Systematic review reveals high rates of survival sex linked to trauma and health risks among unhoused individuals, indicating the need for trauma-informed structural interventions.
Individuals experiencing homelessness are exposed to severe structural and psychosocial precarity, which may lead them to engage in survival sex to meet basic needs. This review synthesizes empirical evidence on the association between homelessness and survival sex. Following PRISMA guidelines, searches were conducted in Web of Science, Scopus, PsycINFO, and PubMed between March and April 2025. Of 488 records identified, 31 studies met the inclusion criteria. Across studies, survival sex was conceptualized as a survival strategy associated with significant physical and mental health risks. Reported prevalence varied widely (8.6%-53%), reflecting conceptual and methodological heterogeneity in definitions of homelessness and survival sex. Key predictors included gender, LGBTQI+ identity, racial and ethnic minority status, mental health problems, prior trauma exposure, food insecurity, and longer or recurrent episodes of homelessness. Engagement in survival sex was associated with higher rates of substance use, HIV/STI exposure, and antisocial behaviors, indicating cumulative and intersecting vulnerabilities. The findings highlight survival sex as a structural and health-related consequence of homelessness. Greater conceptual clarity and methodological consistency are needed to improve prevalence estimates and risk assessment. Interventions should address intersecting vulnerabilities and prioritize trauma-informed, inclusive, and structural responses in research and practice.
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Velasco et al. (2026) studied this question.
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