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

Lead Research Organisation: London Sch of Hygiene and Trop Medicine
Department Name: Public Health and Policy

Abstract

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.

Technical Summary

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.

Publications

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Grenfell P (2016) Decriminalising sex work in the UK. in BMJ (Clinical research ed.)

 
Description ECP evidence-gathering symposium: decriminalisation of sex work
Geographic Reach National 
Policy Influence Type Gave evidence to a government review
URL http://prostitutescollective.net/2015/10/29/decriminalisation-of-prostitution-the-evidence/
 
Description MRC Population Health Scientist Doctoral Award
Amount £300,000 (GBP)
Organisation Medical Research Council (MRC) 
Sector Academic/University
Country United Kingdom
Start 01/2011 
End 12/2014
 
Description Open Society Foundation
Amount $54,700 (USD)
Funding ID OR2015-24978 
Organisation Open Society Foundation, New York 
Sector Charity/Non Profit
Country United States
Start 03/2016 
End 10/2016
 
Description Secondary analysis of existing dataets
Amount £300,000 (GBP)
Organisation National Institute for Health Research 
Sector Public
Country United Kingdom
Start 01/2013 
End 01/2015
 
Description Seed Award in Humanitites and Social Science
Amount £30,000 (GBP)
Funding ID 201445/A/16/Z 
Organisation Wellcome Trust 
Department Wellcome Trust Bloomsbury Centre
Sector Academic/University
Country United Kingdom
Start 01/2017 
End 07/2017
 
Title Behavioural questionniare 
Description We have developed a detailed questionnaire to assess sex workers' exposure to policing practices, experience of violence, sexual health and access to services. 
Type Of Material Physiological assessment or outcome measure 
Year Produced 2018 
Provided To Others? Yes  
Impact None as yet, but will produce invaluable data documenting sex workers experience of violence and policing in teh UK> 
URL http://eastlondonproject.lshtm.ac.uk/
 
Title Migrant sex worker project 
Description Behavioural and biologicl dataset on experiences of migration among sex workers in London. 
Type Of Material Database/Collection of data 
Year Produced 2008 
Provided To Others? No  
Impact Two peer review publications and conference presentations 
 
Description Academic collaboration with UCL 
Organisation University College London
Department Institute of Epidemiology and Health Care
Country United Kingdom 
Sector Academic/University 
PI Contribution LSHTM research team advised the UCL team on the recruitment method respondent driven sampling. Research instruments were shared across the research teams.
Collaborator Contribution We have collaborated closely with the UCL team in the implementation of their research examining sexual health and lifestyles of Eastern European migrants in London. This has involved sharing information on study design including recruitment methods, standardising indicators on sexual health and risk behaviours across the surveys, survey software use, and practical tips on translation and field work methods. It is intended that this collaboration will result in a joint publication to be completed in 2010.
Impact Joint publications are planned in 2010.
Start Year 2007
 
Description Collaboration with London Metropolitan 
Organisation London Metropolitan University
Department Institute for the Study of European Transformations
Country United Kingdom 
Sector Academic/University 
PI Contribution We jointly obtained funding from the ESRC on a dissemination event called 'In whose name? Migration, Sex Work and Trafficking".
Impact Dissemination event as part of the ESRC 'Festival of Social Science', with a joint policy report. This collaboration in multi-disciplinary spanning anthropology and epidemiology.
Start Year 2010
 
Description Service provider and academic collaborations. 
Organisation Open Doors
Country Global 
Sector Charity/Non Profit 
PI Contribution The field work team worked closely with services (CLASH, PSP) during the study in order to recruit participants. During this time the field work team would help out in the service where possible.
Collaborator Contribution The research team collaborated closely with services working with migrant sex workers including CLASH, Praed Street Project, Open Doors and the Homerton Hospital in the design of the study and the development of research instruments. Field workers worked closely with services (CLASH and PSP) in order to recruit participants into the study.
Impact This collaboration has ensured that the research has provided data that is relevant to service providers working with migrant sex workers. Representatives from the services will also contribute to the dissemination meeting planned for early 2010 and all the publications arising from the study.
Start Year 2007
 
