Structural and Social Barriers to Accessing Survivor-Centered Post-violence Care Among Sex Workers in Abuja, Nigeria: A Mixed-methods Study

Gender-based violence (GBV) among sex workers represents a major public health and human rights crisis globally. Effective post-violence response systems are essential for reducing the physical, psychological, and social consequences of violence. However, marginalized populations such as sex workers frequently encounter substantial barriers when attempting to access healthcare, legal aid, psychosocial support, and shelter services. This study aimed to assess access to survivor-centered post-violence care and identify structural and social barriers affecting sex workers in Abuja, Nigeria. A comparative cross-sectional mixed-methods study was conducted among 455 sex workers operating in Gwagwalada, Bwari, and Abuja Municipal Area Council (AMAC). Participants were recruited using respondent-driven and venue-based sampling approaches. Qualitative data from focus group discussions revealed pervasive experiences of stigma, fear of arrest, institutional distrust, and concerns regarding confidentiality that discouraged help-seeking behaviors. Quantitative data were collected using structured questionnaires and analyzed using chi-square statistics and logistic regression, while qualitative data from focus group discussions were analyzed thematically. The findings revealed low utilization of post-violence response services. Approximately 67.3% of respondents reported receiving no support services following violence. Access to healthcare services was reported by only 12.1% of respondents, while psychological support (8.7%), legal aid (6.5%), and shelter services (5.4%) remained critically underutilized. Major barriers included healthcare provider stigma, fear of police harassment, criminalization of sex work, discriminatory shelter policies, and inadequate mental health services. Access to psychological support, legal aid, and shelter services significantly improved recovery outcomes (p < 0.05). The study demonstrates that institutional discrimination and structural violence significantly limit access to survivor-centered care among sex workers in Abuja