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Hello. Good evening, everyone. Thank you very much for coming to this stash education event. My name's Claire Pritchard. I'm one of the registrars working in the Northwest in G. Um, um and it's my pleasure to introduce Nicky Stuart, who's going to talk today on sexual health and sex work. The Nicky is a specialist nurse who currently manages the Safe Project, which is part of Umbrella Sexual Health Services in Birmingham. The Safe project offers a specialist sexual health service for sex workers working and living in the Birmingham and Solihull area. Nicki's worked in sexual health since 1999 and has an interest in providing sexual health and contraception to hard to reach groups using a flexible approach to service delivery and outreach. Uh, this has been a really requested talk through really looking forward to hearing from Nikki. We'll save questions so you can type them in the chat box as you go along, But we'll save them to the end. If that's okay with everyone, then Nicky, I'll hand over to you and thank you for speaking today, person. Hi, everyone. So, um, as Clare's just said, my name is Nicky, and I'm the senior sister of the Safe project, which is based in Birmingham and Solihull. Um, so we'll just get started then. Do you mind clicking the next slide for me? Okay, So the things I'm going to run through or aimed to run through during this session is just a quick look at the law around sex workers. The current environment a little bit about research which has been done and how with currently police sex work, which has an effect then, on the services that we provide and how to provide them. I'm going to talk about N u n. And then particularly talk about the safe project, and I've got a couple of patient journeys as well to go through with you. So the next slide. So I just put this slide up just to demonstrate, um, and to ask, what does the sex worker look like? And the thing is, a sex worker can look like all of these things, and it's really you know, there's no such stereotype or anything like that at all. And as this slide just demonstrates that so we can flip to the next one. So this is just having a look at what the main legislation which relates to sex work. I thought that these, um, acts were really old, but I was told very recently by a solicitor friend that they're actually really recent in comparison to other acts and laws. So we've got the Sexual Offenses Act of 2003, Policing and crime, Criminal Justice and Police Act 2001. And this is in relation to placing advertisements relating to prostitution, the modern Day Slavery Act of 2015, which particularly looks at trafficking and exploitation, and the Serious Crime Act of 2015, which is around sexual exploitation of Children. Next, please. So just to kind of like give you a quick overview, it's actually not illegal to sell sex. Um, so in Great Britain, um, England, Wales and Scotland, prostitution is legal, but what the problem is is there's a number of related activities around prostitution which make it illegal and which also makes it really, really difficult for sex workers. So some of these, um, include soliciting in a public place, curb crawling, owning or managing a brothel, or pimping and pandering and their crimes as well. And the pimping and pandering is kind of the pimps, you know, people, um, renting out sex workers and that kind of thing and controlling what they were, what they're doing. So basically, from this, the focus in the UK is on reducing sex work rather than keeping sex workers safe. And that's really quite important next. So it's illegal to the things that are illegal just to go into a little bit more detail. So it's illegal to operate a brothel. So a brothels defined as a place where more than one as put women but more than one sex worker sells sex. And that could be for instances like we've got lots of like what they call pop up brothels, which is where sex workers might join together and working twos or such, and that that would be illegal as well. So it's illegal to live off the earnings of a prostitute or to control and direct prostitutes. It's illegal to solicit, to sell or buy sex in public places so that covers like your street sex workers, um, cause or incite prostitution for gain and to buy sex from a traffic person is also illegal. Next slide, please. So, in theory, sex workers have similar legal rights as any other citizen, but they can't. It's really difficult for them to claim any labor rights because managing a sex business or profiting from sex work is illegal. So they're kind of in a loophole, really. Um, so local police and other authorities are authorized to make the policy about how the law and lo local regulations are applied in that area. So there's guidelines in such for the police in terms of policing the laws. But it really depends on each neighborhood team and what their priorities are in terms of how they apply that next, please. So this is, um, from the the House of Commons Affairs Committee in 2016 2070. It just gives us a rough idea of what's going on, although I would estimate that the numbers are much, much higher. But there isn't any data, um, post covid to give, really. So the number of sex workers in the UK is estimated to be around 72,800 about 32,000 of them are working in London. It's quite a fluid population, and they'll move up and down the country, so that can change um, you know, every day, really. In 2014 2015 there were 456 prosecutions of sex workers for loitering and soliciting, and there's been an estimated of 100 and 83 sex workers which have been murdered in the UK since 1990. So both of those things just indicate what a vulnerable group that they actually are. On average, the report said that sex workers see an average of 25 clients per week, and in my experience, I would say that was much more as well. But also, the hidden nature of sex work makes abuse and exploitation more prevalent, and almost half of sex workers in the UK are worried about safety from violent crimes. But they're also worried about the