You don't need to be signed in to read BMJ Blogs, but you can register here to receive updates about other BMJ products and services via our site.

Organisation Focus: National Ugly Mugs Scheme

1 Nov, 15 | by shaworth

Some readers may already be familiar with the National Ugly Mugs Scheme, an initiative  which started life in Australia in 1986, developed by a collective of sex workers to circulated descriptions of people that they had encountered, or situations that they had been in, which had been dangerous. Sex workers have an increased risk of violence, and due to the ongoing criminalisation of sex work, this violence is less likely to reported to police.

Many local services supporting sex workers, and sex worker collectives in the UK had their own schemes, but in 2012, that National Ugly Mugs Scheme was launched as a pilot project in the UK, initially funded for twelve months, to draw these initiatives together. Some successful prosecutions by local initiatives working together The project continues to be funded partly by local police forces, essentially acting as an arm’s length reporting tool, allowing them to engage with sex workers without entering into conflict about the illegality of their work. The project remains on the only attempt at a nationally coordinated effort to protect sex workers through anonymised reporting.

Recent evaluation of the scheme suggests that sex workers are more likely to report violence as a result of the service, as they can initially start notification through the NUMS scheme. There are currently 10,000 subscribers to the service, and 16% have avoided a potential client as a result of their use of the service. This would imply, by extrapolation, a significant amount of crimes prevented. Currently 60 incidents per month are reported anonymously to the service, and a quarter of these will then go on to report directly to the police.

To make a report, a sex worker can join the organisation for free, and also register to receive alerts about Ugly Mugs in their area. Those providing healthcare to sex workers should be aware of anonymised reporting schemes in their area.


Interview With MSP Jean Urquhart

24 Oct, 15 | by shaworth

Readers, in particular those in Scotland, may have read about the recent opening of a consultation to decriminalise sex work in Scotland. This Bill, Prostitution Law Reform (Scotland) Bill, is the first stage of an attempt to pass this legislation through the Scottish Parliament. Currently, in Scotland, the issue of sex working is covered by several different pieces of legislation, and the Bill is seeking to revoke these laws to allow adult sex workers to work both in their own premises, licensed brothels and on the street. This Bill has been modeled on pioneering legislation which has been in place since 2003 in New Zealand, and differs significantly from the oft-discussed Swedish model, which criminalises the purchase of sex, but not the selling of it. Views on both sides have been hotly debated recently when the charity Amnesty recommended decriminalisation as a key aim.

The consultation has been developed by the independent MSP for the Highlands and Islands Jean Urquhart, and we are very privileged to have been given the change to interview her for this blog.

You’ve put forward a consultation regarding the legal status of sex work in Scotland and proposed something quite radical, which is that we should repeal the criminalisation of sex work in Scotland and bring in legislation which reflects the New Zealand model of practice where sex work is legal.

That’s correct. My interest grew when MSP Rhoda Grant brought in a Bill -which actually fell- to criminalise the purchase of sex and, at the time, not knowing anything about prostitution or sex work at all, I went to a meeting where Rhoda was talking about her Bill, and met some prostitutes. I found myself thinking, and common sense told me, that actually the prostitutes themselves were making a better case, and I was interested to hear their stories. When we looked at the Swedish model and, listened to the experiences of prostitutes, I realised that criminalisation will never work.

I think that’s because most times criminalisation is brought about by people who want to stop any kind of commercial sexual activity. If you accept, as I believe most people seem to, prostitution as a business that will never be stopped, that we just have to be grown up about this and tackle it head on. In the meantime, what we’re doing is encouraging violence and encouraging people to ignore their health and there’s lots of evidence that shows that. Far better that we accept that there will always be both men and women who sell sex that we have an obligation to protect their health and make it as safe as we can do.

Rhoda Grant’s Bill fell due to a lack of cross party support. Why do you think that now is the right time for Scotland to be considering something like this?

I think that since the Referendum, there’s certainly a lot more interest in everything that we do and how Scotland deals with its own situation. Recently, Edinburgh had always turned a blind eye to things, and then Police Scotland declared nationwide law enforcement and that changed things for quite a few women. I just feel that if we’re going to be a progressive country, rather than go back and take some kind of hard line for the wrong reasons, can we have a debate about the alternatives to that? Without citing the New Zealand model, we can’t have a proper debate about the Swedish model, and we should consider all options. I want people to have a view, and have the debate. It’s not about my view, about whether I consider prostitution right or wrong, moral or immoral, that’s neither here nor there. It’s about giving working men and women the same rights as other people.

