Simon Community Scotland: opening up conversations about sexual health
We had a chat with Harriet and Olivia, two support workers at Simon Community Scotland and based in a women’s emergency accommodation service. Harriet and Olivia have worked with women in homelessness for several years, and some of the women they support have directly or indirectly disclosed their involvement in selling or exchanging sex.
Sexual health is a topic that regularly comes up as part of the overall wellbeing of the women in their service. So, in this interview we discuss how, as housing staff, they have created a space where women feel safe and confident to talk about their sexual health and why it is so vital that services supporting women open up these conversations too.
Firstly, can you tell us more about Simon Community Scotland and the women’s service you are part of?
Olivia: We are a homelessness charity supporting any person who is at risk of homelessness. We provide support, advice, accommodation and care through trauma-informed practice, and we have also been at the forefront of harm reduction practice. Harriet and I are part of a women’s emergency accommodation service that can house up to 15 women. The service is for any woman over the age of 18 who is in crisis and is seeking to stay for 24 hours or more.
No woman comes in with the same circumstances. Beyond the age limitation, our door is open to any woman who needs accommodation – if that’s because she is fleeing violence, facing family breakdown, eviction, addiction or has just received leave to remain immigration status. We strive to be a safe space where we can help women take their next steps – whether that is accessing their own tenancy, supported accommodation or referring them to other services, we are very much a part of their journey.
Harriet: We provide daily living support, emotional and practical support, act as advocates for the women and signpost them to external agencies that can meet their individual needs. As an emergency accommodation, our ultimate goal is to support women to move into suitable accommodation and we do this by following a person-centred approach. And one of the parts we enjoy most about our role is building relationships with the women.
When the women come into your service, they are at a very difficult moment in their lives and they might not know anything about the service. How do you start building those relationships?
O: Our service is very much referral-based, which means that when a woman comes in, we don’t know anything about her. Yes, we get some background, but we take the women as they come through our door. And we try to be very approachable – it’s about going at the peace of the woman we are supporting because, when they first come in, it’s terrifying. It’s not a happy time in their lives. So we try to adapt our original approach – being person-centred means that not every approach will work for everybody.
H: Yes, it’s not a one-size fits all. Being all-female staff, we approach our women as: “we are women too,” and relate to them on that basis. Yes, we are support workers but we are also all women. And a lot of the things they are going through, we might not have gone through, but there is a lot we do understand purely because we are also women.
Our service also has an open door policy, which is about making the women feel invited to our offices, and making them feel welcome. The harm reduction approach has been a huge factor in that we have that openness, and it really breaks down those barriers with a lot of the women – it makes it easier to build those relationships.
How do experiences of selling or exchanging sex come up in your service?
H: Many of the women that we have supported have been or are involved in selling or exchanging sex. I have worked out that over the three year period I’ve been in this service, I have supported 148 women, and out of those I can quite confidently say that 57 of them have been involved in commercial sexual exploitation to some degree. Although I feel that number could be higher.
Unfortunately, due to the stigma around it, a lot of the women don’t necessarily open up to us about their involvement. But we have come to recognise some signs, such as a woman suddenly having new clothes, it can even be certain language they use, sometimes we might notice fresh bruises or they might go in and out of the building particularly through the night. Sometimes we might overhear conversations between other residents discussing their own involvement or other residents’ involvement.
Even, for example – and this can be a bit hard to explain –, we can sometimes recognise mood and behavioural changes when our residents return to the building after we suspect they might have sold or exchanged sex. It’s something difficult to describe, but we know the women, so we can pick up on a sudden mood change.
Some women though have spoken directly to staff about their involvement, but they are definitely guarded about it, which we feel is hugely due to the stigma around the issue.
As housing workers, why do you think it’s important to consider sexual health even if this is not the main focus of your service?
O: Sexual health is just as important as your mental and physical health. In our experience, women feel they cannot discuss their sexual health because, if it’s a health professional, they instantly cannot speak to them. It’s that fear of judgment and discrimination, so women don’t tend to get support.
