Southend: Supporting the health needs of female street-based sex workers

A drop-in clinic has been established for street-based sex workers in Southend, providing them with access to mental health and sexual health workers and a nurse prescriber. It is part of a wider strategy that has been developed to provide better support to this community of women.

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How early days of COVID-19 triggered action

During the early stages of the pandemic, Southend City Council and its voluntary sector partners worked hard to reach out to the homeless community to offer them shelter during the lockdown.

In doing so it made them realise there was a community – women involved in street-based sex work – that were receiving limited support from the statutory or voluntary sectors and were in fact the hidden homeless.

In response, a meeting was jointly hosted in June 2020 by the council and local clinical commissioning group with partner organisations, including the police, housing and charities, to see what should be done. It was decided action needed to be taken and a Street Prostitution Strategy was drawn up, bringing together a whole range of partners from across the city.

“I think that work during COVID was a real eye-opener,” said Tracy Harris, the Head of Communities for Southend City Council, who chairs the Strategic Street Prostitution Group that has taken the lead in coordinating the work.

“We realised we had very little contact or knowledge about this group of women. Yet we know they are particularly vulnerable and suffer from complex trauma. They are often dependent users of drugs and alcohol with high rates of mental health, depression, domestic abuse and previous experience of the criminal justice system. And, of course, they are at risk of harm from sexually transmitted diseases as well as violence and exploitation on a daily basis.

“We got together with the voluntary sector groups that were providing outreach support, such as The Vineyard, and other statutory services to see what we could do. We worked with a woman who had stopped street-based sex work herself and had set up the charity Aspirations to provide outreach support to the women and a drop-in service.

She was known and trusted so we started to build up the support via that drop-in clinic.

From drug support to hairdressing

Ms Harris said as it was an environment the women felt safe in and trusted it meant the services were accepted when they went in. “These women would struggle to visit the drug and alcohol service for example, but our drug and alcohol staff were accepted when they went to this location.

“We then extended what we did and now every Thursday we provide a variety of support. Mental health workers have started going in as have sexual health nurses. We have a nurse prescriber who visits and provides help with their primary care needs, things such as skin infections. She has even arranged for one woman to go for breast-screening.”

The council and partner services are now working with close to 50 women via the drop-in clinic. One woman who has been helped said: “It is a really good service. I have been helped with my physical and mental health – it has made a huge difference to my life.”

For the most complex cases there are fortnightly safeguarding meetings so care plans can be put in place. And, as the drop-in clinic has been developed, the offer has moved beyond direct health support too with hairdressers now going in as well as an arts and craft group.

Ms Harris said: “We have really started building a relationship with the women. Just recently we worked with them to produce a leaflet they could carry with them – it contains all the key numbers they may need if they need support. We have also placed a bird box close to where they work, in a secret location only they know about, which is topped up with condoms so they have plentiful supply if they need them.

“But clearly the goal is help them move away from this industry. Aspirations currently have two women who are ready to go into rehab and another three who have started seeing their children again. We are making progress. It has only been going 18 months so there is plenty we want to build on.”

One of the immediate goals is to get dental services in with the hope that a mobile clinic could start visiting the drop-in centre. “Many of the women have bad oral health – in fact that is one of the key issues the nurse prescriber sees amongst the women – so getting access to a dentist is a priority at the moment,” said Ms Harris.

Other steps are also being taken. The Trauma Alliance, a new initiative led by psychologists at Essex Partnership University NHS Trust, has been recruited to provide trauma-informed care training to services such as the police and probation.

“It has made a huge difference in the attitudes towards the women. They are being seen as the victims rather than as criminals. Our whole approach has changed,” added Ms Harris.

Contact details

Tracy Harris, Head of Communities, Southend City Council: [email protected]