Abstract
BackgroundStreet 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.MethodsWe 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.Results50 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.ConclusionsAccess 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.
Highlights
Street sex workers (SSWs) are a highly marginalised and stigmatised group who carry an extremely high burden of unmet health need
Street sex workers have often experienced extensive trauma including child abuse and domestic and sexual violence [2]. They frequently experience poor mental health, anxiety, depression, isolation, post-traumatic stress disorder, self-harm, and suicide [2, 6, 10]. They are frequently excluded from mental health services due to concurrent substance misuse, termed dual diagnosis, which we know to be a common response to adverse experience and extensive trauma [11]
In this paper we report the perspectives of front-line staff who work with street sex workers in the United Kingdom (UK) on what healthcare services are available to their clients, how they are provided, how accessible and effective they are, and provide a practical summary of key considerations for providers in designing and developing healthcare for SSWs
Summary
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. They experience multiple and interdependent health and social problems [1] and extreme health and social inequality [2,3,4]. Street sex workers have often experienced extensive trauma including child abuse and domestic and sexual violence [2] They frequently experience poor mental health, anxiety, depression, isolation, post-traumatic stress disorder, self-harm, and suicide [2, 6, 10]. There is a considerable gap in healthcare services meeting the needs of street sex workers [12, 13] and little evidence for how to fill this gap with holistic, effective care
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