Sex Workers Program

What is the Program?

The Sex Workers Program is an outreach program based at RÉZO that aims to prevent HIV and other STIs and to improve the quality of life of men who engage in sex work in Montreal by creating a community for sex workers and offering access to activities, support services and information. The program offers two distinct but connected services to male sex workers: street outreach and an evening drop-in program. The primary target group for both services is street-level male sex workers, but escorts, masseurs, dancers and others engaged in sex work via the Internet and peep shows also participate.

The drop-in centre, which serves 350 male sex workers, is situated in a confidential, unadvertised location and is promoted through outreach activities.

Why Was the Program Developed?

In Canada, the exchange of sex for money is not illegal, but many of the activities surrounding sex work are. For example, being found in a brothel or soliciting in a public place is illegal, which makes it difficult to engage in sex work without breaking the law.

Sex workers, particularly those who are street-based, face a range of challenges that affect their health, including legal issues, violence, discrimination, social isolation, poverty, unstable housing and addiction. Barriers to accessing health and social services include restrictive office hours at health facilities, concerns of privacy and disclosure, and limited means of transportation to service locations.

Before 1998, when RÉZO’s sex worker program started, services targeted to men engaged in sex work were entirely lacking in Montreal, though services for women engaged in sex work in the city (such as Stella) had existed since 1995. Through the organization’s regular outreach activities to gay men, RÉZO realized that there were unmet needs among sex workers in Montreal’s gay village, which runs along Sainte Catherine East between Berri and Papineau Streets.

In addition, RÉZO determined that male sex workers often have different needs than other men who have sex with men. In general, male sex workers are an exceptionally marginalized and disaffiliated group, often retreating from family, social networks and society in general. What’s more, they may or may not identify as gay. Therefore, RÉZO’s programming for gay men did not meet the needs of sex workers.

Furthermore, businesses and residents were unsupportive or even hostile toward sex work in their community. Sex workers, largely due to a lack of services accessible to them, were engaging in sex work and drug use and were hanging out close to local businesses and homes.

RÉZO concluded that there was a need for the creation of a new program for men engaged in sex work that addressed their unmet health and social service needs and the negative and unstable relationship of sex workers with residents and businesses in the gay village. The Sex Workers Program was born out of this need.

How Does the Program Work?

The Sex Workers Program has two distinct but connected services. Each service is instrumental to the success of the other:

Afternoon street outreach service: used to engage, instruct and disseminate information on safer sex and drug use to male sex workers
Evening drop-in program: used to provide a safe place for sex workers to meet, rest, access services and resources and build a sense of community

Service 1: Afternoon street outreach service

Location

Outreach workers conduct daily outreach in the gay village to connect with male sex workers. Outreach takes place during the mid- to late afternoon to meet with sex workers.

Outreach occurs on the street and in bars, hotels that rent by the hour, peep shows and strip clubs.

Engagement and Recruitment

RÉZO currently employs five full-time as well as one part-time and two on-call outreach workers who identify sex workers by visiting locations where sex work often takes place and particularly by working with men with whom they have already built relationships to identify other potential participants. The success of ongoing outreach—on the street and in bars, hotels that rent by the hour, peep shows and strip clubs—depends upon repeat visits to establish a trusted presence and discreetly observe people in each location to identify those who are involved in sex work. For this reason, each venue is visited at least once per week. Long-term relationships with the owners of many of these establishments have led to the creation of ongoing service agreements through which RÉZO outreach workers are welcomed for the services they provide.

When visiting an establishment for the first time, outreach workers begin by offering condoms, safer-sex pamphlets and disposal bins for used needles to owners, employees and anyone who has already been identified as a sex worker. As an establishment gains access to such supplies, confidence is built, and outreach workers propose expanded services to respond more directly to the specific needs of sex workers and their customers, such as clinical vaccination against hepatitis A and B and access to information on sexual health, social and legal information, services and referrals. They are also encouraged to attend RÉZO’s evening drop-in program.

The way in which outreach is conducted is based (as much as possible) on the specific location where the outreach takes place, as well as on the specific skills of the outreach worker and the specific needs of the sex worker. In the peep shows, for example, sex occurs in private booths, sometimes accompanied by the use of illicit drugs, especially crack. In the dance bars, sexual services occur in private cubicles. In both places, outreach workers have their conversations with sex workers in the common areas of these establishments and never interrupt them while they are in a booth or cabin.

However, in all outreach encounters, outreach workers must respect the work dynamic of the sex workers and the intrinsic rules of their environment and remain discreet so as not to interfere with sex work or scare clients who are often present while outreach is taking place.

Outreach activities include:

Distribution of food, including juice, drinks and granola bars during outreach
Distribution of condoms, needles and other materials for safer substance use as well as information on HIV, STI and hepatitis A, B and C prevention at the drop-in centre and during outreach
Distribution of bags of groceries at the drop-in centre
Distribution of discreet information cards with location information for the drop-in centre during outreach
Discussions about the evening drop-in and what it has to offer during outreach
Support and referrals for sex workers with HIV and/or hepatitis C and STIs at the drop-in and during outreach

The juices and energy drinks are especially popular when it comes to initially drawing in sex workers, as many of them forget to hydrate while under the influence of drugs. After building trust by offering such supplies, outreach workers are able to speak with the men about their sexual relationships, their customers, their consumption of drugs, as well as their health and life in general.