police from a safety aspect, but also they're worried about being prosecuted as well next. So there's been lots and lots of changes in, um in the sex industry for instants, um, kind of in 2012 2013. Also, most of the sex work that went on was street sex work. And now, as we're a bit more savvy with the Internet and such, it's change so beyond the gays is a huge study, which was done in 2018 at Leicester University and it looked at sex work as a whole. It looked at so many aspects of it, it also looked at and they did a section on the customers. So the punters that actually used the sex workers looked at infection rates and that kind of thing, and they also looked on how they could improve services for sex workers. So, um, at that time, only 10% of sex work was done on the street, 30 to 35% was in brothels and soreness and 55 to 60% was private independent work. Now, since covid there at least five of the brothels that I used to visit before covid obviously closed during covid. And they've not reopened. And I suspect that the brothels and saunas that amount is decreased significantly as well. So the majority of people are working independently and they're working um, online, so that can be for advertising or working in flats and such. And the increase in students sets work is phenomenal, really. And the Leicester University of also just very recently, um, put out a a guideline I suppose, and about how universities should and could support students that disclose that their sex working next, please. So, um, I tried to get an accurate, um, data today for you in terms of how many sex workers are currently working today in Birmingham. But unfortunately, I didn't get the information back in time. But there was a study which was carried out by Aston University and Umbrella, which looked at the estimations of sex workers in Birmingham and Solihull in 2017. And what they did was they looked at the online platforms on. On any given day, you can go through and see who's actually advertising for that area on that day. So this just gives you a snap. It really of the numbers on one particular day that we're actually working in Birmingham and Solihull, and it's really mixed. Females are obviously the largest group, but mail's and trans definitely on the increase. Next, please. So I've already talked a little bit about the research of beyond the gays, but one of the things that they also looked at and found was that 8% of sex workers experienced some kind of violence. That's a huge number and that 50% of them regularly fear for their safety. Um, so that's sex work in general. But online sex workers? Um, it's although obviously they're not on the street. They're still having, um, persistent unwanted contact harassing nonpayment. They're getting verbal abuse abuse and threatened to be outed as well. And quite often they don't always seem quite as serious, inverted commerce kind of thing, and therefore they're less likely to report them. And a lot of the sex workers just feel that it's part of the job, which isn't. And that's what we advocate for, that those things should be reported next. So some of the barriers to report in the police are, I suppose, quite obvious. Um, a lot of it is. They're fit. They're they're frightened of public identification. They don't want people to know that their sex workers, they're worried about You know where that fits in with the law. It's lack of trust, the perception that you know people might have as well. It's part of the job. It's an occupational hazard. Um, it might just be a lot of the sex workers. It's just their daily pressures of daily life. They're just surviving and don't feel that they've got time to go through that system. The system also makes it really, really hard for them as well to go through. It's not exactly, you know, the easiest of systems, the justice system. They're frightened of being joked. Misunderstandings about sex work, um, anxiety's associated with the court procort process. One example of that is, um, and very recently we had a case where, um, one of one of our patient's was in Manchester working and, um, somebody removed a condom. So he called us. Did everything that he could at the time to say, This person's removed the condom. I'm really anxious about it. He went to see, um he went to MASH, which is a similar service to ours up in Manchester and went to Sark, went to the police, gave them his phone and everything, and then, obviously he comes back to Birmingham, and now the police are saying in order to process that they he needs to go back up to Manchester and take his phone, which means he's going to be away from his phone for a period of time. His phone is how he works. So that's really problematic. So of course, that's a barrier for him then, because he can't work without his phone. So the other reason people don't report is because they're worried about If they're working on premises, then they're worried that that might get closed down. And then again, they're not gonna, you know, they've lost their money. Next slide, please. So, um, there's been lots of policy changes or there's lots of reports that have influenced policy. Um, there's guidance that came out in 2015. Um, and it looked at policing sex work. And the focus of that was to minimize threat, harm and risk and to maximize safeguarding. So to try and support the sex worker, Um, it is only a guidance, and it's because it's a guidance. Lots of forces actually don't, um, don't follow it, and it depends on what their local pressures are in that local area as to whether they will do or not. There was also a couple of other reports. There was the Hasse report in 2016, and that was looking at, um saying that soliciting by sex workers and, um, and share ING premises should be decriminalized. Um, and then Obviously, the beyond the gays was all for supporting sex workers. Um, and then there was an all party, um, parliamentary group who produced a piece of work called behind closed doors. Um, that's caused lots and lots of, um, controversy. Really? In terms of, um, it's they they they recommend