Access to healthcare for street sex workers in the UK: perspectives and best practice guidance from a national cross-sectional survey of frontline workers

Abstract

Background Street sex workers (SSWs) are a highly marginalised and stigmatised group who carry an extremely high burden of unmet health need. They experience multiple and interdependent health and social problems and extreme health inequality. Despite high levels of chronic physical and mental ill-health, there is little evidence of effective healthcare provision for this group. They are often considered ‘hard to reach’, but many individuals and organisations have extensive experience of working with this group. Methods We conducted a cross-sectional survey of professionals who work with SSWs in the UK on their perspectives on their access to primary care, mental health, sexual health and drug and alcohol services, how well these services met the needs of SSWs and suggestions of best practice. Results 50 professionals mostly from England, responded. Mainstream general practice and mental health services were found to be largely inaccessible to SSWs. Sexual health, drug and alcohol services and homeless health services better met their needs; this was mostly attributed to flexible services and collaborations with organisations who work closely with SSWs. The main challenges in providing healthcare to SSWs were services being inflexible, under-resourced services and services not being trauma-informed. Best practice in providing healthcare to SSWs includes- seamless partnership working between agencies with case worker support; peer-involvement in service development and engagement, a range of health provision including outreach, presence in community spaces and fast-track access into mainstream services; trauma-informed, gender-sensitive health services in a welcoming environment with flexible, responsive appointment and drop-in systems and consistent clinicians with specialist knowledge of substance misuse, mental health, domestic violence and homelessness. Conclusions Access to healthcare for SSWs in the UK is highly variable but largely inadequate with regards to primary care and mental health provision. The examples of positive healthcare provision and partnership working presented here demonstrate the feasibility of accessible healthcare that meets the needs of SSWs. These need to be systematically implemented and evaluated to understand their impact and implications. As we build back from COVID-19 there is an urgent need to make accessible healthcare provision for marginalised groups the norm, not the exception.

High Seroprevalence of Hepatitis C Virus Among Cisgender Women Who Exchange Sex in the Seattle, Washington Area

“…WES-as well as other women who have HCV-are likely to encounter barriers and stigma when accessing health care. 38,39 One strategy for reaching stigmatized communities is through peer referral. For example, a team from the University of British Columbia found that peer referrals to drug treatment were effective for WES.…”

Mental ill health experiences of female sex workers and their perceived risk factors: A systematic review of qualitative studies

“…Despite the need for services that meet the needs of sex workers, many services are not accessible or do not meet their needs (Potter et al, 2022). Often this is because sex workers anticipate stigma and lack trust in services, as well as referral to and contact from services being di cult.…”

“…Many services are inadequate for people who experience mental illness alongside substance misuse, i.e., dual diagnosis, and this inadequacy is exacerbated by the barriers that sex workers face when accessing services (Potter et al 2022). Integrated services, in community centres and hospitals, should offer information and support on both addiction and mental ill health so those in need are not passed between multiple services, as well as offering post-treatment support (National Institute of Health and Care Excellence (NICE), 2016).…”

“…Sex workers should be asked to give constructive feedback on their experiences of healthcare services so that organisations can improve policies to increase the likelihood of informed care (Bombard et al, 2018;Baldie et al, 2018). These changes may include exibility with appointments, easier access to primary care, trauma-and psychologically-informed staff and offering a variety of information for easier access to resources (Potter et al, 2022).…”

Interventions to improve health and the determinants of health among sex workers in high-income countries: a systematic review

“…22 Many sex workers face large barriers to accessing health and social care. 23 There are few specialist services for this community, 24 and mainstream services are often unaware of sex working and not tailored to sex workers' needs. 17,25 Sex workers are often unaware of available services, 26 and might fear legal implications from being identified as a sex worker.…”