Drug Use, Sex Work and the Risk Environment in Dublin

Drug Use, Sex Work and the Risk Environment in Dublin Dublin Published by the Stationery Offi ce To be purchased directly from the Government Publications Sale Offi ce, Sun Alliance House, Molesworth Street, Dublin 2, or by mail order from Government Publications, Postal Trade Section, Unit 20 Lakeside Retail Park, Claremorris, Co. Mayo (Tel: 01 647 6834/37 or 1890 213 434; Fax 01 6476843 or 094 9378964) or through any bookseller PRN A9/0509 ISBN 978 1 4064 2279 5 €5 Baile Átha Cliath Arna Fhoilsiú ag Oifi g an tSoláthair Le ceannach díreach ón Oifi g Dhíolta Foilseachán Rialtas, Teach Sun Alliance, Sráid Th each Laighean, Baile Átha Cliath 2, nó tríd an bpost ó Foilseacháin Rialtas, An Rannóg Post-tráchta, Aonad 20 Páirc Miondíola Cois Locha, Clár Chlainne Mhuiris, Contae Mhaigh Eo (Teil: 01 647 6834/37 nó 1890 213 434; Fax 01 6476843 nó 094 9378964) nó trí aon dioltóir leabhar. Painting on cover by participant in the North West Inner City Training and Development Project (October 2005) and purchased by Chrysalis Drugs Project, Dublin. © National Advisory Committee on Drugs 2009 Designed by Drug Use, Sex Work and the Risk Environment in Dublin Dr Gemma Cox (NACD) Dr Teresa Whitaker (NACD) 3 Table of Contents Foreword: Minister of State 8 Foreword: Chairperson, NACD 9 Acknowledgements 11 Glossary of Colloquial Terms 12 Acronyms 13 Statutes 14 Executive Summary 15 Introduction to the Research 15 Summary of Research Findings 17 Conclusions and Recommendations 25 Chapter 1. Introduction 29 1.1 Rationale for the Study 30 1.2 Background to the Study 32 1.3 Defi nition of Terms 32 1.4 Study Aims and Objectives 33 1.5 Structure of the Report 34 Chapter 2. Harm Reduction and the Risk Environment 35 Introduction 36 2.1 Harm Reduction 36 2.1.1 Risk and harm 37 2.1.2 Harm reduction and public health policy 37 2.1.3 Harm reduction and sex work 38 2.1.4 Limitations of harm reduction interventions 39 2.2 Th e Risk Environment 40 2.3 Th e Risk Environment in Dublin 41 2.3.1 Macro-environmental structures in Dublin 41 Summary 50 Chapter 3. Methodology 53 Introduction 54 3.1 Research Methods 54 4 3.1.1 Research advisory group 54 3.1.2 Ethical issues 55 3.2 Research Design 55 3.2.1 Participation and exclusion criteria 55 3.2.2 Research instruments 56 3.2.3 Sampling and recruitment procedures 57 3.2.4 Fieldwork and data collection 57 3.2.5 Analysis and interpretation 58 3.2.6 Limitation of data 59 3.3 Profi le of Sample 59 3.3.1 Housing status 60 3.3.2 Substance use 61 3.3.3 Blood-borne viruses 61 3.3.4 Involvement in crime 62 Summary 63 Chapter 4. Becoming a Drug-Using Sex Worker 65 Introduction 66 4.1 Growing Up in a Risk Environment 66 4.1.1 Th e physical and economic environment 67 4.1.2 Th e social environment 68 4.1.3 Family and home environment 68 4.1.4 Peer networks and early initiation into drug use 71 4.2 Drug Transitions – Risk of Dependency 72 4.3 Entering Sex Work 75 4.3.1 Routes into sex work 75 4.3.2 Rationale for engaging in sex work 77 4.4 Interfaces between Drug Use and Sex Work 78 Conclusion 80 Chapter 5. Living and Working in a Risk Environment 81 Introduction 82 Living in a Risk Environment 83 5.1 Risk Production 83 5.1.1 Drug use 83 5.1.2 Homelessness 91 5 5.1.3 Release from prison 92 5.1.4 Living with blood-borne viruses (BBVs) 93 5.1.5 Social networks 96 5.1.6 Gendered risks 97 5.2 Risk Reduction 101 5.2.1 Changing drug-use patterns 102 5.2.2 Coping with parenting 108 5.2.3 Imprisonment 111 Working in a Risk Environment 112 5.3 Risk Production 112 5.3.1 Inexperience 112 5.3.2 Th e physical setting 113 5.3.3 Unprotected sex 117 5.3.4 Drug use 118 5.3.5 Stigma/Shame 119 5.4 Risk Reduction 120 5.4.1 Forewarned is forearmed 121 5.4.2 Moving off the street 122 5.4.3 Staying safe on the street 124 5.4.4 Staying in control 126 5.4.5 Gardaí 130 5.4.6 Routes out of sex work 132 5.4.7 Barriers to reducing risk 135 Conclusion 138 Chapter 6. Th e Professionals’ Perspectives 141 Introduction 142 6.1 A Client Group with Complex Needs 142 6.1.1 Complexity of problems 143 6.1.2 Fragmented service response 145 6.2 Need for Interagency and Interdisciplinary Cooperation 146 6.2.1 Obstacles to eff ective interagency and interdisciplinary working 147 6.3 Changing Drugs and Sex Markets 152 6.3.1 Changing drug trends and patterns of use 152 6.4 Changing Nature of Sex Work 154 6.5 Th e Policy Environment 156 6 6.5.1 Drug policy 156 6.5.2 