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Helping Hackney’s sex workers get the support they need

13/04/17

Which health and social care services do sex workers use? Which are most effective? What stops people accessing help? This is what Healthwatch Hackney wanted to find out when it set out to speak to sex workers in the local community.

Woman walking alone at night

The Healthwatch network exists to listen to everybody’s views of health and social care services. Some people’s circumstances make it harder to find out what they need from services, so Healthwatch work with partners to ensure their voices are heard.

According to a House of Commons report, there are approximately 72,800 sex workers in the UK and around 32,000 work in London. Approximately 11% of British men (around 2.3 million) aged 16 to 74 have paid for sex on at least one occasion.

Healthwatch Hackney worked with Open Doors to give local sex workers the opportunity to talk about their experiences of health and care services. Open Doors is a free and confidential advice service in East London for people working in the sex industry. The service provides support such as condom provision, health promotion and access to a comprehensive clinical sexual health service.

Healthwatch Hackney wanted to find out which services sex workers used, and what they felt worked best to improve their health, wellbeing and chances of getting off the street. A former sex worker had also raised concerns with Healthwatch about cuts to specialist open access services for local sex workers.

Common health concerns

Many sex workers – particularly those working on the street - have multiple health needs, including drug and alcohol dependency, sexually transmitted infections and mental health disorders. Many are homeless, placing them at higher risk of acquiring TB and being victims of violence and sexual assault. Open Doors says most street sex workers are ‘incredibly vulnerable’.

When it comes to accessing health and social care support, people come up against a number of barriers:

Trust

There was a very low level of trust in GPs and other health services amongst sex workers. Most people said they didn’t feel comfortable disclosing information about what they do for a living because they were worried that they would be judged. Some also said they didn’t want to share that they are homeless.

Many sex workers have experienced sexual violence. They told Healthwatch Hackney that they often feel GPs do not understand what they have been through. Open Doors has been pivotal to helping sex workers access care, helping them register with a GP, arranging appointments, sending text message reminders, and accompanying them to appointments.

Access to mental health support

Around 9% of sex workers supported by Open Doors have severe mental health problems, such as schizophrenia, bi-polar and personality disorders. Many also have substance misuse and dependency needs. Depression is also common and several sex workers spoke about suicide attempts, depression, and having PTSD and bi-polar disorder.

Some people felt that their circumstances and drug use meant that their mental health issues were not taken seriously by GPs and other health professionals. One woman said that she saw a different GP every time and felt ‘fobbed off’ when she spoke about her mental health.

Access to sexual health services

Previous bad experiences with sexual health clinics puts sex workers off seeking support, Healthwatch Hackney heard. Some people said that they felt judged or that professionals didn’t understand their needs.

Again, access to a service such as Open Doors has proved vital. Staff have proactively encouraged people to have regular STI tests, provided ongoing support, and built confidence in sexual health care.

Access to stable housing

For sex workers who find themselves in crisis situations, access to emergency housing is vital. This plays a critical role in helping people to recover from drug addiction and improve their wellbeing. For services such as Open Doors, knowing where sex workers are based helps them to provide consistent care and support, and to give people a greater sense of security in their lives.

Since conducting this piece of work, Healthwatch Hackney has written a report detailing its findings, as well as recommendations for how sex workers should be supported. Read the full report.


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