Tackling Health Inequalities Amongst Street Sex Workers –The Leeds Managed Approach as a case study

Focus 

This thesis gathers data from street sex workers who work in the Managed Approach (MA) in Leeds.

Current literature fails to focus on physical or mental health measures, or long-term conditions. Rather, there is a tendency in the sex worker literature to focus on harm reduction, drug use and addiction, and to consider only the risks they pose to others (Department of Health, 2014, Putnis and Burr, 2019). Street sex workers face extreme health inequalities, and without fully understanding the nature or extent of their experiences, from the women’s perspective, little can be done to address these. This thesis addresses this gap in the literature using the following research questions.

• From the women’s perspectives, what are sex-working women’s patterns of engagement with health care providers?

• From the women’s perspectives, what are the critical junctures at which they do and do not seek professional assistance?

• What is the impact of criminalisation, stigma, bias on their health outcomes?

• What are the implications of these findings for future policy and service provision? 

Methods 

Using Feminist Constructivism, timelines were used alongside semi structured qualitative interviews to capture the women’s critical decision-making in their health seeking behaviours. Thematic Analysis (TA) was used to analyse both the timelines and the transcribed interviews – comprising of 16 interviews and timelines from seven interviewees. 

Findings and Discussion 

From the TA, 3 meta narrative threads were generated: service provision; stigma and bias; and adverse childhood experiences (ACEs), trauma and experiences. A key unique contribution of this thesis is the evidence that substantiates both the need to advocate for decriminalisation of sex work, and the decriminalisation of possession of drugs for personal use, if street sex worker health inequalities are to be addressed. Additionally, the rich narrative data provided by the creative methods used that gives a first-hand account of the sex workers’ experiences in healthcare. Activist Pedagogy (Aslet, 2014) is identified as a strategic tool for development. A further contribution is methodological, and this thesis demonstrates effectively how creative methods can be used to work with underserved populations.