Doncaster: Engaging Sex Workers and Other Hard-to-reach Groups

Doncaster’s sexual health provider Solutions4Health has enjoyed great success in engaging sex workers after creating an outreach sexual health nurse post last year. Working with charities and other services, including the drug and alcohol team, the outreach worker is now supporting a host of men and women who otherwise would have been unlikely to have engaged with the sexual health service.

How need for outreach worker became clear

One of the biggest challenges in sexual health is engaging hard-to-reach groups which are known to have poor sexual health outcomes. The consequences are untreated infection, associated ill-health, onwards transmission as well as missed opportunities to implement risk reduction strategies and health promotion.

Work by Doncaster sexual health staff, including Genito-urinary Medicine Consultant, Dr Pooja Shorey, identified sex workers as one of those groups the service was traditionally struggling to reach.

“Our health advisers who inform patients of positive results and carry out contract tracing for the sexual health service have always noticed a hard-to-reach cohort of people who repeatedly miss appointments or don’t respond to phone calls or letters.

“When I looked into them, it became clear there were some common patterns – homelessness, drug use and sex work. No matter what our team tried we simply could not get them to engage. So I began talking to some of the agencies involved in support them – the drug and alcohol team and local voluntary sector groups working with homeless people and sex workers.

“They were supporting the people we were struggling to reach, but they did not have the skills and knowledge on sexual health. From April 2022, under new management and service structure, we were provided with an opportunity to set up an outreach post to work with these groups and attempt to engage sex workers.”

‘The key is winning their trust’

Sexual Health Nurse Specialist Laura Banks now divides her time between the city’s sexual health clinic and the outreach work. The role, which started in summer 2022, has seen her work closely with the Amber Project, a sex worker support charity, Complex Lives, which works with homeless people, the local drug and alcohol service run by Aspire and the NHS hepatitis C outreach team.

Ms Banks initially worked alongside these services in their settings, but has since also started offering a drop-in service for sex workers at the city’s sexual health clinic.

“The key is winning the trust and confidence of the sex workers. These agencies are already trusted so you have to start by going out to their services. I have provided advice and screening at the needle-exchange service and at the Amber Project centre as well as going out with the hepatitis mobile service.

“At first often you will just have a conversation with them – you cannot rush it. You just let them know why you are there and when you will next be there. Then next time they may well be happy to be screened and engage further. It has really worked – so much so that we have just started a drop-in clinic at our own site.”

That is allowing the sexual health team to provide sex workers with other services such as contraception, including LARC (long-acting reversible contraception) implants and injections and cervical cytology screening. “We’ve not been able to do that in the outreach settings yet because some of the venues are not suitable, but we are hoping to start offering that in the future,” added Ms Banks.

The impact is clear to see. Over the past six months, Ms Banks has engaged with around 40 vulnerable people with 20 having taken part in screening to date.

Concerns about syphilis case numbers

Parallel to this time, a possible cluster of syphilis cases had been identified potentially focussed in and around the sex worker community. With rates of syphilis having increased significantly, both locally and nationally, the service has growing concerns for the vulnerable groups in Doncaster and the wider public health implications.

Dr Shorey said: “Syphilis can be very serious, causing still births, blindness and even death. This is very concerning and clearly if it is in the sex worker community there is a risk it could spread quickly. We have now got funding from the public health team to offer £5 food vouchers to sex workers who come forward for screening.”

She said the initiative had led to closer links with other services too. “Some of the sex workers we have come across are pregnant and we have now established a relationship with the local hospital trust’s midwife who works with vulnerable people. It is creating much more joined-up support for this cohort.”

The success of the project has prompted Doncaster to identify other communities that may benefit from the outreach service. “We have a couple of hotels housing asylum seekers and we have a large Romanian community who are not accessing services because of language barriers. We plan to team up with the services that are supporting them to provide outreach sexual health support.”

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