Insight: The Edinburgh clinic helping sex workers stay safe

Dr Alison Scott of the Spittal Street drop-in centre, a pioneering clinic in Edinburgh which is the only one of its kind in Scotland. Picture: Jon Savage/TSPL

Behind a blue curtain in Dr Alison Scott’s consulting room at the Spittal Street sex workers’ clinic in Edinburgh, pretty Romanian prostitute Denise kicks off her black ankle boots and climbs on to the examination couch. On a table nearby, a colourful array of condoms – sensitive, intense, raised rib, flavoured and “football” (all tastes catered for) – are set out like sweets in a tuck shop, along with a similarly extensive selection of lubes.

Denise, an escort, who lives with her partner, but works from a friend’s flat, has come in today because she wants to be checked for STIs. After taking samples from the patient’s vagina and mouth, Scott, a consultant gynaecologist, checks if she should also swab her back passage. “Oh, I don’t do anal,” she replies cheerily.

Examination over, Denise puts her ripped jeans and lumberjack-style shirt back on and chats to Scott. A former bar worker, she stopped selling sex for 18 months, but has started again because she needs the money. She sees one to four men per shift and always uses a condom, but would like to go back on the pill for sex with her boyfriend. Asked about any recent changes in her life, Denise mentions her mother’s diabetes. But then Scott notices a photograph of a little girl on her phone. “Have you had a baby?” she inquires. Denise says, actually, yes, she has. Now 11 months old, her daughter Louisa explains her short break from the industry. And also, one assumes, her return to it.

The drop-in centre offers advice, support and health checks to sex workers. Picture: Jon Savage

Scott’s drop-in clinic is the only one of its kind in Scotland; as it prepares to mark its 10th anniversary, I have been granted unprecedented access to the work it does with the city’s sex workers. Housed in a converted church, alongside NHS Lothian’s harm reduction team and the Edinburgh Access GP practice for the homeless, it takes a holistic approach, combining sexual health screenings with other services: a needle exchange, psychological counselling, and the Scottish Association for the Care and Resettlement of Offenders’ (Sacro) initiative Another Way, which provides advice on housing, benefits and exiting the sex industry.

Just a block away lies Edinburgh’s notorious pubic triangle, a junction on which three lap dancing clubs vie for seediness. On West Port, the Western Strip Bar, with its saloon-style facade, has a board reading “Stag Parties Welcome”; across the road, Baby Dolls, No 1 Showroom, all flaked paint and neon tube signs, faces off against Burke and Hare, its name conjuring up slabs of meat on an autopsy table. Here, though, the women are treated with respect; the clinic may have a tight budget (the examination couch in the room next to Scott’s is a dental chair) but there is a wealth of empathy for the lives of the women and the problems they face.

The clinic’s anniversary comes at a time when the issue of sex work is being fiercely debated. Feminists and law-makers are split into two polarised camps: those who see prostitution as a legitimate career choice and those who see it as a form of violence against women. But most of those who attend are simply trying to keep themselves safe and under the radar while earning a living.

After Denise, comes Chantelle, another escort, in her mid-40s, who wears heavy make-up and a grey track suit. British, but of eastern Asian ethnicity, she is worried because a condom has split. She has no pain or discharge, but still wants to be tested. Scott, a small, but formidable woman, has known Chantelle a long time. In another life, she tells me, she used to work in social care. The pair talk about an eyelash course Chantelle plans to go on; but, spread-eagled on the couch, she suddenly becomes evasive.

Like most of the women, she insists she is in control of her life, but, as Scott takes her swabs, she requests a print-out of the results (these are usually given over the phone).

“Why do you want a print-out?” Scott asks.

“I just need it.”

“Do you have to show it to someone?”

“Yes.”

After she has gone, the exchange continues to play on Scott’s mind. “I don’t think she has a pimp,” she says. “More likely, she needs it to reassure a married punter.”

