Mobile outreach program by sex workers provides key link to health, support services

Evaluation shows outreach by sex workers provides a key link to health, support services

A mobile outreach program staffed by current and former sex workers is associated with increased entry to detoxification and residential drug treatment among women in street-based sex work, according to an evaluation led by the BC Centre for Excellence in HIV/AIDS (BC-CfE) and the University of British Columbia (UBC).

The study, recently published in the peer-reviewed medical journal Drug and Alcohol Dependence, examined the link between accessing Vancouver's Mobile Access Project, or "the MAP van," and uptake of addiction treatment services by women engaged in street-based sex work who use drugs.

"Our study confirms that the MAP van is serving as the first and sometimes only point of contact for street-based sex workers working late night hours and in isolated spaces," said Dr. Kate Shannon, senior author of the study, director of BC-CfE's gender and sexual health initiative, and assistant professor of medicine at UBC. "Our results now clearly demonstrate that peer-based outreach by sex workers can also play a critical role in connecting women with health and support services."

The MAP van, a partnership between the WISH Drop-In Centre Society and the Prostitution Alternatives Counselling & Education (PACE) Society, functions as a nightly (10:30 p.m. to 5:30 a.m.) service run by women, most of whom are former sex workers. The van provides a safe space for sex workers to rest and have water, juice and coffee. Outreach staff members collect and distribute reports of bad dates; distribute prevention resources such as condoms, syringes, mouthpieces, and alcohol swabs; and provide referrals to health, support, and addiction treatment services.

The study interviewed 242 women in street-based sex work and followed them over a period of 18 months from 2006 to 2008. During this time, 42 per cent of women, or 102 women, reported using the MAP van. Women who accessed the MAP van were four times more likely to have entered detox and/or residential drug treatment as compared to women not accessing the MAP van.

This link remained regardless of whether women accessed other out-patient addiction treatment services known to increase referral, including alcohol and drug counselling or methadone maintenance therapy. The study also showed that the MAP van users were significantly more likely than women not using the MAP van to work in isolated outdoor spaces such as alleys or industrial settings, suggesting the van is reaching the most marginalized women in street-based sex work.

"Outreach programs based on harm reduction principles work," said Kate Gibson, executive director of WISH and a co-author of the study. "By reaching women when and where they work, the MAP van is reducing barriers to services and providing a safe environment to access support, information, referrals to health and social services, and harm reduction supplies such as condoms."

Sheri Kiselbach, PACE violence prevention coordinator and former sex worker who has worked on the MAP van, said these results confirm the importance of outreach and prevention strategies led by sex work agencies. "We need to extend these types of services, not cut them back," said Kiselbach.

The MAP van has been in operation since 2003 through a coalition of local, provincial and federal governments and sex work agencies. It has struggled for continued funding until last year, when the B.C. government committed to two-and-a-half years of funding for this service. The MAP van was developed in response to high rates of violence, health-related harms, and murder among women in street-based sex work in Vancouver.

"Outreach interventions are an important means of bringing marginalized populations under the public health umbrella," said Dr. Julio Montaner, director of the BC-CfE and chair in AIDS research at UBC's Faculty of Medicine. "These new results demonstrate yet another reason for the federal government to invest in prevention and treatment to reduce harm among sex workers, rather than scaling up criminalization and enforcement."

In 2009, women made 1,300 contacts with the MAP van per month, and the van distributed 8,000 condoms and 4,800 clean syringes per month.

"The recent Ontario Superior Court decision represents a critical step forward in evidence-based policy, recognizing the role of the current criminal prostitution laws in exacerbating harm among sex workers," said Dr. Shannon. "While we await renewed policy approaches in Canada, sex work-led outreach interventions remain an important means of increasing access to health and support services among sex workers pushed to the margins of society."