Exploring available knowledge and evidence on prostitution in Scotland via practitioner-based interviews

1. Scale of Prostitution - Estimating the Numbers Involved - Scotland Wide and the Four Largest Cities

There are no available data sources to provide definitive estimates of the numbers of people involved in prostitution in Scotland, or the four cities considered. This report therefore attempts to provide more general information about its scale and changes in its prevalence and nature. It includes reference to trend data from the police about the number of prostitution-related crimes that they have recorded, information from 'open source' prostitution and sex work websites on the numbers of adverts, and perceptions of people involved in support services, to provide a general sense of the levels of activity, and compared to previous years. It also provides an overview of some of the information and evidence gaps that exist.

Police recorded crime - crimes associated with prostitution

This section sets out trends over the last ten years in terms of police recorded crime, criminal prosecutions and convictions data. While this data may be thought to be useful in providing a sense of the scale of criminal-related prostitution activity in different local authorities and across Scotland as a whole, there are limitations as to how far this data provides a true picture, and it cannot be used as an estimate of the scale of prostitution in Scotland. Indeed, differences in operational approach, prosecution and sentencing across different areas influence numbers. The statistics are highly influenced by police operational practice and proactivity and record only the information that comes to police attention, which is not all of the prostitution related crime in Scotland. Moreover, there has been some notable variation in approaches across the different cities over the last ten years or so, for example, with Aberdeen and Edinburgh having adopted 'management' or 'discretionary' zones for periods of time which were eventually discontinued ^[23] , with a resulting increase in convictions for prostitution offences in the subsequent period.

Crimes recorded by the police associated with prostitution are recorded as a key category within sexual crime overall ^[24] and account for less than 4% of sexual crimes. In the last ten years (between 2005-06 and 2014-15) there has been a substantial decrease in these crimes, by 49%. Between 2013-14 and 2014-15 there was a 24% decrease from 490 to 374.

The vast majority of crimes within this category (97%) are recorded in Edinburgh, Dundee, Glasgow and Aberdeen, with all four cities recording a decrease over the ten year period. While Glasgow, Aberdeen and Edinburgh saw this trend continue between 2013-4 and 2014-5, Dundee saw an increase of 127%, from 15 in 2013 to 34 in 2014-15 ^[25] .

The majority of prostitution-related crimes comprise of brothel keeping, soliciting services of a person engaged in prostitution and offences related to prostitution ^[26] . Although there are a further 3 crimes aggregated in the 'Crimes associated with prostitution' category ^[27] , in the last two years these only accounted for 5-10% of the category total.

In terms of the three most commonly recorded crimes related to prostitution, in 2014-15, these comprised a total of 353 offences. This was a 20% decrease from 2013-14 and continued the overall downward trend observed across the 10 year period (Chart 1):

Chart 1: Prostitution crimes: 3 key main crimes recorded by the police

Other than a limited few exceptions, the majority of crimes related to prostitution are recorded in Scotland's four main cities (Chart 2). Other than in 2008-09, Glasgow recorded the largest number of crimes each year. Both Glasgow and Aberdeen have seen large decreases in the number of crimes recorded during the 10 year period with slightly more fluctuation in Edinburgh and Dundee. Dundee has consistently recorded the lowest number of crimes related to prostitution ^[28] .

Chart 2: Prostitution crimes recorded by the police in Scottish cities

Consideration of the three main prostitution related crimes broken down by local authority areas since 2004-05 (Tables 1, 2 and 3 below) shows that the most commonly recorded crime in relation to prostitution is 'offences related to prostitution'. The number of these crimes have decreased considerably, in Glasgow and Aberdeen, while figures for Edinburgh and Dundee have shown more fluctuation over the period (Table 1 below).

Table 1: Offences related to prostitution

Local Authority	2004-05	2005-06	2006-07	2007-08	2008-09	2009-10	2010-11	2011-12	2012-13	2013-14	2014-15
Aberdeen	159	154	261	185	229	129	117	32	25	43	24
Dundee	19	32	17	16	36	42	29	21	25	7	18
Edinburgh	44	57	133	32	43	77	47	78	84	46	18
Glasgow	1168	441	307	290	221	168	158	211	214	197	119

The number of crimes recorded by the police associated with brothel keeping are relatively low compared to other offences (the highest recorded being 17 in Aberdeen in 2014-15). The figures also show considerable fluctuation year upon year over the period, with no discernible overall trends (Table 2 below).

Table 2: Crime Brothel Keeping

Local Authority	2004-05	2005-06	2006-07	2007-08	2008-09	2009-10	2010-11	2011-12	2012-13	2013-14	2014-15
Aberdeen	10	4	9	8	0	6	8	7	7	9	17
Dundee	1	5	1	10	8	5	1	0	2	1	5
Edinburgh	0	0	6	3	3	4	3	11	0	11	1
Glasgow	0	1	0	0	4	6	7	14	12	9	9

Crimes of soliciting services of a person engaged in prostitution show considerable variation across cities, with numbers in Aberdeen, Dundee and Edinburgh having decreased between 2011-12 and 2014-15. In Glasgow however, there has been an increase in these crimes between 2011-12 and 2014-15 (from 86 to 108).

Table 3: Soliciting services of a person engaged in prostitution

Local Authority	2007-08 [29]	2008-09	2009-10	2010-11	2011-12	2012-13	2013-14	2014-15
Aberdeen	23	64	37	48	22	8	7	7
Dundee	7	27	28	26	20	11	6	11
Edinburgh	19	13	32	33	21	18	30	12
Glasgow	52	68	64	47	86	96	72	108

Number of people prosecuted and convicted for offences related to prostitution ^[30]

In 2013-14, there were 183 people proceeded against in Scottish courts for crimes related to prostitution. This was a 9% increase from 2012-13 but is still the second lowest figure in the 10 year period.

Chart 3: People prosecuted and convicted for offences related to prostitution

The trend for convictions, unsurprisingly, very closely mirrors the trend for prosecutions. In 2013-14, there were 167 people convicted for offences related to prostitution, a 15% increase from the previous year.

In summary, this data suggests that from a policing point of view, prostitution related crime is on a decreasing trend and relatively few people have been prosecuted or convicted for this offending. As previously discussed, this data only provides insight into the levels of criminal activity related to prostitution, and do not provide an indication of the number of people who are involved in the sale of sex or who buy it.

To consider this question, as part of overall intelligence gathering, the police have used an 'open source' research approach to provide general estimates of the numbers of people who may be involved in prostitution, who sell sex. This involves assessment of some of the main websites where sex/escorts are advertised. These may include duplication, or fake accounts, but recent internal investigation ^[31] showed that there were around 1,800 adverts for sexual services across 4 main websites ^[32] in Scotland in a single day, the majority of whom involved women. An earlier (2014) figure based on more extensive scoping work conducted by the National Human Trafficking Unit, with support from Police Scotland's Prostitution Working Group and associated partners into Commercial Sexual Exploitation within Scotland identified approximately 3000 adverts for escorts across 10 websites, featuring over 20 separate nationalities, the majority of whom were assessed as young adults. Again, these estimates are limited in providing an assessment of the true scale because although some of these represent the most well-known websites, they are not the only ways of arranging transactions. The number of adverts for sexual services/escorts on websites therefore constitute a limited and potentially misleading information source. Furthermore these estimates only provide rough numbers, of those involved and do not enable estimations of the number of people who may use these services.

Police Scotland Current Policy and Approach to Prostitution

The advent of Police Scotland has led to an approach which aims to provide more co-ordinated and consistent policing in relation to prostitution with the overarching aim of robustly policing 'those who control, abuse, exploit or coerce others for the purposes of prostitution'. This is formalised in the new national policy document ^[33] which was developed with the overall aim of ensuring that all operational activity is aligned to this policy, whilst taking into account the diverse needs and circumstances of those involved. In dealing with prostitution and sexual exploitation the overarching principles underpinning this are: the safety and wellbeing of individuals; the safety and wellbeing of communities; and the investigation and prosecution of those who abuse, coerce or exploit or purchase sex in contravention of current legislation.

The overarching aims of the policy involve a focus on the:

• Protection of individuals and communities from threat, risk and harm, including exploitation caused by prostitution.
• Investigation of those who abuse, exploit or coerce and the investigation and disruption of organised criminal activity associated with prostitution through effective and innovative use of current legislation.
• Support or creation of effective partnerships with other agencies, organisations or individuals which will help minimise or eliminate the harm that can be caused through prostitution to individuals or communities.
• Support research and promote debate with policymakers with a view to creating policy and law which makes it safer for those involved in on/off street prostitution, easier to investigate and successfully prosecute those who abuse, exploit or coerce victims through prostitution and which support the diversion from prosecution or exit from prostitution by individual victims.

