Inclusive Public Health in Practice: Mental Health, SRHR, and Service Experience among Female Sex Workers in Bangladesh
1
Medicine, Shaheed Suhrawardy Medical College and Hospital, Ramna 1217, Bangladesh
2
Medicine, Manikganj Medical College, Dhaka, Bangladesh
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
BACKGROUND:
Despite sustained investments in HIV prevention and sexual and reproductive health and rights (SRHR) programs for key populations in Bangladesh, critical gaps persist. Existing evidence remains largely biomedical, with limited attention to mental health, dignity, provider behavior, and lived experiences of care. International models demonstrate the effectiveness of community-led services for female sex workers (FSWs), yet stigma, psychosocial distress, and structural exclusion continue to undermine regular HIV testing and holistic well-being. As Bangladesh advances toward its 2050 development vision amid political transition, inclusive and dignity-centered health systems are imperative. This study examines health behaviors, mental well-being, and healthcare access among FSWs accessing Drop-in Centres (DICs) in Dhaka.
METHODS:
A cross-sectional mixed-methods study was conducted among 214 FSWs attending DICs in Dhaka. Data were collected through structured interviews using a culturally adapted questionnaire covering socio-demographics, SRHR practices, HIV knowledge and testing, substance use, mental health (including suicidal ideation), healthcare utilization, and provider expectations. Ethical safeguards followed UNAIDS guidelines. Quantitative data were analyzed descriptively, and qualitative responses were thematically analyzed to generate policy-relevant insights.
RESULTS:
HIV knowledge and condom use exceeded 90%, reflecting effective NGO-led interventions, and most participants were aware of HIV testing services. However, 38.6% reported suicidal ideation, indicating a substantial unmet mental health burden. Tobacco use was common, with notable use of alcohol, cannabis, and stimulants. Nearly half preferred NGO-based services due to trust and respectful care. Barriers to regular HIV testing included lack of awareness of free services, low perceived risk, misconceptions about cost, and access constraints. Over 80% emphasized respectful provider behavior, underscoring dignity as a key determinant of service utilization.
CONCLUSIONS:
Biomedical gains alone are insufficient for sustainable health equity. Integrating mental health into SRHR, ensuring dignity-centered care, and strengthening public–NGO collaboration are essential to achieving inclusive, resilient health systems aligned with Bangladesh’s 2050 vision.
Despite sustained investments in HIV prevention and sexual and reproductive health and rights (SRHR) programs for key populations in Bangladesh, critical gaps persist. Existing evidence remains largely biomedical, with limited attention to mental health, dignity, provider behavior, and lived experiences of care. International models demonstrate the effectiveness of community-led services for female sex workers (FSWs), yet stigma, psychosocial distress, and structural exclusion continue to undermine regular HIV testing and holistic well-being. As Bangladesh advances toward its 2050 development vision amid political transition, inclusive and dignity-centered health systems are imperative. This study examines health behaviors, mental well-being, and healthcare access among FSWs accessing Drop-in Centres (DICs) in Dhaka.
METHODS:
A cross-sectional mixed-methods study was conducted among 214 FSWs attending DICs in Dhaka. Data were collected through structured interviews using a culturally adapted questionnaire covering socio-demographics, SRHR practices, HIV knowledge and testing, substance use, mental health (including suicidal ideation), healthcare utilization, and provider expectations. Ethical safeguards followed UNAIDS guidelines. Quantitative data were analyzed descriptively, and qualitative responses were thematically analyzed to generate policy-relevant insights.
RESULTS:
HIV knowledge and condom use exceeded 90%, reflecting effective NGO-led interventions, and most participants were aware of HIV testing services. However, 38.6% reported suicidal ideation, indicating a substantial unmet mental health burden. Tobacco use was common, with notable use of alcohol, cannabis, and stimulants. Nearly half preferred NGO-based services due to trust and respectful care. Barriers to regular HIV testing included lack of awareness of free services, low perceived risk, misconceptions about cost, and access constraints. Over 80% emphasized respectful provider behavior, underscoring dignity as a key determinant of service utilization.
CONCLUSIONS:
Biomedical gains alone are insufficient for sustainable health equity. Integrating mental health into SRHR, ensuring dignity-centered care, and strengthening public–NGO collaboration are essential to achieving inclusive, resilient health systems aligned with Bangladesh’s 2050 vision.
| eISSN: | 2654-1459 |
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