HSE clinic sees 43% rise in attendance by sex workers

A HSE clinic offering healthcare to women in the sex industry has seen attendance grow by 43% since it expanded GP services two years ago.

The HSE's Women's Health Service provides care and resources to patients, the majority of whom are victims of sexual exploitation.

Sex work or prostitution is a dangerous profession which can lead to violence.

As a victim of an assault, Paula, who is originally from South America, turned to the HSE's Women's Health Service and its Lead Social Care Worker Joanne Tallis for help.

"A friend gave me Joanne's number and I got in contact with her and received the help I needed," she said.

The help Paula received included hospital treatment, testing for sexually transmitted infections and legal advice.

"I went to a hospital to see (for) the injury I got as a result of the assault and after that, here I come to have my test, my sexual health test and all of that," Paula said.

Joanne Tallis supported Paula following the assault.

The social care worker has been working in this area for 25 years and has witnessed "a complete transformation" in how the industry operates.

When she began her work, Ms Tallis's team was based in Baggot Street in Dublin, where work was predominantly outreach on the streets.

It has since moved indoors with the arrival of the internet, mobile phones and advertising.

The profile of the women has also changed and those who accessed the service last year came from 29 countries.

"In the beginning, we would have had a lot of Irish women and some from the UK, whereas now, three-quarters of clients that use the service would be international clients.

"We've kind of adapted and evolved and certainly my job has changed over the years," she said.

The team works with victims of trafficking as identified under the National Referral Mechanism (NRM) which supports victims of human trafficking.

Those trafficked to Ireland are hugely traumatised by the time they see Dr Aisling Loy, who is a sexual health consultant at the clinic.

Dr Loy conducts health screenings, treatment and vaccinations on patients who are mainly CIS women, but also include trans sex workers.

Victims of sex trafficking are often advised to go to the clinic for screening, due to the risk they have been exposed to over many years.

"So, you've a lot of very traumatised patients that need a lot of assistance in many ways, not just medically, like psychological supports, social supports and it's a full package that they get when they attend here," said Dr Loy.

While most attendees are between 26 and 40 years old, the age range of patients varies widely.

Last year, the youngest client was 18, and the oldest was over 60.

Dr Loy sees patients who she said are put under "extremely difficult circumstances" as part of their work because they are often under duress.

"They are made to sleep with many clients in a day. Sometimes, they're having their menstruation for instance, and they're made try to prevent bleeding by putting cotton pads or baby wipes inside their vaginas which can lead to having infections.

"Being subjected to that repeated exposure in a day, let alone a week or a month can really cause an increase in things like bacterial vaginosis, candida, so we're dealing with a lot of those non STI related infections," Dr Loy said.

Women in the sex industry face significant barriers including stigma, fear, and financial constraints.

Some have children or family members who do not know they are engaged in prostitution which leads to fear and anxiety.

"When they come to our clinic here (in Dublin), it's a very open clinic, but it's not immediately identifiable that this is a clinic for women who work in the sex industry," according to Joanne Tallis.

In the last two years, the service has seen an increase in referrals from social inclusion teams around the country, but the largest number of referrals are peer-to-peer.

Paula told others about it because people are treated with "love, respect and they never force anyone to give information that you don't want to give. They are very supportive and helpful".

Ultimately, Dr Loy said the service is a public health measure which is helping to protect the wider community.

"When you think about it, these ladies are often having intercourse with people in our society who maybe don't realise what protections they are potentially at risk of or maybe their partner is at risk of, so it's important that from a public health measure we ensure they're vaccinated, offered free condoms and STI screening," Dr Loy said.