Description Service provider and academic collaborations. 
Organisation Praed Street Project
Country United Kingdom 
Sector Charity/Non Profit 
PI Contribution The field work team worked closely with services (CLASH, PSP) during the study in order to recruit participants. During this time the field work team would help out in the service where possible.
Collaborator Contribution The research team collaborated closely with services working with migrant sex workers including CLASH, Praed Street Project, Open Doors and the Homerton Hospital in the design of the study and the development of research instruments. Field workers worked closely with services (CLASH and PSP) in order to recruit participants into the study.
Impact This collaboration has ensured that the research has provided data that is relevant to service providers working with migrant sex workers. Representatives from the services will also contribute to the dissemination meeting planned for early 2010 and all the publications arising from the study.
Start Year 2007
 
Description Sex work, violence and policing 
Organisation Homerton University Hospital NHS Foundation Trust
Country United Kingdom 
Sector Public 
PI Contribution I have led the development of a proposal recently awarded funding by the NIHR Public Health Research Programme to examine the impact of police enforcement practices on sex workers' risk of violence, HIV/STIs, emotional health and access to services.
Collaborator Contribution Collaborators have assisted in the design of the study and development of the proposal.
Impact This project has recently been awarded funding and the research started on 1st February, 2017. It has also resulted in presentations at various national conferences including the National Ugly Mugs Conference and the Homelessness, Social Exclusion and Health Inequalities Conference organised by the Faculty of Public Health as well as the submission of evidence to an event organised by the English Collective of Prostitutes at the House of Commons. .
Start Year 2015
 
Description Sex work, violence and policing 
Organisation Imperial College London
Department Imperial College Trust
Country United Kingdom 
Sector Charity/Non Profit 
PI Contribution I have led the development of a proposal recently awarded funding by the NIHR Public Health Research Programme to examine the impact of police enforcement practices on sex workers' risk of violence, HIV/STIs, emotional health and access to services.
Collaborator Contribution Collaborators have assisted in the design of the study and development of the proposal.
Impact This project has recently been awarded funding and the research started on 1st February, 2017. It has also resulted in presentations at various national conferences including the National Ugly Mugs Conference and the Homelessness, Social Exclusion and Health Inequalities Conference organised by the Faculty of Public Health as well as the submission of evidence to an event organised by the English Collective of Prostitutes at the House of Commons. .
Start Year 2015
 
Description Sex work, violence and policing 
Organisation Open Doors
Country Global 
Sector Charity/Non Profit 
PI Contribution I have led the development of a proposal recently awarded funding by the NIHR Public Health Research Programme to examine the impact of police enforcement practices on sex workers' risk of violence, HIV/STIs, emotional health and access to services.
Collaborator Contribution Collaborators have assisted in the design of the study and development of the proposal.
Impact This project has recently been awarded funding and the research started on 1st February, 2017. It has also resulted in presentations at various national conferences including the National Ugly Mugs Conference and the Homelessness, Social Exclusion and Health Inequalities Conference organised by the Faculty of Public Health as well as the submission of evidence to an event organised by the English Collective of Prostitutes at the House of Commons. .
Start Year 2015
 
Description Sex work, violence and policing 
Organisation University of Bristol
Department School of Social and Community Medicine
Country United Kingdom 
Sector Academic/University 
PI Contribution I have led the development of a proposal recently awarded funding by the NIHR Public Health Research Programme to examine the impact of police enforcement practices on sex workers' risk of violence, HIV/STIs, emotional health and access to services.
Collaborator Contribution Collaborators have assisted in the design of the study and development of the proposal.
Impact This project has recently been awarded funding and the research started on 1st February, 2017. It has also resulted in presentations at various national conferences including the National Ugly Mugs Conference and the Homelessness, Social Exclusion and Health Inequalities Conference organised by the Faculty of Public Health as well as the submission of evidence to an event organised by the English Collective of Prostitutes at the House of Commons. .
Start Year 2015
 
Description Sex work, violence and policing 
Organisation University of York
Country United Kingdom 
Sector Academic/University 
PI Contribution I have led the development of a proposal recently awarded funding by the NIHR Public Health Research Programme to examine the impact of police enforcement practices on sex workers' risk of violence, HIV/STIs, emotional health and access to services.
Collaborator Contribution Collaborators have assisted in the design of the study and development of the proposal.
Impact This project has recently been awarded funding and the research started on 1st February, 2017. It has also resulted in presentations at various national conferences including the National Ugly Mugs Conference and the Homelessness, Social Exclusion and Health Inequalities Conference organised by the Faculty of Public Health as well as the submission of evidence to an event organised by the English Collective of Prostitutes at the House of Commons. .
Start Year 2015
 
