The Invisible Men: finding and engaging with the male partners of street sex workers

Men, in general, remain less likely than women to seek medical care, and are only half as likely as women to undertake preventive health visits and/or screening tests. There is a great need to increase men's health awareness and reduce this significant gender disparity. Furthermore, marginalised and socially excluded men rarely access health services, even though the reasons for their social exclusion, particularly drug and alcohol dependency, invariably mean that their need for health interventions is greater than in the normal population.

The Open Doors Sexual Health Service has been working with female street sex workers (SSWs) in the London Borough of Hackney since 2006, in order to help them address their physical, psychological and social needs. Open Doors is based in, and partly funded by, City and Hackney Primary Care Trust. As Open Doors’ staff's relationships with the women grew and the team developed an understanding of the lives of the women and their networks, it became clear that their relationships with the men in their lives (historically characterised as “pimps”) were more significant and enduring than had previously been assumed, and that working with couples had the potential to be of greater benefit than working with the women only.

In July 2008, a male worker joined the Open Doors team, in order to work exclusively with the male partners of women using the service, and to develop access to clinical and social services for this shadowy group. During the first 12 months, the male partners’ coordinator (MPC) engaged with 23 men, each one of whom has needed intensive case management, as illustrated by a Case Study. The MPC's contract has been renewed for a further year, and the scope of the post widened to include other marginalised men, such as street drinkers, squatters and undocumented migrants, achieved by close collaboration with key services, especially the TB service, the Department of Sexual Health (DoSH) and the Specialist Addictions Unit (SAU) in Hackney's local hospital, the Homerton.

This paper will describe the work done by the MPC during the first 12 months of his tenure.