Sex workers suffer from a range of mental health conditions
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Heeramandi, a Netflix series by Sanjay Leela Bhansali, delves into the lives of courtesans in pre-Independence India, bringing to the forefront the untold stories of sex workers. Set in Lahore’s historic red light district, it paints a vivid picture of the complex interplay between societal pressures, personal ambitions, and the pursuit of dignity and freedom. While capturing the resilience and agency of these women, who navigate the harsh realities of their profession under British colonial rule, it also subtly highlights the mental health challenges they face — which are still painfully relevant.
Globally, sex workers continue to face profound mental health challenges exacerbated by societal stigma, violence, economic pressures, and isolation. While much of the public discourse on sex work either romanticises or criminalises the profession, it often neglects the very real mental health struggles. The unique circumstances of their work makes sex workers vulnerable to complex emotional and psychological stressors. Yet, access to mental health services remains limited.
A spectrum of issues
Sex workers suffer from a range of mental health conditions, including anxiety, depression, post-traumatic stress disorder (PTSD), and substance use disorders. These stem from various factors such as violence, exploitation, and societal stigma. Stigma is one of the most significant contributors to their mental health issues. Ostracised, sex workers are deprived of basic human rights, which alienates them from accessing essential health services. This exclusion leaves them vulnerable to severe psychological distress, and the stigma attached to their profession is a major deterrent to their seeking help. Violence is a constant in their lives. Many experience physical, emotional, and sexual violence from clients, pimps, and even law enforcement. This results in trauma and PTSD, significantly affecting their everyday life. The continuous trauma inflicted by violence exacerbates mental health disorders, creating a cycle that is difficult to break without appropriate interventions.
Economic pressures further drive their mental health issues. Many are drawn into the profession out of financial desperation, often as the sole means of supporting themselves and their families. The precarious nature of sex work, along with the lack of alternative employment opportunities, results in chronic stress and anxiety. The instability of income heightens their insecurity, further damaging their mental health.
Substance use is a common coping mechanism among sex workers who rely on drugs or alcohol to manage stress and trauma. However, substance use compounds their mental health problems, trapping them in a harmful cycle of addiction, isolation, and deteriorating mental well-being. The isolation faced by sex workers worsens their access to social support systems, heightens feelings of hopelessness and deepens mental health issues. This lack of support is a recurring theme, historically and today.
An absence of specific interventions
The intersection of sex work and mental health reveals deep-seated challenges that demand comprehensive and compassionate interventions. Although efforts have been made, particularly in addressing HIV prevention and treatment, specific mental health services tailored to sex workers are still lacking. For example, while India has seen initiatives focused on HIV prevention, there is still a gap in mental health services. In Sonagachi, Kolkata, however, a mental health database project, with the goal of providing more targeted interventions and support. This initiative emphasises the need for data-driven solutions that are tailored to the unique mental health needs of the community.
Much progress can be made if the lived realities of sex workers are acknowledged and if interventions address their mental health needs with sensitivity and urgency. Comprehensive research is needed to test the feasibility, acceptability, and effectiveness of interventions co-designed with sex workers in India to promote their mental health and well-being. Additionally, sustained advocacy is required to establish supportive policies that offer a comprehensive package of services, including economic opportunities, access to mental health services, legal protection from violence, and efforts to reduce societal stigma.
Legal support is one area
The mental health crisis among sex workers demands collaborative, compassionate and comprehensive interventions. Legal protection, access to mental health services, and the creation of safe spaces where sex workers can access social support are essential to improving their well-being. As emphasized in the report, “Sex Work and Mental Health: Access to Mental Health Services for People Who Sell Sex in Germany, Italy, Sweden, and the UK”, peer support networks are fundamental to mental health. By focusing on the lived realities of sex workers and advocating supportive policies, society can move toward a more just and humane approach in addressing the mental health challenges faced by this marginalised community.
Manmeet Kaur Bhatia is a Research Fellow at the George Institute for Global Health India. Y.K. Sandhya is Program Lead – Mental Health at The George Institute for Global Health India
Published – November 20, 2024 12:08 am IST
