The effect of police enforcement and extreme social inequalities on violence and mental health among women who sell sex: findings from a cohort study in London, UK

Jocelyn Elmes, Josephine G Walker, Peter Vickerman, Lucy Platt, et al.

Research output: Contribution to journalArticle (Academic Journal)peer-review

Abstract

Objectives: To examine legal and social determinants of violence, anxiety/depression among sex workers.

Methods: A participatory prospective cohort study among women (inclusive of transgender) ≥18 years, selling sex in the last 3 months in London between 2018-2019. We used logistic GEE models to measure associations between structural factors on recent (6 months) violence from clients or others (local residents, strangers), depression/anxiety (PHQ4).

Results: 197 sex workers were recruited (97% cisgender-women; 46% street-based; 54% off-street) and 59% completed a follow-up questionnaire. Street-based sex workers experienced greater inequalities compared to off-street in relation to recent violence from: clients (73% vs 36%); police (42% vs 7%); IPV (56% vs 18%); and others (67% vs 17%); as well as homelessness (65% vs 7%) and recent law enforcement (87% vs 9%). Prevalence of any sexually transmitted infection was 17.5% (17/97). For street-based sex workers, recent arrest was associated with violence from others (aOR 2.77; 95%CI 1.11,6.94) and displacement by police was associated with client violence (aOR 4.35; 95%CI 1.36,13.90). Financial difficulties were also associated with client violence (aOR 4.66; 95%CI 1.64,13.24). Disability (aOR 3.85 95%CI 1.49,9.95) and client violence (aOR 2.55 95%CI 1.10,5.91) were associated with anxiety/depression. For off-street sex workers, financial difficulties (aOR 3.66; 95%CI 1.64,8.18), unstable residency (aOR 3.19 95%CI 1.36,7.49), IPV (aOR 3.77 95%CI 1.30,11.00) and alcohol/drug use were associated with client violence (aOR 3.16 95%CI 1.26,7.92), while always screening and refusing clients was protective (aOR 0.36; 95% CI 0.15,0.87). Disability (aOR 5.83 95%CI 2.34,14.51), unmet mental health needs (aOR 95%CI 3.08 95% CI 1.15,8.23) and past eviction (aOR 3.99 95%CI 1.23,12.92) were associated with anxiety/depression.

Conclusions: Violence, anxiety/depression are linked to poverty, unstable housing and police enforcement. We need to modify laws to allow sex workers to work safely and increase availability of housing and mental health services.

Key words: sex work, policing, housing, violence, epidemiology, mental health, sexually transmitted infections
Original languageEnglish
JournalSexually Transmitted Infections
Publication statusAccepted/In press - 7 Jul 2021

Keywords

  • sex work
  • policing
  • housing
  • violence
  • epidemiology
  • mental health
  • sexually transmitted infections

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