Sex workers are considered to be disease carriers and reservoirs, which restricts their ability to get medical care [1]. The physical and mental health of sex workers is at risk due to numerous interrelated causes [2]. Treatments focusing on a single risk factor are less likely to address complex health inequities caused by stigma, human rights violations, violence exposure, unwanted births, HIV, and other STIs [3]. The health outcomes of sex workers are influenced by personal, social, communal, and governmental factors [4]. One illustration of these problems at several levels is the increased risk of HIV and other STIs among sex worker clients who refuse to wear condoms [5]. The participation of sex workers in healthcare is hampered by stigma and prejudice from healthcare professionals, and physical and sexual abuse is also prevalent [6].

In low-income sub-Saharan countries like Zimbabwe, sex workers had higher rates of HIV infection compared to all women of reproductive age [7]. This conclusion is supported by a study by Maphosa that found that the prevalence of HIV and STI among sex workers in the specific area is more than twenty times higher than the prevalence of HIV in the general population [8]. Accessing HIV and AIDS services can be challenging for sex workers in Zimbabwe, according to reports. Receiving accurate, suitable, and pertinent therapy is significantly hampered by the challenges of admitting sexual orientation [9]. In Zimbabwe, various barriers prevent sex workers from receiving sexual healthcare, such as challenges in finding care. The criminal code in Zimbabwe, which classifies sex work as a crime, restricts sexually active people from sharing information about their jobs and medical requirements to receive treatments like Pap testing and breast cancer screenings [10]. In a single overnight raid with the code “Operation Zvanyanya,” the police captured fifty-three women, which was a high number, according to a report written by Zimbabwean lawyers for human rights. While the women were in police custody, they were denied sanitary pads and attacked with baton sticks by the police [11]. Additionally, condoms are used to prove sex workers' involvement in sex work if they carry them [12].

Previous studies have suggested that women in the sex industry may be more susceptible to mental illnesses, particularly mood disorders, suicidal ideation, and post-traumatic stress disorder [13]. Some Chinese studies suggest that factors at the partner and individual levels, such as age, self-stigma, and sexual coercion, may be associated with less favourable research findings in mental health. On the other hand, research from New York, Australia, Mexico, and other US cities shows links between prior trauma and anxiety, melancholy, and post-traumatic stress disorder symptoms [14]. According to themes of qualitative research conducted in Vancouver and looking at the experiences of transgender sex workers, transgender sex workers experience severe health and social injustices, including trauma and violence, which are connected to socio-structural factors like transphobia, criminalisation, and stigma [15].

Sex workers experience stigmatisation, criminalisation, abuse, and other societal injustices. Every person has the right to be treated fairly by the law and free from torture and cruel treatment. The person's selling of sex has no bearing on these rights. On a worldwide basis, sex workers nonetheless continue to experience disproportionately high rates of violence and other human rights violations. Between 45 and 75% of women encounter physical, sexual, or both sorts of abuse at work throughout their lifetimes, according to a comprehensive study from 2014 [16]. Many times, during discussions about the use of condoms, sex workers are subjected to physical and sexual abuse by clients and predators posing as clients [17]. The rights of sex workers are violated, and their chance of getting HIV and other STDs is increased [16]. Thus, to manage and control sex workers, their intimate partners also use violence against them [5], including threatening to report them to the police. A Lancet investigation found that the places where some aspects of sex work are illegal are also the places where sex workers' rights are most frequently violated [5]. The prevalence of underreporting and infrequent criminalisation of violence against sex workers is high [16]. In some cases, it is done by the police, exacerbating trauma and making it much more difficult for sex workers to receive justice and medical attention. The leading causes of violence against sex workers are criminalisation, contemporary stigma, discrimination, and social marginalisation [4]. These structural problems impact health outcomes and access, increasing physical and mental health risks. Due to the criminalisation of sex work, police can harass and threaten sex workers, extort money through fines or other means, seize their condoms, assault them, and use the prospect of arrest to force them into performing sexual acts. Numerous scenarios have documented each of these misuse [18, 19]. Sex workers claim that such harsh police techniques are a stand-in for enforcing sex laws worldwide.

Sex workers frequently experience stigma and prejudice, which harms their health, safety, and well-being [20]. Due to social perceptions that consider sex work as immoral, illegal, or fundamentally exploitative, it is frequently stigmatised. The stigma associated with this condition can result in discrimination, such as denial of fundamental rights and services, social marginalisation, harassment, and violence [20]. Due to stigma and prejudice, sex workers may encounter considerable obstacles when getting health treatments, such as HIV testing and treatment. This could result in higher HIV transmission rates [21]. Additionally, out of concern for discrimination, sex workers could be hesitant to seek medical attention, which results in treated health issues. As a result, this review aims to examine and analyse the complicated issues that sex workers face in their personal and professional lives. This study revealed three gaps: a lack of social support, legal protection, and inadequate access to healthcare. By investigating the legal frameworks that exist in various nations and analysing the effects of criminalisation on sex workers, as well as by identifying barriers to sex workers' access to healthcare services and developing recommendations to improve access to healthcare services, including sexual and reproductive health services, as well as by examining the social stigma and isolation faced by sex workers and developing strategies to reduce stigma and increase social support, the study will address these gaps.

The literature review is a comprehensive study and interpretation of literature that addresses a specific topic [22]. The literature review aims to cultivate a robust knowledge base to conduct research studies [23]. A systematic review approach was adopted to synthesize evidence on the complexities of the life of sex workers in terms of health care and social context [24]. This systematic review protocol followed the steps, namely: (i) the research question formulation, where the general purpose and review questions are explicitly stated; (ii) the literature search, which uses a thorough and repeatable search strategy to collect data; (iii) quality assessment, where the methodological quality and relevance of selected literature are appraised; (iv) data extraction and analysis, which includes data abstraction, comparison, and synthesis; and (v) the presentation of results, where the interpretation of the findings is presented.