Occasionally outreach will take place in sex workers’ homes, especially in situations where sex workers (with whom outreach workers have already developed a relationship) have been arrested and are restricted by police or a judge from entering some areas of the city where sex work takes place, such as the area where the drop-in centre is located. Outreach can also be conducted through Facebook.

Hepatitis A and B vaccination clinics are held backstage at bars where male dancers work in collaboration with Médecin du Monde.

Outreach workers also approach business owners and residents with brochures explaining the Sex Workers Program and the services offered by RÉZO, including information and resource distribution, mediation between sex workers and other members of the local community, and information on safe recuperation of used needles. RÉZO meets with any interested parties to explain the available services in greater detail. RÉZO also meets annually with the police to conduct sensitivity training on the realities of the lives of sex workers.

Service 2: Evening drop-in centre

Location

The drop-in centre is designed to be a safe place for male sex workers to hang out, meet one another and access services. A part of the centre’s success is due to its confidential location: It is not advertised and is largely unknown to their clients (“Johns”) or neighbouring businesses/residents. Men can come and go as they wish without fear of violence, harassment or stigma. Men learn of its location through the program’s ongoing outreach activities (street work).

The centre is open four evenings a week, from 6:00 to 10:00 p.m. Sex workers are welcome to visit the centre at any time during open hours to access various forms of assistance. Approximately 25 men frequent the centre per night, which adds up to approximately 3,790 visits per year.

Services Provided

When a sex worker visits the drop-in centre for the first time, a staff member orients him to the centre’s services and works with him to assess his immediate and longer-term needs with the help of an intake form.

The centre offers many formal and informal services, each of which helps meet the goal of increasing the quality of life for men involved in the sex trade. These services include:

A comfortable environment for informal conversations: The drop-in centre offers a relaxed environment to sex workers and allows them to discuss their work in an informal way, among themselves and with staff, both individually and in groups. Armchairs are provided and a television with DVDs is available for use.

Food preparation services: The centre has a kitchen and is often stocked with food donated from local organizations; sex workers can also bring their own food to cook in the centre’s facilities. These activities encourage and facilitate interaction by fostering a sense of accomplishment among those who learn to cook and can cook for peers at the drop-in centre.

Clothing bank and hygiene products: To promote good hygiene, sex workers can obtain clothes, including new underwear and socks. Other personal hygiene products (such as deodorant, soap, shaving cream, razors and toothbrushes) are also provided. Showers are not provided at the centre.

Safer-sex and harm reduction tools and information: HIV, STI and hepatitis C testing and information, as well as prevention support and resources (such as literature, condoms, lube, clean needles, containers to safely collect used needles and safer-crack kits) are offered by staff along with support for starting and staying on treatment.

Workshops: RÉZO invites educators from a variety of organizations to the drop-in centre to provide workshops on issues of concern to the sex workers. Past speakers include homelessness advocates and those knowledgeable about interacting with police. Workshops use role-playing and feedback sessions to teach and practice skills related to coping with stress, health concerns and other problems confronted by sex workers.

Case management: Because many sex workers have difficulty or are reluctant to access other services, the staff provides case management support on an ad hoc basis according to their needs. Referrals and support are often related to addiction, housing, physical health, mental health, employment services and legal issues. Sex workers can also be accompanied by staff when accessing such services.

Health and vaccine clinic: RÉZO has partnered with Quebec Health care and social services centres to offer on-site HIV testing, STI testing, vaccinations (for hepatitis A and B, seasonal flu, H1N1, etc.), medical consultation for minor injuries and health concerns and medical referrals through a mobile health unit that visits one evening per week. RÉZO also partners with the University of Montreal to offer on-site dental services to sex workers once a week. Hepatitis C and dental problems among crack and injection drug users, and HIV and STIs among sex workers are the major health problems encountered by the mobile health unit. Sex workers also tend to have problems with their feet from spending long hours standing and walking every day.

Exit services: If a sex worker wishes to exit the sex trade, the program will support the sex worker to do so, offering employment services (such as help with writing résumés and preparing for job interviews) on an ad hoc basis. A computer is available to sex workers for use in searching for employment and writing résumés, and telephones are available for calling prospective employers.

Volunteer opportunities: Sex workers are encouraged to become involved with the centre on a volunteer basis, which provides an opportunity for them to develop a sense of ownership over the program and personal accomplishment. Volunteer activities include making meals for other sex workers accessing the drop-in centre, cleaning the centre, participating in street “clean ups” to collect discarded drug use paraphernalia, and organizing social events for other sex workers. A volunteer committee of sex workers meets regularly to assess sex workers needs and suggest improvements to the program.

