Psychological health and HIV transmission among female sex workers: a systematic review and meta-analysis

Winnie Wing Yan Yuen, Lynn Tran, Carlos King Ho Wong, Eleanor Holroyd, Catherine So Kum Tang, William Chi Wai Wong

Research output: Contribution to journalReview articlepeer-review

29 Citations (Scopus)


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.

Original languageEnglish
Pages (from-to)816-824
Number of pages9
JournalAIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV
Issue number7
Publication statusPublished - 2 Jul 2016
Externally publishedYes


  • HIV prevention
  • harm reduction
  • prostitution
  • psychological health
  • risk behaviors


Dive into the research topics of 'Psychological health and HIV transmission among female sex workers: a systematic review and meta-analysis'. Together they form a unique fingerprint.

Cite this