Police and health home visits to help sex workers

Back in the mid-2000s, Scott became concerned about the number of women whose lives were too chaotic for them to make it to a pre-arranged appointment at the general sexual health clinic so she put pressure on NHS Lothian to set up this one.

In the early days, it was aimed at drug addicts and prostitutes – anyone at raised risk of STIs and unintended pregnancies – but prostitutes quickly became its main clientele; not unsurprisingly they feel more at ease having check-ups in a place where they will not be judged.

Today, it runs once a week and deals with an average of 400 consultations a year. As the numbers have grown so too has the team; on the first day I attend, it includes Scott, three nurses, a clinical support worker and a representative from Another Way. With each consultation, the focus is not only on physical checks and HPV and hepatitis B vaccinations, but on security, with the women given rape alarms and told about the national Ugly Mug scheme, an informal register of dodgy punters. Those addicted to heroin are moved on to a methadone programme, those with mental health problems referred on for counselling, and anyone in need of practical and/or emotional support sent to Another Way.

Over the decade, the dynamics of the Edinburgh sex industry have also changed. The number of saunas has decreased from 11 to five, with many more women working out of flats. And the ratio of indigenous to foreign prostitutes now stands at 51:49. “The needs of the foreign workers are quite different,” says Scott. “Often they don’t have much English, they don’t have much understanding of protecting themselves and having safe sex. Many arrive with blood-borne viruses [hepatitis B, hepatitis C and, in one alarming case, HIV] and sexually-transmitted infections [syphilis, gonorrhoea and chlamydia]. They are not using condoms because they are being paid more to have unprotected sex or in some cases they may not have the choice; it may be being forced upon them.”

In addition to the drop-in clinic, Scott and her team do outreach work, delivering condoms and rape alarms to the remaining saunas and safety advice to the lap-dancing clubs. Together with Police Scotland, they conduct Social Health and Welfare (SHAW) visits to flats where they believe sex work is taking place. With so much advertising now online, senior sexual health nurse Susan McClelland, spends several hours a week sifting through websites such as VivaStreet and Escort-Scotland and trying to make contact with as many women as possible.

Despite their best efforts, however, it’s a transient scene. Women move (or are moved) from city to city; they appear at the clinic a few times, then disappear. Scott worries about the ones they lose track of, like the woman who always came in with bruises and was devastated when she needed a late termination. Where is she now?

Prostitution is one of the most divisive issues in politics today. Those who see sex work as a legitimate career choice tend to support fully decriminalising or even legalising the industry (as New Zealand and Germany have done); those who see it as violence against women tend to support decriminalising the sale, while criminalising the purchase (the so-called Nordic model).

Both camps come armed with arguments which they lob at each other on Twitter and Facebook. The pro-Nordic model lobby insist legalisation would lead to an explosion in the trade (in Germany, there are now 400,000 prostitutes servicing 1.2 million men in a range of mega-brothels) and that failing to criminalise the sale will lead to Scotland becoming a haven for traffickers.

The pro-legalisation lobby, meanwhile, believes criminalising the sale of sex places prostitutes at heightened risk as clients will be less willing to go to the authorities if they suspect a woman is being coerced. Many sex workers also oppose the existing law under which two women working out of the same flat are deemed to be running an illegal brothel; they say this forces them to see clients alone.

In Scotland, the divide has manifested itself in the Battle of the Bills. In 2012, Labour MSP Rhoda Grant failed to garner sufficient support for her Criminalisation of the Purchase of Sex (Bill); then, in 2015, independent MSP Jean Urquhart failed to garner sufficient support for her bill to decriminalise sex work. At the last SNP conference, delegates voted in favour of taking the criminalisation of the purchase of sex route, but the party is still split. A cross-party group, led by Grant and SNP MSP Ash Denham, is trying to mobilise opinion.

When I return to the clinic in late October, I meet two women who insist sex work is an active choice. One, Veronica, combines her escorting with a job in the creative industries. She has a middle-class accent and long, strawberry-blond hair and tilts up her chin with a do-not-pity-me defiance.

