Prevalence and Associated Factors of Sexual and Physical Violence Against Female Sex Workers in Iran: Findings from a Nationwide Survey in 2024.

BACKGROUND: Female sex workers (FSWs) experience a disproportionate burden of violence shaped by structural, social, and individual factors. This study provides updated nationwide estimates of the prevalence of physical violence (PV) and sexual violence (SV) against FSWs and investigates its structural and individual drivers in Iran. METHOD: This cross-sectional study was conducted from December 2023 to March 2024, recruiting 1516 FSWs from 13 major Iranian cities using respondent-driven sampling (RDS). Data were collected via face-to-face interviews using a standard questionnaire. The primary outcomes were self-reported experiences of PV and SV in the last 12 months. Multivariable logistic regression was used to identify associated factors. RESULTS: The RDS-weighted 12-month prevalence was 23.3% (95% CI, 20.0-26.6) for PV and 30.3% (95% CI, 26.4-34.2) for SV. In multivariable models, structural factors were strongly associated with violence. Stable housing was strongly protective against both PV (aOR, 0.38; 95% CI, 0.25-0.60) and SV (aOR, 0.35; 95% CI, 0.21-0.56). Conversely, being a street-based FSW significantly increased the odds of both PV (aOR, 1.33; 95% CI, 1.01-1.76) and SV (aOR, 1.48; 95% CI, 1.13-1.95). Experiencing recent sexually transmitted infections (STI) (PV: aOR, 1.66, 95% CI, 1.26-2.19; SV: aOR, 1.76, 95% CI, 1.36-2.29) and engaging in group sex (PV: aOR, 1.59, 95% CI, 1.08-2.34; SV: aOR, 1.99, 95% CI, 1.35-2.94) were also associated with higher odds of both forms of violence. CONCLUSION: Violence is a major public health issue for FSWs in Iran, with important implications for HIV and STI prevention and care. The strong associations with work environment and housing underscore the need for confidential, stigma-free services that integrate STI/HIV care, post-violence support, and pathways to safe housing.