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The exponential benefits of taking sexual health services out of the clinic and into sex working communities using a ‘needs-led’ approach to overcome the stigma barrier - contraception-esc.com

The exponential benefits of taking sexual health services out of the clinic and into sex working communities using a ‘needs-led’ approach to overcome the stigma barrier

The exponential benefits of taking sexual health services out of the

clinic and into sex working communities using a ‘needs-led’ approach to

overcome the stigma barrier

A. Wells (1), D. Wakelam (2)

GUM Department, Royal Liverpool University Hospital (RLUH), UK (1); The

Linx Project, Liverpool, UK (2)

Introduction: In April 2001 a Nurse Practitioner was tasked to pilot

contact with sex trade workers (STWs) in response to the steep rise in levels of

syphilis, gonorrhoea (including ciprofloxacin resistant) and chlamydia. It was

believed that there was a link between clients attending the genitourinary

medicine (GUM) clinic with resistant gonorrhoea and STWs.

Aims and Methods: Most STW take pride in working safely but don’t

always realise some of the dangers (infection risk due to oral sex). Due to

stigma and other issues which STWs often have (insecure accommodation, substance

misuse, criminal justice, histories of abuse) they have felt alienated from

health services in general and particularly GUM with its invasive questioning

about partners and lifestyles. The Practitioner forged working relations with a

number of agencies: Portside, working with sauna based STWs; Safe in the City,

working with young male STWs; The Linx Project, working with female street STWs.

Through ‘‘cold-calling’’, she linked to escort agencies whose positive

response has led to regular input at agency get-togethers – sexual health is

now a priority in their service delivery. Street STWs and young male STWs proved

the hardest to link into services which led to a clinic being piloted at The

Linx Project, delivered with the assistance of a local FP&RHC Consultant and

further contacts developing with a young man’s hostel and a homeless Drop In.

Results: Outreach to STWs on their own ground is followed by

fast-track appointments at GUM for both STWs and their partners (some of whom

are unaware that they are being fast tracked as they do not know their partner

is sex working). The Practitioner sees them from initial assessment, through

testing to results and treatment. In 2001–02 there were 16 new presentations

at the GUM and 8 reregistrations, in 2002–03 46 and 41 respectively. The

non-judgemental approach of the Practitioner has led to requests for help with

other issues (hepatitis B and C, contraception, general health). The pilot has

been extended and the post is now permanent.

Conclusions: Having a dedicated Practitioner based in GUM but

accessing the client group on its own territory can lead to greater health

benefits than just the detection and treatment of STIs. A sensitive, aware and

needs led outreach approach has resulted in greater take up of services by

individuals and their partners.

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