Cuts to NHS services for sex workers 'disastrous' say experts
British Medical Journal editorial warns of ‘avoidable harms and disastrous long-term costs’ caused by cuts to specialist services
External Link/Members Only Sex workers are at greater risk of violence and ill health due to substantial cuts to specialist NHS health and support services across the UK, according to experts, service providers and rights groups.
An editorial in the British Medical Journal, published this week, warned of “avoidable harms and disastrous long-term costs” of ongoing funding cuts to services available to sex workers.
In the UK, specialist NHS-funded services have so far controlled outbreaks of HIV, syphilis and tuberculosis among sex workers, and outreach programmes have halved the risk of them contracting sexually transmitted infections, according to the editorial’s co-authors, researchers from the London School of Hygiene and Tropical Medicine.
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An estimated 10,000 sex workers use such services , according to National Ugly Mugs, a group that works to improve the safety of sex workers.
Alex Feis-Bryce, the chief executive officer of NUM, said: “The generic funding cuts are very concerning and the impacts are huge. To expect them to access generic services is unrealistic. We know that sex workers are targeted by violent offenders. Without services to protect and to support them when they are victims, offenders will get away with it.”
Georgina Perry, a former manager at Open Doors, a long-established and well regarded NHS service for sex workers in east London, said the service’s funding was being cut by 43%. She resigned last week over the cuts and her concerns that a new funding model, set up by Hackney council, compromised patient confidentiality.
“At one point we had 12 individuals out of 120 living with TB-HIV co-infection,” says Perry. “These are really terrible statistics. When we first started with our street sex workers virtually 100% of them were homeless, they didn’t have GPs, [and] they were using A&E as their primary care. I feel really sad that we are going to go back a decade or more, because we will.”
Her resignation, she said, came after Open Doors was asked to share confidential client information at Street Users Outreach Meeting (SUOM) meetings in Hackney, also attended by police and immigration officers.
Perry said: “I can’t work for a service if I am being forced to give people’s information to the police. It is a principle in the NHS that you don’t breach people’s confidence.”
A spokesman for Hackney council said: “While we are disappointed that a manager at the Open Doors service has recently resigned, both Hackney Council and Homerton hospital are committed to continuing the Open Doors service and providing appropriate health and sexual healthcare for sex workers.”
Teela Sanders, professor of criminology at Leicester University, said cuts were happening at a time when the sex industry is growing. “Specialist services are just going to be focussed on large cities, which doesn’t really reflect what is happening in the sex work community, where there is real growth of people working online. If you cut a service, there are ramifications for health, for safety and for protection.”
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Sanders, who worked as a researcher with support services for sex workers in Manchester, Leeds and Birmingham for 15 years, said: “Over the last 10 years, the commissioning of sexual support services have been reduced and merged with other services. In 2003, the Safe Project (in Birmingham) had eight staff, now it has two-and-a-half. Meanwhile there has been a ballooning and diversifying of the sex industry.”
She said reduced funding meant many services would only offer support to the most chaotic groups, such as street sex workers and drug users, leaving other workers, for instance migrant sex workers, vulnerable.
“Nine of the last 13 murders of sex workers have been migrant workers” she said. “This is the extreme end of what happens when these women are not hooked into services.”
Case Study
Stacey*, a former street sex worker who was addicted to crack cocaine for 20 years, told the Guardian how Open Doors helped her turn her life and the lives of her children, around.
She said: “The moment I walked in I felt so relaxed; nobody judged me. Within hours they found me a hostel. They sorted out my housing benefit, my GP and my mental health. I didn’t even have a clean pair of knickers. They gave me underwear; they gave me a toothbrush. Open Doors broke the chain.
“The staff nurtured me, loved me and guided me. They taught us new ways to live. They took us out and bought us ice cream; it felt like the family I never had. Then, little by little, without you even noticing, they will take steps back. And then you realise that you are capable, you can be independent. But if you need them, they are there.
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“My son wanted to go and start taking drugs, my daughter had stopped going to school. But once I started going to Open Doors, I changed their lives. Now I have a flat; my daughter lives with me, my son with his dad. My son just got six A GSCEs, three of them A*s. He is looking to go to Cambridge; he has already been selected as ‘Gifted and Talented’. My daughter works full-time as a barista.
“I have seen mothers and daughters on the street together: one on one corner, one on the other. It is so sad. I have been raped, I’ve been beaten, and I have been held at gunpoint. I am surprised I am still alive. And to think my daughter could’ve been doing that too.
“Open Doors gave me the chance to carry on and enjoy the rest of my life. I will see my son graduate; see my daughter hopefully get promoted to become manager.
“This government doesn’t know what it’s doing. Open Doors saves lives, it shouldn’t be cut. If I was to win the lottery, I would give half to Open Doors.”
