Sex workers’ experiences of drug and alcohol

services:emerging findings

Nicola SingletonResearch, Analysis &

ConsultancyIn Substance Misuse and Mental

Health

Shannon HarveyStella Project, AVA

Multi-component research project Funded by Pilgrim TrustPilgrim Trust Developed by DrugscopeDrugscope in partnership

with AVAAVA

Overview of project methods

Key Findings Extent and nature of the relationship between

substance use and sex work Service needs and barriers to use Effective interventions – evidence from the

literature Current service provision

Potential recommendations – for discussion

Presentation outline

Rapid evidence review – University of Greenwich

On-line survey of services (n=64) Interviews with women with a history of

substance use problems and prostitution Peer interviewers 19 semi-structured interviews Two geographical areas

Service case studies (3 services) Interviews with staff and service users Site visits

Project components

A high proportion of women engaged in street sex work have a history of substance use problems, particularly opiates & crack and vice versa.

Substance misuse and sex work are mutually reinforcing.

Street drug markets and the sex worker beats are often intertwined.

Violence is a common experience and can be extreme.

But sex work also provides an independent income and a social network.

Substance misuse and sex work

“…Its all about the money even when I’m not using drugs I still need to go out and buy stuff and a McDonalds or something ... Its just having something to show for at the end of the week.”“… it’s about getting and doing something, about associating with people…”

“…once you’re out there and you’re doing what you’re

doing… You need drugs to stay sane, but to pay for the drugs

you need to carry on committing those offences, so

to speak.”

“I’ve been raped, I’ve been beaten up, fucking sodomised, punched the fuck out of, tied up with me arms and that, stripped in the car and thrown out in the middle of the fucking fields and

having to walk home and knocking on someone’s door because you can’t just

walk home. How humiliating can it get?”

“I had problems with my ex-partner and he broke my leg and I ended up in hospital and was in a bad way.”

Support needs will vary over time ranging from basic support and harm reduction services to recovery and exiting support.

Four broad types of needs: Basic physical needs (eg food, clothing, sanitary products, shelter); Mental/emotional needs (eg friendship, counselling, DV protection); Health care needs (eg drug treatment, reproductive care, HIV/STI

care; general medical care); Longer term needs (eg mailing address, NI number, Housing,

employment).

Service needs

Individual barriers Self-esteem/belief that change is possible Partner Children Stigma (drug use & prostitution)

Service/institutional barriers Hours of operation, long waits, long waiting

lists, problems with telephone systems Trust & consistency of key-worker Lack of integration of services Geographical location of services

Barriers to service use“…my ex-boyfriend who sometimes – well we’re on and off. When I try and get a few days of the crack and the smack and just stick to the methadone, he’ll manipulate me to go down and take up my old behaviour..”

“You know I’m quite worried now to say I’m out working… again. And the impact it will it have on my son. I don’t want them coming and taking my son off me.”

“Guilt, shame, my lifestyle – how overwhelming it is to change. There’s a lot I need to change.”

Key factors identified Out-reach/accessibility eg mobile services, drop-in Evening opening hours Involvement of peers eg as worker, mentors etc Enhancement of standard programmes to meet specific

needs of these women Integrated provision or strong case management to

cater for all needs eg mental health, substance use, economic opportunities, social support

Child care provision Women-only provision Non-judgemental approach

Effective interventions

Current service provision

Outreach and accessibility

¾ (69%) offered drop-in and/or open access services

BUT only half provided this in a format likely to specifically support women involved in street-based prostitution 52% had evening opening hours

17 substance misuse services, 8 sex work projects, 1 sexual health

52% had an outreach van or similar 38% used a location close to the area used for

soliciting 30% conducted outreach in prisons

In the past we have done in-reach or have had project working with them such as [the local sex work project]

had specific workers who were funded to go and work more closely with the

women. They would also provide drop-ins. We would also have the outreach

van that used to provide condoms, needle exchange and things like that.

- Substance misuse service

Drop-in provision at a different venue to

main services.- Substance misuse

service

Not open regularly in evenings, however

evening appointments are available and are offered if

a woman is unable to/ struggling to access the service during opening hours. Some evening

outreach sessions provided.

- Sex work project

Evening outreach weekdays, currently expanding to cover

early morning & weekends.

- Sex work project

Enhancement of standard programmes

Although we do not provide an advertised specialist service around sexual violence or

domestic violence, we provide initial support and assessment to

specialist services. In reality women frequently do not engage

straight away with specialist services, we therefore frequently

provide support around these issues as well as accompanying women to specialist services.

