Abstract

ObjectivesThe majority of female street-based sex workers (SSWs) are dependent on illicit drugs and sell sex to fund their drug use. They typically face multiple traumatic experiences, starting at a young age, which continue through sex work involvement. Their trauma-related symptoms tend to increase when drug use is reduced, hindering sustained reduction. Providing specialist trauma care to address post-traumatic stress disorder (PTSD) alongside drug treatment may therefore improve treatment outcomes. Aims to (1) evaluate recruitment and retention of participants; (2) examine intervention experiences and acceptability; and (3) explore intervention costs using a mixed methods feasibility study.SettingFemale SSW charity premises in a large UK inner city.ParticipantsFemales aged 18 years or older, who have sold sex on the street and used heroin and/or crack cocaine at least once a week in the last calendar month.InterventionFemale SSW-only drug treatment groups in a female SSW-only setting delivered by female staff. Targeted PTSD screening then treatment of positive diagnoses with eye movement desensitisation and reprocessing (EMDR) therapy by female staff from a specialist National Health Service trauma service.Results(1) Of 125 contacts, 11 met inclusion criteria and provided informed consent, 4 reached the intervention final stage, (2) service providers said working in collaboration with other services was valuable, the intervention was worthwhile and had a positive influence on participants. Participants viewed recruitment as acceptable and experienced the intervention positively. The unsettled nature of participant’s lives was a key attendance barrier. (3) The total cost of the intervention was £11 710, with staff costs dominating.ConclusionsRecruitment and retention rates reflected study inclusion criteria targeting women with the most complex needs. Two participants received EMDR demonstrating that the three agencies working together was feasible. Staff heavy costs highlight the importance of supporting participant attendance to minimise per participant costs in a future trial.

Highlights

  • Most female street-b­ ased sex workers (SSWs) in the UK use heroin and/or crack cocaine.[1,2,3]. Their drug dependency keeps them entrenched in a ‘work-­score-u­se cycle’,4 5 which contributes to the morbidity and social instability typically seen in this group.[6]. Despite their drug treatment needs, drug dependent SSWs have poorer outcomes from drug treatment services compared with other service users,[7 8] sometimes due to stigma associated with their street sex work.[9]

  • In collaboration with SSWs and service providers, and informed by existing research,[9 15] we developed a novel intervention, to simultaneously address the unique and complex combination of drug use and post-­traumatic stress disorder (PTSD) in female drug-­dependent SSWs

  • We report here the results of the Drug Use in Street Sex worKers (DUSSK) feasibility study, which aimed to (1) evaluate the recruitment and retention of SSWs to the intervention; (2) examine the experience and acceptability of the intervention for participants and service providers; and (3) explore costs to service providers associated with the intervention

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Summary

Introduction

Most female street-b­ ased sex workers (SSWs) in the UK use heroin and/or crack cocaine.[1,2,3] Their drug dependency keeps them entrenched in a ‘work-­score-u­se cycle’,4 5 which contributes to the morbidity and social instability typically seen in this group.[6]. Despite their drug treatment needs, drug dependent SSWs have poorer outcomes from drug treatment services compared with other service users,[7 8] sometimes due to stigma associated with their street sex work.[9] Previous SSW-f­ocussed interventions aiming to reduce drug use have used educational,[10 11] substitute prescribing-­based[12 13] and psychological[14] approaches but none robustly demonstrated a positive effect in reducing drug use.[15].

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