However, having that openness, over time women can feel they can talk about these issues. Part of our role it’s to advocate on behalf of the women, so we prioritise going to medical appointments if they need to. Health professionals can also use a lot of jargon that some women find very difficult to understand, and that even us as women can find really difficult. And because women already feel judged, they are not willing to engage. It’s really important for us that the women feel equal in all aspects of their lives. When you come into a homelessness service, you are in limbo, an absolute limbo. That’s why it’s very important to build those relationships back up. So, as support workers we can be that stepping stone and say “it’s OK. It’s not terrifying.”
H: It’s so important to recognise that sexual health will have an impact on women’s mental health, physical health, it’s all part of one circle and each of these aspects will affect the others. So for us it’s as essential to consider the sexual health of the residents we are supporting.
What are some of the sexual health issues that come up for the women selling or exchanging sex that you support?
H: Unfortunately, often the women who are involved in selling or exchanging sex are not necessarily at that place to open up about any issues they may be experiencing due to the stigma they experience. As support workers, we are in that fortunate position of being so frontline that we can build a relationship with the women. And through this, women might feel safe sharing this information with us. It can be difficult because we have recognised that a lot of the women we support have not had the right education around sexual health. So at times they might not even recognise they are experiencing symptoms related to their sexual health.
When our women have been open about selling or exchanging sex, or even their own personal relationships, we always promote safe sex. We provide condoms, lube and femidoms in the service. We have discussions around consent and try to empower our women to make safe choices for themselves.
One of the main risks we have identified for the women in our service is contracting sexually transmitted diseases. We advise women that condoms don’t just prevent pregnancies, they also prevent STIs, and that condoms should also be used during oral sex. A lot of the women we support only think about pregnancy, and that goes back to the lack of education around sexual health.
We will encourage women to be regularly tested, and as an all-female service, we can relay our own experiences as women to encourage them to take care of their own sexual health and wellbeing. We provide women with information about contraception, and because we have strong links with the Sandyford (our local sexual health clinic), we can signpost women to that service or even ask the clinic to do outreach with us. It’s about giving women the options so they can make decisions about their health.
Are there any sexual health issues that women do not talk about but that as support workers you notice and feel the need to open conversations about?
O: HIV is one of them. There’s a lot of stigma around HIV because it’s associated with sharing needles. But we’ve found that in our service that’s not the case – women who have contracted it, it has been through unprotected sex. When we first started in the service, HIV was terrifying to the women and often for the staff as well, thinking that it’s a life sentence if you contract it. Women were also very guarded and didn’t want to discuss it. It has been through our harm reduction approach and building relationships that the women have become more comfortable.
When we discuss HIV with women, they feel “I’m dirty,” “I’m not worthy of meeting anyone,” but that’s not the case at all. As a service and organisation, I feel we have taken the stigma out of HIV. There is medication now, so if a person has contracted HIV, medication can make the viral load undetectable so they can’t transmit it. There are also PReP (pre-exposure prophylaxis) and PEP (post-exposure prophylaxis) for people who are more vulnerable to contract HIV. So if that is because of selling or exchanging sex, women in our service can access this medication to prevent them from contracting HIV.
O: PReP and PEP are still very new and I think it is our responsibility to inform our women. When we’ve met people with HIV in our service, you can tell they are carrying a heavy weight. They feel unworthy of meeting another partner or going out, but that isn’t the case at all. It is our duty to share this information with them.
As a society there is an assumption that women know everything about their sexual health – how to manage periods, what happens during pregnancy, menopause. But the reality is very different. What has been your experience of this when supporting women?
