<p>Commercial sex work (CSW) remains a deeply contested issue in Sub-Saharan Africa (SSA), shaped by poverty, gender inequality, and structural exclusion. This narrative review synthesises evidence on the motivations, challenges, countermeasures, and success stories reported among women engaged in CSW in SSA. Guided by the Structural Violence Theory, the paper highlights how structural and systemic inequalities, manifested through gendered labour markets, patriarchal norms, household poverty, and limited social protection, compel many women into sex work as a means of survival. The findings also revealed that countermeasures addressing risks and vulnerabilities of CSW in SSA have largely been punitive involving legal restrictions as well as health-based interventions. Further, while criminalisation approaches often exacerbated stigmatisation and vulnerability around CSW, health-based strategies such as the Sex Workers Outreach Programs (SWOP), and empowerment initiatives involving microfinance schemes, and community-led programmes, showed promising results in enhancing the safety and well-being of sex workers. Success stories across SSA illustrate that when policy shifts prioritise poverty reduction, gender equity, and inclusive health access, the potential to reduce exploitation while promoting dignity becomes more attainable. This review argues that sustainable responses and reform efforts are needed to address the structural drivers of commercial sex work rather than focusing solely on its suppression. This includes a reconsideration of punitive legal frameworks to efforts that prioritise harm reduction, protection from exploitation, and increasing access to justice.</p>