TY - JOUR
T1 - Predictors of Depressive Symptoms and Post Traumatic Stress Disorder Among Women Engaged in Commercial Sex Work in Southern Uganda
AU - Nabunya, Proscovia
AU - Byansi, William
AU - Damulira, Christopher
AU - Bahar, Ozge Sensoy
AU - Jennings Mayo-Wilson, Larissa
AU - Tozan, Yesim
AU - Kiyingi, Joshua
AU - Nabayinda, Josephine
AU - Braithwaite, Rachel
AU - Witte, Susan S.
AU - Ssewamala, Fred M.
N1 - Funding Information:
Our special thanks go to the WESW who have participated in the study and made this work possible. We are also grateful to the staff and volunteers at the International Center for Child Health and Development (ICHAD) in Uganda for coordinating the study; Reach the Youth Uganda; Rakai Health Sciences Program, the research teams at Columbia University in New York, New York University, and Indiana University; the Community Collaborative Board; and the Data and Safety Monitoring Board for their respective contributions to the study design and implementation. In addition, we are grateful to the financial institutions that agreed to work with our study participants to open up savings accounts, as well as community health workers who facilitated intervention delivery.
Funding Information:
This study utilized baseline data from the Kyaterekera Project (2018-2023), a longitudinal randomized clinical trial funded by the National Institute of Mental Health (NIMH). Primarily, the trial aims to evaluate the efficacy of adding economic empowerment components to traditional HIV risk reduction (HIVRR) to reduce new incidences of sexually transmitted infections (STIs) and HIV among WESW in the greater Masaka region of Uganda ( Ssewamala et al., 2019 ). Women were eligible to participate if they met the following conditions: 1) 18+ years; 2) reported engagement in unsafe transactional sex (defined as a sex act in exchange for pay) in the past 30 days; and 3) reported engagement in one or more episodes of unprotected sex in the past 30 days, with either a paying, casual or regular sex partner ( Ssewamala et al., 2019 ).
Funding Information:
This work as supported by the National Institute of Mental Health (NIMH) under award number R01MH116768 (MPIs: Fred Ssewamala, PhD & Susan Witte, PhD). NIMH had no role in the study design, data collection, analysis, interpretation of findings and preparing this manuscript. The content is solely the responsibility of the authors and does not necessarily represent the official views of NIMH or the National Institutes of Health.
Publisher Copyright:
© 2021
PY - 2021/4
Y1 - 2021/4
N2 - This study examined the factors associated with depressive symptoms and post traumatic depressive disorder (PTSD) among economically vulnerable women engaged in commercial sex work (WESW) in southern Uganda. Baseline data from a longitudinal cluster randomized study involving 542 self-identified WESW (18-55 years), recruited from 19 HIV hotspots were analyzed. Hierarchical linear regression modelling was utilized to estimate individual, family-level and economic-level predictors of depressive symptoms and PTSD. Family cohesion, sex work stigma, HIV status, financial distress, household assets, number of children and number of household income earners, were associated with PTSD. Similarly, family cohesion, number of people in the household, HIV status, sex work stigma, financial distress, and household assets, were associated with depressive symptoms. Women engaged in commercial sex work are at a higher risk of HIV and poor mental health outcomes. Sex work stigma and financial distress elevate levels of depressive symptoms and PTSD, over and above an individual's HIV status. Family and economic-level factors have the potential to mitigate the risk of poor mental health outcomes. As such, integrating stigma reduction and economic strengthening components in the programming targeting WESW—a key population, may be critical to address their mental health outcomes.
AB - This study examined the factors associated with depressive symptoms and post traumatic depressive disorder (PTSD) among economically vulnerable women engaged in commercial sex work (WESW) in southern Uganda. Baseline data from a longitudinal cluster randomized study involving 542 self-identified WESW (18-55 years), recruited from 19 HIV hotspots were analyzed. Hierarchical linear regression modelling was utilized to estimate individual, family-level and economic-level predictors of depressive symptoms and PTSD. Family cohesion, sex work stigma, HIV status, financial distress, household assets, number of children and number of household income earners, were associated with PTSD. Similarly, family cohesion, number of people in the household, HIV status, sex work stigma, financial distress, and household assets, were associated with depressive symptoms. Women engaged in commercial sex work are at a higher risk of HIV and poor mental health outcomes. Sex work stigma and financial distress elevate levels of depressive symptoms and PTSD, over and above an individual's HIV status. Family and economic-level factors have the potential to mitigate the risk of poor mental health outcomes. As such, integrating stigma reduction and economic strengthening components in the programming targeting WESW—a key population, may be critical to address their mental health outcomes.
KW - Depression
KW - Mental health
KW - Post-traumatic stress disorder
KW - Sex work
KW - Uganda
KW - Women engaged in sex work
UR - http://www.scopus.com/inward/record.url?scp=85101345545&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85101345545&partnerID=8YFLogxK
U2 - 10.1016/j.psychres.2021.113817
DO - 10.1016/j.psychres.2021.113817
M3 - Article
C2 - 33636517
AN - SCOPUS:85101345545
SN - 0165-1781
VL - 298
JO - Psychiatry Research
JF - Psychiatry Research
M1 - 113817
ER -