H: There is a real lack of education about sexual health in general. My knowledge of menopause, for example, I’ve only learnt about it from some of the staff members I work with. We don’t get taught any of this. As women, we have been very lucky that we’ve learnt about sexual health from other women. But a lot of the individuals we support haven’t necessarily had those positive female role models and friendships. It’s only when they get to that age – if we think of menopause – that they notice something in their bodies is changing. Also women who have been in addiction haven’t had periods for years, so they often don’t have that knowledge about menopause and the symptoms.
O: Sex education is very much aimed at the male perception, and there is not enough information of what goes on for the women, even though our bodies go through a lot. When I did research, I found there are more than 30 symptoms of menopause – and there just isn’t a lot of information about them even though all women are going to go through it. Because of addiction, some of our women who are in the 40 to 50 age range haven’t had a period for 30 or more years, and suddenly they start bleeding, having flushes, mood changes.
H: Many of the women we support have addiction, and issues like menopause are framed as “oh they’re using substances, so that’s the problem.” But substance use is a side thing to everything else that’s going on. Yet, the focus is on the addiction. It can be challenging working against some of these barriers sometimes.
O: And there is research showing that women who have managed to be in recovery, as soon as they get to the menopause stage, they relapse. Their bodies are changing, they have mood swings, it’s very difficult. And like Harriet was saying, as soon as women walk into a room, they are not seen as females, all people see is addiction. Like I said earlier, when you are in homelessness you are in a limbo, is as if you don’t have an identity, as if you don’t deserve an identity. We are big advocates of saying “no, you are your own person. You stand up for what you believe in!”
H: Yes, and because some of the women say they feel like second class citizens, we feel it’s on us to be like “no, you are you and you are an amazing woman. Forget the homelessness, forget the addiction, you are a strong woman!”
Talking about being a group of women supporting other women, how do you open up conversations about sexual health, especially when you know a woman is involved in selling or exchanging sex?
H: Well, once those relationships have been built, we have a toolkit. Let’s say one of the women comes to us and she opens up about the fact that she is involved in selling sex - we check with her things like: are you regularly tested? A key thing is that we are very relaxed and open and casual; we don’t make it this big scary thing. It’s so important that we are non-judgmental at this moment. We come at it female to female, you know. I think most women will have had sexual health checks and we appreciate how daunting these moments can be.
O: It’s nothing to be embarrassed about. We are two women discussing something that is going on with our bodies. People fall through the cracks because they are not able to talk about their issues. It’s about being open, present and calm.
H: And recognise that if a woman is involved and she has opened up about it, it’s empowering to get someone to take ownership of her health. We are also really lucky because the Sandyford clinic are really willing to do outreach support with us – and that is because they know it’s sometimes easier to come out to the woman’s home for a health check. It also feels safer for the women because staff are right there. So if a woman comes to us asking for a sexual health appointment, we can just pick up the phone and arrange a date with Sandyford to come here. A lot of women haven’t had that support before, and they see we are dead fast about it and calm, so it’s not this scary thing.
What would you say to workers in any type of service who might not yet feel confident to open up conversations about sexual health with the women they support?
O: I’d say: don’t shy away from it. It’s very important to empower women to take charge of their sexual health just as much as they do with their physical and mental health. It's being relaxed and non-judgmental.
H: And recognising that as support workers, we are supporting individuals with their physical health, their mental health, addiction, housing… if something is going on with their sexual health, it’s just as important, because everything is connected. It’s a circle where one issue can impact the others.
When we both started at Simon Community, there wasn’t a harm reduction approach, so we would want women to open up to us about their substance use, but there was a huge barrier because technically they weren’t meant to be doing it in the building. That’s all changed and we have seen first-hand how the harm reduction policy has taken all those barriers away, and we now have the most open conversations about drug use.
O: Initially our harm reduction approach focused on substances, but that’s now applied across the board. Harm reduction, like Harriet said, has dropped down all the barriers. Women haven’t been to a service like ours before and they know that no question is too difficult. With the open door policy, women know that we are here 24 hours a day and we don’t shy away from difficult conversations.