Housing and homeless policies 164 Conclusion 172 Chapter 7. Conclusions and Recommendations 175 Introduction 176 7.1 Th e Policy Environment 176 7.2 Th e Social Environment 179 7.3 Th e Physical Environment 180 7.4 Th e Economic Environment 183 References 185 Figures And Tables Figure 1: Simple model of risk environment 41 Table 1: Demographic characteristics 60 Table 2: Accommodation 60 Table 3: Substance use and engagement in sex work in the last 90 days 61 Table 4: Self-reported blood-borne viruses and infections 62 Table 5: Off ending behaviour in the 90 days prior to interview 62 Table 6: Current legal status 63 7 Foreword: Minister of State I welcome this fi rst Irish qualitative research on female and male drug using sex workers. Th e overall aim of research was to explore, and gain an understanding of, the local risk environment within which problem drug-using sex workers in Dublin live and work, and their responses to these risks. Th e key fi ndings of this report are that drug-using sex workers are exposed to multiple risks and harms in their living and working lives. Th e impacts on children and families are also highlighted. Th e multiple needs of drug-using sex workers include health, social and legal issues. Addressing their wider social and situational needs is as fundamental to reducing their overall risk of harm as is addressing their problem drug use. I would like to thank the women and men who participated in the research and the research advisory group that facilitated their involvement. I also thank the National Advisory Committee on Drugs who commissioned the work and, in particular, Dr. Teresa Whitaker and Dr. Gemma Cox who carried out the research. John Curran T.D. Minister of State with responsibility for the National Drugs Strategy 8 Foreword: Chairperson, NACD Th e NACD is very happy to present the fi ndings from this fi rst qualitative study of drug use and sex work in Dublin. Th is research fulfi ls a component of the NACD’s remit to advise Government about ‘at risk’ groups (prostitutes) under Action 98 of the National Drugs Strategy (2001-2008). Th is report is the culmination of two and a half year’s intense work by two researchers at the NACD namely Dr Teresa Whitaker (Lead Researcher) and Dr Gemma Cox, the NACD Research Offi cer and is the fi rst internally commissioned research carried out by the NACD. On behalf of the Committee I would like to pay tribute to their professionalism and their sensitive approach to the topic and to the research participants. Hopefully the example they have shown in producing such an excellent piece of work will provide a template for similar “in-house” projects in future years. Th e NACD believe that this highly detailed report will increase understanding of the serious issues facing those who struggle with the daily burden of drug dependency and who engage in sex work. At the outset it was decided to include both women and men sex workers in the research and this report highlights their commonalities (early drug use, lack of formal education, family confl ict, chaotic home environment, physical or sexual abuse, bereavement, homelessness, victims of violence). Th e NACD is indebted to these men and women who spoke so honestly and openly about their experiences. People live in situations not of their own making; therefore a focus on the risk environment highlights the physical, social, policy and economic infl uences that come to bear on this vulnerable group. Within these environments the women and men interviewed implemented a range of innovative strategies to reduce their risks but some of these strategies actually increased the risk of harm, for example some sex workers move off the street and have contact with customers through mobile phones, however this can increase their risk of harm because it makes it harder for services to reach them. Th e Report highlights the harsh realities of their backgrounds, and the current realities of their living and working conditions. By eliciting accounts from drug using sex workers and also from service providers and other professionals a clear picture emerges of the necessary and appropriate policy responses. Arising from its consideration of the fi ndings in this Report, the NACD has made a number of recommendations to Government. Th ese recommendations are presented within the broad framework of the risk environment.

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