This reflects the principles behind the New Zealand Prostitution Reform Act (PRA), in that the position is ethically neutral, and more aiming to protect the rights of sex workers?

That’s right.

You mentioned the importance of having a debate about this issue. This consultation at the moment, won’t lead directly to a Bill?

In time, it would be good to think that it would, but as far as taking it forward is concerned, it won’t go through in this parliamentary session. It’ll have to wait until after the election, (MSPs have the right to introduce a Member’s Bill if a final proposal has cross-party support, but only up until the beginning of June in the penultimate year of that Parliamentary session, a deadline which has since passed) but we will have moved the debate on. Having the results of the public consultation, and the arguments made for and against, it’s easier to present this to the Parliament, or have another MSP take it forward.

What are the opinions of the members of the other parties at present? Is there support for this measure?

There are a number of MPs in every party who have been supportive of the discussion. It’s impossible to say what will happen after the election, as they may, or may not, be there. I do think it’s interesting that because it’s something that’s not really talked about, and once people are used to talking about it, or meet and talk to sex workers, they begin to see things in a different light. That’s not saying that the prostitutes I’ve met are all happy at their work, that’s not the case. I meet lots of people who are not happy at their work, but people have to work.

You’ve mentioned about the importance of talking to and involving sex workers. The consultation is open to everyone, but what efforts have been taken to encourage sex workers to have a voice within it?

The work that I’ve been doing has been with Scot-PEP, which is a sex workers organisation. Certainly on social media the calls have gone out from them to say that this consultation is there and asking for a response. I fondly imagined, after the launch, and we have had a certain amount of publicity, that people would have been rushing to put forward their views, but the deadline is the 1st of December, and I’m led to believe that people usually work to a deadline, and most responses come in the last week. I am keen to talk about the Bill as much as possible, and encouraging people to learn what the Bill is about, as people will have preconceptions that this will result on prostitutes on every corner.

It’s very readable, and the appeal of this for me is that it’s practical and common sense. If you care a bit about these women, then do read it. I was very aware of the argument, and I was part of that before myself, that it’s violent against women. I’m not supporting prostitution, but it can either go on in a safe environment, or underground. We can’t make it go away.

A lot of the words of prostitutes are in this bill, and they say that it is scary. With being criminalised themselves, they have to make decisions about taking clients quickly, and if a client is violent, they know that they aren’t likely to be prosecuted for this. They are always on the edge and always vulnerable. They could be much safer. As far as being safer, we have the situation in Edinburgh now where using a condom can be used against them. Also, people aren’t flush with cash at the moment. If they are prosecuted, they have a criminal record and have to pay a fine. They have to go back to prostitution to pay the fine. We have to break that chain.

You’ve mentioned that people might think that the proposed Bill could lead to “prostitutes on every corner”. Do you think that there is the risk that whilst the people in Scotland may be supportive, that it’s not something they want to see happening close to them?

Sex work is not something that equates to red lights and women sitting in windows, although it might do in some cities. It’s something that is actually quite discreet. Already we know that illegally there are prostitues who work together, and that’s what we want to make legal. But neither they, nor their customers are keen for it to be broadcast. They’re happy with the idea that they can’t advertise. I suspect that there are flats with several women working, but very quietly.

That said, in Edinburgh, with regard to the saunas: there was no one in the streets demanding that they close prior to the Police enforced the licensing. So we already live with it, and there’s no great cry about it. I live in a rural area, but none of the politicians here, our mailbags are not full of letters of complaint about “There’s a prostitute working on my stair, what are you going to do about it?” So Scotland seems to have tolerated it very well in an unofficial way.

You mentioned about the collective working of sex workers. The situation in Scotland is that currently, a single sex worker, working from home, is working within the law, but can’t work with any others in the premises. The New Zealand legislation allows for both sex workers working within premises collectively, and owner operated licensed brothels. Are you to keen to replicate this situation in Scotland?

I think that’s what most people prefer. They’d like to go out to work, and have a safe place to work, which is the big ask. In other words, a brothel, a licensed brothel, would have to be licensed by the local council. All incomes would therefore be declared, so the tax man would be happy!

