Sex workers reporting rape: Understanding their vulnerabilities to improve their care. The characteristics of sex workers who attend Saint Marys Sexual Assault Referral Centre

https://doi.org/10.1016/j.jflm.2020.102068Get rights and content

Highlights

  • The sex worker cohort had higher rates of mental health difficulties.

  • •The sex worker cohort were more likely to have children no longer in their care.

  • •The sex worker cohort had a higher rate of substance abuse issues.

  • •The Saint Marys Centre reported reduced engagement from the sex worker cohort

  • •The sex worker cohort were less likely to disclose personal information.

Abstract

In the UK it is estimated that there are at least 70,000 sex workers, however, relatively little is known about who these people are. The Crime Survey for England and Wales estimated that 1 in 5 women have experienced sexual violence.(Flatley, 2018) 1 However, there is little known about sex workers who access sexual assault referral centres services. This study aims to create a picture of the needs and demographics of sex workers who attend Saint Mary's Sexual Assault Referral Centre and to help focus future research into this unique demographic. Between June 2017 and May 2019 there were 20 people who were reported to be sex workers that attended Saint Mary's SARC for a forensic medical examination. Their case notes were retrospectively analysed and compared to a control data set of similar size from the same time period. Notable findings include 19 of the 20 sex workers were female, 13 were described as white British, and 19 were described as being single. The sex worker population had higher rates of: mental health difficulties; children no longer under their care and substance abuse issues compared to the control group. The Saint Marys Centre reported reduced engagement from the sex worker cohort within the forensic medical examination process and were reported as having higher levels of non-disclosure of personal information. This study has shown the high level of vulnerability of sex workers who attend Saint Mary's Sexual Assault Referral Centre and their unique concerns when attending the centre.

Introduction

In 2015 it was estimated that in the UK there were 72,800 sex workers.2 Sex work, as defined by the World Health Organisation, is ‘the provision of sexual services for money or goods’.3

There isn't a ‘one size fits all’ picture of the demographic of sex workers. It has been acknowledged that people from a range of socio-economic backgrounds make up the sex worker population.4,5 While criticism has been raised around misrepresentation of sex workers within health publications6 a recognised driver to entering the profession is financial gain,7 notably to fund substance dependencies.8

Although tabloid media coverage often reports that sex work is a ‘choice’,9 it is difficult to accept that empowerment is the experience of all sex workers. A spectrum of sex worker types has been described, on one end a young person working autonomously for financial gain to aid studies or provide for their family.10 Whereas the other end of the spectrum encompasses people who are driven into sex work either by drug or alcohol addiction or by coercion.10

Interviews of street sex workers in Bristol undertaken in 2008, showed that these sex workers described a typical working day as ‘a continuous cycle of buying and selling drugs’.8 23% of street sex workers interviewed had permanent accommodation.8 In the same data set seven out of 22 women interviewed disclosed having children however only one woman lived with their child.8 Many also described high levels of self-neglect with infrequent fluid and food intake.8 This narrative was echoed in a more recent survey conducted by the University of Bristol in 2019. One street sex worker stated that the ‘two main reasons [to become a sex worker] are money and drugs’ and another reporting becoming a street sex worker ‘to pay for transport to school and food’.11

With sex workers experiencing high levels of violence and current legislation increasing the rates of lone working, sex workers are some of the most vulnerable in society.12 A systematic review of violence against sex workers showed that lifetime prevalence of violence at work was 41–61% for sex workers.13 Street sex workers are known to report higher levels of violence than sex workers working in brothels or flats. In Britain it has been reported that sex workers who worked outdoors had greater than 6 times higher odds of experiencing client violence than sex workers working indoors14 and this increased risk has been mirrored elsewhere throughout the world.13

The reporting of violence is vital for the safety of sex workers. The perceived change in attitudes of Police Officers in Merseyside has been reported.1,15 One sex worker stated ‘You could talk to them … with the rape case it was so different than before – they were so nice to me no matter what was going on.‘15 National Ugly Mugs (NUM), a resource where sex workers can report suspicious activity from clients, estimated in 2015 that around 10,000 sex workers access NUM alerts.16 As of 2015, 60 incidents were being reported to NUM every month, with only 25% of victims being willing to report directly to the police.16 Although these reports are for a variety of incidents, this shows the daily prevalence of violence within the lives of sex workers.

