Advanced Search Abstract This paper presents an account of a pilot project to design and implement an innovative, sex-worker-driven approach to peer education in London. A min, double-sided tape cassette containing extracts of sex workers talking candidly about their work was compiled from oral history recordings.
The aims were to pilot process issues in compiling the collaborative resource, and to stimulate discussion of health and safety issues, exploring whether the resource could potentially enhance positive changes in sex workers' knowledge and awareness, self-esteem, and lifeskills.
In a limited pilot distribution, 15 sex workers and seven outreach workers in London listened to the tape and completed short evaluation questionnaires. The paper sets out strengths and weaknesses of the pilot method, linking these to broader critical reflections on issues raised about peer education to, for and by sex workers. Broadly, it refers to the practice of those of the same societal group or social standing educating each other.
Peer education embraces a range of complex, dynamic methods that are rarely clearly differentiated Turner and Shepherd, In response to such confusion, the Europeer project was set up to provide peer education guidance Europeer, From a literature review and interviews conducted with AIDS peer education projects in 11 European Union member states, they identified four sub-approaches to AIDS peer education that can usefully be applied in the sex work context.
The aim is often that target group members in this case sex workers can eventually take over responsibility for the project. In the UK context, we might conceive of the English Collective of Prostitutes performing this role, although their enduring policy not to identify whether workers are sex workers or not means it is difficult to say to what extent their work is sex worker driven. With increasing recognition of the active, willful, moral, reflexive and insightful agency of sex workers Nagel, ; Overs, , peer education hence appears to have clear currency in the sex work context.
As with other target groups, it has generally been initiated within a broadly positive and enthusiastic frame Milburn, , and projects that reflect a clear analysis of the social environment for sex work and an understanding of local organization have been promoted Wolffers, The broad promise of the method lies in a range of appealing features that are intellectual we share attitudes and opinions with people we socialize with , financial as it often relies on committed volunteers or low paid workers and emotional requiring coordinated, consensual activity with altruistic motives Hart, Although critical analysis has been limited to date, sex work peer education is, however, problematic on a number of levels.
Whilst they may appear benign, Cohen has argued that they often permit more inclusive and less accountable intrusion into the lives of individuals Cohen, In terms of funding policies, it has been suggested by some commentators that intrusion is based on an unstated policy to protect clients from HIV, rather than through any real health concern for sex workers Alexander, ; Overs, A call for more radical approaches to health promotion and for sex-worker-driven projects is increasingly heard in the UK Scambler and Scambler, , since in contrast to the US Leigh, and other countries Kempadoo and Doezema, , UK sex work projects that adopt the outreach approach rarely explicitly employ sex workers and ex-sex workers with the exception of two projects in Scotland EUROPAP, a.
Another criticism of outreach approaches with sex workers is that they have not permitted cross-fertilization of ideas from other groups of political activists working in allied fields Overs, For example, Peter Scott commented on the way that gay men were gradually excluded from AIDS prevention work as it became professionalized Scott, , but sex work outreach work has not been subjected to the same level of scrutiny.
Outreach projects have also increasingly been criticized for their rather narrow focus on HIV prevention and sexual health. Although by the early s it became clear that voluntary adult sex workers in western countries were not a primary risk in relation to the transmission of HIV and AIDS Plant, ; McKeganey et al.
This is a view that has been subconsciously adopted by some sex workers themselves. For example, during a 1-week women's empowerment training event for sex workers organized in Katmandu, sex workers asked to spend 1 day talking about health. This included drawing body maps. The course organizers reported that the genital areas were all drawn very large and no other organs were depicted Boucher and White, It seems that well-meaning concern risks being translated into new pathology.
Diffusional peer education projects that train sex workers to work as peer educators have encountered problems with alienation, the creation of low-cost workers and lack of recognition of structural barriers, such as harsh policing regimes and poverty TAMPEP, ; Brussa and Mongard, Lessons learned are that it is difficult to predict where the real networks in the community are and that if individuals are trained, in presenting themselves as the one who knows everything, they risk isolation and jealousy from the target group.
High transitional mobility of sex workers often necessitates continuous repetition of cycles of peer educator activity TAMPEP, Like broader peer education initiatives, sex work peer education projects also suffer a lack of theoretical and evaluative credibility. Looking across different target groups, Turner and Shepherd explored a set of claims for peer education that included concepts of modelling, reinforcement, empowerment, self-efficacy and sub-cultural associations Turner and Shepherd, Like Kathryn Milburn in her review Milburn, , they concluded that evidence for a solid theoretical foundation was partial and over-reliance on lay assumptions about theories of learning was evident.
Clearly, further substantial research is needed to explore all these issues. The assumption that forms the basis of the initiative described in this paper is that this in part relies on experimentation with small-scale innovations.
This paper sets out one small pilot project undertaken with sex workers in the UK. Through the cautious reporting of results from a recognizably limited pilot evaluation, it considers the early challenges raised in the context of sex work peer education. This collection is housed in the British Library National Sound Archive under copyright arrangements specified by the interviewees, primarily as a record of our social history Rickard, a.
The idea for developing a peer education resource from this material came from the grass roots level.
Several sex workers who had already contributed interviews had expressed interest in hearing a selection of the oral history recordings and we had many discussions with them about the possibilities for preparing a health promotion resource that drew on sex worker's own wisdom. In this sense, the project was sex worker driven and sex workers were consulted at every subsequent stage. It fitted with a broadly heralded philosophy of initiating health promotion for and by the target population, exemplifying partnership and inclusion Watson and Platt, It also allowed experimentation with techniques for engaging people who give oral history material in reflecting on its content, and determining its format and use Rickard, b.