A glance at the websites suggests Veronica earns between £100 and £150 an hour, but she says it is not just about the money. “I could earn the same amount in other ways. But I enjoy doing this. When you have built a good rapport with someone and you know you have made their lives happier – that’s a good feeling.” She gets irritated by depictions of sex workers as oppressed and is well-versed in the arguments against the Nordic model. “I think, if the purchase of sex is criminalised, it will put a lot of the good clients off, whereas the clients who don’t care that it is illegal will carry on, so the overall quality will go down.”

But “choice” is a subjective concept, more meaningful for some than others. Most people’s lives are played out within fixed parameters, with poverty, addiction and abuse further limiting options. The majority of the women at the clinic exist in a blurred territory between free will and coercion. They do sex work because they see it as the least worst option; they justify it to themselves in order to preserve their dignity. But it doesn’t take long for their vulnerability to become apparent.

Take Elena and Cristina, from Romania, who work in the same sauna and arrive just before closing time. Elena came to Edinburgh five years ago to “offer myself a good life”. She says she found sex work difficult at first, but she learned from her mistakes and now everything is “OK”.

The more she opens up, however, the more ambivalent she becomes. “In my first job, there was not much pressure,” she says. But then that sauna closed, forcing her to move on. And now? She hesitates. “It can be good, but the men come sometimes drunk. You have to say: ‘Stop, because I know you pay me, but you don’t pay me to do this.’ It doesn’t matter to the sauna who comes through the door. They say: ‘You have to take them.’”

When Elena is not selling sex, she paints nails; she gets Cristina to spread out her fingers to demonstrate her handiwork. “One day, I wish I have a big salon with a few girls around me and everyone working,” she says.

Cristina has a plan too: she has a degree in psychology and is spending a year at the sauna to fund her postgraduate studies. When she arrived, her English was quite basic. “The first time I am a little scared. I have to use sign language to tell the men to put on a condom.” The upside of sex work is that she gets to meet lots of men and explore how their minds work. And the downside? “Sometimes they treat you like an object. If they give you money, they think you are a piece of something and do not appreciate you are a human being.”

In June, she will return to her studies and tell no-one how she raised the cash. “My family try to give me everything and if I say I have to do this they will think they have not done enough,” she says. “Saying you have been a prostitute is a bad influence for your life. And I feel a little bit ashamed.”

Certainly, the Belle de Jour-style romanticisation of the sex industry bears no relation to the reality Scott encounters. Not long ago, she saw a 39-year-old with a history of domestic abuse, who woke one morning in September to find her partner dead beside her. He had suffered an accidental heroin overdose and his parents refused to allow her to attend his funeral. Another woman had been pimped by her uncle from the age of 16; now 24, she walks in the red light district offering sex to men, but doesn’t take money because she “isn’t worth it”. While I am there, a sex worker is diagnosed with oral gonorrhoea.

“Many of the women are suffering from complex PTSD due to multiple traumas,” says Scott. “It’s often things like childhood sexual abuse, leading on to domestic violence, leading on to sexual exploitation. Sometimes it comes out at the first consultation, so you get this tidal wave of emotion; sometimes it takes longer.”

Though most of the sex workers deny they’re pimped, McClelland has discovered some of the women on the websites share the same mobile phone number, suggesting they are being centrally controlled. Through the SHAW visits she and Scott know of flats where a fresh crop of girls arrive with suitcases every few weeks. Some of those flats are Airbnbs.

Scott also suspects some of the foreign women have been trafficked, though they are too scared to talk openly. ‘We ask them questions and sometimes their eyes fill with tears,” she says. “Some believe they are coming to Scotland to model, so they have a set of photos taken and end up being blackmailed. But they don’t necessarily view themselves as being exploited; we have to say to them: ‘It is not OK for people to treat you like that.’”