H: And yes, things are going to be uncomfortable, but the only person that should be feeling uncomfortable is the individual you are supporting, so as soon as you realise your discomfort and strip it away from yourself, it’s easy to give that support.
O: And the women will respect you for it.
Sexual health is a topic that regularly comes up as part of the overall wellbeing of the women in their service. So, in this interview we discuss how, as housing staff, they have created a space where women feel safe and confident to talk about their sexual health and why it is so vital that services supporting women open up these conversations too.
Firstly, can you tell us more about Simon Community Scotland and the women’s service you are part of?
Olivia: We are a homelessness charity supporting any person who is at risk of homelessness. We provide support, advice, accommodation and care through trauma-informed practice, and we have also been at the forefront of harm reduction practice. Harriet and I are part of a women’s emergency accommodation service that can house up to 15 women. The service is for any woman over the age of 18 who is in crisis and is seeking to stay for 24 hours or more.
No woman comes in with the same circumstances. Beyond the age limitation, our door is open to any woman who needs accommodation – if that’s because she is fleeing violence, facing family breakdown, eviction, addiction or has just received leave to remain immigration status. We strive to be a safe space where we can help women take their next steps – whether that is accessing their own tenancy, supported accommodation or referring them to other services, we are very much a part of their journey.
Harriet: We provide daily living support, emotional and practical support, act as advocates for the women and signpost them to external agencies that can meet their individual needs. As an emergency accommodation, our ultimate goal is to support women to move into suitable accommodation and we do this by following a person-centred approach. And one of the parts we enjoy most about our role is building relationships with the women.
When the women come into your service, they are at a very difficult moment in their lives and they might not know anything about the service. How do you start building those relationships?
O: Our service is very much referral-based, which means that when a woman comes in, we don’t know anything about her. Yes, we get some background, but we take the women as they come through our door. And we try to be very approachable – it’s about going at the peace of the woman we are supporting because, when they first come in, it’s terrifying. It’s not a happy time in their lives. So we try to adapt our original approach – being person-centred means that not every approach will work for everybody.
H: Yes, it’s not a one-size fits all. Being all-female staff, we approach our women as: “we are women too,” and relate to them on that basis. Yes, we are support workers but we are also all women. And a lot of the things they are going through, we might not have gone through, but there is a lot we do understand purely because we are also women.
Our service also has an open door policy, which is about making the women feel invited to our offices, and making them feel welcome. The harm reduction approach has been a huge factor in that we have that openness, and it really breaks down those barriers with a lot of the women – it makes it easier to build those relationships.
How do experiences of selling or exchanging sex come up in your service?
H: Many of the women that we have supported have been or are involved in selling or exchanging sex. I have worked out that over the three year period I’ve been in this service, I have supported 148 women, and out of those I can quite confidently say that 57 of them have been involved in commercial sexual exploitation to some degree. Although I feel that number could be higher.
Unfortunately, due to the stigma around it, a lot of the women don’t necessarily open up to us about their involvement. But we have come to recognise some signs, such as a woman suddenly having new clothes, it can even be certain language they use, sometimes we might notice fresh bruises or they might go in and out of the building particularly through the night. Sometimes we might overhear conversations between other residents discussing their own involvement or other residents’ involvement.
Even, for example – and this can be a bit hard to explain –, we can sometimes recognise mood and behavioural changes when our residents return to the building after we suspect they might have sold or exchanged sex. It’s something difficult to describe, but we know the women, so we can pick up on a sudden mood change.
Some women though have spoken directly to staff about their involvement, but they are definitely guarded about it, which we feel is hugely due to the stigma around the issue.
As housing workers, why do you think it’s important to consider sexual health even if this is not the main focus of your service?
O: Sexual health is just as important as your mental and physical health. In our experience, women feel they cannot discuss their sexual health because, if it’s a health professional, they instantly cannot speak to them. It’s that fear of judgment and discrimination, so women don’t tend to get support.