what we call a sex bylaw, which means that you don't prosecute the sex worker, you prosecute the person that's actually buying the sex, so that has a huge impact on the sex worker. Um, it kind of pushes them underground. And also it might reduce the number of punters that they get, which makes it really difficult. They're more likely to engage in practices than that are unsafe and such to try and make the money so that there's lots and lots of controversy between the two. And it is hot in Parliament and such about it. Um, but there's no agreement really on which way to go. I would advocate that they decriminalize sex work, and then just, uh it just gives obviously the sex workers much, much more support. Next, please. So there is a national police working group, particularly with around sex work and their priorities are about building understanding, working towards operational consistency. So you haven't got this inconsistency with the neighborhood teams? Um, to try and reduce the vulnerability and improve safety of sex works, um, to target those who exploit them and to try and influence the political environment to change the policy. Um, they were they were actually getting somewhere before covid. And then obviously it became on the back burner, and they seem a little bit quiet about it now, But it's really, really key. And one of the big issues that I have in Birmingham and Solihull is that I can work with neighborhood teams and such like that police teams and I can go to meetings and we can have a really good plan together as what we're going to do. And then what happens is the speak. So the police officer who's responsible for it moves on somewhere else. And over the years that I've been at safe, I must have sat in five or six meetings, and it's just the same thing over and over again. The initial meeting and we never, ever get anywhere or come to a conclusion just because there isn't any consistency in it. Next, please. So I've kind of touched on this already. So these are the things that need to to to take effect in order to tackle some of the inconsistencies that we've just spoken about. So although we do have a single point of contact in a spot, you know, they it is, you know, they get promoted, they move on. And somebody who takes the place hasn't got an interest in sex work, or it's just not on the agenda for that area at that moment in time. So they are biggest problem area in Birmingham is what we call the SoHo Road in Handsworth. And quite openly there's, um, sex work that goes on up and down their, um and their police come up with lots of wonderful ideas of how they're going to tackle this. Um, sometimes it can be a problem. There can be lots of drug paraphernalia at certain places on that road, Or it could be obviously crime. Along with the street sex works, comes organized crime and such like that which can be a problem. And obviously, for residents in that area, it's a huge, huge, huge issue. So things that we've done in the past to try and tackle that pre covid is we used to do street outreach with the bid, which is the business organization for the High Street. We went with C G L, which is our drug and alcohol services, and with the homeless team as well just to try and tackle it. And it worked out really well, you know, it was really successful. Um, but again then the the speech changed. So that move shifted their focus. And the way that the bid kind of got their money changed as well. So suddenly it wasn't on the agenda and those things then, or fell down the wayside. Next, please. So I just wanted to just talk a little bit about the national a glim IX scheme. I don't know that anyone's heard about it, but it's a national scheme and it's a reporting system. So there are charity. They're based in Manchester and they're absolutely amazing. Basically, um, their website has got lots and lots of information about keeping sex workers safe in such, And if we hit the next slide, it just gives you a better idea of what they actually do. So they, they advocate, um, for sex workers. Um, and these are the things that they believe in. They believe there's a right to self determination. The sex workers have a right to live free of violence. They have a right to live free of intimidation, coercion and exploitation. And they have a right to work as safe as possible. And they've got a right to police protection. So those are their main. You know, that's what they believe in. And they do lots of things in order to do that. One of the things that they actually do is a reporting system and sex workers and, um, also kind of, um, organizations like ourselves. We can report any crimes and such into them, and they will then send alerts out to projects like us and also sex workers. So it might be things like, um, if there's non payment or if there's somebody particular car, which there's an issue with, and you can search on the Web site via, um, telephone number, email address and car registration numbers. Um, if we hit the next page, this just gives you a bit of a roundup. Of what? Of some of what m um, do in terms of their advocacy. So obviously we've talked about safety. Um, and they're reporting systems. They actually a non anonymously will feed the report into the police as well. So they'll share intelligence with the police. But it's all done anonymously. So when we get a report, we might get a report to say, I don't know if something like in the Birmingham area on the Soho Road, um, somebody with the name of or who identifies as whatever with registration number and you won't get the full registration number. You might just get the first one and the last couple of letters, and then it'll just give you a summary about what they may have done and just warning people to look out for them. Um, any, um, have been really, really successful in, um, convicting rapist who have targeted sex workers. And also they've been really successful in convicting murderers as well who've targeted sex workers and purely and that can be up and down the country. And it's purely just by feeding in this information