A health needs assessment of street-based prostitutes: cross-sectional survey

Background Research with prostitutes has tended to concentrate on sexual health rather than wider health issues, and has failed to differentiate between street-based prostitutes and off-street workers. Little is known about the general health and background of street-based sex workers, the group likely to have the greatest needs. Methods An interview-based survey amongst street-based sex workers in central Bristol was employed. Results Seventy-one women were interviewed. All reported chronic health problems. Sexually transmitted infections were between nine and 60 times more common than the general population. Many women (44 per cent; n = 31) had experienced sexual abuse and 38 per cent (n = 27) had been in care. Women who had experienced care left school earlier (14.1 versus 15.5 years; p < 0.0001 unpaired t-test) and were less likely to have their own children at home [1/18 (5.5 per cent) versus 8/25 (32 per cent); p = 0.06] The stillbirth rate was 50/1000. Most (97 per cent; n = 69) had been offered more money for unprotected sex. Half (51 per cent; n = 36) had unprotected sex in the last week. All had drug or alcohol dependency problems. In the last week, 22 percent (n = 9/41) of injecting drug users had shared needles and 59 per cent (n = 24/41) had shared injecting equipment, despite most (96 per cent; n = 39/41) knowing the risks. Conclusions The health and social inequalities experienced by this group are much worse than any group highlighted in the 'Tackling Health Inequalities Review 2002' and appear cross generational. In neither that report nor the Sexual Health and HIV Strategy report are sex workers identified as a particularly high priority group. There is the potential for their needs to continue to be unmet.