Most female street sex workers in the UK are affected by the use of illegal drugs, such as heroin and crack cocaine. For most of these women, heroin and crack use reinforces their dependency on sex work and adds to their health and social problems. The need to finance their drug use, and often that of a partner, underpins their involvement in sex work. Drug intoxication also means they are less able to protect themselves whilst working.
Street sex workers who are drug-dependent find using treatment services difficult and when they do, typically don’t benefit as much as other drug users. The 2010 UK Drug Strategy changed the emphasis for drug services from reducing harm through safer drug use to reducing harm by stopping drug use. This makes it even more important for drug services to provide effective treatment for these women.
Managing problem drug use amongst sex workers is complex. They can experience stigma in drug treatment groups from other drug service users. This prevents them from discussing their sex work, a major factor in their drug use. There is also evidence that many drug-using street sex workers are affected by post-traumatic stress disorder (PTSD) from their life experiences. They are unlikely to benefit from other treatment unless this trauma is addressed.
Based on recent research, we have developed a plan to improve the results of drug treatment for these women, by organising NHS and voluntary sector services to work together. This new approach involves creating a stigma-free environment for street sex workers to discuss their work in drug treatment groups, as well as addressing trauma as part of the drug treatment.
This will lead to a patient-focused care package for street sex workers, addressing this longstanding public health and social issue. This project is being conducted by the University of Bristol and NIHR CLAHRC West in collaboration with:
- Bristol Drugs Project
- Bristol ROADS (Recovery Orientated Alcohol and Drugs Service)
- Avon & Wiltshire Mental Health Partnership NHS Trust
- University Hospitals Bristol NHS Foundation Trust
This project is known as the DUSSK (Drug Use in Street Sex Workers) study. We will study how acceptable the new service is for street sex workers and how practical it is to run. How much it costs in terms of staff time will also be addressed.
The project could lead to a reduction in illicit drug use, which may in turn result in reduced involvement in sex work. It could also improve the mental wellbeing of these women. We are in the process of drafting papers for this project.