and then finding matches elsewhere, they offer support to sex workers. They engage with sex workers on a regular basis. They can either engage with them via texting or, um, once one support, um, they drawing covid. They distributed 25 lb vouchers out to all the services that work with sex workers. Um, just to help a little bit in terms of, um, you could use them in Tesco's or Aztar. And it just helped a little bit in terms of, you know, when they're not earning anything, they'll also support through the criminal justice system, and they do training. So we've all been trained in my service by N. Um, and also, they'll do training for the police. Next, please. Um, so I think I've gone through most of this in terms of the things that n, um, do in their checks so you can put in mobile numbers in their in their search bar. They do give out what they call virtual phone numbers, and they call them safety numbers. So somebody's not using their own phone. But the drawback to that is they are premium numbers and therefore they they you know, some of the sex workers may not get as much work through because people don't want to use the premium numbers. Um So the the the last couple of points on there A river services which quite often we would referring to as well. Um, snap is a support network for adult professionals based down in London. They are again advocate and give support to performers. Um, safe info is, um, that's a like a blog which has been set up by sex workers for sex workers. It's really we direct new sex workers to this one because it might be things like, I don't know, um, the type of things that they're offering, they might talk about prices that they might, you know, what would you do for this and that kind of thing? So it's like a place where sex workers can share information together. Um, they quite often on there, they might somebody might say, Oh, I'm not going to work up to I'm gonna tour this weekend and go up to Scotland. Does somebody want to come with me and they'll do that? So recently, I've just had a couple of points on the safe website to say that some of the punters can put some can actually look at their forums, and they're chats, which you know, is not necessarily a good thing. So revenge porn is, um, is really good, um, to have there as a resource. So revenge, porn, what they do again? It's a charity. And, um, we've referred people there whose photographs might have been, um, stolen online. We see quite a lot of adult performers whose, um, content has been used elsewhere. Or where, um, somebody might have acute, you know, have said that they'll oust a sex worker to their family and that kind of thing, and they're really, really good at guarding, supporting and again taking them through that criminal justice system and getting their content removed when it has been put somewhere without their agreement. Next, please. So this article is, um, it's a literature review, and it's really, really recent. It's just been published in The Lancet in the in the second of November of this year. And basically what that looked at was I was looking at sex workers, health and the the determinants of health among sex workers in high income countries. Um, if we hit the next slide, I've just got a bit of a summary of those things, and it will lead us nicely into safe. So next, please. So, basically, um, it looked at what would make you know the best way to help sex workers or to offer services to sex workers. And what it found was currently that any services kind of or uh, focused on women or focused on a particular, uh, type of sex work. Or so, for instance, it might be specifically for street sex workers. Um, and it doesn't necessarily give the whole picture. And what it showed was that policymakers and healthcare providers should improve access to services. But all genders of sex workers, and particularly those that are no sex workers. Um, and it also looks at further research and develop interventions for a greater diversity of sex worker populations and what their social needs are. So, um, essentially as well. One of the things and one of the things that we do is, um, looking at the service that we provide and mapping that with kind of what sex workers want and whether to make sure that what we're delivering actually meets their needs. So next slide, please. So what's safe? So safe as I've said, is the Sexual Health service in Birmingham and Solihull were part of umbrella and umbrella manages the whole survey all sexual health in Birmingham, Solihull. And we're just a small part of that. We're based in the city center at Whittall Street. We've got numerous clinics, umbrella clinics throughout Birmingham and Solihull. And basically we will do a pop up clinic wherever the sex workers are. So if for instances I don't know, one of our bases is Heartlands. If I've got, like, a group of sex workers that are working in East Birmingham, then I will just go over to Heartlands, open up a clinic, and I'd get my sex workers to come there to see me there so we can go basically anywhere. Um, I also do mobile clinic. So I do pop up clinics anywhere where there's two or more sex workers and that can quite often be in their place of work. Um, it could be in the house if there's two or more of them there, or I've got a list of venues where sex happens on the venues that will go to on a rotational basis. We also have a van which is our mobile clinic. We didn't go out during Covid and we're just waiting for our new van to arrive, which hopefully will be really, really soon. Next, please. So why have a specialist project? I hope by everything that I've said up to this point, I've kind of hinted at it. Really? So sex workers are really hard, hard to reach group, and they're often a hidden population. They often have dual lives. If you think about your students, have got dual lives there, obviously studying and and on the side sex working. We've got lots of sex workers who've got families, got young Children and the likes, Um, and quite often they have two different phones. Um, and it's not that they can't go