In accordance with supporting and creating partnerships, and in an effort to minimise the impact of prostitution by reducing the risk of harm experienced by individuals, Police Scotland and key partners have introduced SHaW ^[34] visits to respond to 'off-street' prostitution. These adopt a victim-centred approach as opposed to having enforcement as a priority, and are based on a methodology which has been developed through collaboration between Police Scotland and key partner agencies. Visits are undertaken by Police Scotland and the partner considered most appropriate (within Divisions at addresses where persons involved in prostitution are believed to be operating from). The visits are intended to allow an assessment of vulnerability and to provide advice, where required in terms of available intervention and support services. The key aims are as follows:

• Improve the multi-agency response to prostitution.
• Ensure the safety and wellbeing of persons involved in prostitution.
• Provide advice and guidance, where required, to those wishing to exit prostitution.
• Provide details of support services available.
• Utilise the outcomes of these visits to inform and enhance policies and procedures.
• Provide an accurate picture of the scale of prostitution across Scotland.

In addition officers aim to be receptive to ancillary information and to take appropriate action in relation to any other criminality identified, the identification of victims of trafficking and/or sexual exploitation and information in respect of organised crime groups involved in criminality.

A crucial part of achieving this policy is highlighted as building trust and confidence by improving relationships with women and men involved in prostitution (who sell sex). It is anticipated that this approach will help encourage individuals to report criminality either directly to Police Scotland or through other channels ( i.e. third party reporting mechanisms) with the reassurance that the police will respond appropriately and consistently. In relation to those selling sexual services, Police Scotland: 'will adopt a proportionate and measured response when considering enforcement legislation towards the 'seller' of the sexual activity.' ^[35]

Summary of Local Area Context

The following section provides an overview of the key issues in each of the local areas, it addresses current knowledge on the scale and nature of prostitution as well as identifies key gaps alongside consideration of any change over time, the structure of specialist service provision and current priorities for support. This is followed by consideration of common themes across all areas.

Aberdeen

Structure of service provision

In Aberdeen, a partnership approach titled 'Operation Begonia' between the police and key partner agencies has been in place since 2010 to tackle prostitution. At its root, Operation Begonia was created to tackle on-street issues and identify vulnerable women who require additional assistance, to help break the cycle of prostitution ^[36] . Through the partnership women can receive immediate referrals to key services and have access to agencies which will offer support, as opposed to being reported to the Procurator Fiscal ^[37] . The Begonia partnership is valued by the police in assisting with sharing knowledge and information (without betraying confidences). The police often use partners as a conduit to share general information as well as specific concerns regarding individuals whilst investigating crimes.

In terms of operational practice, Begonia consists of officers carrying out weekly patrols in key areas to gain intelligence and submit regular updates regarding those involved ^[38] , and who are currently engaging with the initiative. Officers' initial engagement with women involves explaining the objectives of the operation and offering them the opportunity to fill out a questionnaire and consent form to allow them to be supported by the key partner agencies which include: 1)Aberdeen City Council - Criminal Justice Social work 2)Alcohol and Drugs Action - Quay Services and 3) Aberdeen Cyrenians.

The operation is currently focussed on street-based prostitution but has the potential to be extended to engage more effectively with off-street prostitution. It aims to gain a better understanding of the needs and difficulties experienced by women involved and to provide support and assistance for women to help them move out of prostitution. The overall aims of the project are to: 1)improve the safety, health and wellbeing of women involved; 2)provide opportunities to support them and make lifestyle changes 3)improve access to all relevant voluntary and statutory services.

Current knowledge re the scale and nature of prostitution and the identification of gaps

Police and key agencies said that giving accurate estimates of the numbers of those involved is complicated by the fact that numbers tend to fluctuate, with increases in people working on the streets, and advertising online, at certain times of the year (such as Christmas with its increased financial pressure). The oil industry in Aberdeen, and large events and conferences such as 'Offshore Europe' were also associated with an increase in numbers, due to increased demand during those times.

Bearing in mind these caveats, according to police intelligence, in November 2015 an estimated 165 women were documented to be working in prostitution in Aberdeen City and Aberdeenshire and Moray. Alcohol and Drugs Action ( ADA) had direct contact with 110 women between April 2015 and June 2016, many of whom had reduced or stopped their street involvement by this point and were engaging with ADA and wider substance use treatment services. Partly as a result of this improved engagement and stability of many women, only 12 of those women were requiring to engage with services via operation Begonia.

Police data for November 2015 showed that 156 intelligence submissions were made in relation to off street brothels - private premises being used for the purpose of prostitution ^[39] . In terms of data for 2014 however, police highlighted that the intelligence picture in relation to the off-street industry and the number of brothels was larger than the number of offences would suggest.

In terms of key locations for on-street activity, the majority of those involved have traditionally operated from the Aberdeen harbour area (with the streets around the harbour being particularly affected). Anecdotally though, there was some evidence of a dispersal of prostitution activity to wider areas of the city, with more discreet methods of meeting regular purchasers enabled by the use of mobile phones, making it less visible to the public. In terms of those working on street that the police had contact with, these were usually local women, with the majority being white and Scottish. Other common characteristics were being unemployed and having a drug addiction, with involvement primarily to fund drug misuse. While the ages of those involved ranged from 21-49, police identified the average age as 33, with on-street offenders often having past criminal histories.

It was suggested that, based on observational anecdote (and not the systematic analysis of evidence) there has been a decline in the on-street market. The move off-street was identified as having been facilitated by the use of mobile phone technology as well as online apps and websites. As well as the use of mobile phones, Alcohol and Drugs Action identified another key factor in the decline as being due to significant improvements in access to drug treatment services in Aberdeen which enabled some women to stop involvement in prostitution, while others had managed to reduce the frequency of their involvement ^[40] . Treatment services delivered by Alcohol and Drugs Action within an integrated service model offers one to one support, a women's group and SMART recovery groups which have been an important part of recovery for many women.

The reduction in on-street activity was illustrated by estimates provided by Criminal Justice Social work who noted that when Begonia started in 2010 there were approximately 129 women signed up, whereas in October 2015 numbers of women engaging were said to be around 13 ^[41] . It is important to note however, that the two main third sector support organisations receive referrals from key agencies as well as self-referrals. Therefore the numbers of women receiving support through the Begonia partnership are not reflective of the much higher numbers of women currently accessing specialist support ^[42] .

As a key partner within Operation Begonia, the third sector support organisation Alcohol and Drugs Action also identified a definite decrease in on-street prostitution over the last 8 years or so. The organisation previously saw an estimated 200 ^[43] women per year who were actively involved in prostitution out of necessity and for basic survival, with the main driver being drug addiction. However, between April 2013 and June 2016 the organisation estimated that they had contact with 110 women ^[44] working on-street (via their outreach work, which entails driving around the traditional red light area in the harbour to identify and engage with women).

Police highlighted how the visibility of the on-street market and the ability to patrol the areas provides the opportunity to make an immediate impact, by stopping and speaking with customers and engaging with the women involved in prostitution. However, with social media and changes in technology leading to lower on-street activity, police suggested that it is more time consuming to build intelligence ( i.e. to regularly trawl the key websites) and more challenging to have an impact with those involved in the indoor market in the same way.

The majority of indoor prostitution is conducted from private flats using various methods to advertise services, from newspapers to online websites, with mobile phones numbers used to facilitate meetings. The indoor market is more geographically dispersed than the on-street industry, although there is a concentration in the City Centre and the West End (affluent and relatively central), there are also instances of the off-street industry elsewhere in the suburbs. Many of the brothels tend to be in rented accommodation (either privately or in the form of serviced apartments).

The majority of those charged with prostitution offences are female, reflecting the fact that the majority of those selling sex are female (with only one male documented as working in prostitution). However, men were more commonly seen in relation to offences in the off-street market than on-street (in terms of in a controlling/organisational position rather than in terms of offering sexual services). Support services were therefore geared towards the assistance of women.

Information summarised from police crime files showed that in terms of the demographics of those working off-street, the majority were foreign workers (with many identified as being Eastern European, often Romanian), with a minority of UK nationals. Ages ranged from 18 years to 48, while the average age was 28. The majority described themselves as unemployed and did not appear to live in Aberdeen, which may suggest a degree of transience and mobility. This is supported by intelligence which suggests that many workers travel to Aberdeen for a specific period of time with the possibility of extending their stay if it is considered profitable to do so.

The particular economic and social circumstances in Aberdeen, with the wealth generated from the oil industry and the high number of men who work within it (often working away from home for several weeks at a time) are suggested to be a lure for involvement in prostitution. Although the off-street market is complex and much of it is hidden, the women that the police and services had engaged with cited a range of reasons for involvement. For some who had come to the UK from other countries, difficulties in finding alternative employment meant they had 'accidentally' become involved in the off-street sex industry. Some had appeared to make a deliberate choice to become involved, seeing it as a potentially profitable line of work (based on information from friends/acquaintances). Others involved cases of suspected trafficking, although many maintained that this was not the case. ^[45]

It was suggested by Alcohol and Drugs Action that large numbers of women were advertising in the North-east and Aberdeen area. While the organisation highlighted that this data was not based on up-to-date police intelligence ^[46] , their own work scoping this issue suggested that there were over 450 people (the majority women) advertising sexual services in the Aberdeen area ^[47] . Reaching women who are working off-street and advertising through websites, was considered more challenging.

