Socioeconomic and social factors associated with perceived inability to exit sex work among female sex workers in Jimma, Ethiopia: a facility-based cross-sectional study

Abstract Background Limited evidence exists on the structural and socioeconomic factors associated with women’s perceived inability to exit sex work in Ethiopia. This study aimed to assess socioeconomic and social factors associated with perceived inability to exit sex work among female sex workers attending Key Population Clinics in Jimma, Southwest Ethiopia. Methods A facility-based cross-sectional study was conducted among 397 female sex workers attending three Key Population Clinics in Jimma Town, Southwest Ethiopia, from September to December 2025. Participants were recruited consecutively during the study period. The primary outcome was perceived inability to exit sex work, assessed using a self-reported questionnaire item asking whether participants believed they were unable to leave sex work because of financial, social, or structural barriers. Data were collected through interviewer-administered questionnaires. Bivariable and multivariable logistic regression analyses were performed to identify factors associated with perceived inability to exit sex work. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported, and statistical significance was declared at p < 0.05. Results Of the 397 participants, 256 (64.5%) reported perceived inability to exit sex work because of financial, social, or structural barriers and the remaining 141 (35.5%) participants did not report perceived inability to exit sex work. Primary or lower education was associated with higher odds of perceived inability to exit sex work compared with secondary education or above (AOR = 1.76, 95% CI: 1.08–2.88). Lack of an alternative source of income (AOR = 2.91, 95% CI: 1.67–5.07), financial dependency (AOR = 2.64, 95% CI: 1.53–4.55), current debt (AOR = 2.38, 95% CI: 1.37–4.12), housing insecurity (AOR = 2.29, 95% CI: 1.34–3.92), poor social support (AOR = 2.88, 95% CI: 1.28–4.64), lack of vocational training (AOR = 2.49, 95% CI: 1.67–4.52), and stigma and discrimination (AOR = 3.44, 95% CI: 1.90–6.20) were associated with perceived inability to exit sex work. Conclusions Perceived inability to exit sex work was associated with socioeconomic, structural, and social vulnerabilities, including limited economic alternatives, financial dependency, housing insecurity, poor social support, and stigma and discrimination. Interventions addressing these structural and socioeconomic barriers may help expand voluntary pathways for women who wish to leave sex work.