home to their partners or their spouses and tell them about their day that they've had, because half the time they don't know what they do, and it just makes it really difficult for them. So what we do is offer a safe space where you can tell us what the issues are at home in your family life, and we also want to know what's going on in. You know, while you're working, is it safe? Are you having any problems? And we can quite often, you know, bridge that gap and help them, then with support that they may need in either side of their lives. One of the other barriers to accessing mainstream services is prejudice and stigma, and I don't remember anybody's worked in sexual health. But one of the questions that quite often get asked when you do with sexual health history is as a risk assessment is, how many partners have you had in the last three months? And how many partners have you had in the last 12 months? That's the question that we never, ever ask a sex worker because you know, they don't want to tell us their numbers that they've had. If you think that they're having 25 partners a week, you know we don't need to know that kind of thing. And quite often, the general kind of questioning, um, in a sexual health clinic. It's not geared for sex workers, and they become come quite embarrassed quite quickly. They're having to tell somebody each time when they come in. Also, attitudes and lifestyles. Also, you know somebody judging them for what they do, and that's something that we definitely don't do and also it's trust they're worried about, you know? Are we going to tell the police? Do we work with the police in such a way that we're going to then tell them what they've been doing? So all of those things are the reasons why you should have a specialist project next, please. So the big big thing is about trust, and, um, you know, they get to see the same team. We're a small team. So one of the team will see the sex workers each time. And you really, really get to know them. And by doing that, you get disclosures. Um and then I really, you know, I believe then that you can really help them, um, and empower them to make to change their life if they want to, um, the delivery of a wide range of frontline harm reduction information and health service initiatives. That's another thing. That's we do. And also it's we facilitate an improvement in health and reduce the risks that are associated with sex workers. We kind of are able to refer out to partner agencies and such, and we know which agencies. Um would that particular person might need next, please. So this is our mission statement. So the same project seeks to promote the health and well being of those who have worked are working or at risk of becoming involved in the commercial sex industry. We aim to reduce harm associated with sex work and our power sex workers to make positive choices. We meet the sex worker wherever they are. At that moment, we don't judge them. We don't say anything that we don't comment on what they're doing or anything. It's about meeting them where they are at that minute and trying to help in whatever way we can. Next, please. So who do we see? We see any sex worker. We see males, females trans and non binary. Um, we see sex workers across the board in whatever way that they might be working as well. Um, quite often what you'll find is that somebody won't just work, um, independently so they won't just work online. Um, they might also work in film, or you might find some of the performers who work in adult film. They might also work in some of the swingers clubs and that kind of thing, so they're not Normally they aren't normally doing one type of sex work. They cross over next, please. So this next picture just shows you the top two pictures are the van, which we go out and do outreach with. This is really useful for street outreach. So just behind the door, um, where you can see University Hospital Birmingham just behind there. We have, like, a fridge, and we have facilities to be able to make hot tea, coffee, hot drinks. We've also got a toilet and such on there as well. So we'll go out onto the red light districts to do street outreach where we can do testing and things, and we'll just do the full testing that they would get into in clinic. Um, the bottom picture is in one of our brothels that we visit, and basically we just work from a toolbox. So what you can see on the on the bed is the toolbox that we work from, and everything that we need then is, um, is kept in there, and it would just basically be what you would see and what you would get in a sexual health clinic next, please. So what do we provide. So, um, we provide a sexual health and contraceptive service. So we do ST I testing, um, contraception. Um, we'll also including lark. So larks for those that don't know a long acting reversible contraception. So those are things like implants or coils? Um, well, obviously, don't do those when we're out and about, we have to do those in a clinical setting. We'll do cervical screening, um, and give sexual health advice as well as vaccinations. Hep a hep B HPB monkeypox. Generally, there's no appointment needed. What tends to happen are clear. I do get full quite quickly, and most of the people that we see well, either text or call us, um, and just say, if you got any slots for today, and we normally are able to fit them in, I save some for what we call walking's. Um, I've got a high number of, um of the male sex workers and trans sex workers taking prep will also assess and prescribe Pepsi. Um, sir, bees are those in the adult industry who work in porn and such. They need just a certificate every four weeks to say that they've been tested on what their results and such are, um, you know, debatable whether it's worth the paper it's written on because they could go out the next day and have sex with somebody and pick up gonorrhea. But it's one way of actually managing that industry. So we give information advice on how to stay safe trafficking. We look for trafficking in some of the questions that we kind of asked