Vulnerability, Risk and Harm for People Who Use Drugs and Are Engaged in Transactional Sex: Learning for Service Delivery
1.1. Stigma and Health Harms
1.2. The Scottish Context
2. Materials and Methods
2.1. Sampling and Participation
2.2. Interview Content and Conduct
3.2. Drugs Used
For my first time, what it was, right, is they told me obviously about heroin, and that, and I was a wee bit obviously wary, and plus they were telling me that I had a client and that coming, she was there obviously in the same house at that time, so I was a wee bit nervous and that, scared, a bit dirty, I think then, so she said here, take this, this will make, calm you down and that, and it did, you know, after I was, I did the deed, I did feel dirty and that, and then that kind of got me into the situation that I needed the drugs to obviously get me out in that zone(326)
“… it was one of my, my friends, they, it was one of their contacts, she gave me the heroin, she was in the same house, and they seen I was really nervous [about having sex], she obviously made up the kit, that was heroin, and gave me it, injected me, because I didn’t have a scooby [clue] what to do, and then the guy come in, we went to the room, and just got on with it.”(326)
“Yeah, I use coke, crack, I use heroin, valium, gabapentin, anything, I like to be out of my face, when I’m in that mood.”(326)
“Vallies, god I could take 20, 30 in the one day I would say”.(326)
“Well they were, they [tablets] were getting posted through my door, so I wasn’t even having to pay for them, and I’m like, oh no, here we go, but I don’t, because of my size and build, it doesn’t take a lot, but you get what, 15 for a tenner or something, …. I wouldn’t be able to remember for days.”(344)
“Oh yeah, I did not like that, he had ketamine in the house, and he used to get it from this girl, and I tried, I tried some of it, and I’d been awake for a few days, and I, it was like a, I had blackouts, I don’t know what happened, I don’t, I mean I know I was there, I know I wasn’t passed out or anything, but it’s just like pure gaps, and I wasn’t really drinking or anything, so it was really bizarre, they just blocked out my memory, and I know that there was nothing really that happened, it was just the two of them chatting, but that was not a nice experience, too trippy, too mad”(324)
“Yeah, it’s so prevalent now it’s overtaken smack, definitely.”(327)
“me and this guy, like we just had this great chemistry, it was just everything that I wanted, he was everything I bloody wanted, right, … I never stopped to question that the first couple of times we’d met, he just stayed really quiet, he was studying me, ….I didn’t see that, I was being manipulated, my god he was good…, and then he, he said right, you’re not smoking this thing properly, you’ve got to breathe it in, and then hold it in, and Jesus, my god, I have never felt anything so amazing my life….and that’s when I knew, right, I, I need to marry this man, I want to smoke this stuff every day”.(324)
3.3. Experience of Transactional Sex
“I was in care, and my boyfriend was 24, and he basically pimped me out, so and got me onto heroin, by telling me it was cocaine, and gave me it for 6 months, then told me what it was, and I was addicted to it by that point, so I had no [choice] to take it.”(327)
“and I met one older guy from the R******* Hub, but because he was from R******** Hub, I thought he’s very nice, he was very nice person, he was 50 years old, but after he started to buy me presents, clothes, I never, but with him I never asked for his help, but with him it was really, I didn’t want to use even, he, somehow, but he was buying me food, when I finally found hostel, he was knocking my door, like too much, I don’t know, I was a little bit scared and then he started to touch me as well, but because he was older, with him it ended up with police and I didn’t call, because nurses saw how he was hugging me sometimes…”(346)
“my benefits had been stopped as well, I was on Universal Credit, so I had no money for eight weeks and that’s kind of how I got into doing it”(344)
- So are you okay with me asking you the question about the first time you sold sex, how old were you?
- I was 24.
- 24, and what was happening at your life at that time that led you there?
- I lost my partner.
- Right, and was that through drug death or?
- And what happened as a result of that then?
- I just gave up”(326)
“I had post-natal depression, and post-natal psychosis, … oh loads of shit happened, and my daughter ended up going to stay with her dad and I’d been off it for 13 years, and I packed a bag and buggered off to [place], and ended up meeting a lassie, and got introduced to [name].
- And did she set up the site for you and stuff like that, or did she just show you how to?