In addition, looking solely at the numbers of those advertising, could underestimate the actual numbers of women involved. Some women were identified as having previously been on the street and had built up regular clients which allowed them to then work from flats or hotels, via the use of mobile phones or different technologies.

Alcohol and Drugs Action had recently made contact with an estimated 348 women advertising sexual services online via adult websites and advertising sexual services in the local area ^[48] . These women were contacted directly via email to inform them of the support services available locally. It had been noted that while women usually didn't access services immediately, there would often be a gradual effect with women coming a few weeks or months later. However, only six women advertising on adult websites took up the offer of face to face support, highlighting the challenge in achieving direct engagement with women who are involved off street, who may not be from the local area/have any prior contact with support services.

The organisation suggested that it was important to distinguish between the traditional street workers with drug problems and women who tend to work in the indoor market. In line with police intelligence, the organisation confirmed that a higher proportion of the latter group are not local women, with many working in Aberdeen on a temporary basis. This group was identified as being harder to engage with, because traditionally they tend not to be the type of people who would use drug and alcohol and other support services. While many do not have a drink or drugs problem, others may not see themselves as requiring this type of support (despite often using alcohol or drugs whilst working). Police also suggested that drug addiction seems less prevalent among this group. The organisation therefore emphasise the wider support they are able to provide via 'Quay services' (a dedicated support service for women involved in prostitution), as distinct from the other core alcohol and drugs action services.

Overall it was acknowledged that while there was a high level of understanding in terms of those involved in street prostitution in terms of their key characteristics, circumstances and support needs (with particular vulnerabilities cited as drug dependency, poor mental and physical health, experiences of domestic violence and trauma) much less was known about the indoor workers. Similarly men involved in prostitution, who sell sex, hadn't been identified as a priority among respondents, because they tended to be involved in lower numbers. Scottish Government Violence Against Women funding for support services meant that other organisations (such as Gay Men's Health) had taken on this mantle.

Dundee

Structure of service provision

In Dundee, Vice Versa is the only third sector specialist support service dedicated to supporting women involved in prostitution in terms of harm reduction and assistance to exit. The organisation works in close partnership with WRASAC - Dundee and Angus (the Women's Rape and Sexual Abuse centre) and CAIR Scotland (which currently offers support programmes and harm reduction services, including blood borne virus infections, sexual health, relationship programmes and drug and alcohol interventions). The organisation also work closely with criminal justice social work through the provision of services and the police, who regularly refer women to their services. At local authority level there is a similar recognition of the importance of dealing with the issue at a partnership level. The Community Planning Partnership issued a statement (in 2013) which set out the overall approach which involves taking a lead role along with other voluntary and statutory organisations in tackling the causes of street prostitution. This set out the context in terms of understanding the wider issues of social marginalisation and gender inequality and recognition of the 'harm caused through prostitution to women, their families and communities.' ^[49]

Current knowledge re the scale and nature of prostitution and the identification of gaps

In Dundee, as in Aberdeen, similar gaps in knowledge relating to the current scale and nature of prostitution were highlighted by police, the local authority and specialist third sector support organisation Vice Versa. Whereas five to six years ago on-street activity was described as being highly visible, with a correspondingly high level of community interest ^[50] and police response, now street-workers were described as fewer in number. The shift from on street to indoor prostitution was said to have happened gradually over this period with increased internet and mobile phone usage to arrange meetings more discreetly ( i.e. in a house or designated back street), having resulted in less visible activity.

Previously, policing around this issue was characterised by pro-active intelligence gathering and targeting (via community analysts) combined with very close partnership working with the third-sector specialist support organisation. However, police broadly characterised their current approach as being more reactive in nature than before.

Based on police knowledge and close partnership working with the specialist third sector organisation, five to six years ago, street workers' involvement in prostitution was identified as through necessity rather than choice, due to addiction issues. Those engaged in street work in Dundee tended to be local women. Indeed, basic demographic figures for women who were supported by Vice Versa between 2011-15, based on the records of 83 women showed that the vast majority were white/Scottish ^[51] , with the highest proportion aged between 25-34 ^[52] .

Of the women supported by the specialist service, the majority were identified as being street-based in earlier years and then later off-street, organised by mobile phone. In terms of personal circumstances, most were identified as coming from backgrounds of deprivation and drug misuse, with involvement primarily to fund drug addiction. Other key vulnerabilities highlighted by Vice Versa were the high prevalence of experiences of abuse (physical, sexual and verbal) and trauma, homelessness and mental health issues.

While the most significant additional support need was identified as substance misuse ^[53] , this may be due to how the specialist service was originally set up, to target women involved in street prostitution who were vulnerable, with chaotic lifestyles, and to address concerns among the wider community within the affected residential area. Crucially though, there is uncertainty as to how far this picture still pertains due to less robust/developed intelligence.

Without detailed intelligence Vice Versa highlighted the difficulty of how best to target resources. Information received was identified as often sporadic (if an agency had picked up on a particular issue, such as women being regularly picked up from a homeless hostel), with no systematic collection or sharing. The importance of having a risk management strategy in place for women involved in prostitution who were identified as vulnerable to violence and sexual violence was highlighted.

While the general trend in relation to street prostitution, over the last few years, has been a decline in visible numbers on street, it was suggested that there are a few women, who are identified and then referred by the police onto the specialist support organisation. Vice Versa suggested that these tended to be women who (often had recently been released from prison), were working on the street for a short period, to develop a number of clients to then allow them to work off-street again. Overall street-work is now described as much more transient, with women identified as generally being well known to key agencies. However, with no evidence of decreased demand, it was generally felt that the dynamics had shifted indoor.

However, fluctuations in on-street numbers were also highlighted and it was noted by Vice Versa that in the last 6 months (pre-October 2016) there had been a slight increase in numbers involved in street prostitution. These included women who had previously reduced involvement, or had exited prostitution. It was reported that women often stated that benefits sanctions and the resulting hardship had impelled them to engage in street prostitution again.

As a result, service providers explained that assisting women with access to basic needs, like food has become an increasing part of their work. Indeed, Vice Versa recorded 56 contacts with women to access food banks and 186 contacts to assist women with welfare rights between April 2015 and April 2016 ^[54] .

After a period of diminished demand for the evening outreach service (which comprised of providing condoms and offering other kinds of essential assistance), and a scoping exercise with service users, a more open access service in partnership with other organisations (including criminal justice, CAIR Scotland substance misuse service and Tayside substance misuse service) was developed. This constitutes a daytime drop-in run twice a week, covering the development of independent living skills and offering opportunities for getting involved in creative arts projects. It ultimately offers an opportunity to 'take time out from the world'. This group is targeted at more vulnerable groups generally, rather than being specifically about women involved in prostitution. This broader focus was identified as important in terms of reducing stigma, as many women did not want to attend services that would identify them as being involved in prostitution.

However, given the transient nature of street prostitution and recent developments, including intelligence from Community Safety Wardens and a spate of sexual assaults on women involved in prostitution, the organisation had recently (September 2016) responded by introducing an early evening (5.30 - 7.30 pm) weekly ^[55] outreach programme to make contact with women and offer support and assistance. Vice Versa noted that although it had only been operating for a few weeks, they have met with women each time they have gone out, approximately 3 on a weekly basis including one 'new' woman, unknown to the organisation each week.

In terms of the current picture and estimates of the numbers involved in indoor prostitution, it was said to be impossible to provide figures. The difficulty of obtaining accurate estimates on the numbers of people involved in indoor prostitution (who were described as harder to reach) was highlighted. While recent ^[56] press figures quoted estimates of 200 women working within indoor prostitution, based partly on open-source advertising ^[57] , police identified that any figures based on this type of analysis is problematic and highlighted that although there may be a certain number of profiles of (mainly) women selling sex within Dundee, there is likely to be a degree of duplication, with the same person operating under more than one profile.

While on-street workers were predominantly all local women, off-street incidents dealt with by the police through more sporadic and specific intelligence ( i.e. that there is a brothel at a certain address), tended to involve non-local women, including Brazilian, Portuguese and Eastern European nationalities. This was highlighted as anecdotal evidence, with robust numbers and estimates currently unavailable. However a recent scoping exercise conducted by the specialist support service also found that those advertising online were less likely to be local women, and were often operating in Dundee on a transient basis ^[58] (with profiles citing a range of other nationalities).

Vice Versa highlighted that the range of ethnicities of women advertising online suggests that there is a more diverse group involved in prostitution than are currently seeking support. It was suggested therefore that there may be cultural barriers to accessing services. Consequently there is a lack of understanding around whether there are similar vulnerabilities as those previously involved in on-street work ( i.e. drug addictions and deprivation). Indeed, it was suggested by police that it's more challenging to understand off-street incidents they have dealt with in terms of drivers for women's involvement in prostitution, personal circumstances and vulnerabilities or support needs.