Every time they come in, we're checking to make sure if you had any problems working. It's one of the questions that we always ask. We give out condoms, contraception and lube. We do late night clinics. Um, some of our brothels are open like late Friday, Saturday night, Thursday, Friday, Saturday night, all through the night. I used to go out and visit them on a Friday and Saturday night, but just as an example of how we do work with the police is the police had given new that we went out and had given some intelligence that there was huge organized crime groups working there. So as we did a risk assessment and decided that that wasn't going to work for us to go in there and specifically if it was raided and our staff were testing at that time. So what we do is we open up the clinic late in the city center and they get taxes down, come and see us, and then the venue will taxi them back up and they come in groups. And that's really, really successful way of kind of targeting that group. We have referral pathways, and we sign post two specialists and partner agencies. And I've already talked about the what we call the ugly books, which is the n, um, reports when I'm out and about, I've got a folder with all of those in, and I'll show them just in case some of the street workers may not be able to have access to them. So I'll show them any reports that and that, you know, valid at that moment in time. Next. Okay, so what do we do with positive results? We manage All are positive results, and our aim is to have a quick turnaround with them. Um, so normally, within probably less than a week, we can test them, um, find contact, somebody who's positive and normally get them in. Um, normally we so, for instance, people that I saw on Tuesday I've seen today for treatment, Um, in terms of partner notification, which obviously is a big thing in sexual health. Um, sometimes it can be easy with the sex workers. Sometimes it can be difficult. So what I tend to say is, go along the lines of Have you got any regular partners or any regular punters that you kind of want to keep, um, or that you might see on a regular basis and they might have regular partners that they don't use condoms with. It's a really good idea in order to protect you, that we actually get them treated. And in the majority of cases, they'll either give me the numbers and we'll do provide a referral or I will actually see them in clinic and they'll just come into the clinic and we don't say anything. We know what they're there for. We just test them and we'll treat them when needed. Um, we also ask and say, you know, for the Independent wants is there anybody you know? Have you seen, for instance, if it was gonna rear, we might go back three months if they haven't had testing in that time and say, Have you kept anybody any numbers where that you might have seen in that time so we can just let them know? And actually, my data for provider referrals is really good compared with the rest of the clinic. And I think it's because we have this quick turnaround next. So this is just an example of some of the partner agencies that we work with. We worked really closely with RSVP, which is the rape and sexual violence project. We've got a specific worker. She's given me a slide, actually, and I'll put that up in a minute. She comes into clinic with us when we do a clinic on a Tuesday. She has a room and sits in clinic. Um, and we well see most of the of the patient's as well. She's also recently organized a space in a local library, which is on the Soho Road, which is our big problem area, and she operates a drop in there where they come in. We've got a need for who is works with Birmingham and Solihull women's aid, who we refer. I also work quite closely with the modern day slavery lead they do most of our net outreach for us. So what they do in terms of checking for any signs of trafficking or anything, they'll go through the reams and reams of online, um, adverts. Obviously, they're looking to see whether there's anything similar where they suspect that they might be trafficking involved. And they'll, if there is anything that they think. Oh, well, that's a bit You know what's going on there? They'll refer over to us, and we'll make contact. Very recently, they had a house in Birmingham where there was lots of trans females that we're working from there, which they picked up online. So we did a joint visit, Um, and now we go in there and we'll test on a regular basis, so that's, you know, really useful to have. And also, if I'm worried about a certain address or somebody's bringing lots of girls to me, then I'll also liaise with her and say, Is there anything going on in this area? And we're just a bit worried that this keeps happening, Um, so that she's a really, really useful person. We've got fast tracks in the C G L, which is our alcohol and drug use. Um, we also work quite closely with housing as well. And the homeless teams, Um, for those people that don't want to sex work anymore, we've got a couple of things that we can refer into One example within our own trust where we've had a couple of sex workers who, Romanian ladies who didn't have very much in the way of qualifications and such. And I referred them over to the learning hub. And now they're working on the wards and things as Hchs. So you know, if that's what they want to do at that time, then we have got means of them exiting if they want to. We also work with mental health teams. That's a really difficult one to work with again, lack of consistency and things. And, um, police wise. We don't really want to work with the police. Um, and we don't really want to give them any information, but quite often, um, we can get information from them, for example, about the venues so that we shouldn't be going to next. Okay, so this is just a little bit about what fee does in terms of the red project. Um it's she I'll just read. It's quite small, actually. She helps sex workers access of her specialist providers. Um, similar to what we do. She supports sex works to find employment. If they wanted