Effect of police enforcement and extreme social inequalities on violence and mental health among women who sell sex: findings from a cohort study in London, UK

ObjectivesTo examine legal and social determinants of violence, anxiety/depression among sex workers.MethodsA participatory prospective cohort study among women (inclusive of transgender) ≥18 years, selling sex in the last 3 months in London between 2018 and 2019. We used logistic generalised estimating equation models to measure associations between structural factors on recent (6 months) violence from clients or others (local residents, strangers), depression/anxiety (Patient Health Questionnaire-4).Results197 sex workers were recruited (96% cisgender-women; 46% street-based; 54% off-street) and 60% completed a follow-up questionnaire. Street-based sex workers experienced greater inequalities compared with off-street in relation to recent violence from clients (73% vs 36%); police (42% vs 7%); intimate partner violence (IPV) (56% vs 18%) and others (67% vs 17%), as well as homelessness (65% vs 7%) and recent law enforcement (87% vs 9%). Prevalence of any STI was 17.5% (17/97). For street-based sex workers, recent arrest was associated with violence from others (adjusted OR (aOR) 2.77; 95% CI 1.11 to 6.94) and displacement by police was associated with client violence (aOR 4.35; 95% CI 1.36 to 13.90). Financial difficulties were also associated with client violence (aOR 4.66; 95% CI 1.64 to 13.24). Disability (aOR 3.85; 95% CI 1.49 to 9.95) and client violence (aOR 2.55; 95% CI 1.10 to 5.91) were associated with anxiety/depression. For off-street sex workers, financial difficulties (aOR 3.66; 95% CI 1.64 to 8.18), unstable residency (aOR 3.19; 95% CI 1.36 to 7.49), IPV (aOR 3.77; 95% CI 1.30 to 11.00) and alcohol/drug use were associated with client violence (aOR 3.16; 95% CI 1.26 to 7.92), while always screening and refusing clients was protective (aOR 0.36; 95% CI 0.15 to 0.87). Disability (aOR 5.83; 95% CI 2.34 to 14.51), unmet mental health needs (aOR 3.08; 95% CI 1.15 to 8.23) and past eviction (aOR 3.99; 95% CI 1.23 to 12.92) were associated with anxiety/depression.ConclusionsViolence, anxiety/depression are linked to poverty, unstable housing and police enforcement. We need to modify laws to allow sex workers to work safely and increase availability of housing and mental health services.

Service user violence against social workers in Italy: Prevalence and characteristics of the phenomenon

Summary Client violence in social services is perceived as constantly increasing in Italy, raising deep concern. This article presents the results of the first online survey on the phenomenon. Involving 20,112 social workers, the aim was to determine the prevalence and forms of client violence towards social workers and to identify key factors associated with such events. Findings The results suggest that the vast majority of Italian social workers experience client violence during their careers. Verbal aggression and threats were most common forms of violence, followed by physical attacks and property damage. Young and less experienced social workers appeared more likely to be victims of violence, as well as those who more frequently work in isolation or without their colleagues’ support. Social workers in child protection services, services for adults and municipality services accessible to the entire population were found to be at higher risk of client violence. The social workers considered the quality of the client/professional relationship and communication skills to be critical in preventing and dealing with aggression by users. Unfulfilled clients’ expectation was considered to be one of the main factors contributing to frustration and the consequent hostile behaviour. Applications Violence against social workers is a ‘wake-up call’ that makes the weakening of welfare services, and therefore of professional social work, more visible. The first nationwide study on service user violence reported by this paper may significantly contribute to raising awareness about the phenomenon in Italy and to the devising of effective prevention programmes.