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

Question 1. Scale and nature of prostitution

• How many women and men are currently estimated to be involved in prostitution Scotland-wide (and broken down by the 4 largest cities, Aberdeen, Dundee, Edinburgh and Glasgow).
• What is the current composition of the 'sex industry' in terms of the proportion of people involved in selling sex within indoor and outdoor (street-based) prostitution and information on location.
• An assessment of how robust the intelligence is regarding the indoor and outdoor markets.
• Any assessment of change over time in terms of an increase or decrease in prostitution/demand for prostitution (and perceived reasons for any change).
• Any information available on the profile of those involved in prostitution in terms of age, country of origin and personal circumstances and the pathways and circumstances of those who enter prostitution
• The impact of involvement in prostitution on risk and health and wellbeing
• Current priorities for policing/local authorities and community partners regarding prostitution.

Main findings

Estimated numbers of women and men involved in prostitution Scotland-wide and broken down by the largest 4 cities

• There are no available robust data sources to tell us definitively about the women and men involved in prostitution, their backgrounds, different prostitution markets or the impact on health and wellbeing. There are however some limited data sources and reflections of professional support organisations and groups that provided us with views on our questions, and perceived changes in trends and evidence gaps. This is based on observations and reflections from professional practice.

Composition of the 'sex industry' in terms of indoor and outdoor prostitution

• Police data has shown a reduction in prostitution related crimes and public complaints about prostitution in the 4 main cities over the last ten years. Police interviewees also confirmed that these statistical changes reflected their experiences of policing prostitution. They said prostitution in public settings had reduced considerably in the last 10-15 years. This may have been because of a growth in off-street prostitution driven by the internet, and smartphone apps, that have enabled more discreet methods for arranging the purchase of sex, with less risk of police contact and possible prosecution. The people who used to work 'on-street' therefore may now be working 'off-street' and setting up meetings online or via mobile phone.
• It was also suggested by specialist support services in Aberdeen that there is strong evidence that the reduction in on-street prostitution may also be partly attributed to improved access to drug treatment services, reducing many women's need to engage in street prostitution on a daily basis to finance a drug dependency ^[6] .
• Research in 4 main city locations has shown that police, local authority, health, third sector and campaigning organisations also recognised this general trend in the reduction in on-street prostitution. However, some fluctuation in on-street numbers was also highlighted ( e.g. 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 ^[7] ). 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.
• While there were some differences in the nature of the policy or service response to dealing with prostitution, developed in line with local priorities and to meet local needs and problems, there was a lot of similarity among the various local profiles of prostitution. Similarities were observed in relation to overall trends and changes over time, the pathways and personal circumstances of people involved and the impacts.
• The police also recognised that as well as this, there is a large group of people involved in prostitution, possibly with different backgrounds, who work indoors ( i.e. within private flats, saunas or hotels - currently estimated to constitute approximately 90% of the market) and may have never been involved in on-street prostitution.
• A number of respondents identified the importance of developing better knowledge and understanding of the scale of the indoor prostitution market and the support needs of those within it, given the lack of robust and reliable information.