Off-site services: Some sex workers have their own residences and tend to be less dependent on drugs than those reached through peep shows and strip clubs and on the street. They tend to remain as inconspicuous as possible and are reluctant to access the services of the drop-in centre. After being introduced to these sex workers—usually through the referral of another sex workers using the program services—RÉZO staff will meet them in their homes or via the Internet, as necessary.

Required Resources

Human resources

1 program coordinator
5 full-time outreach workers for on-site outreach (street work) and drop-in centre support
1 part-time outreach worker for on-site outreach (street work)
2 on-call relief workers for on-site outreach (street work) and drop-in centre support

RÉZO currently recruits candidates for these positions who have completed a post-secondary degree in social work, preferably with a specialization in sexology, psychology or a related field, and who have at least two years experience working with disenfranchised youth. Staff must be comfortable working in a variety of settings, including the street, peep shows, bars and other areas where sex work takes place. This non-exit-based sex work program requires staff who approach work in a nonjudgmental manner with a focus on harm reduction.

Ideally, program staff should have a deep understanding of the challenges related to sex work based on personal experience in the sex trade or experience working with sex workers. Currently there are no peer outreach workers on the RÉZO staff. For strong candidates who have strong skills but who lack training and experience specific to sex work, RÉZO recommends UQAM’s course on street work and social work as well as trainings and other programs run by the Association of Quebec Streetworkers (ATTRueQ) and the Health and Social Services Agency of Montreal.

Material resources

A venue with a confidential address to hold an evening drop-in centre
Comfortable seating, tables and a kitchen
Personal hygiene products (soap, deodorant, razors, shaving cream, etc.)
Centre location information cards that specify that the address should remain confidential
Safer-sex and drug use literature and resources (condoms, lube, clean needles, alcohol swabs, sterile water, crack kits, etc.) for distribution at the centre and during on-site outreach (street work)
Food for meals at the centre and for distribution during drop-in hours
Clean socks and underwear
Donated clothes (particularly winter coats, sweaters, hats and gloves)
Computer with Internet access and a telephone so that sex workers can search for employment, prepare a résumé and communicate with family
Television, DVD player

Financial resources

The number of sex workers who are reached during the outreach component of the program and who visit the drop-in centre will determine the cost of the program in any one year. Not including staff salaries, the program costs approximately $100,000 per year. This includes payment for: centre rent, food, transportation of food to and from the centre, centre maintenance and other health supplies, office supplies and other miscellaneous costs.

Challenges

Staff burnout: Male sex workers can be a difficult and frustrating clientele to engage, and their trust must be built over time. If staff turn over frequently, trust is even more difficult to build.
Police interaction with sex workers can be a direct barrier to program implementation, driving sex workers further from view, necessitating creative outreach methods such as home visits and accepting collect calls.
When sex workers are sent to prison, the continuity of service is disrupted, leading to the potential for further mental and physical health issues as well as setbacks to the search for other employment and recovery from addiction.
Lack of community and police support can slow efforts to reach male sex workers.
Lack of access to program funding and donations of food and clothing can impede the program’s capacity for support and harm reduction.
It is only possible in a large urban setting with a critical mass of sex workers.

Evaluation

The RÉZO staff reports positive feedback from sex workers during outreach and at the drop-in centre, which welcomes more than 350 sex workers. An intake form is filled out for each visitor to the centre, collecting such information as age, race, language, health and sexual orientation, drug use of each visitor as well as his reason(s) for visiting the centre.

Additionally, the staff has noticed the effect their program has had on tensions between sex workers and the general mood of the local community. Since the start of the program, police and local community members speaking with RÉZO’s outreach staff have expressed an increased sense of awareness of sex workers and the specific challenges they face. RÉZO’s Sex Worker Program is increasingly known throughout the community as a resource for mediation between sex workers and residents and merchants.

Lessons Learned

Providing sex workers with a convenient and confidential location to meet and access multiple practical assistance services on-site promotes feelings of safety and comfort and reduces barriers to accessing harm reduction services.
Providing services in a non-sexualized environment supports the stability of a program by keeping support services in a safe, neutral setting, away from the milieu in which sex workers meet clients.
Keeping a dedicated core team of outreach workers plays an important role in the development of a relationship with individuals who use the program that is built on confidence.
Maintaining program staff over the long term and using the same staff for street-level outreach and drop-in centre services helps to develop trust between staff and male sex workers.
Opportunities to relax, chat and cook meals together facilitates community building among male sex workers.
Improving the health and quality of life of sex workers can improve their ability to engage in socially responsible behaviour, which can improve their relationship with the community at large.

Program Materials

Other Useful Materials

Information found on the CATIE website

Resources

Stella
2009, Stella
Client resources
English, French
More information

La solution à l’hépatite C, c’est toi
2010, RÉZO
Client resources
French
More information

Contact Information

Claude Poisson
Program Coordinator, Travailleurs du sexe
RÉZO
P.O. Box 246, Station C
Montreal (QC) H2L 2K1
(514) 521-7778 #224
(514) 529-7777 evening drop-in centre
coordinationtds@rezosante.org
www.rezosante.org