Sex workers’ self-reported physical and mental health in Greece. A repeated cross-sectional study in 2009, 2013 and 2019

Abstract

In Greece, given the precarious nature of the sex work industry, sex workers health and wellbeing is of concern. However, relevant research remains limited. This study examined whether sex workers’ self-reported physical and mental health deteriorated across time points during the economic recession in Athens, Greece. The study focused on 13 areas where off-street and street-based sex work occurred. Cross-sectional data was collected from the same areas in 2009 (i.e. before the economic recession began) and in 2013 and 2019 (i.e. at time points during the recession). Self-reported physical and mental health decreased in 2013 and in 2019 compared to 2009. A positive association was found between the country’s gross domestic product and sex workers’ self-reported physical and mental health. The opposite was found for annual aggregate unemployment. The determinants of better self-reported physical and mental health were sex workers’ economic condition, Greek nationality, off-street sex work, and registered sex work status. The opposite was found for more years’ involvement in sex work and drug consumption. Findings indicate the need for more inclusive health strategies, especially during periods of economic downturn when sex workers’ physical/mental health is likely to decline. This is the first study to investigate the association between economic recession and sex workers' self-reported physical and mental health.

Keywords:

• Sex work
• physical health
• mental health
• economic recession
• drug consumption

Acknowledgements

I thank the journal’s editor, Peter Aggleton; its administrator, Ilaria Longo; and two anonymous reviewers for feedback on the manuscript. A data appendix, codes and software tables were provided to the Editor and anonymous reviewers during the review process.

Thanks also go to the study participants. The project could not have taken place without the collaboration, resources and feedback provided by the Hellenic Centre for Diseases Control and Prevention/National Public Health Organization, the Syggros Hospital, the Organization Against Drugs, the Hellenic Police, the Red Cross and PRAKSIS.

Members of the Centre for Pluralist Economics at Anglia Ruskin University and of Pembroke College, University of Cambridge provided fruitful insights during the design of this study. Knowledge transfer from the Meander Research Hub is greatly appreciated.

Disclosure statement

No potential conflict of interest was reported by the author.

Availability of data and material

The data and codes that support the findings of this study are available on reasonable request.

Funding

This study was supported by funding from Anglia Ruskin University, UK.

Notes

1 The procedures used in this study adhered to the tenets of the Declaration of Helsinki. The ethics protocol stated that the study would use aggregate data. During data collection, participants did not have to reveal their identity. Informed consent was obtained verbally. Additionally, the addresses of ‘οίκων ανοχής’ were not recorded. Moreover, photography and video/voice recording were not allowed. Given the research protocol, participants were made aware of the kind of questions that would be asked before a brief interview. Participants were informed that they could terminate their interaction/collaboration with the team at any time. At the end of each interview, it was stressed that the study would only report aggregate data. Participants were also asked whether they had felt uncomfortable with any of the survey’s questions. In cases where sex workers did not want to participate in the survey, the research team thanked them for talking and did not proceed. Given the research protocol, sensitive questions relating to the reasons behind involvement in sex work, workplace abuse, exploitation, family status/children, and immigration status were not included.

2 A five-point Likert-scale was used to enquire into participants’ economic condition. Answers ranged from ‘very bad’ to ‘very good’.

3 To record illicit drug consumption, the study utilised WHO’s Alcohol, Smoking and Substance Involvement Screening Test (WHO 2013) by asking participants whether they had ‘consumed illicit drugs, such as cannabis, speed, mephedrone, cocaine, crystal meth, ecstasy, heroin, LSD and magic mushrooms, in the last four weeks.’

4 The median and interquartile ranges of EQ-VAS and CES-D are given below:

2009 period; EQ-VAS {Median = 60; IQR: 48; 68}; CES-D {Median = 15; IQR: 10; 18}.

2013 period; EQ-VAS {Median = 56.5; IQR: 46; 63}; CES-D {Median = 19; IQR: 14; 23}.

2019 period; EQ-VAS {Median = 53; IQR: 43; 63}; CES-D {Median = 22; IQR: 15; 27}.

Total sample; EQ-VAS {Median = 57; IQR: 46; 65}; CES-D {Median = 18; IQR: 14; 24}.