Street sex workers in the BJGP
Molly the harlot arrives in Hogarth's London
There isn’t much arguing that street sex workers fall into the category of ‘hard-to-reach’. At least in terms of delivering healthcare. Even in substance misuse clinics this is a topic that is rarely discussed and often denied. One of the long-term disappointments of primary care is that it is failing to use its potential to get to this kind of group where real health inequalities can be addressed.
This British Journal of General Practice paper looked at the outcomes from a primary care drugs treatment programme for street sex workers. They set up a ‘one-stop shop’ where sex workers in Derby could access a full range of medical, social and drug treatment services including prescribed treatments for heroin addiction, contraception and sexual health services.
They recruited 34 participants who met the inclusion criteria: basically female heroin users who had offered sex for money in the previous 4 weeks. They used the Christo inventory to measure quality of life in people who use drugs and measured them at entry and at one year. The women self-reported on involvement in sex work and the researchers measured heroin use through the overall percentage of positive urine samples.
The results showed an improvement in health and wellbeing with the mean Christo scores reduced from 12.05 at entry to 8.97 at 1 year (p<0.001). Out of the 34 women at the start only 11 (33%) reported being involved in sex work at 1 year. They had 30 urine samples at the start of the study of which 26 (87%) were positive for heroin and 21 out of 29 (72%) were positive at 1 year.
This paper rightly highlights the difficulties in accessing this group of people. It would be easy to be critical of this paper and one can highlight the relatively small numbers, the absence of controls and the fact that the only objective outcome wasn’t significantly changed.
However, that would rather miss the underlying point – it should be read for inspiration as much as anything. It highlights the scope of general practice to access ‘hard to reach’ groups, address inequality and improve health.
.
.
Litchfield J, Maronge A, Rigg T, Rees B, Harshey R, & Keen J (2010). Can a targeted GP-led clinic improve outcomes for street sex workers who use heroin? The British journal of general practice : the journal of the Royal College of General Practitioners, 60 (576), 514-6 PMID: 20594441