Prostitution involving male and transgender groups was identified as less prevalent, and therefore hadn't to date been a particular priority for police attention. Subsequently, specialist support service in Dundee is targeted specifically at women.

Overall, work is on-going to improve multi-agency approaches and there was optimism around the SHaW visits ^[59] , in place in Glasgow and Edinburgh (currently being evaluated), in terms of its potential for improving the safety and understanding of current support needs and reducing risk among those involved in off-street prostitution.

Edinburgh ^[60]

Structure of service provision

Edinburgh has been seen as traditionally adopting what has been described as a 'pragmatic' approach to prostitution. In particular, a unique feature had been the licensing of saunas and massage parlours used by sex workers. However following a police operation around saunas in 2013, the Council's Regulatory Committee approved a period of consultation on a proposal to remove licensing arrangements for saunas and massage parlours from the Council's Public Entertainment Resolution, the rationale being that while: 'The Council has historically licensed these premises as a risk reduction approach to minimise harm…recent police reports have indicated that this approach is no longer proving effective ^[61] .' A decision not to license saunas was approved by the Regulatory Committee on 3 February 2014.

At the 15 November 2013 meeting, a motion was also approved to develop a harm reduction approach at saunas and massage parlours, and for the Director of Health and Social Care to provide a further report on progress in January 2014 to the Corporate Policy and Strategy Committee. Following intensive partner engagement, in 2014 the Committee approved a 'Harm Reduction Framework for Sex Work' in the city. Saunas and massage parlours (no longer licensed) were a focus of the Framework, however engagement with partners had indicated that a more holistic approach was required, which would also include work to address issues arising from both 'street' and 'on line' prostitution.

Further development and implementation of the Framework was remitted to a multi-agency group, which involved a range of public and third sector partners delivering key services to sex workers, who were to secure the engagement and involvement of sex workers in the development and implementation of the Framework.

The Principles of the Framework include that effective engagement with those who buy or sell sex has to be based on a 'pragmatic approach, which does not align itself with any particular ideological or sociological perspective or value judgements'. Other key features include harm reduction involving a holistic approach which takes into account the different environments in which sex is bought and sold, attempts to find common ground between different organisations with differing views, multi-agency working and a person centred approach. The multi-agency group has subsequently coordinated a wide variety of improvements in service interventions, information sharing, and monitoring and evaluation systems.

Edinburgh interviewees all conveyed a strong ethos of partnership working, and support is offered on a multi-agency basis, with a strong focus on harm reduction. This multi-agency approach was regarded as a key strength by those interviewed.

In terms of on-street support provision, there is close partnership working between Police Scotland, the NHS, SACRO, Streetwork (through the Streetwork Women's Project), and the Salvation Army. In addition, the Crown Office and Procurator Fiscal service meet regularly with the key partners. Information exchange between the partners was seen as key. Support to on street workers was shared and coordinated between the Police Scotland Street Liaison Officers, SACRO, the Streetwork Women's Project, the NHS, and the Salvation Army, with a variety of outreach support provided from various agencies 5 nights a week from a van situated in the area where the women work. A system of confidential exchange of information about the women is seen as a vital aspect of this joined up service provision. Needle exchange, condom supplies and signposting to other services are some of the services provided by all these agencies.

The indoor market, which is less visible, was viewed as presenting difficulties around service provision in terms of identifying and accessing women and offering available support. This situation was viewed as having been exacerbated by the shift away from saunas and into private flats, with increased use of the internet and developing technologies (such as apps) as a means of advertising and arranging meetings. However, Edinburgh has recently adopted the approach initially rolled out in Glasgow in terms of engaging with those identified as selling sex within the indoor sector. SHaW ^[62] visits, are led by the NHS (based on police intelligence or from further assessment following overt complaints such as anti-social behaviour etc.), and aim to establish whether women working in flats visited are safe and aware of the range of support they can access.

The Women's clinic provide confidential support and services for women involved in prostitution and/or who use substances. It is a joint initiative between NHS Lothian's harm reduction team, Chalmers Centre and Sacro's 'Another Way' service. It offers holistic support and a range of services including sexual health screening (testing for blood borne viruses including HIV, Hepatitis B and Hepatitis C) and immunisation against Hepatitis B. Family planning services and the provision of contraception, harm reduction services (including the provision of condoms and safety alarms), emotional, practical and social support and referrals to other health-related services as well as the Sacro 'Another way service ^[63] '. It is a unique service in Scotland and the only one specifically for those involved in prostitution.

In addition, weekly visits to the saunas are undertaken with the SACRO Another Way Service. Women are met and encouraged to attend services, and if necessary, can be supported one-to-one within the sauna. These tend to be short support interventions due to the working environment and women are encouraged to attend the Women's clinic (offering specialist sexual health support for drug users and those women who sell sex) or the SACRO office for a more appropriate setting. The Another Way Service project worker also has a weekly presence at the Women's clinic and offer support within the Willow project, a partnership between NHS Lothian, City of Edinburgh Council and SACRO to address the social, health and welfare needs of women in the criminal justice system (some of whom may have been involved in prostitution, may currently be involved or are at risk of being involved). As part of a holistic approach to addressing the health needs of women who access the service, the Willow project also aims to help women take control of their sexual health.

Further support within this framework is provided by ROAM outreach, launched in 1994, and the first established project in Scotland to respond to the needs of men involved in prostitution, who sell sex and cruising men in Edinburgh. They undertake outreach sessions in Public Sex Environments, on-line outreach, sexual health check-ups, and free condoms and lubricant.

In line with the findings from the other case study areas, respondents from Police Scotland and support agencies highlighted the difficulties in estimating the numbers involved in prostitution, and this held true for women, and men.

Current knowledge re the scale and nature of prostitution and the identification of gaps

The hidden nature of the population was seen to make estimates difficult police explained that they reacted to intelligence received, and were clear that, in relation to indoor work, the reactive nature of their response meant that there were large gaps in knowledge. Shifts in the way those involved in prostitution are working, in particular the use of new types of technology, were typically regarded by respondents as making both estimating numbers of, and offering support to, those involved in prostitution increasingly problematic.

Compounding this hidden nature, some highlighted the stigmatisation of involvement in prostitution, which led to many women feeling unwilling to disclose their involvement during contacts with key services. Some expressed concerns that using service contacts as estimates would be inaccurate, because of the stigma and the shame felt by some women, which would mean that they would not disclose involvement in prostitution. The lack of disclosure of whether an individual sold sex was also identified in terms of male service users.

However, the Women’s clinic for women involved in prostitution reported seeing around 400 women in 2013, with numbers increasing steadily since 2007, with the exception of 2014 which saw a slight reduction in attendance.

A number of respondents perceived a significant reduction in the number of women working on street in the past few years. This was reported across the range of interviewees.

In terms of street activity amongst women, this tends to be concentrated in the Leith/docks area. Police Scotland reported seeing 4 women on a night working on the street, compared to around 12 a number of years ago. This marked decline in numbers was echoed by other agencies. In Edinburgh the Salvation Army, SACRO; Streetwork Women's Project, and the NHS who provide street outreach from a van on different nights reported a similar decline in the number of women working on the street accessing this service. Indeed one respondent suggested that on some nights they may not even see one woman. A fluctuation in numbers was also reported with variation in terms of the season, with a number of respondents reporting an increase in women involved in prostitution around Christmas (due to financial pressure).

However, overall this decline in numbers on-street was seen by most interviewees as being more about reduced visibility, owing to a change in the way in which on street working is organised. Increased use of mobile phones, and the internet/e-mailing, as a way of contacting clients and arranging on street pickups was suggested by several interviewees as contributing to lower visibility of prostitution activity. This led interviewees to suggest that there may well be more women working than they were currently aware of. Whether some of the decrease has been by way of displacement indoors was unknown. However Police Scotland suggested that movement to certain types of indoor venues (such as saunas) would be too difficult for many women on the street, owing to chaotic lifestyles, which would preclude them from becoming involved in indoor work requiring shift-work.

A recent scoping exercise on street-work has also revealed that women in Leith are now working from an area some distance where the mobile units park. It is therefore suggested that women don't access the units as they are too far away, and in an isolated area. Unfortunately, support providers are unable to park closer to the women due to the objections of local residents. A review of services and their locations is currently underway, but it may be the case that there are more women on the streets than previously thought, now that areas most commonly used have been identified.

Estimates for numbers involved in the indoor market were seen as even more problematic. Police Scotland reported that they generally reacted to intelligence received, and therefore would be unaware of activities where no intelligence was provided. However, the indoor market was generally regarded as being far in excess of the on street market. One NHS interviewee estimated that there were approximately 130 women involved in prostitution within the sauna environment in an average week ^[64] . In addition, large numbers of women advertise online, with an estimated 300-400 online adverts every week. Many of these women are often transiently in the location, making it difficult to make contact with them and offer available services.

