Norton-Hawk [ 17 ] also found that being under the control of a pimp increased the likelihood of violence, partly because of the pressure to earn extra money. The principal role of outreach is to distribute condoms, provide clean needles and syringes, offer information and advice on safer sex and sexual health and refer sex workers to clinic-based services for STI screening and other health needs [ 7 ]. Exit strategies Workers who wish to leave the sex industry may face multiple obstacles depending on their level of vulnerability [ 12 ]. Pressure from clients for unprotected sex combined with drug dependency and competition among workers for clients lead street workers to offer, or be persuaded to accept unprotected vaginal or anal sex for more money [ 3 , 8 , 17 ]. Some STI, such as chlamydia and gonorrhoea, cause mucosal inflammation, while others, including primary syphilis and HSV, produce ulceration. Some of the girls were beaten and forced to have sex with "several men in a day, several times a week", the jury was told. In this setting, sex may either be exchanged directly for drugs, or drugs may be supplied by the pimp in exchange for earnings [ 15 ].
Several studies have reported higher levels of psychological distress levels in CSW, than a non-CSW control group, even after adjusting for confounding factors such as age, previous rape and crack cocaine use [ 37 , 40 , 41 ]. Sex workers in the UK will continue to face multiple hazards for as long as the occupation continues to be seen as a policing problem rather than a welfare issue. The Sex Workers in Sexual Health Project in Coventry reported on 10 CSW who had successfully exited over 2 years [ 60 ], but few services exist owing to funding constraints and lack of multi-agency co-operation, with the majority concentrating on harm reduction rather than exiting. There has also been a diversification of sexual services, into areas beyond the traditional exchange of sex for money. HIV infection causes progressive immunodeficiency which in turn leads to life-threatening opportunistic infections and cancers. There are significant differences between indoor work and street work, in terms of harm and risk to health. Co-infection with HIV and hepatitis B or C is associated with a worse prognosis than with either alone. The government's refusal to license indoor workplaces also acts as a barrier to ensuring that such premises conform with employment and health and safety legislation, and do not harbour children or trafficked women. Abdul Aziz, 41, of Armstrong Hurst Close, Rochdale, was also convicted of trafficking for sexual exploitation but cleared of one charge of rape. The men, from Rochdale and Oldham, "groomed" girls, one as young as In contrast, are those who are driven into commercial sex work through drug addiction or coercion, and have little autonomy. Services for CSW Assessment of needs Service provision to this highly heterogeneous population needs to be tailored to the local needs expressed by sex workers themselves, which are shaped by the individual's own professional, behavioural and social context. Service providers must therefore be prepared to overcome these barriers and seek to establish trust by providing surroundings in which confidentiality, non-judgemental attitudes and sympathetic listening predominate [ 7 ]. Only one-third of assaults were reported to the police. Norton-Hawk [ 17 ] also found that being under the control of a pimp increased the likelihood of violence, partly because of the pressure to earn extra money. These workers may have entered sex work for a specific reason e. Liverpool Crown Court heard the men plied their victims with drink and drugs so they could "pass them around" and use them for sex. Sharing needles and syringes contributes to the risk for acquiring HIV, hepatitis B and C and syphilis, and this accounts for the majority of infections among CSW who are supporting opiate addictions [ 35 ]. Sexual health services should include screening for, and treatment of STI, provision of condoms, and education to reduce disease transmission. Low educational level, learning difficulties and a criminal record can also act as barriers to the reintegration of sex workers into the non-sex workforce [ 7 ]. Others make a career decision to work in the sex industry and may enjoy a high level of job satisfaction and independence [ 11 ]. As a result, these workers are not compelled to agree to unsafe sexual practices for higher earnings, and use condoms with all clients [ 20 ]. These relate to the acquisition of sexually transmitted infections STI , harm through violence from clients or pimps, factors associated with the use of drugs and mental health. The principal role of outreach is to distribute condoms, provide clean needles and syringes, offer information and advice on safer sex and sexual health and refer sex workers to clinic-based services for STI screening and other health needs [ 7 ]. These problems require careful evaluation and counselling [ 3 , 55 ] backed up by practical measures such as the provision of emergency housing. Referral can also be made to other services including counselling, housing and drug programmes.
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