However, having that openness, over time women can feel they can talk about these issues. Part of our role it’s to advocate on behalf of the women, so we prioritise going to medical appointments if they need to. Health professionals can also use a lot of jargon that some women find very difficult to understand, and that even us as women can find really difficult. And because women already feel judged, they are not willing to engage. It’s really important for us that the women feel equal in all aspects of their lives. When you come into a homelessness service, you are in limbo, an absolute limbo. That’s why it’s very important to build those relationships back up. So, as support workers we can be that stepping stone and say “it’s OK. It’s not terrifying.”
H: It’s so important to recognise that sexual health will have an impact on women’s mental health, physical health, it’s all part of one circle and each of these aspects will affect the others. So for us it’s as essential to consider the sexual health of the residents we are supporting.
What are some of the sexual health issues that come up for the women selling or exchanging sex that you support?
H: Unfortunately, often the women who are involved in selling or exchanging sex are not necessarily at that place to open up about any issues they may be experiencing due to the stigma they experience. As support workers, we are in that fortunate position of being so frontline that we can build a relationship with the women. And through this, women might feel safe sharing this information with us. It can be difficult because we have recognised that a lot of the women we support have not had the right education around sexual health. So at times they might not even recognise they are experiencing symptoms related to their sexual health.
When our women have been open about selling or exchanging sex, or even their own personal relationships, we always promote safe sex. We provide condoms, lube and femidoms in the service. We have discussions around consent and try to empower our women to make safe choices for themselves.
One of the main risks we have identified for the women in our service is contracting sexually transmitted diseases. We advise women that condoms don’t just prevent pregnancies, they also prevent STIs, and that condoms should also be used during oral sex. A lot of the women we support only think about pregnancy, and that goes back to the lack of education around sexual health.
We will encourage women to be regularly tested, and as an all-female service, we can relay our own experiences as women to encourage them to take care of their own sexual health and wellbeing. We provide women with information about contraception, and because we have strong links with the Sandyford (our local sexual health clinic), we can signpost women to that service or even ask the clinic to do outreach with us. It’s about giving women the options so they can make decisions about their health.
Are there any sexual health issues that women do not talk about but that as support workers you notice and feel the need to open conversations about?
O: HIV is one of them. There’s a lot of stigma around HIV because it’s associated with sharing needles. But we’ve found that in our service that’s not the case – women who have contracted it, it has been through unprotected sex. When we first started in the service, HIV was terrifying to the women and often for the staff as well, thinking that it’s a life sentence if you contract it. Women were also very guarded and didn’t want to discuss it. It has been through our harm reduction approach and building relationships that the women have become more comfortable.
When we discuss HIV with women, they feel “I’m dirty,” “I’m not worthy of meeting anyone,” but that’s not the case at all. As a service and organisation, I feel we have taken the stigma out of HIV. There is medication now, so if a person has contracted HIV, medication can make the viral load undetectable so they can’t transmit it. There are also PReP (pre-exposure prophylaxis) and PEP (post-exposure prophylaxis) for people who are more vulnerable to contract HIV. So if that is because of selling or exchanging sex, women in our service can access this medication to prevent them from contracting HIV.
O: PReP and PEP are still very new and I think it is our responsibility to inform our women. When we’ve met people with HIV in our service, you can tell they are carrying a heavy weight. They feel unworthy of meeting another partner or going out, but that isn’t the case at all. It is our duty to share this information with them.
As a society there is an assumption that women know everything about their sexual health – how to manage periods, what happens during pregnancy, menopause. But the reality is very different. What has been your experience of this when supporting women?
H: There is a real lack of education about sexual health in general. My knowledge of menopause, for example, I’ve only learnt about it from some of the staff members I work with. We don’t get taught any of this. As women, we have been very lucky that we’ve learnt about sexual health from other women. But a lot of the individuals we support haven’t necessarily had those positive female role models and friendships. It’s only when they get to that age – if we think of menopause – that they notice something in their bodies is changing. Also women who have been in addiction haven’t had periods for years, so they often don’t have that knowledge about menopause and the symptoms.
