Approximately 26,500 women, men and transgender people engage in prostitution in Israel (Santo & Carmeli, 2016). Studies have shown worldwide that 95% of prostitutes are women of which 5% are male to female transgender women (Christine & Basil, 2005; Santo & Carmeli, 2016; Weitzer, 2018). Prostitutes in Israel have a wide age range of 14-75 years, and are comprised of diverse, multi-cultural and multi-socioeconomic backgrounds (Santo & Carmeli, 2016). Approximately 70% of these women are mothers, about 70% are Israeli citizens, while ~30% are foreign women who either came on a tourist visa or were illegally trafficked (Santo & Carmeli, 2016).
The Ministry of Health’s Public Health Bureau established a mobile clinic in 2008 as part of a policy to allocate government resources to reduce prostitution in Israel and further enable the diagnosis and treatment of STD's. Thus, the goals of the mobile clinic are to protect the health of women in prostitution; establish a therapeutic relationship that will enable them to escape the cycle of prostitution and violence; and increase public health by preventing STD's resulting from the sex industry. The mobile clinic’s main activity includes outreach assistance to women prostitutes in the third largest northern Israeli city of Haifa, and in the north of Israel by providing them with medical, nursing, social and psychological services. These include providing sexual health education, information and tools for the prevention of venereal diseases, and diagnosis and treatment of diseases, as well as counseling and guidance on the accessibility of additional medical treatments relevant to this population. The latter include treatments for psychiatric conditions and advanced treatments for chronic diseases, such as HIV and hepatitis C.
This poster aims to present the mobile clinic's outreach work for women involved in prostitution. Specifically, the demographics of the prostitutes treated in the clinic will be surveyed and the clinic’s treatment model will be presented.
Methods:
About 1,600 women have been examined at the clinic since its inception. In 2017, 348 patients (95% women, 2.5% men, 2.5% transgendered) were examined in the mobile clinic of which 62% were native Israelis and 32% immigrants from the former Soviet Union at least 15 years previously. There were 10 women without status or on tourist visas (Shiloah, 2018). Twenty-six percent of the patients were Israeli-Arab, higher than their proportion of the Israeli population. The average age of Israeli-Arab women in prostitution is lower than that of other Israeli women and immigrants (28 vs. 33 years) and the percentage of Israeli-Arab men in prostitution is higher than other Israeli men in prostitution (5.5% versus 2.5%) as well as the rate of transgender individuals (5.5% versus 2.5%). The age range of the treated women was 15-64 years; 64% of them were mothers; and 28% of them raised their children at home (Shiloah, 2018). Mothers and pregnant women comprise a high number of prostitutes; and these women require a very unique and comprehensive nursing and social assistance approach (Monto, 2014).
The work in the clinic is divided into three practical pillars that create a holistic and multidimensional treatment model:
- Multicultural sensitivity:
Most women who come to the mobile clinic are Jewish, and there is also a significant percentage of women from Arab society in all its forms - Muslim, Christian, Druze. Additionally, there are women from the former Soviet Union, Ethiopian women, and women from other countries around the world who have been illegally trafficked or are illegal immigrants. The mixture of cultures requires the clinic’s staff to recognize the culturally unique meanings of engaging in prostitution and to provide correspondingly culturally sensitive responses. The clinic’s staff encompasses a multicultural team speaking four languages (Hebrew, Arabic, Russian and English) and includes Jews, Muslims and Christians. Women prostitutes in Haifa usually come from a traditional background and thus require special attention, sensitivity and sometimes even caution. This is because there are communities that denounce them severely and sometimes violently. The clinic’s staff also take into account the various sensitivities when treating men versus women versus transgender people (Renland & Skilbrei, 2008; Ellison & Weitzer, 2017).
Results:
- Multi-dimensional and multi-disciplinary therapy:
The clinic’s staff consists of professionals from three disciplines; medical, nursing and social work. Nursing care deals with prevention (education, advocacy, training and minimizing damage). Medical staff is concerned with the diagnosis, treatment, the accessibility of long-term treatment and corresponding care, the provision of emergency treatment and accompaniment to hospitals, and creating a therapeutic framework for every aspect of physical or psychological conditions. Medical staff also diagnose HIV and hepatitis C and establish contacts with the Interdisciplinary Center, which manages psycho-emotional therapy for women in the clinic, and also works with other medical personnel in the community. These include: The Addictions Unit, hostels for girls and women, and emergency housing for girls and women. Finally, under the mobile clinic’s multidisciplinary framework, medical staff and social workers work together to promote the sexual health and education for their patients in the sex industry.
- Female Autonomy and Support:
The multi-cultural and multi-professional approach at the clinic creates a holistic therapeutic framework that enables access to individualized services for people in prostitution. Accordingly, each individual is able to not only maintain her sexual health while engaged in prostitution, but also receive the support for the exit from the profession and consequent rehabilitation. The clinic is a member of the Task Force on Human Trafficking and The Coalition Against Prostitution in Israel. The political agenda is evident in the clinic's work, but at the same time it does not cloud it but allows a meaningful and important discussion between the staff and the patients about the need for a world without prostitution. This discussion is a productive discussion that has transformed women's rehabilitation processes. Despite the clear political agenda, all people who come to the mobile clinic are treated without exception and we have a good relationship with all individuals who are currently working in prostitution and are leading the institutionalization trend to make prostitution a legal profession. The feminist agenda led by the clinic staff sees prostitution as a practice of sexual violence (Dworkin, 1993) and the practice of subordinating women and oppression (MacKinnon, 2005). Nevertheless, the staff of the clinic considers it essential to treat every individual as a whole person who may have been compelled to resort to prostitution or who may have chosen to be in the profession. The clinic strictly adheres to the voice of individuals in prostitution and represents them honestly when required to advocate for their needs in legislative processes and committees in the Knesset.
Conclusion:
The three practical pillar committees in the mobile clinic create a unique and effective work structure to assist the at risk prostitute population in the north of Israel. The relentless striving for professionalization and specialization in the fields of medical and nursing care, health promotion and public health protection is in practice in the mobile clinic. The medical and nursing expertise in the clinic leads in detecting, diagnosing and treating sexually transmitted diseases and provides a wide range of treatment for an endemic population of sexually transmitted diseases. We conclude that this mobile clinic is providing a vital public health service.