Digital transformations in sex work: A scoping review of social media use by female sex workers in Low- and Middle-Income Countries
1Liverpool School of Tropical Medicine, Liverpool, United Kingdom
2Malawi Liverpool Wellcome Programme, Blantyre, Malawi
3Centre for Sexual Health and HIV/AIDS Research, Harare, Zimbabwe
4London School of Hygiene and Tropical Medicine, London, United Kingdom
*Corresponding Author, Doreen Sakala, Malawi Liverpool Wellcome Programme, Queen Elizabeth Central Hospital Campus Blantyre, Malawi, Email: Doreen.Sakala@lstmed.ac.ukAbstract
Introduction
Female Sex Workers in Low- and Middle-Income Countries face increased risks of violence, exploitation, stigma, and limited access to healthcare, leading to vulnerability in their communities. Modern communication technologies have transformed FSW interactions with clients, facilitating easier and more accessible connections. This scoping review explores the use of social media by women involved in sex work in Low and middle-income countries to understand how communication technologies have been adopted and exploited to engage with various stakeholders in the industry.
Methodology
We conducted a scoping review following a pre-defined eligibility criterion, systematically searching multiple databases (PubMed, Global Health, Medline, CINAHL, Google Scholar) for English articles published between 1991 and 2024. Two reviewers screened all identified articles and eliminated duplicates using Covidence software. Thematic analysis was performed using NVivo 12 to identify key themes.
Results
The search yielded 9,442 articles with eight articles meeting the eligibility criteria for inclusion. Social media was reported to provide an opportunity for women to expand their clientele beyond their immediate geographical confines increasing their income. Use of social media reduced women’s exposure to health risks due to reduced physical contact with clients reducing exposure to HIV and other sexually transmitted infections. Social media also increased physical safety through reduced exposure to violence and increased capacity to screen clients prior to any physical contact. Despite these advantages, women who use social media for selling sex face cyber security risks including the non-consensual dissemination of their pictures and videos, online harassment, and bullying.
Conclusion
The scoping review found that there is limited research on women’s usage of social media in sex work in LMIC. Social media empowered female sex workers but also posed risks to their autonomy and mental health. Further research is needed to understand the challenges these women face to inform effective policies and practices.
Article notes
Competing Interest Statement
The authors have declared no competing interest.
Funding Statement
Yes
Introduction
The 21st century has witnessed unprecedented progress in digital communication technologies, outpacing all other technological advancements and reaching nearly 50% in Low and Middle-Income Countries (LMIC) (1). The emergence of new communication technologies has diversified virtual human interface with websites and social media platforms providing opportunities for social interaction (2). Social media platforms have facilitated access to information, connections with others, and the discovery of and engagement with niche communities (3).
The advent of the internet and digital spaces has led to profound impacts on people’s lives, including women involved in sex work. Over time and with the increasing availability of online opportunities, the sex work landscape has transformed in many countries across the globe, from traditional in-person interactions to online environments (4,5). This shift was first observed in the early 1990s when sex workers began to gravitate towards the Internet as a means of selling sex (6). Since then, FSW engage in selling sex both online and offline, with a growing number increasingly transitioning to online platforms (7).
Online sex work falls into two categories: online service delivery such as webcam modelling, phone sex, and virtual reality experiences (8) and, when the websites are used to market sex, screen clients and make appointments, but sex is sold offline and in person with the client (9). FSW who use the first category are exposed to fewer risks than those who use the second category since there is no physical contact with clients. In High-Income Countries (HIC) where selling sex online is common, the associated benefits include a wider clientele and the ability to pre-screen clients before deciding to meet with them (6). Some websites and social media platforms provide clients of sex workers the opportunity to post reviews which determines FSW scores and their prospects for attracting more clients (10). Social media has also connected FSW with their peers for friendship and support, including discussing and sharing health concerns and safety issues (11). For FSW who rely on marketing sex online only, social media interactions offer protection from both physical harm including getting mugged or raped (12) and risks such as sexually transmitted infections (STI), in. Despite the widespread availability of the internet, low-income countries remain underserved in terms of access and usage (13). In 2022, 92% of the population in high-income countries used the internet, compared to only 56% in low-income countries (14). There is limited empirical research data on the use of social media within the context of sex work in LMIC (15). However, sex work that is facilitated, advertised, performed and accessed via various social media platforms is increasingly popular in LMIC (16,17). For the 2025 fiscal year, the World Bank classifies low-income economies as those with a GNI per capita of $1,145 or less and lower-middle-income economies as those with a GNI per capita of between $1,146 and $4,515 (18). We conducted a scoping review with the aim of understanding how social media is used by women engaged in selling sex and how it promotes engagement in sex work for women in LMIC.