Within the indoor market itself, interviewees reported a significant shift in ways of working. There has been a move away from saunas in recent years leading to more women working in private flats, using the internet to advertise themselves and social media. This shift was seen as challenging in terms of service provision and being able to offer support and raise awareness of services available. However, the Women's clinic regularly text numbers from adverts selling sexual services to highlight available services and encourage women to self-refer.

Overall these changes in arranging the sale of sex through the use of technological developments were seen as increasing difficulties both in terms of identifying and reaching women involved in prostitution to offer services and support, and providing accurate estimates of numbers. One respondent also highlighted how the expansion of the use of apps to organise the sale of sex had made it more difficult even than online advertising on certain websites.

A key issue to emerge from the interviews was the different profiles of women working on the street, compared to those working indoors. Street workers were typically seen to be older, the vast majority Scottish, and also the vast majority (Police Scotland estimated 90%) were characterised as having serious drug addictions - in particular intravenous drugs. Their lives were typically seen as chaotic, and were identified as an extremely vulnerable and 'desperate' group.

Indoor workers were viewed as being a significantly more mixed group, indeed a common view was that there was a much lower proportion of Scottish women, with many being Eastern European. Women's clinic data from 2014-15 show that 43% of women attending are non- UK (majority Romanian) and 56% are from the UK ^[65] . Those from outside of the UK were also generally younger. This combination of factors was highlighted as making them more vulnerable, as they often had no established support networks in place. In terms of drug addiction, there were mixed views. While some thought that drug addiction was not such an issue in the indoor market, others believed that it was still prevalent. However in terms of those involved in prostitution in the indoor market, substance misuse was generally described as involving non-intravenous drugs, with a higher consumption of 'party' drugs, or alcohol. The indoor market was seen as significantly more diverse, with women from a wide variety of backgrounds. This group was also seen by some interviewees to be more transient, with some women moving from place to place frequently. Indeed women involved in prostitution were identified as often moving around Scotland and elsewhere in the UK with some identified as having entered Scotland via other European countries. Across both the indoor and street-work sector mental health issues and vulnerability among women involved were identified as being a significant issue in terms of support needs.

In relation to men involved in prostitution, who sell sex, the age group involved was reported to have changed over time, with a shift from the under 20's, to 20-40 year olds, with a move away from the sector being predominantly made up of what were described as 'rent boys', to an older group who often have stable jobs and accommodation. It was also suggested that for many men, involvement in prostitution is described as short-term and transitional. However, overall it was also highlighted that there are a number of gaps in understanding regarding this population in terms of numbers involved, personal circumstances, drivers and support needs.

Glasgow

Structure of service provision

The approach to support services for women and men involved in prostitution in Glasgow has changed over the last 5-10 years. Glasgow used to have a centralised model of support services where health checks, methadone clinics, addictions' support, social work, psychological support and housing were accessed from within a centralised location. Health and addictions services are now accessed through non-specialised mainstream provision in community settings and the centralised service focused on helping people to exit prostitution through the development of individual care plans. This means that there is no consistent service-user trend data over the time period, and although there are perceptions of a reduction in street based prostitution, it is not possible to compare the number of people using services. Because services have historically been focused towards prostitution in street-based settings, it is also not possible to provide estimates of the numbers and trends in people involved in indoor prostitution.

Current knowledge re the scale and nature of prostitution and the identification of gaps

Police officers, and support services perceived a reduction in the amount of street-based prostitution in the last 10-15 years. Some research participants suggested that these perceptions may have been affected by changes the ways in which sex is sought, advertised and arranged and also by the design of support services, rather than an actual reduction in the scale of the activity.

For example, some respondents advised caution when relying on observational data because there may have been a displacement of prostitution from visible 'street' settings to less visible 'indoor' settings. This move away from outdoor settings may have been prompted by the growing use of smartphone apps to set up meetings, which means there is possibly less need for buyers and sellers to travel to specific red light areas to buy and sell sex.

As well as an effect from street-based workers moving away from traditional 'red light' areas, there were perceptions that of a growth in off-street prostitution and, possibly prompted by new technology that makes the marketing of indoor prostitution services easier, people from different backgrounds and personal circumstances were now involved in it. Research participants observed that this new group of people seem to be involved for different reasons, with fewer problems with drug addiction and homelessness and possibly had more 'stable' lives, owning properties, having jobs, and families, or had come from other countries or other parts of the UK to work in Glasgow, sometimes temporarily.

'Routes Out' does not have 24 hour staffing resources to capture comprehensive information equally across all times of the day but its service statistics help to build a picture of when prostitution happens in Glasgow.

This information showed a reduction in the number of attendances at their drop-in service. In 2013/14 there were 608 presentations at the drop-in which reduced to 286 presentations in 2014/15 and further reduced to 114 presentations 2015/16. The individual women presenting reduced from 119 to 80 to 55 over the same period. There was also a reduction in the number of outreach sightings. In 2013/14 there were 233 outreach sightings which reduced to 103 in 2014/15 and further reduced to 52 in 2015/16. The individual women sighted reduced from 66 to 46 to 26 over the same period. Most of these women were in their thirties and forties.

There was a reduction in the volume of prostitution information from Police Scotland. In 2013/14 Routes Out received 167 pieces of prostitution related information which reduced to 108 in 2014/15 and further reduced to 80 in 2015/16. The individual women reduced from 109 to 91 to 53 over the same period.

In response to this Routes Out identified the peak times to be between 9pm and 11pm with activity post-midnight. On 6th January 2016 it launched new operating nights and times, Wednesday, Thursday, Friday and Saturday 9pm - 1am and offers a drop in service at 75 Robertson Street as well as an outreach service between these hours. From 1 ^st April 2016 to 31 ^st August 2016 they have had 251 presentations at the drop-in, (74 individual women) 242 outreach sightings (59 individual women), 75 pieces of prostitution information from Police Scotland (52 individual women) and identified 56 new women involved in prostitution.

Perceptions of police and support workers are also possibly influenced by changes in the design of support services. Changes to these in the last 5 years were prompted by a review of services in 2010 that suggested the existing approach was passive rather than active in nature and focused on minimising the harm but not necessarily focusing on enabling people to leave. Since then, the Routes Out service has included a 'case management' approach, where service users' data is shared among agencies and where people are more formally encouraged to exit prostitution through the development of action plans (although the support services still work on minimising the harms to people who are not ready to leave prostitution.). Some research participants from sexual health and addictions support services suggested that a consequence of perceptions of this more formal 'exit' focus may have been a greater reluctance to use services among people who felt that they were not in a position to consider exiting prostitution at that time.

The mainstream delivery of health and social work services, as opposed to previously specialised services, was also suggested to be a barrier for some people. Some interviewees suggested that this might have led to fewer people disclosing their involvement in prostitution to service providers, because of a perceived stigma associated with it.

For example the Sandyford service sees approximately 60,000 people at Sandyford a year, but only 300 women (out of 40,000) women self-reported being involved in prostitution. Staff believe this is an under-estimation of the real number, and there may be a hesitancy for people to say that they are involved, even in anonymous settings.

Some people, including health workers, social work professionals and other support organisations said that they viewed Glasgow as having more of a 'zero tolerance' approach to prostitution, compared to previous times. This was referring to the active 'exit' focus that is perceived as the focus of services' design, rather than 'harm reduction' that has been more of a focus in the past. Some support organisations said they were frustrated about how difficult it now is to meet people involved in prostitution to provide services, or undertake research in Glasgow because they perceive that this has caused a reluctance among some of the people involved in prostitution, particularly people involved in indoor prostitution.

Despite the perceived reduction in street-prostitution, participants said the locations where it did take place were often the same locations where prostitution had been prevalent historically. In Glasgow, the popular areas for women involved in street prostitution included the business district area directly west of Central station, up to Anderston train station, Glasgow Green and areas of the East End. For men involved in prostitution, Kelvingrove Park remains the main location. The greater use of mobile phones and smartphone apps was claimed to have led to less need for red light areas and locations for meetings can now be more fluid and flexible and located in places that are more convenient for buyers and sellers, for example nearer to buyers' and sellers' accommodation.

Interview participants felt much less informed about the nature and scale of indoor prostitution in Glasgow and Scotland, and had much less experience of providing support services within these settings, and fewer perceptions of its nature and changes over time.

'Outreach' services within the redesigned approach in Glasgow, include on-street support, 4 nights a week Weds-Saturday between 9pm-1am including pro-active contact with, and visits to women and men selling sex in 'indoor settings' (via 'police operation Lingle'), this policing led approach was discontinued with a move towards a more multi-agency support approach embodied within the SHaW ^[66] visits. Because people involved in indoor prostitution may not necessarily want to be contacted by support services, it is a complicated and sensitive area of work that is perceived to be an important priority for future services. A consequence of this is that it is not possible to use data from past work of this sort as a means of calculating the numbers of people who are involved in off-street prostitution.

