Many sex workers suffer from high levels of violence. File picture: Christian Hartmann/Reuters

Johannesburg - When police busted Thembi, they came to her home, stripped her naked and confiscated boxes of condoms, which they claimed was evidence that she was a sex worker. In the past, clinics have turned Thembi away, with the nurses saying they don’t assist prostitutes. Pastors have told her to leave church.

It is a stigma Thembi knows well from working 15 years as sex worker. “This is why my colleagues suffer from depression, it is because they are rejected by their families, they are abused by the police and their clients,” says Thembi, who didn’t want her real name used.

For a long time, health professionals and caregivers have known that South African sex workers suffer from high rates of depression and post-traumatic stress, but no one knew the extent of the problem.

But now this has changed with a new study that has provided a snapshot of a group of sex workers who work in one of South Africa’s best-known townships. The study, which appeared in the journal, Plos One, found that in a sample of sex workers in Soweto, more than two-thirds of them suffered depression.

Of that same sample, 39, 6% showed symptoms for post- traumatic distress disorder (PTSD). The cause of this, according to one of the authors of the paper, Jenny Coetzee, is due to the high levels of violence they experience. “You are going to find very high levels of trauma and depression - and with that comes high levels of drinking,” said Coetzee.

The researchers focused on 508 sex workers across Soweto in a study that took place over seven months during 2016. Of that total, only two of the participants weren’t black and 16 were migrants. What the study further revealed was that two-thirds of the sex workers went hungry regularly and 50% of them were binge drinkers. Only 14% claimed they had never been a victim of violence.

But this statistic, believes Coetzee, might be misleading. “We only asked about specific forms of violence, so there was a whole plethora of different perpetrator types that we didn’t ask about, that people told us about but we weren’t able to record,” said Coetzee. “For example we were often told about uncles, brothers or fathers who had raped them as young women.”

South African sex workers are not alone. A survey in India found that female sex workers had depression rates of 39%, while in Nepal it was 82.4%.

In Israel, nearly a third of sex workers suffered from PTSD and research from Switzerland revealed that 50.3% of sex workers suffered from some form of mental health disorder. The authors of the study hope their research will assist in understanding the burden of mental health among sex workers. The plan is to also broaden the study to a national level.

“The idea is to continue this kind of work and have it feed into programmes. South Africa has a national sex worker strategy and the idea behind all of this is to support the implementation of that, through evidence.

“So we can say, look we are in Soweto and this is what the profile of men and woman are, who are engaging in sex work and these are the issues and needs they have,” said Coetzee.

Ishtar Lakhani, the advocacy manager at the Sex Worker Education and Advocacy Taskforce (Sweat), said dealing with mental health issues among sex workers would require a multi-disciplined approach.

“There is little access to services such as social-psycho support for people in general in South Africa, so we need to address mental health services in this country,” Lakhani said. “Even if, magically, we improve services overnight in South Africa, the laws around crimina- lisation of sex work will be a huge impediment.”

One country that has addressed these problems, according to Lakhani, is New Zealand which decriminalised sex work a decade ago. “Research has shown there that it has improved access to services across the board. There was reduction of stigma and less fear of going and getting help,” she said.

Thembi fears that the police are able to track her profile on the internet, where she finds her clients. But like many sex workers, she has to manage this threat so she can provide for her two children.

“We need laws to remove this stigma, and only decriminalisation can do this,” she says.

The Saturday Star