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Maintaining the health of sex workers through outreach work

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Donna Cardell, RN.

Drug Worker/Outreach Worker, Community Healthcare Bolton NHS Trust, Greater Manchester

In 1997, three registered general nurses, assisted by a team of volunteers, set up a mobile health unit and needle exchange for sex workers. The nurses work in the community drug team of Community Healthcare Bolton NHS Trust. The service operates one night a week and is staffed by the mobile unit driver, a nurse and two volunteers.

In 1997, three registered general nurses, assisted by a team of volunteers, set up a mobile health unit and needle exchange for sex workers. The nurses work in the community drug team of Community Healthcare Bolton NHS Trust. The service operates one night a week and is staffed by the mobile unit driver, a nurse and two volunteers.

Sex workers consistently avoid using statutory services such as GPs, family planning clinics and genito-urinary clinics to obtain advice or provisions. However, since the service was introduced, 290 women from mainly the Bolton area have visited the Vehicle for Advice and Needles (VAN), and the service regularly receives over 30 visits a session.

The VAN provides an abundance of written literature on sexually transmitted infections and blood-borne viruses, and the outreach workers are trained on sexual health issues.

Streetlife (Cardell, 2001), a report on Bolton sex workers, was compiled from conversation with sex workers, other workers on the mobile unit and professionals in contact with sex workers. It also draws on data from an earlier survey in 1995.

Summary of the findings
Ninety per cent of the sex worker respondents were drug users and 76% of these said they needed drugs or alcohol to work. Of these, 76% injected drugs and used the needle exchange. Eighty-one per cent used heroin, 40% methadone and 29% crack cocaine.

Seventy per cent of respondents had received, or were in the process of receiving, immunisation against hepatitis B. The mobile health unit began an immunisation programme in July 2000, which may be why most had been immunised. All respondents said they could get free condoms and 66% got them from the VAN.

More than 80% had experienced violence or aggression while working. Of these, 3% had experienced verbal abuse from local residents, while 73% reported physical abuse from punters.

Most sex workers view the police as law enforcers who lack concern for their welfare. However, over the past two years, the attitude to the prostitute liaison officer has changed from ambivalence to tolerance, and, in some cases, grudging respect. The sex workers have begun to view the prostitute liaison officer as a figure of safety, and have subsequently reported incidents that previously went unreported.

Recommendations
Continued support for multiagency working is essential to provide opportunities for other agencies to offer a range of services to sex workers through outreach work.

Preventive work with young people at risk of involvement in sex work is important. Drug treatment and harm-reduction programmes should continue to be made easily accessible and diversionary schemes for those who want to leave sex work should be developed.

Conclusion
The sex workers, all of whom were women, value the service provided to them by the outreach team.

There is a feeling among the sex workers that they have a place of their own, which offers a safe haven for support and advice. The outreach workers are considered a valuable source of information, and are well respected by the sex workers.

However, the main difficulty is that the VAN is only available to sex workers in Bolton one night a week, which puts constraints on the amount of health care that can be provided. In order to explore the issues that merit further investigation, a more holistic service for sex workers needs to be made available, which can be accessed more regularly. This situation highlights the need for more funding and resources.

- For further information, write to: Bolton Community Drug Team, 26-26a Higher Bridge Street, Bolton, BL1 2HA.

Cardell, D. (2001)Streetlife - Report on street sex work in Bolton. Available from: www.bolton.nhs.uk.

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