Following presentations at health professionals' training events on sex work, in which one of the authors used extracts of recordings from the above collection and mentioned the sex workers' ideas, an outreach worker from a London sex work project contacted us to explore possibilities of setting up such a resource for and by sex workers.
From here we set up collaboration with a key gate-keeper at a project with established networks with female sex workers in London. Deciding on pilot tape content and approach We did some background research to explore whether recorded narrative material had been used before in sex work peer education and found few examples, aside from instructional videos on sex techniques.
This initiative had not been evaluated at the time of writing, but anecdotally the London Network of Sex Work Projects reported that the approach is popular with sex workers, potentially effective and well received Ugly Mugs Newsletter, July ; J. We determined that further exploration with an alternative narrative-based approach had intuitive appeal. Our decision to focus on occupational health and safety issues was driven by: This need was for specific information about domination fantasy role-playing that includes the taking and surrendering of power.
It was reported anecdotally to us by outreach project workers and sex workers working in London chambers that many sex workers were choosing to enter this specialist form of sex work, but with a lack of knowledge, putting both their own and their client's health at risk. The four aims of the pilot project are listed in Figure 1. Pilot tape design and development Using extracts from the OHP project, the authors edited down a min health education tape 14 min per side.
It contained stories and ideas about different aspects of health and safety in sex work. These were issues mentioned by those interviewed as ideas that sex workers wanted to pass on to other people doing the same job or stories of how they had learned some of the subtleties of working more safely.
The authors selected extracts through consultation with three of the seven sex workers who gave the oral history material and the outreach worker collaborator. Extract examples from the full transcript of the tape are included as Figure 2 to give a flavour of the range of material included.
A full version of the original selected extracts of recordings was played to the medical personnel at the collaborating outreach project prior to editing the final cut, in order to check the medical accuracy of the information described in the extracts. We were advised not to include an extract about the effect of combining Viagra with amyl nitrate, as the medical personnel felt this would be partial since no information was to be included about other drugs that can react with Viagra.
We were also advised to make it clear that the extract relating to the use of a natural sea-sponge during menstruation should include the interviewer's question: The intention was to emphasize that natural sea sponges are not risk free. The tape was edited accordingly. We also wanted to experiment with different styles of presentation.
Hence our selection of extracts was also modified by a desire to use a range of different voices on Side A Mandy, Kate, Leila, Lolita, Lauren and Jackie and on Side B we drew on just one person's account Carl. The names used were aliases, usually working names, that were specified by the sex workers who gave the recordings.
By choosing these individuals, although the selection was confined to sex workers working in the UK, an attempt was made to include a range of regional and national accents including those from Birmingham, Sheffield, Zimbabwe, London and Plymouth.
Each person whose voice was used had already signed copyright access to the British Library with no restrictions on its use by the authors. However, through further consultation with those whose extracts were selected, two of the seven chose to have their extracts read by an actor for anonymity. In selecting the actor, we experimented with recordings by a number of friends and colleagues, and finally chose an actor who had herself worked as a sex worker's maid.
Forty copies of the tape of extracts were made and a tape box insert was prepared. This insert was designed to include an abstract image on the outside cover so that sex workers could potentially take the tape home without others instantly knowing it contained information relating to sex work.
A minimal amount of information about the tape was included on the inside cover of the tape insert Figure 3. Pilot tape distribution The tapes were initially distributed to a limited sample of sex workers via the outreach worker collaborator.
She played the tape to groups of sex workers who came to the weekly drop-in. She also carried a walkman with her when visiting flats on her weekly outreach service, distributing the tape to flat-workers and offering them the chance to listen to it immediately if they wished or to keep the tape and listen to it in their own time. This distribution took place over a time limited 2-month period, from April to May This time limit was contingent on restricted funding.
Tapes were also played by the authors and collaborator to other outreach project workers at the distribution site and at one other sex work project in South London during this period. Pilot evaluation All those who heard the tape were asked to fill in a brief item self-completion questionnaire Figure 4.
This was designed to be brief and succinct, mainly open-ended, and to fit onto a two-sided A4 sheet, guided by the assumption that a long and onerous questionnaire would limit return rates. With no substantial funding available or likely to be made available without some pilot evidence to support our hunches, and given that we were keen to respond quickly to sex workers' ideas, the evaluative design employed was brief, speculative and lacked rigour in these conventional evaluation terms. The pilot evaluation sample was small.
It was estimated that over a 2-month period, the outreach worker distributing the tapes would be able to access about 40 women. In reality, this potential sample was smaller, as outreach work at the pilot site was interrupted by other emergencies. In total, 30 tapes were distributed and 22 evaluation forms were returned: Eight sex workers did not return questionnaires during the limited time scale of the pilot project.
Re-tracking them was problematic as they did not revisit the project drop-in or receive a second outreach visit during the pilot period. Due to the limited sample size, analysis was restricted to very basic descriptive statistics and drawing out comments in qualitative form. Together with broader developmental process issues described in this section, these were used to evaluate the pilot resource.
Results Pilot sample characteristics There was a fairly even balance amongst the 15 sex worker respondents according to how long they had been doing sex work.
Three had been working for less than 1 year, six for 1—2 years and six for 3 years or more. One respondent worked in a street setting and did escort work. One of the flat-workers noted that she no longer worked but was a land-lady for other sex workers. In terms of identified ethnic origin, three sex workers were black UK or mixed race and the remainder were white. Four sex workers were aged 31—50 years, eight were 19—30 years and one was under 18 years.
Two sex worker responses were missing for age. The project workers did not specify age or ethnicity. Process issues Five sex workers listened to the tape in a working flat and five in the outreach project drop-in centre. Two took it home to listen to, while a further two listened to it in the car.