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‘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
Although women who use drugs and are involved in prostitution are among society’s
most vulnerable and stigmatised groups, little specialised support exists.
DDN
reports
News focus |
Analysis
ON THE MARGINS
6 |
drinkanddrugsnews
| July 2013
www.drinkanddrugsnews.com
‘Many of the women
talked about wanting
longer-term change...
getting a job, having a
nice home, being with
their children.’
GEMMA LOUSLEY