Valuable lessons are to be learnt in promoting sexual health to women who work “off street” in saunas, massage parlours, and other premises, according to an outreach project doing just that in north west England.

Gaining access is a major hurdle and takes a time and patience. Total honesty about the project and its aims—assessing the needs of this group and offering women health advice—and clear communication are essential. The starting point may be nothing more than delivering condoms to the door. For women who work in their own homes it may entail meetings on neutral territory—in nearby parks or car parks—until rapport and trust are built up.

The caseworker’s attitude and demeanour are crucial—a focus on improving the women’s sexual health, no underlying attempt to lure them away from the work; an unquestioning acceptance of the work; and respect for the women and willingness to learn from and build on their knowledge.

So far, since the project started in December 1999 the caseworker has achieved unfettered access to four massage parlours and 10 women in their homes. In all, 135 women are contacted regularly and are given contraceptive supplies and advice on sexual health and relevant local services; 21 have been immunised against hepatitis B.

Off street sex workers are a neglected group, yet are estimated to be three times more numerous than their on street counterparts, and they indulge in more high risk behaviours, especially unprotected penetrative sex.