Health provision for sex workers largely ‘one dimensional’ and stigma remains major barrier

Sex workers’ health needs are largely not being met with the majority facing stigma and feelings of being reduced to ‘one dimension’, according to the first report of its kind.

The research conducted by a partnership between the University of Birmingham and Birmingham City Council’s Public Health Division found that adults working in various forms of sex work are struggling to access healthcare, and that specialist provision has focused on sex workers’ sexual health, rather than a wider set of health needs.

Drawing on data from existing studies, an analysis of health data from Birmingham, and across England, and first-hand accounts from sex workers, the study found that sex workers need better access to support for mental ill health and physical health conditions, as well as some who may need support with drugs and alcohol use.

Caroline Bradbury-Jones, Professor of Gender Based Violence and Health in the School of Nursing and Midwifery at the University of Birmingham and lead author of the study said:

“This is the first study of its kind to give a voice to sex workers about their needs when it comes to accessing healthcare. We have heard loud and clear that there is a significant amount of stigma which is a barrier to getting help, and that sex workers are perceived through a single-issue lens of their work and not treated as a whole person.

“We have also seen examples of good practice including training and service provision that is geared towards the needs of a diverse group of people who work in the sex industry. Our study also draws on data that shows the wider scale of the health needs of this group, including significant mental and physical health needs.”

Dr Justin Varney, Director of Public Health, Birmingham City Council said:

“Sex workers are an often a forgotten part of our community in Birmingham. We usually only talk about them in the context of crime and disorder issues. Sex workers face significant marginalisation, stigma, discrimination and social exclusion and they often face multiple, overlapping health challenges such as violence and complex trauma, substance misuse, mental health issues and poverty.

“Sex workers rarely get compassion or understanding for their life circumstances and the choices they are having to make to survive, and despite being one of the national NHS inclusion health communities relatively little is understood about their health needs or how we can better help them live healthier lives.

“This study, which brings together evidence and lived experience, is an important step toward addressing this ignorance and structural discrimination and is helping us to better serve and meet the needs of the most vulnerable and socially excluded in Birmingham.’

“I’m a human, not just a sex worker”

Sam (not their real name) is one of the researchers who worked on the project who has lived experience of sex work. Their experience has been vital in framing the research and working with communities to best understand their needs. As well as a researcher, Sam was also able to share reflections on the barriers that they have faced.

Sam reflects on an experience of going to the doctors:

“People's body language and the way they talk to you would just be completely different when they found out what I do. I do feel very judged. It can be it makes it quite intimidating when you do need like support on healthcare and like you kind of have to have to mentally prepare yourself for that.

“I think that not even just in healthcare, but in general. I think when you work in the industry, people assume that your entire identity is based around the work and it’s like, I’m a human not just a sex worker.”

Sam’ experience tallies with many of the men and women that the researchers worked with, that some healthcare workers’ biases result in experiences of stigma for sex workers when accessing healthcare.

Significant increase in demand

The data also suggests that sex workers were 35 times more likely to use drugs, significantly more likely to smoke, and are up to 20 times more likely to experience mental ill health.

Dr Eleanor Molloy from the Institute of Applied Health Research at the University of Birmingham and a co-author of the study said:

“The report has highlighted that a more compassionate approach is needed to provide healthcare for a group of people that are being unfairly marginalised solely because of their line of work. Working with researchers with lived experience has been a hugely beneficial opportunity to better understand the best questions to ask and sensitively empower sex workers involved to be heard and listened to.”