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The multiplicity and interdependency of factors influencing the health of street-based sex workers: a qualitative study
  1. N Jeal1,
  2. C Salisbury2,
  3. K Turner3
  1. 1
    The Milne Centre for Sexual Health, Bristol Royal Infirmary, Bristol, UK
  2. 2
    University of Bristol, Belgrave House, Bristol, UK
  3. 3
    Academic Unit of Primary Health Care, Department of Community Based Medicine, University of Bristol, Bristol, UK
  1. Dr N Jeal, The Milne Centre for Sexual Health, Bristol Royal Infirmary, Lower Maudlin Street, Bristol BS2 8HW, UK; nikki.jeal{at}


Objectives: To obtain a detailed understanding of the lives of street-based commercial sex workers (SSWs) and how factors in their lives interrelate to affect their health.

Methods: In-depth interviews with 22 SSW working in Bristol, England.

Results: The SSWs described their working day as a continuous cycle of selling sex, buying and using drugs, then returning to work. They explained that they placed themselves at risk of sexually transmitted infections, rape, physical assault, verbal abuse and murder when selling sex and physical violence when buying drugs. Most of the women injected drugs and detailed how this behaviour had resulted in life-threatening illnesses, including deep vein thromboses, pulmonary emboli and abscesses. Some interviewees gave accounts of sleeping in crack houses, on friends’ floors or car parks, and most participants mentioned that they did not eat, drink or sleep regularly. This self-neglect led to weight loss and physical and mental ill-health. Respondents described pressures that forced them back out to work, such as unstable accommodation, separation from children and other individuals taking their drugs or money.

Conclusions: SSWs are trapped in a cycle of selling sex and buying and using drugs. Multiple pressures from within and outwith this cycle keep them in this situation. The multiplicity and interdependency of health problems and pressures suggest that this group are best supported with integrated multi-agency services that work flexibly across all areas of their lives. A rigid or punitive approach is likely to be counterproductive and may increase risks to the wellbeing of SSWs.

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  • Funding: The study was funded by the charity Wellbeing of Women. The researchers are independent of the funder who did not influence the research process, findings or reporting in any way.

  • Competing interests: None declared.

  • Ethics approval: Ethics approval was obtained.

  • Contributors: The protocol and interview schedule were developed by all authors. NJ collected and analysed the data, under the guidance of KT. NJ drafted the manuscript. All authors redrafted the manuscript and approved the final version. NJ is the guarantor.