O: Sex education is very much aimed at the male perception, and there is not enough information of what goes on for the women, even though our bodies go through a lot. When I did research, I found there are more than 30 symptoms of menopause – and there just isn’t a lot of information about them even though all women are going to go through it. Because of addiction, some of our women who are in the 40 to 50 age range haven’t had a period for 30 or more years, and suddenly they start bleeding, having flushes, mood changes.
H: Many of the women we support have addiction, and issues like menopause are framed as “oh they’re using substances, so that’s the problem.” But substance use is a side thing to everything else that’s going on. Yet, the focus is on the addiction. It can be challenging working against some of these barriers sometimes.
O: And there is research showing that women who have managed to be in recovery, as soon as they get to the menopause stage, they relapse. Their bodies are changing, they have mood swings, it’s very difficult. And like Harriet was saying, as soon as women walk into a room, they are not seen as females, all people see is addiction. Like I said earlier, when you are in homelessness you are in a limbo, is as if you don’t have an identity, as if you don’t deserve an identity. We are big advocates of saying “no, you are your own person. You stand up for what you believe in!”
H: Yes, and because some of the women say they feel like second class citizens, we feel it’s on us to be like “no, you are you and you are an amazing woman. Forget the homelessness, forget the addiction, you are a strong woman!”
Talking about being a group of women supporting other women, how do you open up conversations about sexual health, especially when you know a woman is involved in selling or exchanging sex?
H: Well, once those relationships have been built, we have a toolkit. Let’s say one of the women comes to us and she opens up about the fact that she is involved in selling sex - we check with her things like: are you regularly tested? A key thing is that we are very relaxed and open and casual; we don’t make it this big scary thing. It’s so important that we are non-judgmental at this moment. We come at it female to female, you know. I think most women will have had sexual health checks and we appreciate how daunting these moments can be.
O: It’s nothing to be embarrassed about. We are two women discussing something that is going on with our bodies. People fall through the cracks because they are not able to talk about their issues. It’s about being open, present and calm.
H: And recognise that if a woman is involved and she has opened up about it, it’s empowering to get someone to take ownership of her health. We are also really lucky because the Sandyford clinic are really willing to do outreach support with us – and that is because they know it’s sometimes easier to come out to the woman’s home for a health check. It also feels safer for the women because staff are right there. So if a woman comes to us asking for a sexual health appointment, we can just pick up the phone and arrange a date with Sandyford to come here. A lot of women haven’t had that support before, and they see we are dead fast about it and calm, so it’s not this scary thing.
What would you say to workers in any type of service who might not yet feel confident to open up conversations about sexual health with the women they support?
O: I’d say: don’t shy away from it. It’s very important to empower women to take charge of their sexual health just as much as they do with their physical and mental health. It's being relaxed and non-judgmental.
H: And recognising that as support workers, we are supporting individuals with their physical health, their mental health, addiction, housing… if something is going on with their sexual health, it’s just as important, because everything is connected. It’s a circle where one issue can impact the others.
When we both started at Simon Community, there wasn’t a harm reduction approach, so we would want women to open up to us about their substance use, but there was a huge barrier because technically they weren’t meant to be doing it in the building. That’s all changed and we have seen first-hand how the harm reduction policy has taken all those barriers away, and we now have the most open conversations about drug use.
O: Initially our harm reduction approach focused on substances, but that’s now applied across the board. Harm reduction, like Harriet said, has dropped down all the barriers. Women haven’t been to a service like ours before and they know that no question is too difficult. With the open door policy, women know that we are here 24 hours a day and we don’t shy away from difficult conversations.
H: And yes, things are going to be uncomfortable, but the only person that should be feeling uncomfortable is the individual you are supporting, so as soon as you realise your discomfort and strip it away from yourself, it’s easy to give that support.
O: And the women will respect you for it.
