How to respond sensitively to women's substance use:
Harm reduction approaches prioritise pragmatic goals and are more focused on reducing or alleviating immediate harms than longer term behavioural change. In the context of selling or exchanging sex, it may involve providing a “warm drink, clean clothes, access to toiletries and shower facilities, free condoms, sexual health testing, needle exchange services, advice about safer sexual or injecting practices, and the availability of someone to talk to.” Women can also receive support in relation to reporting sexual violence and safety planning.
In addition to the above, the Encompass Network advocates for “comprehensive harm reduction services to support women.” Many women selling or exchanging sex indoors are migrant women who are moved around the country, face language barriers, and do not know what local services are available. Online outreach and engagement could be one method of providing this. Further to this, information and advocacy for housing, health, offending, finance and welfare and independent living should be available. Women also benefit from group activities and support in informal settings.
Similarly, the Welsh study recommends addressing women’s needs simultaneously. This would include access to emergency food, furniture and other essentials; access to emergency accommodation or domestic abuse refuge; fast track drug treatment; and intensive one-to-one support while receiving drug treatment. It also emphasises the importance of having a consistent support worker, treating individuals who sell sex away from other problematic substance users, and developing holistic approaches that offer treatment to partners and family members.
The following points can help when support women who sell or exchange sex who use substances:
In addition to the above, the Encompass Network advocates for “comprehensive harm reduction services to support women.” Many women selling or exchanging sex indoors are migrant women who are moved around the country, face language barriers, and do not know what local services are available. Online outreach and engagement could be one method of providing this. Further to this, information and advocacy for housing, health, offending, finance and welfare and independent living should be available. Women also benefit from group activities and support in informal settings.
Similarly, the Welsh study recommends addressing women’s needs simultaneously. This would include access to emergency food, furniture and other essentials; access to emergency accommodation or domestic abuse refuge; fast track drug treatment; and intensive one-to-one support while receiving drug treatment. It also emphasises the importance of having a consistent support worker, treating individuals who sell sex away from other problematic substance users, and developing holistic approaches that offer treatment to partners and family members.
The following points can help when support women who sell or exchange sex who use substances:
- Recognise that the substance use of a woman, of her partner or associates can push her to sell or exchange sex. Women’s personal use and that of others connected with her should be considered.
- Be aware that women can be forced and coerced into selling sex by dealers and pimps and that such control should be regularly assessed.
- Recognize that women also use substances as a means of coping with what they must do sexually to get money, but that it may also prevent them from exiting the ‘sex industry.’
- Provide women-only spaces and services given women’s experiences of trauma, prior abuse and exploitation, and ensure clear links are in place with local Violence Against Women support services.
- Be mindful of the interconnected needs of women selling or exchanging sex who use substances. Establish referral pathways and prioritise multi-agency collaboration – it is essential given the multi-layered nature of women’s needs.
- Be aware that women could start selling sex at any time given poverty and pressures, and so this should be included in reviews and ongoing work.
- Provide clear assurances about confidentiality and recording, so the woman can retain control of her information and disclosures about selling sex.
- Provide compassionate and non-judgemental response – women need positive relationships in their lives.
- Provide accessible information on the effects of drugs, safe injecting practice and how to safety plan.
- Recognise that using substances can increase individuals’ vulnerability and that punters will exert pressure to have sex without condoms. Help women to access sexual health screenings, condoms, lube, and STI and BBV testing.
- Ensure that you have a way of maintaining contact with women, particularly if there are waiting lists for accessing services.
- Work with the women to identify practical barriers to accessing services, i.e. is the location difficult to get to, can they afford to pay for transport, do they have access to Wi-Fi/technology, and looking at how these can be overcome.
- Try to be flexible in how you work with women and recognise that women may disengage and re-engage and should not be penalised for this.
