Reducing drug use in female street sex workers: a feasibility study

Most female street sex workers in the UK are affected by the use of illegal drugs, such as heroin and crack cocaine. For most of these women, heroin and crack use reinforces their dependency on sex work and adds to their health and social problems. The need to finance their drug use, and often that of a partner, underpins their involvement in sex work. Drug intoxication also means they are less able to protect themselves whilst working.

Street sex workers who are drug-dependent find using treatment services difficult and when they do, typically don’t benefit as much as other drug users. The 2010 UK Drug Strategy changed the emphasis for drug services from reducing harm through safer drug use to reducing harm by stopping drug use. This makes it even more important for drug services to provide effective treatment for these women.

Managing problem drug use amongst sex workers is complex. They can experience stigma in drug treatment groups from other drug service users. This prevents them from discussing their sex work, a major factor in their drug use. There is also evidence that many drug-using street sex workers are affected by post-traumatic stress disorder (PTSD) from their life experiences. They are unlikely to benefit from other treatment unless this trauma is addressed.

Based on recent research, we have developed a plan to improve the results of drug treatment for these women, by organising NHS and voluntary sector services to work together. This new approach involves creating a stigma-free environment for street sex workers to discuss their work in drug treatment groups, as well as addressing trauma as part of the drug treatment.

This will lead to a patient-focused care package for street sex workers, addressing this longstanding public health and social issue. This project is being conducted by the University of Bristol and NIHR CLAHRC West in collaboration with:

  • One25
  • Bristol Drugs Project
  • Bristol ROADS (Recovery Orientated Alcohol and Drugs Service)
  • Avon & Wiltshire Mental Health Partnership NHS Trust
  • University Hospitals Bristol NHS Foundation Trust

This project is known as the DUSSK (Drug Use in Street Sex Workers) study.

Project aims

We will study how acceptable the new service is for street sex workers and how practical it is to run. How much it costs in terms of staff time will also be addressed.

Anticipated impacts

The project could lead to a reduction in illicit drug use, which may in turn result in reduced involvement in sex work. It could also improve the mental wellbeing of these women.

Links and downloads

  • Drug use in street sex workers (DUSSK) study protocol: a feasibility and acceptability study of a complex intervention to reduce illicit drug use in drug-dependent female street sex workers Read the protocol paper

Lead collaborators

CLAHRC West staff

Jo Kesten

Dr Joanna Kesten

Rita Patel

Dr Rita Patel

Katie Warner

  • Project Support Officer
  • Evaluation
  • Management and administration

Partners on this project

Avon and Wiltshire Mental Health Partnership NHS Trust

Avon and Wiltshire Mental Health Partnership NHS Trust provides services for people with mental health needs, drug or alcohol dependency and people with learning disabilities. It covers Bath and North East Somerset, Bristol, North Somerset, South Gloucestershire, Swindon and Wiltshire and provides a specialist service throughout the South West.

University of Bristol

The University of Bristol is internationally renowned and one of the very best in the UK, due to its outstanding teaching and research, its superb facilities and highly talented students and staff. Its students thrive in a rich academic environment which is informed by world-leading research. It hosts the Elizabeth Blackwell Institute for Health Research.