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Identifying possible reasons why female street sex workers have poor drug treatment outcomes: a qualitative study
  1. Nikki Jeal1,
  2. John Macleod1,
  3. Chris Salisbury1,2,
  4. Katrina Turner1,2
  1. 1Centre for Academic Primary Care School of Social & Community Medicine Bristol, University of Bristol, Bristol, UK
  2. 2The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) University Hospitals Bristol NHS Foundation Trust, Bristol, UK
  1. Correspondence to Nikki Jeal; nikki.jeal{at}


Aims To explore street sex workers (SSWs) views and experiences of drug treatment, in order to understand why this population tend to experience poor drug treatment outcomes.

Design In-depth interviews.

Setting Bristol, UK.

Participants 24 current and exited SSWs with current or previous experience of problematic use of heroin and/or crack cocaine.

Findings Participants described how feeling unable to discuss their sex work in drug treatment groups undermined their engagement in the treatment process. They outlined how disclosure of sex work resulted in stigma from male and female service users as well as adverse interactions with male service users. Participants highlighted that non-disclosure meant they could not discuss unresolved trauma issues which were common and which emerged or increased when they reduced their drug use. As trauma experiences had usually involved men as perpetrators participants said it was not appropriate to discuss them in mixed treatment groups. SSWs in recovery described how persistent trauma-related symptoms still affected their lives many years after stopping sex work and drug use. Participants suggested SSW-only services and female staff as essential to effective care and highlighted that recent service changes were resulting in loss of trusted staff and SSW-only treatment services. This was reported to be reducing the likelihood of SSWs engaging in drug services, with the resultant loss of continuity of care and reduced time with staff acting as barriers to an effective therapeutic relationship.

Conclusions SSWs face many barriers to effective drug treatment. SSW-only treatment groups, continuity of care with treatment staff and contact with female staff, particularly individuals who have had similar lived experience, could improve the extent to which SSWs engage and benefit from drug treatment services. Service engagement and outcomes may also be improved by drug services that include identification and treatment of trauma-related symptoms.

  • sex work

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  • Contributors All authors were involved in the design of the study and the topic guide as well as preparation of the manuscript. NJ undertook data collection. KT and NJ undertook data analysis.

  • Funding NJ is funded by a National Institute for Health Research (NIHR) Post Doctoral Fellowship (award reference number PDF-2011-04-038). KT and CS are supported by the NIHR Collaboration for Leadership in Applied Health Research and Care West (CLAHRC West) at University Hospitals Bristol NHS Foundation Trust. This paper presents independent research funded by the NIHR.

  • Disclaimer The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

  • Competing interests All authors have completed the ICMJE uniform disclosure form at and declare: NJ is funded by the NIHR through a postdoctoral fellowship.

  • Ethics approval NRES Committee Southwest_Frenchay ref: 14/SW/0076.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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