Research participants were generally wary of making estimates based on official police data or observational data of their own, and they said they were even less confident than they might have been in the past about making estimations of the scale and nature of prostitution in Glasgow.

Although this research is therefore unable to provide accurate estimates of the levels of activity, it has found perceptions changes in the environments where prostitution happens. Concerns were frequently expressed about this gap in information about the scale and nature of indoor prostitution and the consequences this evidence gap has for the appropriate delivery of support services to the people involved in it.

There is little available data on the number and profile of men involved in prostitution in Glasgow, but police officers and support workers recognised some of the same patterns in changes in visible activity. In previous times there were certain locations within the city where male prostitution was prevalent. The number of people who are involved in selling sex in 'on-street' settings has however much reduced, although there is still some activity in the traditional locations, and the phenomenon is increasingly 'indoors'. This has meant that it is difficult for workers to estimate the number of people involved, their backgrounds, needs and to offer support services to them.

Common Issues Identified Across All Four Areas:

While each city has different features in terms of rates of offences related to prostitution as well as the structure of service provision developed in response to the particular characteristics of the local area, a number of cross-cutting issues were identified in relation to estimating the scale of prostitution, change over time and understanding the profiles and characteristics of those involved. The remainder of the report therefore discusses key cross-cutting themes that were identified across areas.

Methodological difficulties in estimating prevalence of prostitution

It is difficult to attach estimates of prevalence in prostitution (for women and men involved both on-street and off-street) partly due to the stigmatised and largely 'hidden' nature of prostitution and for a number of related methodological reasons, including that individuals involvement may be intermittent and transient, with women and men dipping into and out of involvement depending on personal circumstances. In addition involvement may fluctuate depending on the time of year and in response to perceived increased demand ( i.e. attached to events which involve a large influx of visitors to a city) or at times of increased financial pressure ^[67] .

Decline in on-street prostitution

While it is difficult to attach firm figures to the scale of street prostitution, the numbers are widely reported to have declined in the traditional red light districts across the four cities over the last few years. Mobile phone and online technologies are generally identified as the key driver behind this shift from on-street to off-street prostitution, having enabled more discreet methods of arranging the sale and purchase of sex, with less risk of police contact and possible prosecution. However, Alcohol and Drugs Action also highlighted the importance of better access to drug treatment, recovery and other key services to address underlying reasons for working as being important. For some women this meant a reduction in involvement rather than complete cessation ^[68] .

Some fluctuation in on-street numbers was also highlighted ( i.e. in Dundee there had been a recent slight increase involving women who had previously reduced involvement or had exited prostitution and were impelled to engage in street prostitution again due to hardship caused by benefits sanctions). Further complexity was recognised in Edinburgh and Aberdeen where limited evidence suggested that there may have been a degree of dispersal or shift in the location of on-street prostitution activity resulting in lower visibility.

Women who continue to sell sex on-street (or were street-based in earlier years and had moved to off-street work organised by mobile phone) were identified as having a range of vulnerabilities and complex needs. Common issues faced were alcohol and serious substance misuse problems, lack of secure accommodation, mental health problems and often backgrounds of deprivation and abuse. This is encapsulated in the description of the expert group on prostitution in 2004 that on-street prostitution should be seen as '..a means of survival by people with accumulated personal difficulties' ^[69] .

Estimating the scale of indoor prostitution

The scale of indoor prostitution, which is now thought to comprise the vast majority of the market (Police Scotland estimated this to be 90% of all sex sold in 2014), is much less visible than on-street activity and therefore commonly acknowledged as even more difficult to estimate. One method which gives a sense of the numbers involved is via the analysis of online open-source advertising ( i.e. via the main escort sites). However, attached to these figures are a number of important caveats: there is likely to be a degree of duplication ^[70] and they do not include those advertising via other means, or not advertising at all but nonetheless operating indoors ( i.e. with arrangements made via mobile phone or working within saunas or brothels). In addition the picture often changes rapidly, with websites constantly being updated with new profiles, and new websites emerging. It can therefore only provide a 'snapshot' in time of one particular, aspect of the market (which could be described as more formal or structured).

Provision of support to those involved in indoor prostitution

The shift from on-street to indoor prostitution has precipitated recent changes in approach to engaging with those involved in prostitution. For specialist support services this has, in a few cases, resulted in the reduction or closure of night-time drop in services (due to decreased demand), and more targeted outreach ( i.e. to saunas as well as red light areas). Attempts were also being made to promote available support services across key agencies, to increase the number of referrals, as well as to reach those involved in indoor prostitution who advertise online, to promote available support and services ^[71] . In addition, a recent initiative to provide support and assess the safety and wellbeing of those involved in indoor prostitution, involving close partnership between police, sexual health services and key agencies, is currently operating in Glasgow and Edinburgh (with evaluation on-going to inform a planned wider roll out in Aberdeen and Dundee) ^[72] . The SHaW ^[73] initiative, involves health professionals and police visiting flats where police intelligence has been provided ^[74] , to ensure safety, offer welfare support (of varying kinds including substance and alcohol use, sexual health, mental health and social support) and help women link in with available services.

Understanding the profiles and key characteristics of those involved in indoor prostitution

Although based on limited evidence across the four cities ^[75] indoor prostitution is widely understood to involve a higher proportion of foreign nationals than on-street prostitution. This is supported by information from the Women's clinic, whose service users are mainly indoor workers, a high proportion of whom are from outwith the UK ^[76] (with the caveat that women attending the clinic may not be representative generally of those involved in prostitution). It is currently not possible to say what proportion of those involved are not from Scotland or the wider UK, or indeed how this compares with the past due to a lack of measurement or previous baseline. Furthermore while on-street workers were broadly characterised as a particularly vulnerable group, often coming from backgrounds of accumulated disadvantage and deprivation, some suggested that the indoor market involves a more diverse group, with women coming from a wider range of socio-economic backgrounds.

In terms of other key characteristics, again based on limited evidence (of those police, health and third sector support services have come into contact with), it is suggested that drug and alcohol misuse problems among those working indoors, although prevalent and often concerning ^[77] , is less likely to involve intravenous drug use (although this broad characterisation of 'indoor' does not necessarily include those who previously operated on-street and had moved to indoor prostitution organised online or by mobile phone).

However, a number of research participants contested the distinction between two distinct and homogenous profiles of 'chaotic' on-street and 'more stable' off-street workers, and said there was a diverse, shifting and overlapping continuum of reasons and vulnerabilities behind why people become involved in different settings. A few respondents highlighted how women may move to off-street work as their lives become more stable, and depending on personal circumstances ( i.e. receiving treatment for addiction, receiving secure accommodation, access to a phone/internet access, all factors which may circumvent the need to engage in on-street prostitution).

Current gaps in knowledge and challenges in the provision of support

Thus there was a general consensus among a number of respondents that there are a number of gaps in terms of knowledge of indoor prostitution, in relation to the numbers and profiles of those involved, and the nature and extent of their support needs ^[78] .

In terms of off-street workers, a number of respondents expressed concerns regarding their welfare, particularly as a high proportion are currently not accessing support or assistance despite the risks associated with prostitution ( i.e. in terms of violence/sexual violence and sexual health risks). This was highlighted as a particular concern for those from outside the UK, who may face a number of barriers including language difficulties or cultural barriers in accessing assistance. In addition, there is also recognised to be a high degree of mobility among some of those working in the indoor market, who may work in different locations across Scotland, the wider UK, or Europe for short periods of time, with implications for consistency of support and the provision of services. Overall a number of respondents expressed concerns that a lack of awareness of key services and support available meant increased risk and vulnerability for those involved.

Pathways and personal circumstances

Based on knowledge of those (mainly women) that agencies and key services had supported, and acknowledging that there may be a large proportion of those involved in prostitution who are currently not accessing support, a number of key pathways/reasons for involvement were cited with the need for money being the key overall driver. Although the range of factors cannot be considered representative or indeed comprehensive ^[79] , they do provide an indication of some of the circumstances which might lead to involvement, based on the professional experience and insight of those who provide support services. An important caveat to highlight is the recognition that a key part of the picture (the first-hand experience of those involved) is missing from this account. Furthermore, although certain factors were highlighted within the context of on-street or indoor prostitution, it is reasonable to infer that many aspects may be relevant across both, to varying degrees.

