Prevalence and structural correlates of gender based violence among a prospective cohort of female sex workersBMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b2939 (Published 11 August 2009) Cite this as: BMJ 2009;339:b2939
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EDITOR- In relation to Shannon et al's alarming findings of high
prevalence of violence towards sex workers, it must be asked whether we as
health professionals are ready to respond to this. Not only are voluntary
sex workers victims of violence, but there is increasing awareness of the
huge numbers of women and children who are traffiked within the UK to
effectively work as sex slaves. These individuals are notoriously
difficult to recognise. While many are traffiked from abroad, others are
young vulnerable children, often from care homes, who are groomed by
'boyfriends' who then pimp them to others. G.P.s and GUM doctors as well
as gynaecologists will undoubtedly encounter some of these people with
requests for contraceptives/ T.O.P.
It is my view that health
professionals should therefore be encouraged to be vigilant for traffiked
women and children as well as victims of physical abuse. Medical students
should be educated to be aware of traffiking and abuse of sex workers as
part of their medical education. It may also be of use to introduce a
standard screening question about physical, emotional or sexual abuse
when taking a sexual history. Along with strategies implemented by police,
it is to be hoped that we as doctors can play a part in the fight against
the abuse and exploitation of vulnerable women and children.
Competing interests: No competing interests
Shanon et al (1) data now provides strong evidence regarding gender
based violence against female sex workers, working on streets, and must be
congratulated for their study. The study may also have implications for
mental health problems in long term, although it was not directly studied
I would like to make few comments here, although may not be directly
related to the study. Female sex worker of age 14 or over were recruited
and by U.K perspective one may wonder about child protection issues but
story is different in Canada. Canada’s age of consent to sexual activity,
have been 14 since 1892 and it is only recently raised to 16, and is now
in line with U.K, Australia and many states of USA (2). Although, the
legal framework does not consider a 14 years old girl’s physical,
emotional, mental and psychological capabilities to make decisions, in
order to avoid unnecessary physical or sexual harm. Who is then
responsible for these young people’s well being? One bad decision may ruin
the chances of having any possibility of decent life in future. Young
girls working as sex workers are often have traumatic past, including
running away, physical/sexual abuse, bullying, dysfunctional family life,
mental health problems and substance misuse. Often substance abuse alone
can be responsible for prostitution.
20% of the study population was under 24 years of age and it will be
interesting to know the percentage of girls under 16 and physical/sexual
violence against them, in comparison to relatively older group. Such a
traumatic experience at this tender age may decide the future line of
action for these young girls and as a result they may be ‘suffering in
silence’. Will it be different from the classical ‘learned helplessness’?
1. Shannon K, Kerr T, Strathdee SA et al. Prevalence and structural
correlates of gender based violence among a prospective cohort of female
sex workers. BMJ 2009;339:b2939
2. "Canada's age of consent raised by 2 years". CBC News. 2008-05-01.
Imran Mushtaq, Associate Specialist-Child & Adolescent
Psychiatrist, Milton Keynes SP-CAHMS, Eaglestone Centre, Standing Way,
Milton Keynes MK6 5AZ
Competing interests: No competing interests