CHAPTER 4: Illicit Drug Use and Health-Seeking among Sex Workers in a Nigerian City by Ediomo-Ubong E. Nelson
The use of illicit psychoactive substances is a significant public health problem among sex workers. national surveys of sex work in the United States suggest that the rate of drug use among sex workers is up to 80% (Alexander, 1998). The link between illicit drug use and sex work is complex, and there is no consensus on the existence of a causal relationship. Some studies indicate an economic-based relationship in which drug dependence, coupled with limited opportunities for income generation among poor drug-using women, predispose them to sex work (Romero-Daza, Weeks & Singer, 1999).
Sex work serves as a means of generating income to support drug addiction. Sex workers may also use drugs to cope with the psychological trauma associated with sex work (Gossop et. al., 1994; Nelson, 2012). The relationship between drug use and sex work varies depending on the type of sex work investigated (Goldstein, 1979; Sillbert & Pine, 1982). The use of drugs in order to deal with the aversion which sex workers feel towards their clients has also been reported (Plant, Plant, Peck & Setters, 1989).
Similarly; sex workers may use drugs to enhance feelings of self-control and self-confidence, to suppress guilt associated with selling sex (Young, Boyd & Hubbard, 2000), or to medicate the psychological effects of exposure to violence (Weeks at. al., 1998).
Drug use among sex workers is associated with various consequences for their emotional, mental and physical health. For example, drugs increase sex workers risk of infection with Sexual Transmitted Infections (STIs), including HIV (Weeks et. al., 1998; Sterk, 1999), physical violence and rape, especially in the hands of drug using pimps and clients (Silbert & Pines, 1982; Miller & Schwartz,1995). Furthermore, drug use is linked to various forms of psychiatric disorders, including anxiety and affective disturbances (Johnson & Kaplan, 1990; DeMillo, 1989; Mehrahian, 2001). Drug users have higher rates and severe levels of psychological impairments than do individuals who do not use drugs (Campbell & Stark, 1990; Burch, 1994), and sex workers who use drugs are clearly at risk of these problems. Drug use is also significantly related to decline in the psychosocial well-being of sex workers, especially their level of psychosomatic complaints and social insecurity (Vanwensenbeeck, 1994). Illicit drug use is part of many factors impacting negatively on the health of sex workers. Other factors are violence, sexual abuse, societal stigma and the cognitive and behavioural coping strategies associated with the intrusive nature of sex work. This paper reports findings of a qualitative study of illicit drug use and health-seeking for drug-related morbidity among sex workers in a Nigerian city.