First of all in relation to street prostitution which is broadly characterised as survival behaviour among women from local areas of deprivation (usually to fund serious addictions), the following pathways or circumstances leading to involvement in prostitution were cited as important by respondents:

• Insecure accommodation and particularly the hostel environment was identified as significant, with other women encouraging involvement, or alternatively women being groomed by a partner to feed a drug habit. In terms of the latter, some men were said to be keen to become involved with women selling sex as they were known as an 'earner'. (Third sector support). Indeed homelessness was identified as a common risk factor 'with women looking for a place to stay having to…exchange sexual favours to have a bed over them.' (Third sector support)
• A more gradual and subtle grooming process through gifts and alcohol was also highlighted, a common scenario described as being 'they weren't pimped or pushed out on the street but they stayed at someone's house when they were 14 and the guy was really nice to them and said look you can stay here as long as you want and help yourself to drink and then it became - "but you have to have sex with me for that". (Third sector support).
• Also cited as important was the context of the family, with some women coming from backgrounds where there has been alcohol or substance misuse across different generations, and who may have had a drug or alcohol problem since their teens. In some cases 'normalisation' of prostitution through family members i.e. through mothers or siblings involvement was identified. (Third sector support and Local authority).
• Experience of local authority care was noted as a key factor in increasing the risk of sexual exploitation, and young women and men (over the age of consent) in 'transitions' from care services, who were targeted by purchasers of sex, because of their vulnerabilities. (Third sector support and NHS)

In terms of indoor prostitution, those involved are identified as a more diverse group in terms of backgrounds, nationality and socio-economic status. Although key gaps were identified in terms of an in-depth understanding the circumstances of those involved, particularly in terms of their support needs, generally speaking women working indoors (in saunas, flats, escort agencies etc.) were characterised as having more stability in their lives. Indeed they are often required to turn up for shifts and participate in a rota (with failure to do so often resulting in a fine or dismissal). What follows is therefore a very limited illustrative outline of some of the key pathways/reasons for involvement in prostitution according to respondents who have regular contact with women:

• Some women arriving from outside the UK faced who faced difficulties upon arrival in terms of finding employment and secure accommodation ended up becoming involved in prostitution, while others had moved to Scotland with the specific purpose of working in prostitution as it was perceived to be lucrative. (Third sector and police)
• Although the level of involvement is hard to gauge, students involvement in prostitution for income or to fund their studies was highlighted, with 'sugar daddies' identified as a particular form of prostitution ( i.e. whereby some would receive a monthly allowance or gifts in exchange for dates and sex). (Third sector support and strategic organisations)
• Previous convictions (for often relatively minor offences such as shoplifting), were identified as a barrier to alternative employment, with some women unable to find a job and worried about disclosure. Common scenarios identified were someone who was previously working in the field of healthcare, education, childcare, social care background and had subsequently moved into prostitution. ( NHS and third sector support)
• In terms of those who accessed specialist sexual health services ^[80] , many reported working to pay their mortgage. Some also have regular employment in addition to selling sex and are engaged in prostitution to achieve a financial target and then exit once they have achieved their goal (sometimes temporarily). ( NHS)
• One agency reported having worked with women who are forced or coerced into prostitution by pimps or partners. The support worker described these cases as often challenging and complex because 'sometimes it's quite subtle so we might meet a woman and she might say I have a really good friend and actually when we get to the bottom of it that person's taking 50% of the money they're making and they're really the person who's taking them to work and picking them up at night or that kind of thing. So we tend to find that a lot of the women we work with don't just face abuse from a partner but they face abuse from a partner who's forcing them to work in prostitution.' (Third sector support).
• Anecdotal links were also highlighted in terms of lap-dancing and webcam work as an access point for men to make contact with women and for women to become involved in prostitution. ( NHS and third sector support).

While these factors give an illustration of some of the pathways, reasons and circumstances cited by key agencies for women's involvement in prostitution they are by no means comprehensive or definitive. Some research participants contested the distinction between two distinct profiles of 'on-street' and 'indoor' workers, and said there was a diverse and overlapping continuum of reasons why people might have been involved in different settings. In addition, these reflections are necessarily limited in that they are based on women who have contacted agencies for support and have disclosed some of the reasons behind their involvement. However, they echo many of the key processes cited within the wider literature which lead to involvement in prostitution ^[81] . Overall, financial pressure for a range of reasons, and inadequate income, either due to low pay or benefits issues (highlighted as having been recently exacerbated by welfare reform for a number of women) were cited by a range of respondents as key in understanding why many seek to generate an income through involvement in prostitution in the absence of alternative options. In addition, a number of third sector and NHS respondents said that having a history of vulnerabilities is common among women they support (with a range of causes including substance use, alcohol, mental health, past history of trauma/abuse/gender-based violence).

Young adults and vulnerable people

We heard evidence of the payment for sex from people from vulnerable backgrounds and settings ( e.g. looked after and accommodated children, young adults and other vulnerable people). In Scotland 'vulnerable young people procedures' include support for young people up to 21 years' old and child protection and health workers were aware of the 'grooming' of people for sex from these backgrounds. Although some of the young people (young women and men) in this group may be above the age of consent, in workers' experience these interactions were exploitative and typically involved informal and manipulative arrangements for setting up situations - 'networking' through friends and acquaintances, arranging 'parties', gradually introducing people to alcohol, drugs and sex, 'peer abuse', and using gifts or payment in kind for sexual services.

These participants recognised threats of exploitation to 'looked after' young people, and vulnerable adults, and also that technology has created more opportunities for manipulation through phones, messaging, gaming software and the anonymity and control that they enable. There were also perceptions that this puts a far larger group of young people (over the age of consent), including those not necessarily previously considered to be in a vulnerable situation, at risk of being manipulated into prostitution.

Impact of Involvement in Prostitution: Risk and Health and Wellbeing

The following section considers the impact of involvement in prostitution on health and wellbeing, with a particular focus on the risks associated with violence and victimisation and sexual health. It also touches on some of the more general and longer-term health impacts highlighted by respondents. A key caveat at the outset is that these findings are based only on the professional insights of those that come into contact with people involved in prostitution through the criminal justice system (police and social work) or through the provision of support and key services (third sector specialist and NHS). It is therefore recognised that this may only present a partial picture of those who require or have sought particular kinds of support or assistance. Indeed, there may be some groups whose experiences are not reflected (this is particularly the case for the indoor market where a number of gaps in knowledge have been identified). However, the Women's clinic and related support organisations providing a wide range of services to high numbers of women annually, were able to offer useful insights into this area ^[82] . In addition, many of the respondents had an in-depth knowledge of these issues, often built up over a number of years.

Violence and criminal victimisation

The numbers of those working within prostitution who are victims of crime ( i.e. in terms of physical or sexual assault) are not routinely analysed ^[83] . There were perceptions among police respondents that experiences of violence and sexual victimisation were common for this group of people, but also that rates of reported crime were low compared with the real risk of victimisation. This was perceived to be pronounced for reported crime in relation to the off-street industry.

Overall, a number of police respondents also noted that while reports of sexual and other violent crime were often reported by women in relation to men who purchase sex in the on-street industry when it was more prevalent (albeit at a low level), it was suggested that similar reports in relation to the off-street industry were even lower by comparison. Police in Aberdeen also mentioned the issue of clients being victimised which were also generally not reported in relation to the off-street market ^[84] . The lower frequency of reported crime in relation to this was generally identified as a concern and attributed to under-reporting for a range of reasons. To improve rates of reporting in relation to indoor prostitution, Police Scotland emphasise the importance of improving trust and better communication between police and those involved (Strategic policy).

A number of police officers who responded identified one of the key reasons for under-reporting as being related to the stigma associated with prostitution. One police street liaison officer who described street prostitution as dangerous and suggested that women face abuse on a daily basis, argued that this stigma led to women seeing themselves as unworthy, and a subsequent belief that they may not be believed and assisted by police if they do report an offence. This was echoed by a sexual health practitioner with experience of supporting women within the criminal justice system: 'I think the police at the moment are working really hard to get rid of that picture that a lot of females have that they wouldn't be helped, but they're ashamed of themselves and because they already have this picture of themselves as being the lowest of the low for selling their body and doing what everyone says is a horrible thing to do, they wouldn't speak to the police, they wouldn't go to the police' ( NHS).

Similarly a third sector support worker in another area highlighted that there were significant levels of rape and violence experienced by women they have supported through their service. She noted that when she started: 'I was horrified at the levels of violence that these women were experiencing'. Despite the seriousness of the offences, she highlighted how often, women would not report incidents to the police, due to the fear of being criminalised.

In terms of levels of violence against women involved in street-work, it was suggested by a number of respondents that most have had experiences of some sort of violence ranging from verbal threats and abuse, through to sexual violence and assault. The experiences of those working within indoor prostitution were identified as more 'unknown' by a range of respondents. Indeed, a few third sector organisations and some NHS respondents with particular experience of supporting those involved in on-street prostitution noted that because of a lack of knowledge of those operating in the indoor market, it was currently difficult to comment on the prevalence of physical and sexual violence and to quantify risk among this group. However, a number of respondents including NHS specialist sexual health practitioners and third sector support workers who regularly provide support and assistance to those involved in indoor prostitution agreed that violence and abuse of women working within this context was also common.