- Sex work project

We are a drug treatment agency so our approach is always going to

engage women with drug treatment… but we would also

recognise that the woman’s drug issues and sex-working will be

interlinked. Substance misuse is never just about taking drugs, and to help somebody exit or what you would call recovery is about other

factors too such as housing, health, what people are doing with their health, how they are sourcing

their money.- Substance misuse service, West

Midlands

Involvement of peersWe have found that most

women using our substance misuse services in our

organisation frequently do not want to openly disclose their involvement in sex work with

other service users, which therefore has an impact on

being able to provide peer led services for sex workers.

- Sex work project

We would refer to providers

who offer peer support.

- Drug service

Peer support brings commonality, so the

immense shame many women feel is broken

down a bit because it's shared amongst peers. Women can bring their experiences and feel valued, and accepted

and not alone.- Drug service

I have seen it as a positive and negative. I have had concerns about the sometimes lack of

training and supervision of peers and a lack of stability and

distance from the peer’s own issues-can be detrimental to both

parties. Sometimes there is a hurry to involve women who are doing well into becoming peers;

sometimes this can lead to a relapse or collusion.

- Drug service

One of the biggest advantages of this place is the support women

give each other, you are all part of a group and you’re all sharing, you

are all supporting each other, friendships are made. Quite often,

very positive relationships are built, peer support & mentoring is massive, and I think (substance misuse services) miss out on all

that.- Sex work project, West Midlands

Women-only space was not common 42% offered session times that were women-only 28% offered session times that were only for

women involved in prostitution Women’s involvement in service provision

Only 1 service had a woman on their board of treetess with experiences of prostitution and drug use

Only 4 employ these women as staff 28% have them as volunteers 58% consult them through service user groups 23% admit that these women are not involved in

any way in design, development or delivery or their services

Women-only spaceAs soon as you start getting better,

everyone looks attractive… and if someone is flirting with you and your self-esteem is

low, you’ll get drawn into probably the wrong kind of relationships. Because I did that, I was 8 months sober, met someone

who was still drinking, who wasn’t quite far into recovery as I was, and ended up doing it with him. So a women’s group is a good

thing to have because you can get women’s opinions in as well… men are

different from women obviously, biologically. We are also socially in a

different world.- Women’s group leader, peer-led recovery

project, Yorkshire

We create this big space and we provide lunch, and people all sit here, sit around the table and eat lunch, staff are in here

with the women, eat with the women. That is important, keeping no hierarchy

that’s what we are trying to create, women in this together anyone could be

in each other shoes, it does not make any difference you know, nobody knows if you are a woman that’s just come out of prison or a sex-worker, nobody knows if you’re under the mental health team

we are just women and we are just together in one space and it doesn’t

matter.- Sex work project, West midlands

92% said child contact issues were important or very important for women they worked with

91% said child protection concerns were important or very important

BUT only 29% provide a service in relation to children and/or pregnancy issues

Children

Creche available for children under 5 for women attending

structured day care / appointments- Sex work project

Women need to feel safe; they need to feel that they have their own

space that is their space. Most of our women have experienced some sort of sexual abuse so it’s important to offer them their own space. If you

think about it especially in probation services where women make up only

3% of the total number, and they have to sit in those waiting rooms, with all these men especially if you

have a child in tow, in terms of space, for the children they have

nothing, no toys for the kids, it’s all bars and black and white.

- Sex work project

Integrated provision

What I noticed is that our workers and the [local sex work project] workers, do work really closely together when they

are working on a case and they are really flexible about where is the best place to see that person rather than

having fixed ideas of oh it needs to be here.

Another issues is time – most women can only come in evenings, whereas our workers are here from the morning so it’s about finding that middle ground.

- Substance misuse service , Yorkshire

We have [two drug services], because they are independent, they tend to be away a lot and they just don’t seem that open

to working together, I don’t know if they see it as

competition, there just seems to be barriers.

- Sex work project, West Midlands

Prostitution Strategy (2006) the first step must be ‘to set them free from the drug

addiction that constantly forces them back onto the street’ ‘this is a particularly vulnerable group of problematic drug

users due to their need to finance their drug use, and often that of their partners, through prostitution’

Drug policy (2010) No mention of the words ‘prostitution’, ‘woman’, ‘women’ or

‘girl’ in document. Call to End Violence Against Women & Girls

National Ugly Mugs scheme, 12 month pilot July 2012 – July 2013

Research (through embassies) on international best practice Human trafficking – the Government Strategy 2011 Troubled families

Current policy landscape

Where next? Increasing the policy focus. Guidance for commissioners Best practice guidance for services Training for practitioners Exploration of diversity of relationship between

drug use and sex work and of different types of sex work.

Potential recommendations

Thank youQuestions?