Sexual Practices and Their Associates in Iranian Female Sex Workers

The sex trade has become an important social and health issue and, providers, clients, and their families are at an elevated risk of numerous health and psychosocial disorders depending on the social and cultural characteristics of every society. Regarding the health aspect, the type of sexual services provided is highly important as they may alter the risk of health conditions among the involved population. Noticeably, very few studies shed light on the current status of these behaviors and their determinants among women sex workers in Iran. The present study was conducted to reveal the pattern of certain sexual practices and their contributing factors among Iranian female sex workers (FSWs).

In the current study, 200 FSWs were selected via snowball sampling, and the participants were interviewed by trained voluntary FSWs using a researcher-made questionnaire.

On average, participants started selling sex at 23 ± 6 years of age and were currently selling sex to 6 clients per week. In addition, 56% and 38.50% of the participants reported that they provide anal and oral sex to their clients respectively. Only 47.50% of the participants reported using condoms when having sex with their clients. Those without a job (B_{unemployed/employed} =  − 7.42, 95%CI: − 13.30, − 1.53), those who were sexually abused during their childhood (B_yes/no =  − 6.44, 95%CI: − 11.36, − 1.53), and those who their childhood was under no family supervision (B_never/always =  − 6.49, 95%CI: − 12.48, − 0.50) started sex work at younger ages when compared to other participants. Also, the per-week number of clients was related to factors such as job status (B_{unemployed/employed} = 1.92, 95%CI: 0.15, 3.67), satisfaction with being a sex worker (B_yes/no = 1.66, 95%CI: 0.62, 3.12), and marital status (B_{married/single} =  − 1.51, 95%CI: − 3.02, − 0.05). Moreover, there were statistically significant relationships between providing anal sex and the place of residence (OR_urban/rural = 5.02, 95%CI: 1.03, 23.78) and marital status (OR_{married/single} = 0.52, 95%CI: 0.33, 0.92). Having been sexually abused during childhood was significantly associated with providing oral sex to the clients (OR_yes/no = 2.31, 95%CI: 1.14, 4.74).

Unprotected, anal, and oral sex were prevalent among the Iranian FSWs. The results highlight the importance of better access to health, educational and consultancy services to improve the sexual knowledge, attitude, and practice of Iranian sex workers and their clients.

The high prevalence of certain sexual practices such as anal and oral sex among FSWs should be effectively addressed by authorities and NGOs to prevent the potential negative consequences of such behaviors in sex workers, clients, and their families.