Sex workers’ experiences of drug and alcohol services: emerging findings Nicola Singleton Shannon Harvey Research, Analysis & Consultancy Stella Project, AVA In Substance Misuse and Mental Health Multi-component research project Funded by Pilgrim Trust Developed by Drugscope in partnership with AVA Presentation outline 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 Project components 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 Substance misuse and sex work “…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 “I’ve been raped, I’ve been beaten up, fucking those offences, so to speak.” punched theof fuck out of, tied up with in street sex work Asodomised, high proportion women engaged all about and that, stripped“…Its in the car and the money even when I’m havemeaarms history of substance use problems, particularly notfucking using drugs thrown out in the middle of the fieldsI still need to go out and buy opiates & crack and vice versa. stuff and a McDonalds or something ... Its and having to walk home and knocking on having something to show for at the end someone’s door because youjust can’t just walk Substance and sex are mutually reinforcing. of the week.” home. misuse How humiliating can itwork get?” “… it’s about getting and doing something, Street drug markets andabout the associating sex worker are often with beats people…” intertwined. Violence is a common experience and can be extreme. But sex“I work also provides an independent income and a had problems with my ex-partner and he broke my leg social network. and I ended up in hospital and was in a bad way.” Service needs 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). Barriers to service use “Guilt, my lifestyle – how overwhelming “…my shame, ex-boyfriend who sometimes – well it is toon change. There’s needget toachange.” we’re and off. WhenaI lot tryIand few days Individual barriers of the crack and the smack and just stick to the methadone, he’llquite manipulate toto gosay down “You know I’m worriedme now I’m Self-esteem/beliefand that change is possible up my old behaviour..” outtake working… again. And the impact it will it have on my son. I don’t want them Partner coming and taking my son off me.” 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 Effective interventions 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 Current service provision Outreach and accessibility 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 provision at a ¾Drop-in (69%) offered drop-in and/or open access services different venue to main services. BUT only half provided this in a format likely to - Substance misuse specifically service support women involved in street-based prostitution 52% had evening opening hours 17 substance misuse services, 8 sex work projects, 1 sexual Not open regularly in evenings, health 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 outreach weekdays, 52% had an outreach van or similar Evening currently expanding to cover early morning & 38% used a location close to the area used for soliciting weekends. - Sex work project 30% conducted outreach in prisons Enhancement of standard programmes 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 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 Involvement of peers We have found that most women using our substance misuse services We would refer to in our organisation frequently do not providers who want to openly disclose their offer peer support. involvement in sex work with other - Drug service One of the biggest advantages of this users, which therefore has an service place is the support women giveimpact each on being able to provide peer other, you are all part of a group andled services for sex workers. you’re all sharing, you are all supporting - Sex work project each other, friendships are made. Quite often, very positive relationships are built, peer support & mentoring is massive, and Peer support brings I have seen it as a positive and negative. I I think (substance misuse services) miss commonality, so the immense have had concerns about the sometimes out on all that. shame many women feel is lack of training and supervision of peers - Sex Midlands broken down a bit because it'swork project, Westand a lack of stability and distance from shared amongst peers. the peer’s own issues-can be detrimental Women can bring their to both parties. Sometimes there is a experiences and feel valued, hurry to involve women who are doing and accepted and not alone. well into becoming peers; sometimes this - Drug service can lead to a relapse or collusion. - Drug service Women-only space As 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 Women-only space was not common 42% offered session times that were women-only 28% offered session times that were only for women We create this big space and we provide lunch, in sitprostitution andinvolved people all sit here, around the table and Women’s involvement with the women. That is important, keeping in no service provision eat lunch, staff are in here with the women, eat 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 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 Children 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. 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 Creche available for children under 5 for women attending structured day care / appointments - Sex work project - Sex work project Integrated provision 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 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 Current policy landscape 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 Potential recommendations 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. Thank you Questions?