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The mental health of female sex workers is affected by violence and sex (1). There is a hypothesis that female prostitutes are subject to trauma and depression due to childhood sexual abuse and are more exposed to high-risk sexual behaviors due to an untreated mental trauma and the inability to adapt to the crisis (2). Sexual behaviors are considered high-risk when people are not aware of their own health or their sex partner’s, and have unsafe sex with a risk of having sexually transmitted infections. The high-risk sexual behaviors or unsafe sex include sexual relations with multiple partners, unprotected sex (sex without a condom), sexual violence, drug or alcohol use in sexual relations, and unusual oral and anal sex (3,4). One of the main outcomes of these behaviors is the risk of HIV, which has the highest mortality rate in association with sexually transmitted infections. Other outcomes include syphilis, chlamydia, gonorrhea, and hepatitis (4). Women with high-risk sexual behaviors have little support and often suffer from violence, homelessness, and drug addiction. They need attention and support to reduce HIV/AIDS infection and to retrieve their physical and mental health (5). The World Health Organization (WHO) has defined mental health as “a state of complete physical, psychological, and social well-being and not merely the absence of a disease”. It is the promotion and prevention of mental disorders or the treatment and rehabilitation of mental illnesses to such a degree that the person is aware of their potential, can deal with everyday stress, work productively, and be useful to the society (6). The basic principles of mental health are: respect for oneself and others, knowing the limitations, knowing that human behavior relies on various factors like the existential personality and the needs or factors that affect them for action. WHO has aims for promoting mental health including: preventing mental illness by creating social and psychosocial support systems as well as timely treatment and treatment of mental illness (7). Mental health has a direct relationship with social support. In a study, depressed people had less perceived social support than healthy ones (8). Appropriate social support can be a contributing factor in empowering the women with high-risk sexual behaviors (9). It has been reported that support from the family or a sexual partner has been effective in quitting addiction in the women with multiple sexual partners (10,11). Social support is defined as a combination of interpersonal interactions among or assistance provided Abstract Objectives: The violence and prostitution are examples of the stressors in the women with high-risk sexual behaviors and can create a psychological crisis in these women. The purpose of this study was to determine the relationship of mental health with social support in the women with high -risk sexual behaviors visiting drop-in centers (DICs) in Tabriz, Iran, in 2017. Materials and Methods: This cross-sectional study was conducted on 149 women with high-risk sexual behaviors, visiting three DICs in Tabriz, Iran. The sampling was purposive and non-random. Data were collected using socio-demographic characteristics, social support (PRQ-part 85), and mental health (GHQ-28) questionnaires. A test of multivariate linear regression was performed to identify a number of mental health determinants and explanation of variance. Results: The mental health score was 50.7 (18.2), the score ranged from 0-84. The best status belonged to depression subscale [10.5 (7.1)] and the worst status belonged to social dysfunction subscale [14.6 (4.5)]. The mental health and its subscales had a significant relationship with social support (P < 0.001, R= -0.55 to -0.33). The variables of social support, drug use, and spousal violence were able to predict 35.4% of mental health variance in the women. Conclusions: According to the results, appropriate strategies are needed to promote social protection and mental health in the women with high-risk sexual behaviors in order to reduce the sexually transmitted diseases especially HIV/AIDS in the society.

Mental Health and its Relationship With Social Support in Iranian Women With High-Risk Sexual Behaviors