Sex Worker Analysis of Health Needs (SWAN)
Report summary
The Sex Worker Analysis of Health Needs (SWAN) report offers a comprehensive picture of sex workers in Â鶹ÊÓƵ, the West Midlands and the UK.
The study that took place in 2023, highlights the health and wellbeing needs of sex workers and the degree to which these needs are being met. The findings have major implications for health policy and provision across the country.
The SWAN study provides evidence for how sex workers experience significant health inequalities because of their line of work.
Barriers to accessing services include stigma, concerns about safety and potential legal ramifications of disclosing their occupation. However, sex workers want and need the same level of access to services as everyone else. Indeed, sex workers are at higher risk of many health problems in comparison to non-sex workers, both with regards to sexual health and many health conditions.
It is hoped that the findings and recommendations in this report will be used to inform the design and delivery of health services in Â鶹ÊÓƵ, and more widely in the UK, to better meet the health needs of sex workers.
Study details
The SWAN report was produced through a partnership between researchers at the University of Â鶹ÊÓƵ and Â鶹ÊÓƵ’s Inclusion Health Team.
The academic team worked alongside two co-researchers who have lived experience of sex work. The SWAN study was a multi-method study comprising four parts:
- a literature review that focused on evidence-based health interventions for sex workers
- a quantitative study that analysed local and national health databases to get a picture of the health profile of sex workers
- qualitative interviews with 20 adult sex workers and separate focus groups with staff working in health services supporting sex workers
- deep dive exploration of the lived experience of three sex workers and their needs in relation to accessing healthcare
Report findings and recommendations
Findings from each of the four phases of the SWAN study are integrated in this report but will later be published separately in more detail.
The study found the experience of sex workers to be extremely diverse. Discussions about sex work are often dominated by themes of:
- abuse
- violence
- exploitation
- trafficking.
While these were also evident in the findings of the SWAN study, there is a more nuanced perspective that needs to be considered.
The stigma perceived by sex workers creates a barrier to accessing health services. Other barriers include:
- concerns about safety
- the need to explain their needs to multiple people
- possible legal ramifications of disclosing their line of work
- time of day of clinics
When sex workers do engage with health services, they are reluctant to share personal information and, if they do, often report feeling judged, unheard or misunderstood. Others report coming across a ‘saviour’ figure in health services, a member of staff who will go above and beyond to act as a point of contact for sex workers to build trust.
Service provision tends to focus on sexual health, but health needs extend far beyond that. Support for substance misuse and mental health topped the list of non-sexual health needs for sex workers, but the study also found that those who work in the sex industry experienced increased risk of multiple health conditions including, particularly regarding mental health.
Sex workers had an 87% higher risk of being admitted to hospital for any condition compared to non-sex workers.
What ideal services would look like
- Appropriately trained staff who understand the nuances of sex work, and who do not default to judgement, sympathy, assumptions or discrimination.
- Visible advertising of services available and how to access them as well as improved availability.
- Safe spaces for sharing and peer support.
- Tailored services that are inclusive of sex workers’ needs.
Interventions require improved evaluation, so that we can better understand what works well and ensure this good practice is rolled out.
Next steps
The recommendations contained in the report are aimed at service providers, who are called upon to consider their provision in line with the findings of the SWAN study.
Although the study was conducted locally in Â鶹ÊÓƵ, it is likely that findings have relevance in other geographic locations around the UK. Therefore, the recommendations should be considered by those responsible for funding and commissioning health services for sex workers across the UK.
Download the SWAN summary presentation
Page last updated: 16 July 2024