Providing care for street commercial sex workers in Middlesbrough, England

Opaneye AA, ⁽¹⁾⁽²⁾ Surtees M, ⁽²⁾ Hunter E, ⁽²⁾ Bailey T ⁽²⁾ , Hunter D ⁽²⁾, Yuffy D ⁽²⁾
1 Department of Genitourinary Medicine, Middlesbrough General Hospital.
2 Women's Drop-in Centre, Middlesbrough

Key words: commercial sex workers, social care, sexually transmitted infections, HIV, morbidity, mortality, tolerance zone.

Introduction
Middlesbrough is a large coastal town in the northeast of England, and it has an active seaport called Teesport. The population of the town and its environs is about 500,000. Although activities and signs of urban regeneration are visible, there are areas of deprivation and poverty. As in other towns and cities in the United Kingdom, parts of Middlesbrough have been declared Health Action Zones and Education Action Zones. Street commercial sex workers operate in Middlesbrough and this has been previously reported ⁽¹⁾⁽²⁾. Despite initial positive signs for their welfare, it our belief that more needs to be done and the sooner the better. In our opinion, the provision of a tolerance area or zone will be a step in the right direction. Prostitution is a risky business associated with physical injuries and possible death ^{(3) (4)}.

Service provision in Middlesbrough

Women's Drop-in Centre 
Following a need assessment, the Women's Drop-in Centre (WDC) was started on Zetland Road in January 1996.⁽⁵⁾ The centre opens on Friday evenings for three hours - 1800 to 2100hrs. Tees Health Authority funded the project as a harm reduction exercise based on a health model. The funding came out of the HIV prevention budget. The Cleveland Police have always been aware of the existence of the centre and members of WDC cooperated with the police in the Prostitution Task Group meetings and other matters of mutual interest. The WDC provides services for female commercial sex workers who operate on the streets of Middlesbrough. These workers are given warm beverages - tea, coffee, hot chocolates and biscuits. Toilet facilities are available. If they request, there are opportunities for counseling and tests for sexually transmitted infections including HIV. Treatment is also provided if necessary. The outreach officers go on the streets to contact the workers and distribute free condoms and encourage safer sexual practices. More than 500 condoms are distributed weekly. At the centre the girls have a chance to meet as a group and find it a safe haven. The sex workers discuss with the centre staff such issues as drug addiction, housing, and domestic violence. The girls also have a chance to alert other workers to "dodgy" punters i.e.violent clients who rape and rob the girls. Soon after the centre started it became obvious that there were sex workers of very young age, some less than 13 years old. Our experience was published in the local newspaper ⁽⁶⁾. The Barnados organisation became aware of this situation and decided to do something to help these young girls. Following a pilot study, a project was started.

The SECOS project
By April 2000, the Secos (sexual exploitation of children on the streets) project was fully up and running under a full time project leader. This project concentrates on pre-teen and early teenage female sex workers. Efforts are made to help them exit this trade. This project is not involved in adult commercial sex workers. There is however support for other agencies doing so. There are full time and part- time staff in the Secos project. This project is a good local resource for social policy makers on matters related to young girls involved in prostitution.

Crime and disorder
There are many issues involved when prostitution or sexual exploitation is debated. With particular reference to Middlesbrough, many residents feel angry that sex workers operate on their doorsteps. There were instances when kerb crawlers approached young girls who were not sex workers. The parents of such girls were furious and demanded action.⁽⁷⁾ This has led to high profile policing operations and enforcement measures to deter kerb crawlers and sex workers. Some kerb crawlers were reported for summons and some sex workers were arrested or cautioned. It is a reasonable action to remove prostitution from residential areas since residents do not welcome sex workers and their clients on their doorsteps. Experience has shown that many sex workers are addicted to drugs and use their earnings to feed this habit. Arrests and fines only serve to aggravate the situation. There is need for practical solutions. Efforts to eradicate prostitution are unreal and only drive the problem underground. Some senior law officers have in the past called for legalisation ⁽⁸⁾ and some would prefer the red-light zone option ⁽⁹⁾.

Welfare and not warfare
Prostitution is one of the consequences of child sexual abuse ⁽¹⁰⁾, low self-esteem and poverty. Sex workers are messengers of these social ills and inequities. The warfare should be directed against the inequities while the messengers receive welfare. In an earlier report, ⁽¹⁾ we recommended a multi-agency approach to the problem and we welcome the Secos project. Some support given by the police is recognised, though there is still a lot to do. Since we started this centre, several "dodgy" punters forms have been filled, many sex workers have suffered physical injuries, some have been raped, some have had their children taken away, some have been treated for serious infections, a few have been reported missing and three have been murdered. A report from London has documented that the mortality associated with commercial sex work is higher than the expected rate for women of similar age ⁽³⁾. Indeed prostitution is a risky business.
We agree that there should be zero tolerance of the activities of sex workers and their clients in residential areas. While efforts are being made to tackle the roots of poverty and social inequities, the welfare of these marginalised people, commercial sex workers is the responsibility of the council. Providing a tolerance area or zone is the first step. Otherwise, they will continue to suffer physical injuries and in some cases death.

References

1. Opaneye A, Surtees M. Female Street prostitutes in Middlesbrough. Int.J of STD and AIDS 1998; 9(4); 245.
2. Opaneye A, Hunter E. Morbidity and mortality associated with sex industry. eBMJ 14th March 2001.
3. Ward H, Day S, Weber J. Risky business: health and safety in the sex industry over a 9 year period. Sex. Trans. Inf. 1999; 75: 340-343.
4. Church S, Henderson M, Barnard M, Hart G. Violence by clients towards female prostitutes in different work settings: questionnaire survey. BMJ 2001; 322: 524-525.
5. Clinic opens for red light women. Northern Echo 30th January 1996.
6. Young girls are risking all in Teesside's evil vice trade. Evening Gazette 22nd May 1997.
7. Long arm of the law ignores the vice girls… Evening Gazette 12th January 1998.
8. Let's make it legal. Evening Gazette 3rd April 1998.
9. Red-light zone plans in battle on vice. Evening Gazette 22nd. January 1998.
10. Opaneye A. Young girls seen at genitourinary medicine department in Middlesbrough. Sexual Health Matters 2001; 3(4): 102- 103.

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