Fig. (1). Prisma flow diagram describing the systematic review process.

Table 2 below illustrates the categories constructed in this study. The categories consist of two themes and seven subthemes. In the evaluated research, the population consisted of many women who are sex workers facing health care and social problems.

In a health and social setting, the study sought to analyse and examine the complicated lives of sex workers critically. This study found that sex workers typically struggle with significant health concerns due to several factors, including the stigma associated with their line of work, limited access to healthcare facilities, and the nature of the profession itself. One of the biggest challenges for sex workers seeking medical care is the stigma and discrimination they encounter. Many medical professionals hold incorrect beliefs about sex work and may be unwilling to treat patients or unintentionally do so. The results are in line with the previous studies. Moreover, the results of the study coincided with the findings of a study by Shannon et al. [61] and Benoit et al. [45], as well as the precede-proceed model by Lawrence Green (1974) that social constructs like stigmatization and discrimination alter the quality of life for sex workers, consequently predisposing them to mental health problems and fear of seeking health care services [62].

Due to this, various health conditions, including STIs, HIV/AIDS, and mental health disorders, are not treated. The reviewed articles also mentioned limited access to healthcare services as a significant health challenge for sex workers. This can be attributed to several factors, including the fact that some nations consider sex work illegal or criminal, the fact that there are not enough resources available, or the places where sex work is done [41]. As a result, access to preventive care and seeking medical attention when necessary is restricted for sex workers, which might worsen their health concerns. However, the nature of sex work itself carries certain health risks, including the possibility of physical harm, sexual assault, and contact with STDs [32]. The survey also revealed that it can be challenging for sex workers to receive medical treatment during regular business hours due to the profession's long hours and unpredictable schedules [4]. Overall, the difficulties that sex workers have access to healthcare highlight the need for policies and services that recognise this community’s particular difficulties and offer access to safe and supportive healthcare services to promote sex workers' health and well-being.

The general population stigmatises and discriminates against sex workers in the social setting. This is due to the widespread perception of sex work as immoral or abnormal, which may lead to negative attitudes toward sex work and individuals who engage in it. The results include social marginalisation as well as prejudice in employment and housing. The fact that sex work is prohibited only makes the social struggle that sex workers face worse [5]. When the research was examined, it became clear from numerous studies that sex workers are subjected to harassment, violence, and arrest by law enforcement, further isolating them from society and reducing their ability to seek legal or medical assistance [31, 16]. The challenges that sex workers face generally demonstrate the need for laws. The Precede-Proceed model proposes that to address the life complexities of sex workers in a social and health context, social constructs like stigmatization and discrimination among society, as well as the healthcare personnel, need to be addressed in order to improve the quality of life for sex workers. Increased incidence of STIs and HIV/AIDS among sex workers can be reduced by addressing the behavior of society and healthcare personnel towards sex workers [62, 63].

This comprehensive assessment offers crucial information on the difficulties faced by sex workers in South African communities in terms of healthcare and social challenges. To avoid healthcare and social battles among sex workers, the healthcare and social partners must actively work to eradicate this scourge from society. Addressing the social and medical issues faced by sex workers is a complicated issue that calls for multiple solutions and total commitment from all social and healthcare partners, including government and civil society. Evidence-based programs must be created to address the social and medical issues that sex workers encounter and to construct a theoretical framework. Additionally, there is a need for safety precautions, the beginning of campaigns to lessen stigma and violence, the provision of specialized healthcare services and sensitivity training for healthcare professionals, the development of social support networks, and the encouragement of research projects that consider the perspectives of sex workers.

The study was only concerned with the difficulties faced by sex workers in a medical and social setting. The included studies' quality and methodology differed, which could have introduced biases and weakened the validity of the results. Another issue is language bias, which resulted in the omission of critical viewpoints and studies by excluding papers published in languages other than English. The hidden and stigmatised nature of sex work can also lead to underreporting and restricted access to reliable data, affecting the assessment’s thoroughness. In the discussion, methodological limitations were not fully covered. The search methodology may have unintentionally left out a number of pertinent items, which may have impacted the thorough results. Notably, the lack of direct observation as a methodology may have prevented a more complex comprehension of the topic under study.

In conclusion, sex workers in South African communities face complex and varied social and health challenges. A multi-pronged strategy, including legal change, destigmatisation, and improved access to healthcare and social support services, will be needed to address these problems. To ensure that sex workers can receive the treatment and services they need to maintain healthy and satisfying lives, healthcare providers and policymakers must collaborate.

Leshata Winter Mokhwelepa contributed to the concept and design. Leshata Winter Mokhwelepa, Gsakani Olivia Sumbane, and Mxolisi Welcome Ngwenya participated in the acquisition, analysis, or interpretation of data. Leshata Winter Mokhwelepa and Mxolisi Welcome Ngwenya contributed to the drafting of the manuscript. Gsakani Olivia Sumbane and Leshata Winter Mokhwelepa carried out a critical review of the manuscript for important intellectual content. Leshata Winter Mokhwelepa, Gsakani Olivia Sumbane, and Mxolisi Welcome Ngwenya performed the formal analysis. Leshata Winter Mokhwelepa, Gsakani Olivia Sumbane, and Mxolisi Welcome Ngwenya provided administrative, technical, or material support. All authors have given their approval for the manuscript to be submitted.