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Camden, Islington and Haringey: Sexual health outreach support for sex workers

In the London boroughs of Camden, Islington and Haringey, a long-established sexual health promotion outreach team provides a trusted gateway linking sex workers with other services.

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Introduction

A key element of the inclusion health challenge is finding ways to reach and gain the trust of vulnerable communities to offer support. In the London boroughs of Camden, Islington and Haringey, a long-established sexual health promotion outreach team provides a trusted gateway linking sex workers with other services.

The challenge

Sex workers are vulnerable to a range of health and wellbeing issues and require specialist support, but it takes time and effort to build trusting relationships with this community group. 

The London boroughs of Camden, Islington and Haringey have sizable sex-working communities. Some people work from flats or brothels, others work on the street. It’s a transient population – many are from overseas, some speak very little English, and they may be regularly moved between locations. 

This means that sex workers may not be in contact with, know about or feel confident in accessing clinic-based services. Sexual health promotion outreach plays a critical role, but trust has to be built and earned by anyone working with this community group. 

Outreach support

Camden, Islington and Haringey’s sexual health outreach service is provided by Central and North West London NHS Foundation Trust (CNWL), commissioned and funded by the three councils. The service is known as CLASH in Camden/Islington and SHOC in Haringey. It provides targeted sexual health outreach services and clinics for vulnerable community groups – including dedicated support for sex workers. 

These services include: 

  • Health promotion specialists providing one-to-one advice, information, support and signposting for sex workers. 
  • ‘Clinic in a box’ – the testing/screening element of the outreach service, with the equipment taken to locations such as hostels, drug and alcohol services, bars and clubs, migrant centres, community centres and street outreach. 
  • A walk-in sexual health clinic for sex workers in Camden and Islington with three sessions a week, one exclusively for women (interpreters are available on the phone and Mandarin interpreters, also known as ‘cultural mediators’, attend one session a week). 
  • Access to PEP and PrEP medication to reduce risk of HIV. 

Health promotion is at the heart of the service, including advice on how to work safely, access to sexual health screening and contraception. The small team of outreach workers are based at the main sexual health clinics in Camden and Islington. They build trusting relationships through which they can respond to immediate health and safety needs with early detection, treatment, prevention, and support to access follow-up care. 

Strong links and partnerships with housing, drug and alcohol services and other NHS services play an important part in improving people’s health and wellbeing and reducing health inequalities. With such a small team, these links are essential.

They also work closely with the Salvation Army and the ‘Find and Treat’ service, delivered by University College London Hospitals NHS Foundation Trust, which is tackling TB and key public health infections in London’s vulnerable communities. Find and Treat offers sexual health screening, treatment and vaccinations via their mobile van. 

Building trust

Emma Stubbs, Head of Drugs, Alcohol and Sexual Health at Camden Council, said the service can provide a gateway to other support for sex workers. 

Here in Camden, nobody has access to that community except our sexual health outreach service. We want to hear their voices, there’s a lot we want to involve them in, but everyone struggles with access. We always end up reaching out to CLASH.” 

With more than 30 years of experience, CLASH and SHOC are well known in the communities they work with. Team Manager, Kaylee Linton, said: “Sex workers are a community where trust has to be built and earned, and we have been successfully building and developing that trust for a long time.” 

Street-based workers are particularly vulnerable. They will often have substance misuse issues and are working to meet their drug, alcohol, food or accommodation needs. Most have experience of trauma and violence. The historic ‘red light’ areas have largely disappeared, so it’s harder to find these people through community outreach – they are more likely to be found via drug and alcohol services or as street homeless. 

Kaylee said: “It can make a real difference if we’re able to get a street sex worker into accommodation. Then we can work with them on their other needs – detection and screening of infections, prevention and treatment, drug and alcohol misuse, access to housing and support to think about exiting or reducing sex work. Sexual health promotion outreach plays a critical role in removing barriers to the support and care these people need.” 

Next steps

The team is looking at how to involve service users more in service design. Kaylee Linton said: “Our sex workers tell us that this is their job, they choose to do it. They don’t identify as being trafficked. However, we do see trauma impacting them, so improving access to psychology services and counselling is something we are looking at.” 

The holistic person-centred approach is important to service users. “We listen to the trauma, the loss of families, why they are doing this, their addiction, housing problems – it’s not just about sexual health.” Regular de-briefs, supervision and safeguarding is provided for the team members. 

We try to empower our service users to take control of their lives, to think about their needs and wants. We want to empower them to make behavioural change, be safe, and achieve and maintain good sexual health. We use joint working and referrals to start making that change happen.” 

Emma Stubbs said: “Everyone knows about this service and sees the benefits of working in partnership with them. It’s really about trying to support people to only engage once. CLASH/SHOC is a good example of how successful that can be for people who don’t really feel part of the health system, the care system, or any system at all. It’s a lynchpin service that we can circle around for this community.” 

Contact

Emma Stubbs, Head of Drugs, Alcohol and Sexual Health, Camden Council: [email protected] 

Emma Demblon, Service Manager – Islington and the Specialities, CNWL NHS Foundation Trust: [email protected]