Effectiveness of sexual health service delivery within a drop in centre
for street sex workers
D. Wakelam (1), A. Wells (2), A. Webb (3)
The Linx Project, Liverpool, UK (1); GUM department, Royal Liverpool
University and Broadgreen Hospital, UK (2); Abacus Clinics for Contraception and
Reproductive Health, Liverpool, UK (3)
Introduction: Street sex workers (SSW) are a socially excluded and
difficult to reach group. The majority are drug users and many have no fixed
home. Their consequent chaotic life style and fear of discrimination or
judgemental attitudes explains their difficulty in accessing standard services.
The Linx project actively supports SSW to overcome these barriers and assists
them in accessing a range of services. In late 2002 a drop in centre for SSW was
opened. Twice weekly there is a session from 8–11pm when SSW can drop in for a
chat, meal, a wash and to obtain condoms and clean clothes. Outreach Linx
workers make contact and distribute condoms on the street where they inform the
women of the service available and give them a lift in and back if requested.
Aims and Methods: to pilot a sexual health service within the Linx
drop in sessions providing pregnancy testing, contraceptive advice and supplies,
blood testing for viral infections and hepatitis B vaccination. By making
personal contact it was hoped this would also assist in easing access to
mainstream contraception and infection screening services.
Results: An outreach health adviser from the genitourinary medicine
clinic with experience of working with sex workers and a senior doctor in
contraception agreed to attend an evening drop in once a month. In the first six
months 9 women were seen at six sessions on 15 occasions. In the second six
months a further 14 women were seen at seven sessions. Over the year 35 visits
were made. Eleven women started a hepatitis B vaccination programme and 10 made
arrangements to attend for full infection screening. Three started on
Depo-Provera and two had Implanons fitted. The Linx staff were trained in
performing and interpreting pregnancy tests. A number of women were referred in
directly by the Linx workers to either the contraception or infection testing
services. An audit of both the SSW and the Linx Project workers showed that the
women were very pleased to have this service and felt more confident about
requesting help at Linx than at standard health services.
Conclusions: an outreach service in a space where the SSW feel safe
can improve the access of an often marginalised group to health services and
reduce the risk to public health of not offering protection against unwanted
pregnancies and infections.