Description BASSH conference 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? Yes
Geographic Reach National
Primary Audience Health professionals
Results and Impact This was attended by 120 health professionals working in the field of sexual health service delivery and research

One GUM consultant based in Leeds has subsequently contacted the project to discuss collaborating on a research question
Year(s) Of Engagement Activity 2010
 
Description ESRC Festival of Social Science 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? Yes
Geographic Reach National
Primary Audience Public/other audiences
Results and Impact 50 students, policy makers, sex worker campaigners and advocates attended. There was a ten minute presentation, followed by a panel discussion.

There was some media coverage of News 24.
Year(s) Of Engagement Activity 2011
 
Description European Public Health Conference 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Professional Practitioners
Results and Impact Presentation of preliminary findings from the systematic review examining the impact of (de)criminalisation on sex workers' risk of violence, HIV, sexaullly transmitted infections and acess to services.
Year(s) Of Engagement Activity 2016
 
Description Health Protection Agency 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Type Of Presentation Keynote/Invited Speaker
Geographic Reach Regional
Primary Audience Health professionals
Results and Impact 40 members of staff at the Centre for Infections at the Health Protection Agency attended the meeting. We presented findings of both the qualitative and quantitative study. Following the presentation we discussed the difficulties in conducting research and public health surveillance among sex workers.

The staff asked for the papers to be circulated around the department.
Year(s) Of Engagement Activity 2012
 
Description Homelessness, Social Exclusion and Health Inequalities 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Professional Practitioners
Results and Impact Presentation of a literature review on health impacts of criminalisation of sex workers.
Year(s) Of Engagement Activity 2015
 
Description International Harm Reduction Conference 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Health professionals
Results and Impact A member of the team presented preliminary results of the qualitative study at the International Conference on the Reduction of Drug Related Harm held in Bangkok in April 2010. The presentation was to an audience of policy makers, service providers and researchers in the field of drug use and sex work.

We have been asked to present results at other conferences as a result of this.
Year(s) Of Engagement Activity 2009
 
Description National Ugly Mugs Conference 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact We were invited to present some research on health impacts of policing practices among sex workers. Over 150 service providers, sex workers and policy makers attended the conference held by National Ugly Mugs. One outcome of the presentation was the development of a small grant by Open Society Foundation for a literature review to synthesise qualitative and epidemiological data on the effect of criminalisation on health and safety of sex workers. We have also developed a proposal for a mixed method study to examine this question which we have recently submitted to the NIHR Public Health Research Programme.
Year(s) Of Engagement Activity 2015
 
Description Policy brief: Homicide 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact A policy brief was published summarising key findings of a literature review on the homicide rates among sex workers in the UK.
Year(s) Of Engagement Activity 2017
URL https://www2.le.ac.uk/departments/criminology/people/teela-sanders/sex-work-and-homicide
 
Description Policy brief: Mental health 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact A policy brief was published summarising literature on mental health among sex workers and key structural drivers of poor mental health.
Year(s) Of Engagement Activity 2017
URL https://www2.le.ac.uk/departments/criminology/people/teela-sanders/BriefingPaperSexWorkandMentalHeal...
 
Description Presentation to Mortimer Market GUM 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Health professionals
Results and Impact 30 health professionals working at Mortimer Market GUM clinic or in affiliated sexual health services attended to here a presentation of both the qualitative and quantitative study. This prompted many questions about the sexual health needs of sex workers

We've been asked to present the results at the MMC Researchers group meeting in April 2011
Year(s) Of Engagement Activity 2010
 
Description Project Dissemination meeting 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Health professionals
Results and Impact We presented the findings of the research to an audience consisting of health professionals, project collaborators, researchers as well as some policy makers (Home Office and Department of Health)

Following the presenations we discussed most effective ways in which to disseminate the findings to include, a policy briefing and workship in collaboration with the London Metropolitan University foccusing on application of findings to policy, dissemination via the UK Network of Sex work projects.
Year(s) Of Engagement Activity 2010