On the margins – news focus

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Little specialised support exists for women who use drugs and are involved in prostitutionsays a new report from DrugScope.

‘I’ve been raped, I’ve been beaten up, fucking sodomised, punched the fuck out of,’ says one woman interviewed for The challenge of change: improving services for women involved in prostitution and substance use, a powerful new report from DrugScope and Ava (Against Violence and Abuse). She also once had to knock on random doors after having been stripped and thrown from a car. ‘How humiliating can it get?’ she says. ‘Once that happens you don’t fucking forget.’

The report looks at current service provision and makes recommendations for both policy makers and services. Violence was an issue for most of the women interviewed, whether from partners or ‘punters’, and added to this were mental health issues – often from past physical or sexual abuse – poor physical health, increased HIV risk and ‘very low’ self-esteem.

The latter was often the result of dual stigma, the report states, with the stigma from involvement in prostitution often weighing more heavily – ‘most women had told their families about their drug use, but many were concealing their prostitution’, it says.

While ‘women involved in street-based prostitution who misuse drugs and/or alcohol are one of the most marginalised and stigmatised groups in our society’, it states, it’s rare for them to be discussed in these terms and they are too often absent from ‘policy and practice addressing the needs of the most vulnerable’.

That’s because, DrugScope policy and engagement officer Gemma Lousley tells DDN, they remain a largely hidden group. ‘The stigma associated with prostitution means that they often don’t disclose their involvement, and in any event, few large scale surveys have collected information that can give us a reasonable estimate of the size of this group. Having said that, the Drug treatment outcomes research study found that 10 per cent of women starting drug treatment said they had exchanged sex for money, drugs or something else – although this probably captures involvement in “sex work” beyond what could strictly be defined as street prostitution, it indicates that the size of this group of women is significant and merits real attention.’

The ‘process of change and recovery’ is likely to be a lengthy one, the document stresses, making it vital that a range of support – from harm reduction to help in exiting prostitution and support for ongoing recovery – are provided. The report looks at the kinds of interventions that work best, as well as the women’s own expectations and experiences of services.

Barriers to accessing help included a lack of flexibility and wider support around housing and employment, it says, while services also need to improve accessibility and develop a ‘flexible approach’ to missed appointments. 

‘It’s important to recognise that there are some good services out there that are working to meet the specific needs of women involved in prostitution and substance use,’ says Lousley. ‘However our research found that, overall, there is a lack of specialist, tailored support. So, for instance, measures that increase service accessibility for these women – such as evening and weekend opening hours, outreach services, childcare provision and women-only sessions or times – aren’t always in place.’

Although peer support was widely available in the services surveyed, they didn’t always offer access to women-only peer support, she adds. ‘So there’s a question around how far this support is being provided by “real” peers, with similar histories and experiences. There’s good evidence that tailoring of standard drug and alcohol programmes is an effective approach, but a relatively low proportion of the substance misuse services we surveyed reported providing advice and information around prostitution. Many of the women talked about wanting longer-term change in their lives – getting a job, having a nice home, being with their children – but felt that the support they were receiving didn’t really extend beyond being put on a script.’ 

The report also calls for staff training and development to help tackle stigma, as well as ‘robust’ assurances of confidentiality. How much of an issue can the attitudes of some drug workers be? ‘The issues we identified were less about attitudes as such, and more about awareness of the particular issues facing this group of women. Again, it’s also important to say that many of the women interviewed spoke about receiving really good support from keyworkers. However, some did report stigmatising attitudes from staff  – some of them felt that they were being “judged” or “looked down on” when they disclosed their involvement in prostitution – so it clearly is an issue for them.’

Staff turnover can also lead to issues around building trust and rapport, she stresses. ‘Given the vulnerability of this group of women, this can be particularly problematic, and differences in age and gender too. As the research highlights, most of the women had experienced violence and abuse, therefore some reported problems with having a male keyworker.’

This means that – along with ongoing aftercare – women-only provision is vital, she says. ‘Women may not feel able to talk openly about some things in mixed groups, and their safety needs to be considered too. Many of these women are extremely vulnerable, and some men will try to exploit this. Some of the women interviewed were in relationships with men who were manipulating and coercing them into sex work to get money to support their own use of drugs – so the need for women-only provision is clear.

‘If it isn’t possible for services to be women-only, then women-only groups or spaces should be made available.’

Report at www.drugscope.org.uk