Prostitution and sex work: nature and prevalence in England and Wales (report)

University of Bristol, commissioned by the Home Office and the Office of the South Wales Police and Crime Commissioner, October 2019

The University of Bristol was commissioned by the Home Office and the Office of the South Wales Police and Crime Commissioner to look in to the current ‘nature’ and ‘prevalence’ of prostitution in England and Wales, involving adults aged 18 or over. The research was carried out between May 2018 and June 2019.  We were not asked to report on policy or law.  Drawing on the literature and initial findings, we used the following definition:

Prostitution and/or sex work constitutes the provision of sexual or erotic acts or sexual intimacy in exchange for payment or other benefit or need.

Following a systematic search of the existing national and international evidence base, including a review of previous prevalence studies, we sought views, data and personal experiences through a 6-month public online survey, yielding almost 1200 often detailed responses with over 500 from those currently or formerly involved in selling sexual services.  We also worked through NGOs and support services to identify individuals unlikely to respond to online surveys. We completed follow up in-depth email interviews with 42 individuals.  We invited 155 organisations, collectives and individuals to consult on our draft finding at four regional meetings in early 2019.

Given methodological and ethical constraints, we recognise two groups whose voices are under-represented or absent within this report: (1) Migrant sex workers; (2) British and non-British individuals who are/were forcibly coerced, who are/were trafficked, who are/were sexually exploited and/or who are traumatised in relation to their experience.

In terms of ‘prevalence’, currently in England and Wales there is no source of data which allows for the production of representative population estimates for this group.  Stigma, the private and hidden nature of the sex industry, complex engagement patterns and definitions of activities mean that estimating prevalence is challenging.  Producing an accurate estimate would require studies to follow the guidance and recommendations on data collection jointly produced by the UNAIDS and World Health Organisation (WHO) (2010) and/or to use statistically representative samples.  Focused and small-scale prevalence studies are also more likely to be accurate.  The report provides guidance on such work.

In terms of ‘nature’, overall, we found that the way that sex is sold in England and Wales today is both complex and diverse.  It is common for individuals to move between settings and services, for safety or to maintain income, and to engage full-time, part-time (sometimes alongside other paid work or study), intermittently or casually.  Looking across our data, we identified and structured our commentary around the following:

Cross-cutting themes

Identifying sex work, identifying as a sex worker

·         Social identities, inequalities and routes in

·         Patterns of engagement and moving between settings/services

·         Advertising, payment and third parties

·         Risk, harm and managing safety

·         Buyers and buying

 Settings and services

·         Bar-based sex work and hostess bars

·         BDSM, kink and fetish

·         Brothels, parlours, saunas

·         Erotic and exotic dance

·         Erotic massage

·         Escort: independent

·         Escort: agency

·         Pornography, glamour, erotica

·         Sex parties

·         Street and outdoor sex work

·         Sugar arrangements

·         Telephone, text-based, TV-based, live voyeurism

·         Therapeutic services

·         Webcamming

Individuals selling sex in England and Wales today are varied in terms of demographics and motivation. At the same time, there are recurrent patterns of experience or identity that mark some individuals’ entry into the sex industry and/or the type of setting, service or the conditions in which they work.

We found that a substantial proportion of individuals (mainly women and trans women) are selling sex to get by financially, given different constraints in their lives around caring responsibilities, physical and mental health, lack of access to social security benefits and support services, workplace discrimination, or other reasons.  Their situation is compounded by stigma and managing safety, and many find that the longer they sell sex, the harder it can be to leave completely.  This moves beyond individual ‘choosing or ‘not choosing’ and recognises the structural economic and social context in which choices are narrowed: or in the case of those coerced in to selling sex, choices removed.

Sexual minority women face barriers to health care

The Conversation, October 23, 2019 9.25pm AEDT

Stigma and discrimination are common experiences that people who identify as LGBT or sexual minority face when accessing health services. One report found that one in seven LGBT people in the UK avoided seeking healthcare for fear of discrimination from staff. As many as one in four also experienced negative remarks against LGBT people from healthcare staff.

