Sex workers experiences of HIV prevention, healthcare access and mental health in the West Rand District, South Africa: a qualitative study
- 1Sefako Makgatho Health Sciences University
Abstract
Sex workers experience disproportionate HIV vulnerability, while access to prevention, healthcare and mental health support is shaped by economic, social and institutional conditions. This study explored sex workers experiences of HIV prevention, healthcare access and mental health in the West Rand District, South Africa. A qualitative descriptive-interpretive design was used. Twenty unique participants were recruited through purposive and snowball sampling: five completed individual semi-structured interviews and 15 different participants took part in two focus group discussions comprising seven and eight participants. Data were audio-recorded with permission, transcribed verbatim and analysed using reflexive thematic analysis informed by Braun and Clarkes six-phase approach, with NVivo 15 used for data organisation. Six themes were developed: sex work as economic survival rather than simple choice; HIV prevention under unequal client power; healthcare access shaped by stigma, fear and confidentiality concerns; participant-reported mental health distress as part of everyday sex work; peer educators as trusted bridges to care; and the need for inclusive and differentiated support. Participants described substantial knowledge of condoms, HIV testing and pre-exposure prophylaxis, but their accounts indicated that prevention preferences were negotiated within income needs, client demands, safety concerns and disclosure risks. Participants also reported anxiety, stress, trauma-related experiences, depressive symptoms and substance use in relation to work and healthcare experiences; these reports were not clinical diagnoses. Peer educators were described as trusted sources of information, referral, emotional support and clinic navigation. Overall, the findings suggest that meaningful access extends beyond geographical availability and is shaped by confidentiality, dignity, economic opportunity costs and trusted relationships. The findings support consideration of integrated, differentiated and peer-linked approaches in district-level HIV, healthcare and mental health planning.
Related
- Health workers' and administrators' experiences of duty handover on maternity wards in public health facilities in Hoima District, Uganda: a qualitative phenomenological study
- Health workers and administrators experiences of duty handover on maternity wards in public health facilities in Hoima District, Uganda: a qualitative phenomenological study
- The Views of Clients and Healthcare Professionals on the Perceived Effectiveness of HIV Prevention Programmes in Selected O. R. Tambo District Municipality Clinics
- Examining the scope and characteristics of workplace violence prevention training for healthcare workers: a scoping review protocol
- Beneficiary experiences in the Medicare Diabetes Prevention Program: a qualitative focus group study
BibTeX
@misc{maphauphau2026workers,
title = {{Sex workers experiences of HIV prevention, healthcare access and mental health in the West Rand District, South Africa: a qualitative study}},
author = {Z. Maphauphau and M. B. Randa and M. Hoque},
howpublished = {medRxiv},
year = {2026},
month = oct,
doi = {10.64898/2026.10.13.26365391},
url = {https://www.medrxiv.org/content/10.64898/2026.10.13.26365391v1},
note = {CC BY},
}
RIS
TY - UNPB
TI - Sex workers experiences of HIV prevention, healthcare access and mental health in the West Rand District, South Africa: a qualitative study
AU - Z. Maphauphau
AU - M. B. Randa
AU - M. Hoque
PY - 2026
DA - 2026/10/13
PB - medRxiv
DO - 10.64898/2026.10.13.26365391
UR - https://www.medrxiv.org/content/10.64898/2026.10.13.26365391v1
AB - Sex workers experience disproportionate HIV vulnerability, while access to prevention, healthcare and mental health support is shaped by economic, social and institutional conditions. This study explored sex workers experiences of HIV prevention, healthcare access and mental health in the West Rand District, South Africa. A qualitative descriptive-interpretive design was used. Twenty unique participants were recruited through purposive and snowball sampling: five completed individual semi-structured interviews and 15 different participants took part in two focus group discussions comprising seven and eight participants. Data were audio-recorded with permission, transcribed verbatim and analysed using reflexive thematic analysis informed by Braun and Clarkes six-phase approach, with NVivo 15 used for data organisation. Six themes were developed: sex work as economic survival rather than simple choice; HIV prevention under unequal client power; healthcare access shaped by stigma, fear and confidentiality concerns; participant-reported mental health distress as part of everyday sex work; peer educators as trusted bridges to care; and the need for inclusive and differentiated support. Participants described substantial knowledge of condoms, HIV testing and pre-exposure prophylaxis, but their accounts indicated that prevention preferences were negotiated within income needs, client demands, safety concerns and disclosure risks. Participants also reported anxiety, stress, trauma-related experiences, depressive symptoms and substance use in relation to work and healthcare experiences; these reports were not clinical diagnoses. Peer educators were described as trusted sources of information, referral, emotional support and clinic navigation. Overall, the findings suggest that meaningful access extends beyond geographical availability and is shaped by confidentiality, dignity, economic opportunity costs and trusted relationships. The findings support consideration of integrated, differentiated and peer-linked approaches in district-level HIV, healthcare and mental health planning.
ER -