“Beneath the surface of the city lie hidden and painful realities”: Understanding the lived experiences of health professionals providing services to female sex workers in Iran

Vulnerable Women’s Counseling Centers (VWCCs) in Iran provide counseling and prevention services to female sex workers (FSWs) as a key strategy for HIV prevention. Understanding how working with this highly stigmatized population affects the occupational well-being of health professionals is essential for improving provider–client relationships and strengthening HIV prevention efforts. This study aimed to explore the lived experiences of VWCCs’ staff in providing health services to FSWs. This qualitative study employed a descriptive phenomenological approach. Semi-structured interviews were conducted with 17 staff members from VWCCs across six provinces in Iran. Data were analyzed using the seven-step Colaizzi method with MAXQDA software. Purposeful maximum-variation sampling was used to capture a diverse range of staff experiences across different occupational roles. The core experiential finding was a fundamental paradox: participants simultaneously derived profound professional meaning from their work while experiencing substantial emotional, ethical, and social challenges. More specifically, participants reported a sense of satisfaction from promoting public health and supporting vulnerable groups, alongside feelings of moral discomfort associated with the perception of facilitating sex work. Staff reported psychological consequences encompassing initial shock, altered perceptions of sexual topics, emotional distress and rumination, constant comparison and projection onto others, and sexual-risk salience, alongside conflict between professionalism and personal and social considerations. Additionally, distrust and disillusionment with social institutions manifested as increased cynicism. Participants also reported limiting personal and family relationships through heightened vigilance, reduced social interactions, and diminished marriage intentions. Finally, occupational challenges encompassed feelings of incompetence, concealment of professional identity due to social stigma, exposure to aggressive behaviors, and the perceived need for resilience and pre-employment training. The findings highlight that working in VWCCs provides staff with professional fulfillment while exposing them to significant psychological, ethical, and social challenges. This underscores the need for organizational support programs, specialized training, and strategies to reduce occupational stress. Such interventions are essential to maintain staff mental health and, consequently, enhance the quality of services provided to this vulnerable population.