 

Evaluating the cost-effectiveness of existing needle and syringe programmes in preventing hepatitis C transmission in PWID

Drug and Alcohol Findings (UK), 2019

What would happen to rates of infection with hepatitis C if we closed down all the needle exchanges? Research has established that needle/syringe programmes are a cost-effective way to reduce spread of HIV, but just two studies have considered the same issue in relation to hepatitis C.

In three UK municipalities, the answers were predicted to be more infections, lost low-cost opportunities to improve and save lives, and in two of the areas, greater health-related costs overall. Conclusion was that these services are among the best investments UK health services can make.

HIV and Trans Women: A Literature Review

Transgend Health. 2018; 3(1): 239–250

Abstract:

Trans women are a key, yet under-researched, population in the HIV epidemic. However, there remains a paucity of data on the health and wellbeing of trans women at risk of, or living with, HIV in the United Kingdom.

This article provides a narrative review of key empirical research into HIV among trans women. In an effort to explore individual and social factors in relation to HIV in this population, we outline key tenets of identity process theory from social psychology and the concept of structural violence from medical anthropology.

We focus on published studies around the following themes: (1) epidemiological data, (2) syndemic factors (3) barriers to social support, (4) HIV and gender transitioning, and (5) access to and engagement with health care.

We identify lacunae and thus call for United Kingdom-based research in the following areas: (1) the prevalence and incidence of HIV in trans women, (2) the impact of syndemic factors on HIV risk and acquisition in trans women, (3) the nature of social support for coping with syndemic factors, (4) the interface of gender transitioning and HIV, and (5) barriers to accessing HIV prevention and care services.

There is great scope (and urgency) for research into HIV among trans women, especially in the United Kingdom, to reduce incidence in this group, to enhance engagement in HIV care across the care continuum, and to improve the health and wellbeing of those living with HIV. A tentative model for HIV prevention and care is presented in this article.

Scotland to embed LGBTI teaching across curriculum

The Guardian, 9/12/2018

Scotland will become the first country in the world to embed the teaching of lesbian, gay, bisexual, transgender and intersex rights in the school curriculum, in what campaigners have described as a historic moment.

State schools will be required to teach pupils about the history of LGBTI equalities and movements, as well as tackling homophobia and transphobia and exploring LGBTI identity, after ministers accepted in full the recommendations of a working group led by the Time for Inclusive Education (TIE) campaign. There will be no exemptions or opt-outs to the policy, which will embed LGBTI inclusive education across the curriculum and across subjects and which the Scottish government believes is a world first.

Factors associated with testing for HIV in people aged ≥50 years

BMC Public Health 2018 18:1204

https://doi.org/10.1186/s12889-018-6118-x

Published: 26 October 2018

Factors associated with testing for HIV in people aged ≥50 years: a qualitative study

Abstract

Background

Despite a decline in the number of new HIV infections in the UK overall, the number and proportion of new HIV diagnoses in people aged ≥50 years continues to increase. People aged ≥50 years are disproportionately affected by late diagnosis, which is associated with poorer health outcomes, increased treatment complexity and increased healthcare costs. Late HIV diagnosis also has significant public health implications in terms of onward HIV transmission. It is not fully understood what factors affect the decision of an older person to test for HIV. The aim of this study was to identify factors associated with testing for HIV in people aged ≥50 years who tested late for HIV.

Methods

We interviewed 20 people aged ≥50 years diagnosed late with HIV to identify factors associated with HIV testing. Interviews were audio recorded, transcribed verbatim and thematically analysed.

Results

Seven themes associated with HIV testing in people aged ≥50 years were identified: experience of early HIV/AIDS campaigns, HIV knowledge, presence of symptoms and symptom attribution, risk and risk perception, generational approaches to health and sexual health, stigma, and type of testing and testing venue.

Conclusion

Some factors associated with testing identified in this study were unique to older individuals. People aged ≥50 years often do not perceive themselves to be at risk of HIV. Further, stigma and a lack of knowledge of how to access HIV testing suggest a need for health promotion and suggest current sexual health services may need to adapt to better meet their needs.