All third sector specialist support organisations and NHS sexual health services therefore, as part of their core approach work closely with the police in this respect and encourage reporting whenever possible (also acting as a third party reporters where individuals do not wish to have contact with the police, often offering access to the Ugly Mugs scheme ^[85] ). Despite this encouragement, a number of respondents highlighted the reluctance of women to report to the police with one suggesting that some women were almost inured to the risk of violence: 'I think it's very unreported because it's almost seen as part of the job, part of the hazards'. (Third sector support). This point was reiterated by a specialist health practitioner who suggested that often women think 'well he's paying for it, therefore I just have to put up with it'. She also suggested that, related to this, many do not identify incidents of assault as such until: 'often one of us points out that what happened to them wasn't acceptable that that is assault, but often they don't see it as assault and they don't have the self-esteem to value themselves enough.'

One third sector support organisation which provides outreach to women involved in on-street prostitution described street prostitution as risky, not just in terms of abuse from some men who purchase sex but also from members of the public (women were known to suffer frequent verbal abuse and some physical abuse, i.e. having things thrown at them whilst working etc.). In addition, the personal circumstances (typified by chaotic drug and alcohol use) of those who typically engage in street work, was commonly highlighted as making this group particularly vulnerable to assault and attack.

In terms of indoor prostitution, it was felt that there were still high levels of risk, but levels of knowledge were lower and information sharing more difficult. This was a commonly voiced concern, with a number of respondents highlighting how the lower visibility of prostitution now makes it more challenging to identify and engage with those involved.

This was also highlighted in relation to of male prostitution, where it was suggested that it has become more challenging to reach those involved and get safe sex messages across. It was suggested that men involved in prostitution who sell sex may therefore be at increased risk of mental and physical harm. There is also an awareness of a proportion of unreported incidents of physical and sexual violence in relation to male prostitution, with work on-going to try encourage and support men to report such incidents.

One police respondent highlighted overall that, because a high proportion of those now working within the sex industry are migrants from outwith the UK, many face language difficulties and barriers to accessing assistance which may be compounded by a lack of awareness of key services and welfare benefits. These factors may therefore increase the risk for those involved. Indeed, it was suggested that in terms of off-street workers, the fact that many receive no assistance whatsoever leaves them vulnerable.

Sexual health

Sexual health risks in terms of unintended pregnancy and sexually transmitted infections were also identified as an area of concern among a number of respondents. The ability to negotiate safe sex and deal with pressure from some purchasers to have unprotected sex (for which women could usually receive higher remuneration) was highlighted as particularly difficult for certain groups of women.

The Women's clinic reported seeing a recent slight increase in serious sexually transmitted infections between 2014 and 2015 ^[86] . This was thought to be due to demand from some men for unsafe sex, as well as some women's lack of understanding of risk and lack of ability to negotiate condom use. Another possible factor highlighted was that some of the managers of off-street venues ( i.e. saunas) are described as reluctant to keep condoms on site. While NHS Lothian regularly supplies condoms to women working within saunas on a weekly basis ^[87] , the managers may not retain the stock, which means that not all women may have access to them following the staff outreach visits. It was also suggested that fewer customers within the sauna environment ^[88] since the removal of licenses, may have increased pressure on women to engage in risky behaviour for money ^[89] .

The pressure to engage in unprotected sex was highlighted as being even more acute for women with addiction issues, as described by one sexual health practitioner: 'A lot of females report getting more money for unprotected sex and if they're desperate, if they have habits that often happens and when I speak to them once they're stable…they all recognise that it's risky behaviour, but they all say - I needed the money'.

Another group who were identified as particularly vulnerable by the Women's clinic, are migrant women with poor or basic English, who may be subsequently unable to negotiate sexual terms and conditions such as condom use, and types of sexual activity. These women are then liable to manipulation and exploitation by the men who pay for sex. They are thus at risk of unintended pregnancy and sexually transmitted infections, blood borne viruses and HIV. Indeed comparative statistics from the Women's clinic based on a study of 100 women attendees showed that those involved in prostitution from outwith the UK are younger - a majority (76%) were aged under 25 compared with 22% of UK women. They also had higher rates of unintended pregnancy as well as rates of gonorrhoea, hepatitis B and syphilis in comparison with women from the UK ^[90] .

General and longer-term impacts

In terms of the more general impact and longer-term involvement in prostitution, a number of respondents from the third sector and the NHS (providing a range of assistance to women involved in both indoor and on-street prostitution), highlighted risks to mental health, in terms of stress, anxiety and depression and the escalation of alcohol or substance misuse. However, in relation to the perceived link between involvement in prostitution and mental health a few respondents highlighted how this is complex and that many women who sell sex have problems and vulnerabilities which precede involvement in prostitution ( i.e. mental health problems and/or drug/alcohol misuse), which may be exacerbated by the experience of selling sex.

One specialist sexual health practitioner with experience of supporting high numbers of women described how mental health could be adversely affected: 'In the longer term it can be very damaging because a lot of it is about appearance and being chosen…. And it doesn't do much for their self-esteem and that can press buttons for many of them with eating disorders' In addition, she emphasised how assault within indoor prostitution was also common, with resulting trauma, frequently exacerbating existing problems: 'often there's a background of gender based violence…and a lot of the way men treat them taps into these traumas and vulnerabilities, so….you can find an escalation in alcohol use because that's the only way they can get through their shift is to drink or to take some other illegal substance. So mental health problems are common.' Indeed this practitioner estimated that the majority of women who access services have mental health problems and other vulnerabilities. However a campaigning organisation highlighted the complexities around the link with mental health issues, suggesting that some may enter prostitution because of mental health problems, which prevented them from accessing other types of work, rather than necessarily developing them as a result of involvement.

Another third sector organisation who have supported women involved in on-street prostitution for many years highlighted that for women who have exited, the impact of their involvement can be significant. Key issues identified were fear (often of being recognised by a former client for women who have moved on), shame and how to reconcile this, and mental health problems:

'What we've seen recently is, I suppose a sign of the project being around (for a number of years), is that we've seen women who, life was okay, they've got out of prostitution, they've got their lives sorted, and they just want to stop. They don't want to engage any further. And a year or so later coming back because they're having flashbacks, they're having panic attacks. And really struggling to deal with the fact that they had contact with men who they didn't want to have sex with. So it was in their eyes, unwanted sexual contact, but there was not another option at that time. That while they consented to it, they didn't want to do it. So the long-term cost to women can be significant.' (Third sector support).

Two third sector support workers based in different cities identified how a lot of women currently or previously involved in street prostitution, because of chaotic lives (and alcohol and substance misuse) are often isolated from families and friends and have experienced relationship breakdown, with children having been removed and taken into care. However, it was also noted that these damaged relationships may not necessarily be because of prostitution (indeed often families and friends may be unaware of it), but around wider substance misuse and offending behaviour.

It was further highlighted by one respondent with specialist knowledge of addictions, that while the picture is complex, engagement in prostitution often compounded problems for those women who have drug and alcohol addictions. Therefore recovery could be made more difficult as alcohol and drugs are often used as coping mechanisms to deal with involvement in prostitution, with assault and trauma commonly experienced.

Less vulnerable people and managing risk

While the majority of respondents acknowledged the risks and negative impacts of prostitution, it is important to note that one NHS sexual health practitioner with experience of providing services to high numbers of women over a number of years highlighted how there are a few women who would prefer not to be described as vulnerable: '….they feel they have made choices for whatever reason, and they are very comfortable with what they are doing, they are very safe, they've got layers of safety from a physical health point of view, to stop themselves getting infections, or getting assaulted or having an unintended pregnancy.' This worker also highlighted that some of the women they encounter have a job and are involved in prostitution as an additional source of income. However, these women were identified as being in the small minority of those seen, approximately constituting around 10-20% (although caution should be attached to this figure based on the informed estimation of one practitioner).

Thus it is suggested that there may be a proportion of those involved in prostitution who are less vulnerable to risk for a range of reasons. While it is unclear as to why this should be the case, one possible explanation for this was put forward by a respondent who suggested that that online methods of advertising and arranging meetings with purchasers had potentially improved safety due to the ability to 'vet' clients and request proof of identify ^[91] . In addition online innovations such as forums for sharing advice on safer working practices as well as Ugly Mugs alerts were also highlighted as positive.

It is not possible to say what proportion of the wider population of those involved in prostitution are similarly 'comfortable' and able to manage risk in this way, however it should be noted that the 10-20% estimate refers only to those women who attend specialist services (and therefore may not necessarily be representative of the wider group who are not currently accessing services).

In relation to risk, a number of respondents from both campaigning organisations and the third sector raised the issue of how the context in which sex work is undertaken increases or decreases levels of risk. Indeed several highlighted how current legislation around brothel keeping criminalises women who are working together for safety: 'they're getting criminalised for something, which is essentially a kind of survival tool'. (Third sector support). However, there were divergent views among some respondents in terms of whether (regardless of the mitigation of short-term risks of violence, assault and sexual health through certain working practices) there are inherent longer-term harms caused by involvement in prostitution. On the whole however, most respondents who provide services and support to those involved in prostitution emphasised a range of risks and adverse impacts associated with prostitution in the short and longer term, in relation to general and mental health, safety and wellbeing, and sexual health.