It’s 9.30pm on a Wednesday. I am at a separate but connected drop-in centre in Edinburgh’s red light district. Every night, three or four women will be out plying their trade around Salamander Street, Duncan Place and the appositely named John’s Place; sometimes the number will rise as new or occasional prostitutes join the regulars. There will be anything up to 15 women out over a month. A handful more will appear in the run-up to Christmas.

For years, the Salvation Army, the charity Streetwork and NHS Lothian all ran vans serving coffee, condoms and chat on different nights of the week; but the vehicles were clearly marked and some of the residents were uncomfortable with their presence.

Now, the three organisations and Another Way have joined forces to run the once-weekly service at the Turning Point building on Links Place; most weeks they are joined by one of Police Scotland’s two prostitute liaison officers.

As I arrive, the workers are tipping out the contents of several bags on to a table: a mountain of chocolate biscuits spills over on to the condoms, sanitary pads and bras. Soon Rachel, a former heroin addict, wanders in, rubbing her arms to ward off the cold. As she stocks up on Penguins and prophylactics, the prostitute liaison officer, Gemma Knox, warns her to keep away from a particular spot because residents have been complaining about discarded condoms. “That’s so disrespectful,” Rachel says. “I always bring those doggy-poop bags to put mine in.”

Knox has already told me about her efforts to gain the women’s trust; she wants them to understand that if they report a crime they will be taken seriously and treated well. Although she has only been doing this job for 18 months, she has been based in Leith for a decade and knows most of the women by name. She says many are forced out to fund their boyfriends’ habits.

But soliciting for sex in a public place is still a crime. If someone complains, the woman involved will be arrested (though not by Knox); first-time offenders will get a warning, while repeat offenders may be charged, though the majority end up in diversionary schemes.

Once a week, Knox targets kerb crawlers in a marked car; she tries to keep a low profile, but occasionally the women see her and harangue her for damaging trade. “They will say: ‘I lost that punter because of you.’ But mostly they know I have a job to do and that I care about their welfare.”

Knox says the regular women are street-wise; they carry rape alarms and watch out for each other, checking out the registration numbers of the cars their friends get into. “But then you see the new girls: they look so vulnerable. They haven’t thought it through; they have no idea about the possible consequences. You think: ‘Please, can I just drive you home?’”

Rachel, a mother-of-two, fidgets with her hair as she tells me she has drifted in and out of prostitution over the years. “It’s one of those jobs you will stop and start. Every time you stop you’ll say: ‘I’m not doing that again,’ but then something comes up and you’ll say: ‘God, I need money quickly.’ It’s a go-to for a lot of girls.”

“When I was in the saunas, I remember thinking: ‘I could never go on the streets.’ I don’t know what shifted in my life that made me a bit braver because it is quite frightening and dangerous.”

Now on methadone, Rachel no longer has a pressing need to sell sex. “I do want to get out of prostitution, but it’s all I know. It’s kind of my social life. I realise that sounds sad,” she says.

Her support worker at Another Way has been encouraging her to join a community project that offers activities such as painting, photography and gardening. So what does she fancy doing? “I love to write,” she says. “I keep a diary. I’m not Anne Frank or anything, but I do like writing.”

Most of the sex workers I meet want to get out eventually. Even those who say they are happy have ambitions: to own a musical instrument shop; promote sportswear on Instagram; or enjoy a life of settled domesticity. It would be nice to think these are not just pipe dreams; that one day, Elena will be queen of her own nail salon.

Leaving is not easy – most try and fail several times before they succeed – but a quarter of the women Scott refers to Another Way do exit in the end; and those who can’t, or don’t want to, still benefit from the clinic’s collaborative approach.

To mark its 10th anniversary, the clinic is bringing Inside Outside, an exhibition featuring the voices, photography and art work of women who are or have been prostitutes, to Sacro’s offices in Albany Street.

The display, produced by Encompass, a network of Scottish agencies dealing directly with women in the sex industry, gave many of those who took part their first chance to tell their stories.

