Experiences of female migrant sex workers from Eastern Europe and effect of multiple vulnerabilities on risk of STIs/HIV

Most countries view migrants as a health threat, yet the process of migration is a health threat to migrants themselves and this in turn can cause risk to the receiving communities. The mobile nature of the communities, language barriers and illegal or undocumented status often means they are likely not to benefit from public health programmes or access health services which tend to target more stable communities. These reasons contribute to the lack of knowledge of migrant sex workers in London. There is little information on how migrant sex workers are established within social networks in the UK and how these social networks can provide support to promote safer sex practices. What is also lacking is information on whether the duration of stay in the UK affects their ability to make social connections, increases or decreases risk of being infected with STIs and other harms associated with sex work. Our research aims to answer these questions with a view to contributing to the design and delivery of appropriate health promotion interventions and increasing access to sexual health services. Through conducting in depth interviews with migrant sex workers the research will build up a picture of the different types of sex work that are occurring and how migrant women end up as sex workers. By collecting data on levels of sexually transmitted infections amongst migrant sex workers and UK born sex workers the research will highlight whether migrant sex workers are at more risk of STIs than UK sex workers and point to some of the reasons behind this. The findings of the research will serve to improve access and effective delivery of sexual health services for sex workers including migrant sex workers and will explore the effect of multiple deprivations such as poverty, poor housing, lack of residency status on vulnerability to STIs and how these factors interact with migration.

Background: International research suggests increased odds of health risk and inequalities in health service access amongst recent migrants with some research highlighting elevated health risk and inequality among migrant women in particular. Women in sex work face abuse and exploitation, and this is exacerbated for migrant women by insecure immigration status. According to Home Office figures, 50% of London sex workers are migrants and 5% of these enter the UK against their will. Women from Eastern Europe and the Former Soviet Union currently make up 25% of all female sex workers in London, the largest non-UK group. Evidence from other countries suggests that migrant sex workers suffer racial discrimination, ghettoised work conditions, reduced access to medical and legal assistance and violence. Exploitation, violence, drug use and sexual risk behaviours have been associated with sex work in the UK, but there is little research on how these factors interplay with migration to impact on sexual health.
Aim: The aim of the study is to measure risk and individual, environmental and structural determinants of sexually transmitted infections (STI) and HIV among female migrant sex workers from EE and the FSU in order identify health promotion needs and potential interventions for migrant sex workers.
Methods: This project comprises two linked studies: (i) a qualitative study among female migrant sex workers from EE and FSU, and of relevant service providers aimed at defining types of migrant sex workers; describing entry into sex work and the social organisation of sex work networks to assess how they promote or exacerbate health risk; and (ii) a cross-sectional survey of sex workers recruited through their social networks to measure prevalence of STIs and HIV and assess related risk factors among female sex workers recently migrated form EE and FSU compared with domestic sex workers and more established migrant sex workers. The close collaboration with service providers at Camden Primary Care Trust, and outreach services working with sex workers (the Poppy Project, CLASH, the Praed Street Project, Open Doors and the Homerton Hospital) ensures that the project has close links to intervention and service provision.