title: The multiplicity and interdependency of factors influencing the health of street-based sex workers: a qualitative study.
abstract: OBJECTIVE
  To obtain a detailed understanding of the lives of street-based commercial sex workers (SSWs) and how factors in their lives interrelate to affect their health.
  
  
  METHODS
  In-depth interviews with 22 SSW working in Bristol, England.
  
  
  RESULTS
  The SSWs described their working day as a continuous cycle of selling sex, buying and using drugs, then returning to work. They explained that they placed themselves at risk of sexually transmitted infections, rape, physical assault, verbal abuse and murder when selling sex and physical violence when buying drugs. Most of the women injected drugs and detailed how this behaviour had resulted in life-threatening illnesses, including deep vein thromboses, pulmonary emboli and abscesses. Some interviewees gave accounts of sleeping in crack houses, on friends' floors or car parks, and most participants mentioned that they did not eat, drink or sleep regularly. This self-neglect led to weight loss and physical and mental ill-health. Respondents described pressures that forced them back out to work, such as unstable accommodation, separation from children and other individuals taking their drugs or money.
  
  
  CONCLUSIONS
  SSWs are trapped in a cycle of selling sex and buying and using drugs. Multiple pressures from within and outwith this cycle keep them in this situation. The multiplicity and interdependency of health problems and pressures suggest that this group are best supported with integrated multi-agency services that work flexibly across all areas of their lives. A rigid or punitive approach is likely to be counterproductive and may increase risks to the wellbeing of SSWs.
authors.affiliation: The Milne Centre for Sexual Health, Bristol Royal Infirmary, Lower Maudlin Street, Bristol BS28HW, UK. nikki.jeal@UHBristol.nhs.uk
authors.forename: N
authors.initials: N
authors.lastname: Jeal
authors.forename: C
authors.initials: C
authors.lastname: Salisbury
authors.forename: K
authors.initials: K
authors.lastname: Turner
mesh_terms: D000293:Adolescent; D000328:Adult; D004739:England / Q000453:epidemiology; D005260:Female; D006304:Health Status; D006703:Ill-Housed Persons / Q000706:statistics & numerical data; D006801:Humans; D001523:Mental Disorders / Q000453:epidemiology / Q000209:etiology; D008875:Middle Aged; D009034:Mother-Child Relations; D036301:Qualitative Research; D011477:Sex Work / Q000523:psychology / Q000706:statistics & numerical data*; D012747:Sexual Partners; D012749:Sexually Transmitted Diseases / Q000453:epidemiology; D012959:Socioeconomic Factors; D019966:Substance-Related Disorders / Q000453:epidemiology; D047568:Unsafe Sex; D016387:Women's Health