- She just showed me how, and I did it, I took it from there myself.”(323)
“[after] the first punter, I got into a hackney, went right home to *** Street, and greeted [cried]”(334)
3.4. Drug-Related Harms
“I have done that in the past, aye, I’ve used other people’s pins, I’ve used pots, I’ve been desperate and shared, so there is a chance of having Hep C there, aye, I need to get tested again, I think actually, because I’m not sure if I’ve got it or not, you know how your antibodies fight it and all that.”(344)
“I was using a lot of old equipment and I didn’t know where to get [it], and I was ordering online, but I had a few of syringes, and I, I have scars on my hands now, and my veins are really bad.”(346)
“They share pipes…Aye, they’ve all got scabs all over their face and aye, so it’s horrible.”(325)
3.5. Sexual Health Harms
- So did you, do you always practice safe sex?
- No, not always, no.
- Was that an agreement you came with, with people, or was that just, was that like?
- No, there was a couple of times I was raped, and my first experience was in a sauna and the man raped me anally, and that was really quite a hard experience to go through, but normally,… what was the question again?
- It was about safe sex, about condom use really.
- No, I don’t, I don’t always use a condom, because they’ll sometimes ask you, oh I’ll pay a bit extra if you don’t use a condom, and then I’ll judge it by how they are, their appearance and stuff like that, and then just to get my drugs, I would go for it, you know what I mean, and it was more money for drugs.”(327)
“I’ve got, only had so many smear tests in my full life, I’m bad for no going to them, aye.”(334)
3.6. Information Needs
“I asked about cocaine, because I feel that my heart is weird, I was scared and I was told that its better never to inject cocaine, I was not doing that after, because yeah, I was told its better not to, even small amounts.”(346)
“…when I try a drug, right, I get quite obsessed about it, I want to know all about it, I want to know its story, it’s like I want to intimately become, meet it….Yeah like I study it, how does it work and so the Seroquel you know, I looked it up and I was like, did you know that this was used recreationally in like the big parties in [city] and things, and they called them Susie Qs.”(324)
“It was a partner I was with, he would inject me and what a mess he would make of me. Looking back I think ‘oh my god’, but that’s why I won’t inject anyone because somebody was at my house not that long ago asking me [to inject for them].”(344)
“she’d fell into a gang down there, and she was, I think she was gang raped by them and they were threatening her, that she couldn’t tell anyone, and she didn’t trust anyone, they were telling her that she knew they, they knew people in the police and stuff.”(324)
3.7. Service Needs
“Do you know what, listen, and do what you say you’re going to do, it’s two so simple things, right, and keep in touch with the person, don’t just say you’re going to do something and then the person never hears from you again, because then they lose trust in everybody,… the only people we don’t want to lose trust with is this lot, so that would be my main, main thing, is if you promise a woman, you’re going to do something, you do it, and you do it the next day, or as soon as you can, but you give them a timescale.”(333)
“Yeah, well I was just saying that this is actually the first time that I feel like they have listened to me, because I told them that I, I only wanted 30mL [methadone], I was only using a tenner bag a day, and I thought 30mL would cover it, and the worker is actually listening to me this time, so I feel like I’m a bit more in control about it, so that helps.”(344)
4.1. Key Findings
4.2. Discussion of Findings
4.3. Information and Service Needs
4.4. Strengths and Limitations of the Study
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
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Matheson, C.; Bon, L.; Bowman, L.; Hannah, A.; MacLeod, K. Vulnerability, Risk and Harm for People Who Use Drugs and Are Engaged in Transactional Sex: Learning for Service Delivery. Int. J. Environ. Res. Public Health 2022, 19, 1840. https://doi.org/10.3390/ijerph19031840
Matheson C, Bon L, Bowman L, Hannah A, MacLeod K. Vulnerability, Risk and Harm for People Who Use Drugs and Are Engaged in Transactional Sex: Learning for Service Delivery. International Journal of Environmental Research and Public Health. 2022; 19(3):1840. https://doi.org/10.3390/ijerph19031840Chicago/Turabian Style
Matheson, Catriona, Lesley Bon, Louise Bowman, Adrienne Hannah, and Katy MacLeod. 2022. "Vulnerability, Risk and Harm for People Who Use Drugs and Are Engaged in Transactional Sex: Learning for Service Delivery" International Journal of Environmental Research and Public Health 19, no. 3: 1840. https://doi.org/10.3390/ijerph19031840