Tuesday, 16 July 2013

The Challenge of Change: Improving services for women involved in prostitution and substance use

DrugScope, with AVA (Against Violence and Abuse), has recently published ‘The Challenge of Change: Improving services for women involved in prostitution and substance use’, the report of a research project that encompassed an evidence review, interviews with women with a history of prostitution and substance use, an online survey of services, and observational site visits. Following a launch event at the House of Lords on 2nd July, hosted by Baroness Corston, a London-specific launch will be taking place at City Hall on 18th July, with the Deputy Mayor Victoria Borwick speaking at the event.

As its title indicates, the focus of the ‘Challenge of Change’ project has been on policy and practice to address the drug and alcohol treatment needs of women involved in street-based prostitution. While there are no good estimates of the number of women involved in street prostitution and substance use, the Drug Treatment Outcomes Research Study (2007) found that 10% of women starting drug treatment said they had exchanged sex for money, drugs or something else, indicating that the size of this group is significant. As our research highlighted, women involved in prostitution and substance use experience considerable harms, including mental and physical health problems, sexual health risks, and very low self-esteem. Violence was also a significant issue for most of the women interviewed for the research, from a partner or, more often, from a client or ‘punter’.
In spite of this, women involved in prostitution and substance use command little attention within national policies; the
2010 Drug Strategy, for instance, contains no mention of the words ‘prostitution’ or ‘sex work’, or even ‘woman’, ‘women’, or ‘girl’. Where drug and alcohol problems among women or involvement in prostitution are mentioned, guidance is rarely provided on addressing the issues together, despite the mutually reinforcing nature of drug use and prostitution. All of the women interviewed for our study reported working on the streets to obtain money for drugs, and many made it clear that this was the reason that they became involved in prostitution in the first place.

The qualitative interviews, which were conducted by peer researchers, highlighted the barriers to accessing services that this group of women can face. These include personal barriers, such as very low self-esteem, as well as organisational barriers, including service hours of opening and a lack of childcare provision. A key issue for these women is the relationship with their keyworker. For such a vulnerable group, consistency is crucial to aid engagement with services; many women feel the effects of ‘double stigma’ as a result of using drugs and being involved in prostitution, and it takes time to develop the trust necessary to open up. However, several interviewees mentioned that they had experienced frequent changes in keyworker. Interviewees also spoke of feeling ‘judged’ or ‘looked down on’ by staff following disclosure of their involvement in prostitution, and disparities in gender and age were also highlighted as problematic.

The research also identified positive interventions for women involved in prostitution and substance use, including evening opening hours for services, outreach provision and support with childcare arrangements. Women-only provision was identified as crucial, and interviewees also spoke of the importance of support from ‘real’ peers – that is, women with experience of using substances and involvement in prostitution. The research highlighted the tailoring of standard drug and alcohol programmes as an effective approach, and the importance of integrated provision, to address the multiple needs of this group of women, was also clear.   

While there are services that are working to address the specific needs of these women, our research highlighted that the problems they face are not always well catered for. Tailoring of standard programmes remains underdeveloped in substance misuse services, and while all the services we surveyed said they provided access to domestic and sexual violence services, only a minority had these available in-house. Peer support was widely available; however, there was less ready access to women-only peer support. Finally, although many women interviewed for the research spoke about wanting longer-term change in their lives – getting a job, having a nice home, being with their children – in-house support with education, employment and housing was not available in the majority of services we surveyed.

Our report sets out good practice recommendations for services, as well as policy recommendations for decision makers and commissioners, which we believe will improve services for this marginalised, stigmatised and traumatised group of women. The challenge now is to ensure that these recommendations are heard and, of course, implemented.

‘The Challenge of Change: Improving services for women involved in prostitution and substance use’ is available here.

Gemma Lousely, Policy Officer

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