Methodology
Overview
We used the Scoping Studies Methodological Framework developed by Arksey and O’Malley (19). This involves identifying the research question, identifying relevant studies, selecting studies, charting the data, and collating, summarising, and reporting. The selection of this framework was based on its ability to accommodate diverse methodological designs within an interdisciplinary field.
Search Strategy
Two reviewers, DS and GJ, conducted a comprehensive literature search using PubMed, Global Health, Medline, CINAHL, and Google Scholar. These were selected to identify literature in public health, behavioural and social sciences. Global Health and Google Scholar are particularly strong for LMIC studies and studies on marginalised populations such as FSW. We searched for publications using the key concepts: ‘female sex work’, ‘women selling sex’, ‘women’, sex work’, ’social media’, ’Low and middle-income countries’, and their synonyms (see Supplementary file 1). A third reviewer, BK, resolved disagreements on paper inclusion.
Following the initial database searches, we imported all papers identified into Covidence software available at https://www.covidence.org/ to facilitate the identification and elimination of duplicates (20). DS and GJ, independently performed an initial screening of titles and abstracts and then conducted a full-text screening, where 21 discrepancies were identified. To resolve these differences, the reviewers referred to the eligibility criteria for the studies and engaged in discussions, with a third reviewer, BK, who made final decisions for inclusion.
Eligibility criteria
We included studies published in English between 1995 and 2024 to capture developments since the emergence of social media platforms in the late 1990s. The population of interest was women identified as involved in selling sex, specifically within LMIC. We aimed to include peer-reviewed articles with quantitative, qualitative and mixed-methods designs that focused on complex social phenomena such as the use of social media within sex workspace. However, only qualitative studies were identified on the topic in LMIC and included. We excluded systematic and meta-synthesis reviews.
Charting the extracted data
DS created a data chart in an MS Excel spreadsheet to describe all selected publications by title of article, author and year, country, study aim, study design, population, social media platform explored and, key findings (Table 1).
Synthesis of results
The review followed a thematic analysis approach (21), and DS and GJ coded texts line by line from the results, discussions and conclusions of the included studies. We used NVivo 12 (QSR International, Warrington UK), to organise and manage the data extraction process. DS and GJ used an inductive coding approach to identify initial themes. DS and GJ developed second-order themes collaboratively to identify descriptive themes, patterns, similarities, and differences. To ensure accuracy and reliability and trustworthiness, we shared the codes and descriptive themes with all authors for full analysis.
Results
The search returned a total of 9447 citations, out of which 702 duplicates were identified and removed. The remaining 8745 articles were screened by title and abstract and 8684 articles were removed because they did not report usage of social media for sex work by women living in LMIC but rather focused on a different target population such as Men who have Sex with Men (MSM), adolescents’ usage of social media, the elderly, students, and Intravenous Drug Users (IVDU). We remained with 61 articles for full-text screening and removed a further 53 articles at this stage as they reported outcomes, we were not interested in with others not from LMIC and we remained with eight articles that met the eligibility criteria. Fig 1 details the search and exclusion process and the reasons why some papers did not meet the inclusion criteria. Results were reported thematically with themes aligned with the aim of the study.
Results
Four key categories were identified: women’s introduction to online sex work, utility of social media in sex work in LMIC, mechanisms of social media sex work and risks and online sex work. A description of the themes is given below.
Women’s introduction to online sex work
FSW were introduced to selling sex through social media with friends, colleagues, and clients playing significant roles in this transition (31). For instance, some women learned about online platforms from peers who had already established an online presence, sharing tips on creating profiles, attracting clients, and handling transactions securely (15,23). Clients themselves sometimes suggested moving interactions online for increased discretion and convenience, introducing FSW to specific apps or websites.
During the COVID-19 pandemic, lockdowns, and restrictions such as the early closure of bars and entertainment venues severely limited FSW ability to solicit clients in person. This sudden loss of traditional income sources provoked many FSW to rethink their traditional strategies and quickly adapt in response to the prevailing economic situations by embracing digital communication technologies. In Senegal and Zimbabwe, for example, women began utilising video and audio calls via WhatsApp, an instant messaging application that allows sending of photos, videos, documents, and location. The women also used WhatsApp to offer services remotely, while others turned to Facebook to advertise and connect with potential clients (24,25). These platforms allowed them to reach a wider audience while adhering to social distancing measures. Other FSW developed innovative methods such as online parties or online group chats, to engage clients. However, the shift to online sex work was not without challenges as many FSW faced limitations such as a lack of funds to purchase internet data bundles (23,24). The high cost of data in countries like Zimbabwe made sustained online presence financially burdensome. Poor internet connectivity, especially in rural or underdeveloped areas, hindered consistent communication and could lead to missed opportunities or misunderstandings with clients (24).