to do, she does safety planning with them. Safety tips and things. Um, she they their project offers counseling for survivors of sexual violence or any kind of counseling. She's great if we go and do outreach together. Um, I'll see, um, sex workers, um, and do testing and that kind of thing. And she'll do lots of fun things. She'll just do like creatives stuff. So she might just sit and they might just color and chat. Or she's done nails and things as well. So it works really, really well, um, and just helps in terms of again building up trust and set. I've talked about her dropping that she's got now over in Handsworth, and she does like what we do. She assists with reporting any incidences to, um, ugly mugs. Next, please. So I've just got Oh, my gosh, I'm running out of time, so I'll just quickly run through. Um, give a couple examples of some of the things that we have done. Um, so this patient female patient, she came to us from General Clinic and had spent about six months coming into the general clinic every couple of weeks until somebody asked her the question about her being a sex worker. So she said yes. So she was referred over to us. So actually, she wasn't a sex worker as such. She'd been exploited from a really, really young age from about 15 and 60 Um, and what she thought was normal because it was just what had been happening to her. She was being exploited by she worked in a strip club and was being exploited by the manager in the strip club who would take her over to Spain and take a passport offer in such and, um well, we all know what probably would have gone on, and this all came out. We were seeing her for about 67 months before we actually got to the bottom of the story. So we, for an example, would be She told me that she was going to Spain, that she had no choice but to go to Spain. So it was about saying to her, Okay, so I can't change what's going to happen. But what can we do to make sure that you're going to be safe while you're there? So the things that we did was we put an implant in her arm. We did ST I testing. And I also put her on prep as well, because there was lots of drugs which was involved as well. When she was there, she said sometimes she was being injected. Um, and a lot of the sex that was happening was anal sex as well. So those, uh, at that point, we didn't actually no, um, how deep this went. And we wasn't really fully aware of what was happening at that time. Anyway, Eventually, she finished a degree, graduated and then didn't have anything reason to stay in Birmingham. Ended up going back down to London, which we kind of advised her not to do because we told her what would happen if she did go back down to London. We got to the point of getting her into an emergency hostel and, um, emergency, uh, emergency housing. And at the very last minute, as we're about to send her on her way, she said I can't do it. I've got to go back down to London went back down to London, and about a month or so later we had a phone call to say that she had managed to get out. She'd been locked in a room for the whole time. She was there to cut a long story short. She ended up eventually reporting to the police what had been going on, and they because she had support in Birmingham. They put her into a safe house in Birmingham. So today, as of like now at the moment, so she's back in Birmingham. She's in a refuge. We've managed to get her some counseling, Um, just to obviously help with the things that have happened previously to her. So one of the things that she said to me, she says she does sex work. It is her choice now to do that, but she does it because it's a comfort to her because that's all that she knows. All that she knows is that she can exchange sex for something else. Um, and that's her way of getting comfort. So obviously, through counseling and through regular coming to see us and making sure she say will gradually, you know, work that through her and fear did a marvelous job with her completely and feel quite often they'll just go and meet her and they'll go shopping for the day and that kind of thing. So that's just an example of, you know, some of the work that we actually do do next slide. Um, this guy is, uh, MSM to a man who has sex with men and his an Asian guy. And his problem was which again we didn't find out initially, Is that he when he works, when his sex works, his sex works as a female, but his housing wasn't very good, and he couldn't necessarily dress up because people would just come into his accommodation. Um, and therefore he had He couldn't do that, so he couldn't live as he wanted to do. It was really high risk sex he was having as well. So we obviously got him on prep. He was constantly coming back with infections. And one of the things that we did with him was he had mental health issues and his housing was a problem. So with his with his consent, um, we obviously have managed to sort some housing out for him. And we've also liaise with his CPN and his psychiatrist. One of the things he just used to come in and say was, No one listens to me or knows the full picture you guys do. So we were able to liaise then to obviously get him some help. And he's currently having CBT is still threats working, but he's able to live as he wants to live as well, which is really, really good. I think we probably should skip the next slide. I've got another case and I'll take any questions because I see we're running out. If you wanted to. Do you want to skip again? We've got just over four minutes, so it's up to you. If you wanted to do one more slide, maybe, um well, let me just I'll go to this one actually where you are. So this is a really good example of how, like the number of sex workers can change at any one time. So and it's a really transient group. So during the Commonwealth Games, which were held in Birmingham Oh, I was just run off my feet completely um, we have, like, banners that go on the some of the adult platforms, like adult work and Viva Street, which is where a lot of the advertising goes out. So it was just advertise umbrella