Sexualized Substance Use and Psychosocial Vulnerabilities Among Sex Workers in Spain: Findings from a Cross-Sectional Study

Sexualized Substance Use (SSU) refers to the use of substances to intensify sexual experiences, often involving substances such as methamphetamine, mephedrone, or GHB/GBL. This cross-sectional study examines with a multifaceted syndemic approach the prevalence of SSU among sex workers in Spain, their motivations, health risks such as sexually transmitted infections (STIs), substance related health consequences, and experiences of lifetime violence victimization. It also explores psychosocial factors including recreational use, perceived sexual satisfaction, and social support, providing a multifaceted view of SSU. A total of 98 sex workers (ages 18–60; 57.1% cisgender women, 30.6% cisgender men, 4.1% transgender women, 1% transgender men, and 6.1% non-binary) were recruited through Non-Governmental Organizations (NGOs) and social media to complete an online questionnaire. Data were analyzed using descriptive statistics and hierarchical regression models. Findings show that 25.5% reported SSU in the last 12 months. Regarding health outcomes, 44.9% had experienced an STI at some point, though 93.9% reported using preventive methods. Main motivations for SSU included escaping reality or coping with emotions such as shame, sadness, anxiety, or emptiness. Furthermore, 86.7% of participants had experienced some form of victimization in their lifetime, particularly LGBTQIA+ women. Regression analyses revealed that sexual satisfaction (β = 0.74) was positively associated with SSU, while perceived social support (β = -0.25) was negatively associated. These results highlight the psychosocial vulnerabilities linked to SSU and underscore the importance of tailored sexual health interventions and harm reduction strategies to support the well-being of sex workers.