Research project DR/38 (Research action DR)
Situation:
The international literature associates sex work and drug use with considerable health risks. In addition to this, these phenomena are often studied together. Among other topics, the prevalence of drug use among sex workers is addressed. However, Belgium has a lack of national prevalence data about drug use within the general population and more in particular among sex workers.
Sex workers are exposed to specific health risks, among which STD’s (sexually transmitted diseases), blood borne viruses and violence. Moreover, the use of substances is associated with more risky behaviour for their health. For example, needle sharing (intravenous drug use) increases the risk for infection with blood borne viruses. The use of alcohol and stimulants is associated with an elevated risk for STD’s: restraints blur and protection measures such as consistent condom use are neglected.
A large proportion of the literature focuses on street prostitution: these sex workers are said to be most frequently exposed to the professional hazards; moreover they appear to be more often drug-dependent.
Several factors, such as sex work, have an impact, not only on the physical health, but also on the mental health. A higher correlation with psychological and psychiatric symptoms has been found. The psychological stress, caused by the profession, can lead to increased drug use and so sex workers find themselves in a downward spiral.
Both drug use and sex work carry a criminal label which causes stereotypes and stigmatization. Drug-using sex workers live isolated from others, and in particular from non-using people. As a result, their social life is harmed and they are victim to a double stigmatisation.
Moreover, the use of health care by sex workers is limited and inconsistent. The literature indicates numerous barriers to access services, including the structure of the existing services, fear for the control apparatus and stigmatization. This target group needs specific care that tackles the different areas in which drug using sex workers experience difficulties.
Research aims
(1) To study the nature and the extent of legal and illegal drug use among female sex workers in Belgium. For this purpose we include window prostitution, sex work in private houses, bars, street prostitution and – in an explorative way – the escort sector. These sectors will be examined in five cities and their surroundings (Antwerp, Brussels, Charleroi, Ghent and Liège).
(2) (a) To map the most frequent drug-related health problems, including physical, social and mental aspects and (b) to understand these health problems in-depth and to examine which problems are the most acute from the perspective of the sex workers.
(3) To explore (a) their specific needs for preventive and curative drug-related health care, (b) their knowledge on existing drug treatment, © their motivations and experienced obstacles for addressing the existing drug related services.
(4) To test the findings of previous objectives against existing initiatives and practices.
Methodology
By means of a literature study we will obtain a detailed picture concerning the use of drugs, drug-related health problems and -needs and experiences with drug treatment among female sex workers.
Two instruments (a quantitative and a qualitative instrument) will be developed based upon (a) existing instruments and (b) a focus group. For this occasion we will invite researchers, staff members from services that offer care for problems related to the profession of sex worker and staff members from the low threshold drug treatment.
Several objectives require a quantitative component: a reliable estimation of drug use as well as drug-related health problems and -needs and of experiences with the drug treatment necessitates quantitative measurement. At least 500 respondents in the five cities and their surroundings (100 per city and surroundings, each time 25 per type of sex worker, except for the escort sector) will be subjected to a structured questionnaire.
Within the qualitative component a checklist with open questions in a variable order will be used during a face-to-face in-depth interview. The perspective of at least 25 female sex workers (in each city, if present, the different types of sex workers and the local dominant scenes) is central to explore the underlying processes and meanings.
After the data-analysis, five focus groups will be organised with invitees that work in the field. The results obtained in the previous research phases will be presented to the participants; the focus group participants will be able to discuss their interpretation of the results. Furthermore, these groups will reflect about suitable work methods and strategies to tackle drug-related health problems and –needs.
Middelengebruik onder sekswerkers in België Een kwantitatieve en kwalitatieve studie in vijf sectoren van de seksindustrie : eindrapport
Gent : Academia Press, 2011 (SP2412)
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