Sociocultural and Structural Determinants Affecting Women's Health Among Female Sex Workers in Cameroon: A...

Female sex workers (FSWs) face significant sociocultural and structural determinants that adversely affect their health and wellbeing. This qualitative pilot study explored the lived experiences, health behaviors, and underlying social determinants shaping women's health among FSWs, using the PEN-3 cultural framework to inform contextually relevant interventions.

We conducted a qualitative phenomenological study with 30 FSWs recruited through purposive and snowball sampling in Douala (n=20) and Kribi (n=10). In-depth, semi-structured interviews were conducted in English, French, or Pidgin and transcribed verbatim. Data were analyzed using thematic analysis in NVivo, guided by the PEN-3 framework, incorporating both deductive and inductive coding approaches.

Participants included three types of FSWs: street-based FSWs (n=17), VIP-based sex workers (n=7), and female exotic dancers (n=6). Findings revealed a complex interplay of economic survival, stigma, and structural vulnerability. Economic pressures drove high client volumes and engagement in risky sexual practices, including condomless sex for higher pay. Participants reported widespread exposure to violence, harassment, and exploitation, including from uniform officers, compounded by the illegality of sex work. Stigma and marginalization contributed to maladaptive coping behaviors such as substance use. Despite limited engagement in formal health-promoting behaviors, notable resilience was evident through peer solidarity and informal financial support systems. Significant gaps in sexual and reproductive health knowledge were identified, with reliance on unsafe methods for pregnancy prevention and frequent use of abortion services. Community-based organizations provided HIV-related services but did not comprehensively address broader health needs.

FSWs' health outcomes are shaped by intersecting sociocultural and structural determinants, including economic vulnerability, stigma, and criminalization. Addressing these challenges requires multi-level, woman-centered interventions that integrate sexual and reproductive health services with economic empowerment, stigma reduction, and policy reform. Improving FSWs' health is critical not only for equity but also for broader public health impact.