Profiles, pathways and circumstances of those who enter prostitution

• People who continue to sell sex 'on-street' were perceived by organisations to have a range of vulnerabilities and complex needs, commonly including alcohol and substance misuse problems, lack of secure accommodation, mental health problems and often backgrounds of deprivation and abuse. Some organisations referred to on-street prostitution as 'survival behaviour'.
• Research participants had less information about people involved in prostitution in 'indoor' settings. However, there were some indications that a higher proportion of foreign nationals are involved ^[8] . Some respondents said they believed there were fewer alcohol and drug problems within this group, although others noted that drug use is still concerning, but is less likely to involve intravenous use than within the on-street market. It was also suggested by some participants that people involved are drawn from a wider range of socio-economic backgrounds. However, other 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 explaining why people might have been involved in different settings. Indeed 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, having secure accommodation, access to a phone/internet access, all factors which may circumvent the need to engage in on-street prostitution).
• Overall, there was concern from police and health workers that health and safety support services are less available for those involved in indoor prostitution, because they do not often use 'drop-in' services and are less easy to identify and promote/offer services to.
• Views on the pathways, reasons and circumstances cited by key agencies for women's involvement in prostitution are by no means comprehensive or definitive. 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 do echo many of the key processes cited within the wider literature which lead to involvement in prostitution ^[9] . Overall, financial pressure for a range of reasons, and inadequate income ^[10] , commonly combined with having a history of vulnerabilities (with a range of causes including substance and/or alcohol misuse, mental health problems and a past history of trauma/abuse/gender-based violence) were cited by a range of third sector and NHS respondents as key in understanding why many seek to generate an income through involvement in prostitution.

Impact of involvement in prostitution on health and wellbeing

• Information about personal health and wellbeing impact was based 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). This may therefore only present a partial picture of those who require or have sought particular kinds of support or assistance.
• 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. Police Scotland therefore recognises the need to work collaboratively with health and other partners to encourage reporting, particularly among harder to reach groups.
• A number of reasons for under-reporting were cited including the stigma of being involved in prostitution, fears of complaints not being investigated seriously, fear of being criminalised and the suggestion that some may be inured to the risk of violence and abuse.
• Less 'visibility' of off-street workers was also highlighted in relation to male prostitution, where it has become more challenging to reach those involved and get safe sex messages across. It was suggested that those involved in prostitution may therefore be at increased risk of mental and physical harm.
• Sexual health risks are identified as an area of concern affecting those involved in prostitution. There was evidence raised of perceived vulnerabilities within certain groups of sellers and the possible financial and physical exploitation of people involved in prostitution who sell sex ^[11] . For example, there may be perceived opportunities among some buyers to manipulate and sexually exploit people where there are perceived vulnerabilities, for example those with addictions, those who have poorer language skills ( i.e. among migrant populations), and with people who have less experience or understanding of the risks. In situations like these it may not be as possible for people involved in prostitution who sell sex to negotiate their consent for types of sexual activity and condom use, leading to increased risk of unintended pregnancy, STIs, blood borne viruses and HIV.
• A number of respondents raised longer-term risks to mental health, including stress, anxiety and depression from being involved in prostitution. 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 and further compounded by trauma experienced.
• One health practitioner with experience of supporting high numbers of women involved in prostitution over a number of years said that in her experience, although the majority of women they provide services to experience mental health problems and/or have other vulnerabilities, there are a few women who prefer not to be described as vulnerable and feel they have made choices they are comfortable with. These women were described as taking assertive action to manage risks. In this practitioner's view this was a small minority of the women currently seen and accessing services (although caution should be attached to this estimate being based on the experience of one practitioner). While there is uncertainty regarding the wider proportion who are similarly able to manage risk in this way, there are a range of views on the nature of the vulnerabilities of people involved in prostitution and the extent to which risks are inherent within it.
• 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.

Current priorities for policing/local authorities and community partners regarding prostitution

• A new national policing policy document sets out the current priorities of the police which include focusing on protecting communities and individuals from threat, risk and harm including exploitation, investigating the people who abuse, exploit or coerce, working in partnership with harm-reduction practitioners and supporting research and debate with policymakers.
• Across all areas investigated there was a strong recognition of the importance of partnership working between relevant agencies (including drug and alcohol support and sexual health services) to reduce harm to those involved by improving health, safety and wellbeing and providing assistance to exit. Commonly held priorities are therefore to continue to work in partnership to provide an holistic service to meet the (often complex) needs of women.
• The shift from on-street to indoor prostitution has posed challenges for service delivery and precipitated recent changes in approach to better engage with those involved in prostitution. Reaching those not currently accessing support services within the indoor market was identified as a key priority for a number of respondents.