One of the women, Wendy, 36, agrees to talk to me about her descent into heroin addiction and street prostitution, and the effort it has taken to leave it behind. A petite, live-wire of a woman, she opens the door of the flat she now shares with her seven-year-old son, Jackson, and ushers me in. It is 11am, but she is fully made-up – a symptom she says of her chronic Obsessive Compulsive Disorder, a condition common to former addicts.

We take cups of tea into her bedroom. One wall is covered with Sons Of Anarchy paraphernalia. She says the TV series, which charts a biker’s recovery from drug addiction, brought her strength as she battled her own demons.

Wendy’s story is as traumatic as any I have heard: bullied at school, then raped by her uncle at 15, she began to see her body as a commodity, having sex with a succession of boys who used her and moved on. At 20, she fell in love with a heroin addict who beat her and, after a spell in prison, forced her to start using as well.

Eventually, she began selling sex on the streets. “I needed money for the drugs,” she says. “I didn’t want to rob people, I didn’t want to shoplift. I justified it to myself by saying that at least this way I was the only one getting hurt.”

Wendy doesn’t understand how anyone can say prostitution isn’t dangerous. “I was terrified in every car I got into,” she says. “You didn’t know if the guy was going to strangle you: all he had to do was lock the door.” She was assaulted many times. But the trauma went beyond the physical. “I always say that, for every car I got in, I might not have been physically raped, but I was emotionally raped, because the whole time you are screaming inside your head: ‘What are you doing? Get out. This is wrong.’”

I ask Wendy if she believes any women are sex workers by “choice”. “Well, the higher end girls – the escorts – maybe. But on the streets every story was tragic, every girl was tragic. I never saw anyone smile,” she says.

In the piece she wrote for Inside Outside, she describes seeing a frail Romanian girl – “a bag of bones” – having sex in a doorway. She looked like she was dead inside; like she had given up. “The light had gone out of most of the girls’ eyes, but I must have had a wee spark left,” she says.

Wendy’s journey back was not straightforward; after staying clean for the first three years of Jackson’s life, she suffered a 13-month relapse, during which he went to live with her mother. Today, she is free of drugs – methadone as well as heroin – but she is not yet free of her past. Living back in her home town, she is taunted by teenagers who have heard the rumours. “They shout: ‘hooker’ and ‘how much?’ at me,” she says.

She has an on-off relationship with a man she first knew at school, but he is too embarrassed to be seen in public with her. And, in any case, her history of abuse means she now finds any kind of intimacy difficult. “You know how people like to lie and have a hug: it makes me rigid just to think about it,” she says. “I don’t know how to accept someone wanting to put their hands on my hair; I don’t know how to accept someone wanting to hold my hand; I don’t know how to accept someone wanting more than sexual contact because that is all I know.”

Nevertheless, her life is improving. Taking part in Inside Outside has built her confidence and she is currently trying to set up a youth project to help prevent other young people going down the same path; she sees them in her neighbourhood, hanging round kebab shops and smoking bongs.

There is time yet for her to study – she is conspicuously intelligent – but for now she wants to focus on Jackson. During our interview, Wendy shares some terrible experiences – the time her ex took a piece of her scalp off with a floor brush; the time she was held hostage for 48 hours – but the only moment she cries is when she talks about the impact of her relapse on her son.

“It’s really hard to hear that, at three years old, your son felt lonely at nursery because his mummy wasn’t there,” she says. “You beat yourself up. I can’t go back and change things, but I can make sure that every single day of that wee boy’s life from here on in, I will be there 100 per cent.”

As Jackson runs into the room and flings himself on top of her, it is clear their bond has been repaired. They have a relationship built on honesty. She has told him she took “bad drugs” and that, for a while, she wasn’t “a good mummy”.

One day she will tell him about her time on the streets; not every single detail, just as much as he wants to hear. “I will do that because I want my son to grow up understanding the world is not always a lovely place,” she says. “It’s not always safe and it is important to treat women with respect; it’s important you don’t use people. As long as Jackson grows up to be a gentleman, I will have done an all right job.”

All the names of sex workers and their children have been changed