The Health Needs of Sex Workers and the Factors that Enable or Hinder Their Access to Services: A Co‐Produced, Multimethod Study in the United Kingdom

Background ‘Sex work’ encompasses various services, including online and direct selling of sex, both indoors and outdoors. While legal in the United Kingdom, certain activities (e.g., soliciting) are prohibited. Globally, sex workers encounter multiple challenges, with legal frameworks and societal attitudes affecting their health and safety. Despite this, literature on sex workers’ health needs is limited and tends to focus on sexual health and violence. We aimed to understand the wider health needs of sex workers and the factors that enable or hinder their access to services. Methods This multimethod study encompassed four phases: a literature review on health interventions for sex workers, quantitative analysis of the health and wellbeing needs of sex workers using national databases, qualitative interviews with sex workers and health service staff, and rapid ethnography examining the healthcare needs of three sex workers. This article focuses on the overview findings from all four phases. The study featured embedded co‐research, researching with two expert‐by‐experience co‐researchers. An adapted version of the Andersen model was our theoretical framework. Findings from each phase have been organised according to the model’s key constructs related to sex workers’ access to health services: (1) actual use, (2) barriers to access, (3) enabling factors, (4) need and (5) psychological factors. Results The study highlights significant negative health impacts associated with experiences of violence, stigma and structural barriers within healthcare systems faced by sex workers. Health services often overlook the broader needs of sex workers, focussing primarily on sexual health. Additionally, social stigma contributes to mistreatment by healthcare providers. Across all study phases, several consistent barriers to healthcare engagement emerged fear of stigma, limited trust in providers, restricted clinic hours and logistical challenges for night workers. Conclusion The combined insights from across the study phases demonstrated a significant gap. While sex workers face significant and intersecting health challenges, many services fall short in adequately addressing these needs. The study thus underscores the inadequacy of many health services in addressing sex workers’ needs. It points to the need for a supportive environment with knowledgeable, nonjudgemental staff. These findings inform the design of health services to better address sex workers’ health concerns and are relevant to local, national and international efforts to improve health outcomes for sex workers.