One area of interest in the purchasing of sexual services is the buyers, ‘Punters’, themselves. ‘Punters’ have been reported to actively normalise violence and sexual violation against women.17 Similarly safe sex practices are often disregarded, with condom use being the focal point of negative experiences reported by punters17 and anecdotal reports from sex workers of punters trying to ‘slip off’ condoms during sex.11

In the North West of England, NHS statistics have shown that 10% of women in the general population use sexual and reproductive health services.18 Although sex workers could be assumed to have poorer sexual health outcomes due to the nature of their work, female sex workers have also been shown to attend genitourinary medicine clinics at a greater rate.19 Female sex workers, however, have been shown to be twice as likely to be diagnosed with chlamydia and three times more likely to be diagnosed with gonorrhoea than the general population.19 Within the sex worker population, male sex workers have been shown to have higher rates of STIs and HIV than their female peers.20

Sexual Assault Referral Centres (SARCs) offer a wide range of services throughout the UK in response to rape and sexual assault. Although services available differ from centre to centre they include acute crisis support, forensic medical examinations and ongoing support through ISVA (Independent Sexual Violence Advisors) and Counselling services. NHS England in their 2018 ‘Strategic direction for sexual assault and abuse services’ states that Sexual Assault Referral Centres should be providing care specifically tailored to sex workers.21

The aims of this study are.

  • 1)

    To gain an improved understanding of the Saint Mary's SARC service users who are identified as sex workers

  • 2)

    To compare the demographics of this subgroup with the rest of the Saint Mary's SARC population.

Section snippets

Method

Twenty-two case notes pertaining to sex workers (male or female) were identified from the Saint Marys Sexual Assault Referral Centre electronic dashboard from a 24-month period (June 1, 2017 to May 30, 2019). These cases had been scheduled for a Forensic Medical Examination (FME) appointment following a substantiated, alleged or suspected sexual assault during the study period. For the purposes of this paper the term ‘alleged assault’ will encompass sustained, alleged and suspected. Sex workers

Results

Of the 20 case notes identified for sex workers; 19 self-identified as being female, 17 as being white and 19 as being single. The mean age of sex worker service users was 31.4 years. Table 1 details the demographics for the sex worker group and the control group, allowing for comparison. The type of sex work the service users were undertaking can be also found in Table 1.

As part of routine practice at Saint Marys SARC a Learning Disability Screening Questionnaire (LDSQ)22 is completed by all

Discussion

Previous research has looked into data of sexual assault and violence against sex workers through the criminal justice system however these studies have not looked into sex workers who attend sexual assault referral centres.24 The picture of the lives of these sex workers presents a diverse and unpredictable group. Although the slightly increased age of sex workers may account for the increased number of children the sex workers reported having, the sex worker group did also report higher rates

Conclusion

This is the first study of its kind to look into sex workers attendance at a sexual assault referral centre in England and should be used as an initial profile of this small subset of service users. Although sex workers make up a very small proportion of attendees at Saint Mary's they are a diverse group of people who have intersecting vulnerabilities worthy of consideration. Limitations of this study included having a small data set and relying on the process that all service users who were

Declaration of competing interest

I declare that authors listed have no competing financial, professional or personal interests that might have influenced the outcomes of this study.

References (28)

  • M.M. Chanda et al.

    Contraceptive use and unplanned pregnancy among female sex workers in Zambia

    Contraception

    (2017)
  • J. Flatley

    Sexual Offences in England and Wales : Year Ending March 2017

    (2018)
  • B. Brooks-Gordon et al.

    Production, Income, and Expenditure in Commercial Sexual Activity as a Measure of GDP in the UK National Accounts

    (2015)
  • C. Overs

    Sex Workers Part of the Solution : An Analysis of HIV Prevention Programming to Prevent HIV Transmission during Commercial Sex in Developing Countries

    (2002)
  • F. Betzler et al.

    Sex work among students of higher education: a survey-based, cross-sectional study

    Arch Sex Behav

    (2015)
  • Home Office

    A Coordinated Prositution Strategy - and a Summary of Responses to Paying the Price

    (2009)
  • N. Putnis et al.

    Evidence or Stereotype? Health Inequalities and Representations of Sex Workers in Health Publications in England

    (2019)
  • C.W. Cange et al.

    Female sex workers' empowerment strategies amid HIV-related socioeconomic vulnerabilities in Cameroon

    Cult Health Sex

    (2017)
  • N. Jeal et al.

    The multiplicity and interdependency of factors influencing the health of street-based sex workers: a qualitative study

    Sex Transm Infect

    (2008)
  • R. Flood

    NAKED TRUTH Sex Worker's Daughter, 18, Says She's PROUD of Her Mum's £160-An-Hour Job and Says There's ‘more Admin than People Realise

    (2019)
  • W. Spice

    Management of sex workers and other high-risk groups

    Occup Med

    (2007)
  • M. Hester et al.

    The Nature and Prevalence of Prostitution and Sex Work in England and Wales Today

    (2019)
  • Amnesty International

    Amnesty international policy on state obligations to respect, protect and fulfil the human rights of sex workers

    Amnesty Int

    (2016)
  • K.N. Deering et al.

    A systematic review of the correlates of violence against sex workers

    Am J Publ Health

    (2014)
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