NDARC Technical Report No. 237 (2005)
The mean age of the sample was 34 years and approximately one-quarter of the sample identified as being of Aboriginal and/or Torres Strait Islander (A&TSI) origin. The median years of school education completed was 9. Fourteen percent reported having no fixed address, or current homelessness and nearly half the sample reported being homeless within the past 12 months. Income apart from sex work in the past month came from several sources, and the vast majority reported sex work as their main source of income in the past month. More than half of the sample reported moving out of home before age 16.
Sex work history and working conditions
The median age that participants reported starting sex work was 19, with almost one third starting before 18. Length of involvement in the sex industry ranged from four months to 39 years, and participants had worked in various other sectors of the sex industry. The majority of participants reported starting sex work because they needed the money for drugs, and this was also the main reason for remaining in the sex industry. Just under half the sample reported the money as being the most enjoyable aspect of their work, and the biggest concern for approximately one-third of the sample was the provision of a safe work environment (such as safe houses). Three-quarters of the women reported providing services on the street, two-thirds reported providing them in cars and just over half the sample reported using a safe house (in areas where safe houses were available). Two-thirds of the sample reported that they found sex work very stressful, and half stated that clients were the reason for this stress. The overwhelming majority of women reported ever having experienced violence while working, most commonly physical assault and rape.
Drug use and drug treatment
Ninety four percent of the sample had ever injected any drug, and the median age of first injecting was 18, with approximately one-quarter of the sample reporting first injecting before the age of 16. There were relatively heavy patterns of heroin, cocaine and cannabis use reported among some of the women, while patterns of methamphetamine and alcohol use remained sporadic. The vast majority of the sample was heroin dependent according to the Severity of Dependence Scale (SDS) while approximately one-third was cocaine and cannabis dependent. Participants who were cocaine dependent were more likely to report sharing injecting equipment in the past month and less likely to use condoms when having penetrative sex with clients. Approximately two-thirds of the sample was in drug treatment at the time of interview.
Sex work and drug use
Approximately half the sample reported injecting drugs prior to commencing sex work, and one-quarter reported commencing sex work within 3 years of injecting drug use initiation. Just over one-quarter of the sample reported starting sex work prior to injecting drug use, and approximately three-quarters reported that their drug use had increased since they started sex work.
Injection-related risk behaviours
There were very few reports of borrowing used needles among the injecting drug users, while one-fifth reported lending a used needle to someone in the preceding month. Almost two-thirds of the sample reported sharing other injecting equipment in the past month. Approximately two-thirds of the sample reported testing positive for HCV. There were no reports of HIV positive results.
Unwanted sexual activity
Three-quarters of the sample reported experiencing some form of child sexual abuse before the age of 16. Almost two-thirds of the sample reported that someone had sexual intercourse with them after the age of 16 when they had made it clear they did not consent.
Mental health problems
Approximately half of the sample reported severe current depressive symptoms in accordance with the Beck Depression Inventory II. Depression was associated with homelessness in the past 12 months, A&TSI status, and cannabis dependence. Approximately half the sample reported ever having tried to kill themself, and approximately one-quarter had first attempted suicide by the age of 18.
Borderline Personality Disorder
Approximately half the sample screened positively for a diagnosis of Borderline Personality Disorder (BPD), which was associated with a range of adverse outcomes: earlier age of injecting drug use initiation, benzodiazepine dependence, cannabis dependence, sharing injecting equipment, current severe depressive symptoms, and adult sexual assault.
Post-traumatic stress disorder
All but one of the participants reported having experienced at least one traumatic event in their lifetime, with a large proportion reporting multiple traumas. Rape, physical assault, child sexual abuse and witnessing someone being badly injured or killed were the most commonly reported traumas. Approximately half of the sample met Diagnostic and Statistical Manual of Mental Disorders (DSM-IV (TR)) criteria for a lifetime diagnosis of posttraumatic stress disorder (PTSD), and one-third reported current PTSD symptoms.
Approximately three-quarters of those participants who developed PTSD said they had spoken to a health professional about the associated symptoms. Those reporting current PTSD were more likely to have experienced a greater number of traumas than those who did not report current symptoms.
Access to mental health services
Approximately one-quarter of the sample had ever been admitted to a psychiatric hospital, and the most common reasons for admission were depression and anxiety. Just under half of the sample reported speaking with a health professional about a mental health problem other than their drug use in the past 6 months, most commonly for depression.
Crime and police contact
Just under half of the sample reported engaging in criminal activity in the month prior to the interview, and just over half of the sample had been arrested in the preceding 12 months. Over half the sample reported ever having been in prison, and a small proportion had been in prison in the preceding 12 months. There were mixed reports regarding experiences with the police. Equal proportions of participants reported experiences of police harassment, poor treatment, and assault reports not being taken seriously, as well as police assistance, respectful treatment, and police assistance after assaults. Despite the large majority of women reporting experiences of violence at work, very low proportions had reported these incidents to police.
Access to information and emotional support
Participants generally had good access to information on safe sex and drug use, bloodborne virus information and legal support. Access was particularly good to information on the sex industry in general. A substantial minority of the group reported having no emotional support.
Citation: Roxburgh, A., Degenhardt, L., Larance, B. and Copeland, J. (2005) Mental health, drug use and risk among female street-based sex workers in greater Sydney, Sydney: National Drug and Alcohol Research Centre.
Amanda Roxburgh, Louisa Degenhardt, Briony Larance, Jan Copeland