Exploring Perceptions and Experiences of Health Needs Among Women Who Sell Sex.

Women who sell sex in street-based settings (WSS) experience overlapping social and structural vulnerabilities, including housing instability, stigma, violence, and interactions with the criminal legal system, which shape their health and risk environments. Overlapping vulnerabilities to factors such as violence and substance use can drive health inequities. We used a syndemics framework to help understand how WSS perceive and manage these overlapping vulnerabilities. Participants were recruited from two community drop-in centers serving women in the street-based sex trade in a Midwestern region of the USA. We conducted 6 focus groups (n = 26 participants) to understand more deeply women's experiences of social and structural factors which may contribute to health inequities. Participants were adults, self-identified as women, spoke and understood English, and reported exchanging sex for something of value (food, drugs, money, or shelter) at least once in the previous three months. Most participants identified as Black/African American (69%) and engaging in sex work for 15 years or longer. Using thematic analysis, we identified themes regarding violence, substance use, mental health, and sexual and reproductive health. Experiences in each of these areas shaped women's perspectives on their health, their perceived risk of HIV and other STIs, and their narratives surrounding entry into and exit from sex work. By centering the voices of WSS, our findings contribute to the future development of tailored interventions that consider syndemic risks while fostering resilience and agency.