Abstract
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 Clarke’s 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.