services, so to speak, um, and drawing, um, the Commonwealth Games. We had a couple of Brazilian ladies that just showed up in clinic asking for us as a safe clinic. So we saw them. We tested them, we sorted whatever problems they had at that moment in time. But what we do is leave our numbers with them and we say to them, You know, any problems when you're working any issues whatsoever, give us a ring, send us a WhatsApp, and we'll try and sort it out. So whenever they are either passing through Birmingham working or they've got any issues that you know, they do that now as well. In fact, I spoke to one of them early today who had managed to get a smear test from somewhere and was having a colposcopy. And she didn't understand what any of the letters meant. So she messaged me for me to be able to go through that with her. So although We're based in Birmingham and Solihull. We do support sex workers wherever they are. Really? Next slide has just got our contact details on and, um, the website, which we have as well. So I'm happy to take any questions or anything if anybody's got anything. Thank you very much. Niki, Um, we've got a question in the chat from Elena who says Thank you so much for sharing The Incredibles work you do. Are there any opportunities for medical students to have work experience with your organization? And what advice would you give to medical students interested in getting into this line of work? So, in terms of in line of workers in sex work or in terms of in line of work, as in sexual health, I'm not sure I'd give any advice in terms of getting into sex work. But I presume she means it's sexual health. Um, I suppose, um, we definitely do have medical students, um, that come in and sit with me? Definitely. Um and I think it's whoever is the contact. I know the contact. Our clinic for medical students is Doctor Boothby. We definitely have a medical students in the clinic and those that do have an interest in normally do come over and sit into my clinic. Absolutely no problems at all. And I suppose if you're interested in getting into the line of work is definitely go down the G um route or the contraception route. Definitely. Um, yeah. As every single day of my day is completely different. And even when I worked in the general clinic, 100% no, two days are the same. So although the policies, procedures and guidelines you're working to the way that they fit into patient's is always always different 100%. Thanks, Nicky. Can I ask what led you to specialize in sex work? Particularly. So, um, it happened by default. Really? Obviously, I've been, um, in sexual health for a long time. I managed and worked the clinic at the L G B T center, which absolutely loved because again, that's a vulnerable, marginalized group. I also ran clinics in the homeless team, and I didn't really have much choice. The person who was doing my job left suddenly and my manager just said, Well, you go over and cover for 12 months. Um, I seem to do that quite a lot. I covered the HIV service for a while as well, when they couldn't get anybody manager wise. Um, so I did. And then I just loved it so much that I decided that that's where I've stayed. So even if they tried to move me now, I'd say no, thanks. We've got another question in the chat from Kate. So So thank you for an incredible talk again, Um, what would you advise for those of us who work in sexual health? What can we do to improve access and support in general clinics for sex workers? I suppose, um, asking the question is always a good one. And, um and just let me just have a look What it's called, um, Bash have just brought out the clinical standards for sexual health management of people involved in sex work. And if you haven't seen that document, it is well worth just having a look at it. Um, it made me think, Oh, yes, we're doing the right thing. That's good. But it's definitely full of some of the stuff that I've talked about or where people are working and the type of questions to kind of ask. And I suppose if somebody is coming in on a regular basis is then maybe is to ask that question about, you know, Are you sex working or is something else that's going on? We have it on a pro, former on they first come in, but I don't know what other services actually do, but I think it is just to ask the question and make a safe environment for them to then disclose the information. Do you have any tips on how to ask that question? Because it's universally on performers. Um, but I feel like I don't get that many disclosures in clinic, even though I actually patient that question. So along the lines of have you ever have you ever been paid for sex? I don't know how you ask it in your areas that you are, but have you ever been paid for sex? Have you ever done any sex work? You know, Are you Is anybody controlling anything that you do? Especially they've got lots and lots of partners. I'm just Does that help? Yeah, that's great. Thank you. I think that's all the questions. Oh, sorry. Emma's got one. Um, So thank you for the talk again. If a patient discloses that they are a sex worth there, Um, do you have any advice on places to sign? Post them. Aside from national ugly mugs, are there any national databases of health services for sex workers or similar N um, have it they hold on, um, 100%. They hold one. Um, there is a couple of other websites that are useful. Um, and I can't think what they are off the top of my head. But maybe I could email them over to you, Claire, or email them to the, um to your to the email address of stashing you could share it of those that are interested. But then, um, definitely have a rundown of all the services that are available. And if you get really stuck, then give me a call and I can direct people into what direction or help if I can do Brilliant. Thank you. So we're just over time. Um, so everyone's really enjoyed that talk, Nikki. Thank you very much. Oh, no. Thank you for inviting me. It was great. I hope everyone has a lovely evening and we'll finish it there. Thanks again, Nikki. Thank you. Bye. For now, everyone