Elaine Gallagher, an Outreach coordinator for Spectrum Community Health, has developed a project to ensure that commercial sex workers (also known as escorts) have wider access to sexual health services in Wakefield.
Escorts are a hard-to-reach and vulnerable client group who face greater risks to their safety than many people in the general population, including:
• A greater risk of sexually transmitted infections (STIs) due to the nature of their work
• Risks of encountering violent or unpredictable behaviour from clients
• Greater risk of abuse and harms such as sexual exploitation and trafficking
• Lack of specialist support services to understand their unique health needs
These risks are complicated by their infrequent contact with mainstream sexual health services, which can be due to fear of facing stigma around sex work and lack of trust in authorities.
By consistently engaging with escorts in the community, Elaine is building trusting relationships, delivering much-needed services and helping to identify and safeguard women at risk of abuse. She provides STI testing, health promotion, pregnancy testing and contraception advice for 30 escorts in the Wakefield district, as well as referring them into our clinical services.
The fundamental challenge is in supporting these women to engage consistently, access healthcare support and build up trusting relationships with our staff.
Developing an understanding of the emotional challenges facing many escorts is also an important part of Elaine’s work. For these women, late diagnoses of STI’s can mean loss of income, damage to their street reputation (making it difficult to find clients), subsequent problems with debt and other issues. In establishing this project, Spectrum set out to:
• Engage with sex workers in the community and increase their awareness of sexual health services
• Identify and appropriately safeguard any patients at risk of harm
• Provide regular STI testing and health promotion to reduce the risk of STI’s
• Provide wider access to contraception, particularly Long-Acting Reversible Contraception.
• Reduce risks relating to an unplanned pregnancy
Elaine drives engagement by going out into the community to find locations frequented by sex workers, including street areas and parlours as well as relying on ‘word of mouth’ to find women who work from domestic residences. Her efforts protect a network of vulnerable women from harm, many of whom struggle with factors such as unstable/temporary housing, domestic abuse or other issues alongside their health needs.
Since the project began:
• Commercial Escorts are now engaging with sexual health services and accessing clinics for follow-up support if required. This includes 5 escorts who are now using Long-Acting Reversible Contraception (LARC).
• Over one year, Elaine has built a caseload of 30 patients. This has taken time and persistence - for example, some patients might start to engage positively after weeks of reassurance - but then change their minds, cancel appointments or stop attending.
• Reluctance to use conventional sexual health services is becoming less of a barrier in the sex worker community, largely due to the relationship-building done by Elaine. Visiting patients at home or in a familiar place removes their fear of facing stigma and ensures that escorts feel comfortable, making them more likely to engage positively.
• An ongoing relationship with the Outreach coordinator supports vital contact for safeguarding concerns which can identify risks around violence, abuse or exploitation.
• The recruitment of an Outreach Worker to support the increased workload was achieved thanks to the growing workload and demand for outreach services.
This project is delivered as an expansion of Spectrum’s existing sexual health services in the Wakefield District. Best practice and any significant learning from it (for example, in responding to vulnerable clients, sharing knowledge around safeguarding procedures, etc) is fed back to our clinical teams and shared with the Sexual Health Provider Network, which Spectrum leads in Wakefield.
Spectrum has two sister sexual health services (in Barnsley and in Wigan & Leigh) which can also implement this learning, although their Outreach is focused differently according to local priorities and concerns.
Spectrum also works closely with local authorities, charities and other support organisations to refer any patients who are thought to be at risk of harm, and has strict procedures for escalating any concerns. Our wider Outreach services in Wakefield also engage with young people.
The primary value creation in this project is for Elaine’s patients, some of whom have experienced domestic abuse, childhood trauma or mental ill health with little support from family in addition to their current needs. These circumstances make Elaine’s regular visits a huge help for their health and wellbeing. Importantly, her access to sex workers is an opportunity to utilise safeguarding training and look out for any red flags, specifically around trafficking and violence.
Elaine made a difference to the life of an escort when she supported a young patient who discovered she was pregnant. Due to financial problems, the patient couldn’t afford to stop her sex work and continued seeing clients on a regular basis. This work began to cause strain on her relationship with her partner.
To help ease their situation, Elaine suggested that ‘online’ sex work would be a safer alternative, allowing the patient to earn money whilst eliminating sexual contact. This could also continue after giving birth and would provide a safer environment to care for a baby. The patient received contraception soon after.
Elaine continues care with her patients for as long as they need her and sees many regular patients on a monthly or bi-monthly basis, providing check-ups and re-assessing any safeguarding issues.
This project is managed by Elaine, who is supported by clinical staff when referring patients for follow-up care. She worked alone in the community until a Support Worker recently joined her, and their main focus continues to be on patients. Below are some examples of patient feedback regarding this project, written on a popular escort website where Elaine promotes Spectrum’s sexual health services:
“Superb professional, discreet service, fast results and all carried out by such a lovely lady. Thanks, Spectrum for your service it is much appreciated.”
• “I have used them for a very long time they’re very friendly and do their job very well and we need to stay safe.”
• “Very professional and friendly service, HIV tests in minutes, other results back in days. Elaine is lovely, I’m extremely grateful.”
• “I have been using this service for the last few years and they are very professional and discreet, Elaine is just so lovely and non-judgemental.”
• “Excellent service, which all girls on here (website) should take advantage of to stay safe! Discreet and confidential. Thank you will be using the service regularly!”