The study was conducted at a settlement for internally displaced persons located within the urban fabric of Bamako. This settlement is characterised by precarious socio-economic conditions and marked social porosity. It not only accommodates victims of displacement but also serves as a gathering point for a transient population experiencing social breakdown. Consequently, the sex workers interviewed had varied backgrounds, with some having been forcibly displaced, whilst others came from neighbouring neighbourhoods or were engaged in circular migration.

This is a descriptive cross-sectional study based on a quantitative approach. The study took place from April to June 2025.

The study involved sex workers aged between 13 and 25 who had been working for at least three months. Due to the difficulty in accessing this population (self-protection, mistrust), snowball sampling was used, enabling the recruitment of 30 participants. The snowball sampling process involved identifying two initial participants—working women from the community, referred to as “seeds”—who were already connected to stakeholders in the field. Their role was crucial in establishing connections with other members of this community while fostering a climate of trust. In total, 35 workers were contacted. Of these, 30 had participants to join, representing a participation rate of 85.7%. The five refusals observed were largely due to a distrust of the anonymity offered, stemming from time constraints inherent to their professional activities.

Recruitment was completed with 30 participants. This number was chosen based on the exhaustion of networking resources within the site’s limited geographical scope. Any eligible person who was not physically or mentally capable of answering the questions was excluded from the study.

Data were collected using a structured questionnaire during confidential individual interviews focusing on the main variables: sociodemographic characteristics, consumption habits and experiences of violence.

Quantitative analyses were carried out using SPSS version 16; quantitative variables were expressed as means and standard deviations. The descriptive analysis consisted of describing the study sample. The quantitative variables were presented as means and standard deviations, whilst the qualitative variables were presented as percentages

Authorisation was obtained from the administrative and traditional authorities prior to conducting the study. Participants were informed of the objectives and purpose of the study. Participation was voluntary and based on free and informed consent, as well as their right to refuse or interrupt the interview at any time, without constraint

Although this protocol had not received approval from an official ethics committee, the study was conducted in accordance with the fundamental ethical principles governing research. Informed consent was obtained systematically. Regarding minor participants, aged 13 to 17, who find themselves in situations of family breakdown, homelessness, or forced displacement, making access to legal guardians impossible, we have opted for an informed consent procedure with the guardian at the site level. The principles of beneficence and non-maleficence were ensured by the anonymization of data, by the assignment of identification numbers, as well as by the scrupulous respect for confidentiality. To compensate for the absence of institutional supervision, a procedure for referral to psychosocial support services, accessible via the site, had been established for any participant showing distress in relation to the violence mentioned.

A unique identification number was assigned to each participant to ensure anonymity. The precise location of the study site has not been disclosed in this paper; we have identified it as a site for internally displaced persons in an urban area of Bamako. This confidentiality measure aims to strengthen the protection of participants against stigmatisation and to prevent any potential legal or social repercussions linked to the sensitive nature of the phenomenon under study.

The majority of participants were aged between 16 and 24. Educational attainment was generally low, with a high proportion of those who had never attended school (Table 1).

Table 1.Breakdown of participants by socio-demographic characteristics.

More than one in two participants 17/30 reported using psychoactive substances (56.7%) (Figure 1). Tobacco was the most commonly used substance, followed by tramadol, alcohol and cannabis, at 76.5% (13/17), 58.8% (10/17), 41.2% (7/17) and 35.3% (6/17) respectively (Figure 2). Regular use was reported by more than half of the users, with instances of poly-substance use observed.

Figure 1. Breakdown of participants by psychoactive substance use.

Figure 2. Breakdown of participants by type of psychoactive substance used.

Violence was virtually ubiquitous: the majority of participants reported physical violence (93.3%), and a significant proportion reported sexual violence (70%) (Table 2).

Table 2. Breakdown of respondents by type of violence experienced during their career.

The results confirm that psychoactive substance use was common among sex workers in precarious circumstances, corroborating the findings of other authors [4][11][12]. According to the literature, the motivations for use appear to be varied: stress management, adapting to the demands of work, or seeking to enhance performance and stamina [4]-[13]. Sites for internally displaced persons in Mali often constitute spaces of social reconstruction where poverty, insecurity and limited access to health services coexist. In this context, the use of psychoactive substances may appear as a coping strategy in the face of daily pressures, particularly to alleviate stress, fear or trauma linked to life experiences. The substances identified in our study were similar to those observed in other international contexts, where tobacco, alcohol and misused medicines predominate [1]-[14]. A study in Marocco highlights that some sex workers combine alcohol, tobacco and other substances, influencing their health behavior [15]. In Mali, the use of certain substances such as tramadol or alcohol may can also be influenced by their relatively easy availability on informal markets, a phenomenon well documented in major West African cities. The consumption observed among sex workers is part of an urban context in Mali characterized by the misuse of psychoactive substances [8]. In Bamako (Mali), where the consumption of psychoactive substances, particularly alcohol, is associated with risky sexual behavior among sex workers [10]-[16]. This availability contributes to the normalisation of their use, including among young and vulnerable populations. According to other authors, these practices are part of an environment marked by strong social influences and economic constraints [9]-[17].

Beyond economic determinants, substance use practices can also be embedded within specific socio-cultural dynamics. The link between substances, economic vulnerability and entry into sex work has been established by Malian authors [18]. In the Malian context, characterised by strong social and religious norms, the use of psychoactive substances among women, and particularly among sex workers, is likely highly stigmatised. This stigma would reinforce their social marginalisation and limit their access to health services or support mechanisms.

Furthermore, some participants may integrate these these practices into socialisation patterns within their professional environment. Substance use can thus play a role in managing interactions with clients, by reducing anxiety, increasing disinhibition or facilitating resilience in the face of the demands of sex work.

Furthermore, the high prevalence of violence observed in our study reflects the structural vulnerability of this population, as described by some authors [6]-[10]. The literature often highlights complex interactions between substance use and exposure to violence [16]. Violent behaviour among sex workers is thought to be linked to intoxication following substance use [19].

The high levels of violence reported in this study illustrate a situation of particularly marked structural vulnerability. In the context of sites for internally displaced persons in Mali, the absence of formal protection mechanisms, overcrowding and precarious living conditions increase exposure to physical and sexual violence. The interaction between substance use and exposure to violence appears to be bidirectional to the literature. Toujours selon les informations de la litteratture, on the one hand, substance use may increase exposure to high-risk situations by impairing judgement or the ability to negotiate. On the other hand, the violence experienced may act as a trigger or aggravating factor for substance use, as a coping mechanism in the face of trauma.