psychology / Q000635:transmission; D006801:Humans; D008603:Mental Health; D011788:Quality of Life; D040242:Risk Reduction Behavior; D021841:Safe Sex / Q000523:psychology; D060386:Sex Workers / Q000523:psychology*; D012747:Sexual Partners; D012749:Sexually Transmitted Diseases / Q000517:prevention & control / Q000523:psychology
keywords: HIV prevention; harm reduction; prostitution; psychological health; risk behaviors