Discussion
This scoping review highlights a lack of empirical evidence on social media use within sex work in LMICs. This gap may be attributed either to a lack of research attention in this area or to the limited number of women engaging in sex work through social media in LMIC settings. We found that despite the lack of evidence, social media plays a significant yet under-explored role in reshaping the sex work landscape, and one that was strengthened as a result of COVID restrictions in LMIC from 2020 to 2021. The findings also underscore the transformative impact of social media platforms on the practices, opportunities, and vulnerabilities faced by FSW.
The advent of social media platforms has enabled FSW to shift from traditional, in-person solicitation to more discrete and far-reaching online practices. Platforms such as WhatsApp and Facebook, have emerged as vital tools for client solicitation, facilitating broader geographic reach and reducing the dependency on physical proximity (23–25). This transition aligns with global trends observed in high-income countries, where technology has revolutionised sex work (3,30–32). Yet, limited access to reliable internet connectivity and affordable data bundles remains a barrier, highlighting persistent digital inequalities that exacerbate existing socio-economic disparities (24,33).
Introduction to social media platforms involved middlemen who often managed transactions on behalf of FSW. While this arrangement has facilitated their work, it had challenges including exploitation (22,28). Eliminating these middlemen through social media meant that FSW were empowered to negotiate directly with clients, retain full payments of the transaction, and exert greater control over their work (16). This economic autonomy represents a critical advantage of independent management of social media accounts linked to sex work, but the attainment of this independence demanded FSW to adopt protective strategies such as using pseudonyms and maintaining multiple social media accounts to allow them to reduce the potential for social harms linked to solo online transactions. These tactics demonstrate the resilience and resourcefulness of FSW, as they manage the dual pressures of economic survival and societal judgment.
Social media platforms have become important conduits for accessing a broader array of important information including health information. FSW frequently use social media to gather insights into sexual health issues before seeking medical attention, reducing barriers to healthcare access in conservative or stigmatising environments (28). While this practice empowers FSW to make informed health decisions, it also underscores the need for accessible information that emphasises the importance of seeking professional medical assistance (34).
Despite the benefits, online sex work introduces new risks. Concerns around digital privacy, including the unauthorised dissemination of images and videos, was pervasive and often resulted in severe psychological and social repercussions, such as isolation and depression (23,25). The pervasive social stigma surrounding sex work exacerbates these challenges, with leaked content leading to social isolation and familial rejection (23). Furthermore, online platforms expose FSW to cyber harassment and hacking, necessitating enhanced digital literacy and security measures to protect their identities and livelihoods (24,25).
The findings reveal a perceived trade-off between physical and social media risks. While online platforms reduce exposure to physical violence and sexually transmitted infections, they introduce psychological and reputational hazards that are often more enduring (25). This contrast reflects the complex realities of navigating sex work in the digital age, where safety and vulnerability coexist in new and challenging ways. The risks of online sex work identified in this study, including online harassment, and blackmail, are consistent with existing literature on the vulnerabilities of social media-based sex work (28).
The findings also demonstrated that peer networks play a pivotal role in fostering safety and resilience among FSW. Through these networks, women share strategies for client screening, negotiate safer meeting arrangements, and provide emotional and practical support (28). This sense of community underscores the collective agency of FSW in mitigating risks and enhancing the benefits of their professional experiences.
Limitations
The scoping review included only eight studies reflecting the limited body of research on women who use social media for sex work in LMIC. Such scarcity of research underscores the need for further studies to provide a comprehensive understanding on the topic. This small evidence may therefore limit the generalisability of the findings and provide an incomplete understanding of the topic. The studies included in the review also did not cover all LMIC regions comprehensively omitting insights from countries where social media use may be prevalent but not documented.
Conclusion
This review illustrates how women use social media for sex work and the double-edged nature of social media in sex work within LMICs. Social media for sex work is protective from a health perspective as it empowered women, provided them with access to health information and reduced exposure to STI and HIV. It however also exacerbated social risks such as leakage of pictures and videos that lead to stigma affecting one’s psychological well-being and mental health. More work needs to be done to identify the potential role of social media in Sexual Reproductive and Health (SRH) interventions and risk reduction approaches for FSW in LMIC. Future research should also focus on developing tailored interventions to address these risks, including digital literacy programs and robust online safety measures. Policymakers and stakeholders must also work toward creating inclusive digital environments that safeguard the rights and dignity of FSW while leveraging the transformative potential of technology to enhance their safety and well-being.
Supporting information
Data Availability
All relevant data are within the manuscript and its Supporting Information files.
Acknowledgements
The author wishes to thank the Adapted Microplanning Eliminating Transmissible HIV in Sex Transactions (AMETHIST) consortium where this study was embedded in and the Liverpool School of Tropical Medicine where she is undertaking her PhD studies.