At the moment, the situation is that anyone benefiting from the earnings of prostitution is a criminal: be they partners or children. The thing is that most prostitutes are people like you and me. There’s a stigma attached to prostitution and certain stereotypes, but they are as diverse as any other group of working women, as are their clients. We need to stop stereotyping prostitutes and the people who buy sex, because they look just like our fathers, brothers and uncles. Even if we can get people to recognise this fact, that would be something.

With regard to the licensing by local authorities, what is to stop local authorities who do not agree with the change in the legislation merely passing by-laws, rejecting all licensing applications for brothels, or putting in prohibitive fees for the process of licensing? In New Zealand certain regions passed legislation banning all trade on the streets, thereby banning street-based prostitution.

We can’t really cover that in the Bill, as the Bill is an ask, and these have to be negotiated with the local authorities. I think these are other fights for other days, as it does not have the stipulations for these. We would just asked that applications meet the criteria set down by local authorities. If we were able to see as much of this law passed as possible, we can work out the details to be taken forward, or amendments. I’m not sure how New Zealand dealt with that.

In addition, New Zealand’s research picked up that about a quarter of sex workers used drugs, and research from Glasgow has suggested that the figure is higher. Is there the possibility that this could be exploited, by say, the Police, who will no longer have the power to enter brothels?

The Bill isn’t attempting to solve the problems of human trafficking, drug and alcohol addiction, or poverty. The Bill does require cooperation from the Police. Drug use is covered by other legislation, and the Police enforce that how they wish. The idea that criminalisation of the purchase of sex is a cure all for trafficking, or drug use or rape is nonsense.

You have specifically mentioned the case in Edinburgh where the change in local policy with regard to the brothels has been brought about by the Police. Did they find in New Zealand that their relationship with the Police improved after the PRA was introduced?

What’s interesting about the New Zealand model, on which the Bill is based, is that it was only passed by the chairman’s casting vote. Politicians were clearly divided. It was passed, but by one vote, on the caveat that it would be implemented immediately, but reviewed in five years. Five years later, it was reviewed and agreed to be re-reviewed in eighteen years. So that suggests that whilst it’s not perfect, and no-legislation is, but if the Police had serious issues with it, or if it wasn’t working, then this wouldn’t be the case. But I think this Bill moves us on and shows us as a progressive nation. I can’t tell you the situation exactly with regard to the relationship with the Police in New Zealand, I can’t tell you categorically, but it’s indicative of something that they are prepared to review it again in eighteen years.

Moving on, you’ve mentioned the improvements in health, and our readers obviously have an interested in the prevention of transmission of sexually transmitted disease. The New Zealand PRA made the use of condoms mandatory, with fines against clients who refuse to wear them are you intending to propose something similar?

At the moment prostitutes are panicking about this, because in Edinburgh the presence of condoms has been used as evidence against them. So the current legislation isn’t helping in encouraging prostitutes to use condoms. All of the evidence: the Lancet, in Healthier Scotland, the UN Aids program… they are all supportive of decriminalisation in terms of allowing ease of access to preventative methods, so this would seem to me to be in their favour.

The New Zealand PRA makes inspection of the licensed brothels mandatory, to check that they are meeting Health and Safety standards. Are there plans for similar measures in Scotland, will there need to be a new body for inspection created?

No, there wouldn’t need to be a new body. It would be carried out by the local authority, or by Health and Safety, in the usual way. I think that checking that a business meets the standards is the responsibility of the Local Authority.

Our readers are, as health professionals, are also interested in child protection. You’ve stipulated that our laws in Scotland regarding the issue of under-age sex work are already robust; however, are those who are under-age, and selling sex, at risk of prosecution themselves, or are they considered to victims of circumstance?

Absolutely. This was something that was really concerning me. There is a commonly held belief that children that are abused are more inclined to prostitution, or children of prostitutes are more included to prostitution, but there is no difference, but we should be entirely intolerant of those under eighteen being sex workers. The prostitutes themselves agree with this, and we do refer to this in the Bill. This Bill is for those eighteen and over, and there is zero tolerance for exploitation.

You’d mentioned about the issue of trafficking.

Amendments to current legislation with regard to trafficking, specifically in relation to prostitution, failed during current consideration. We didn’t want to conflate the issue of prostitution and trafficking, as there are many kinds of slavery. Our point, is that trafficking is not just about prostitution. We have no doubt that people are trafficked into prostitution in the UK, and those people who have trafficked should be prosecuted.

Just a final point, this Bill does cover the issue of both male and female sex workers?

Yes, there are a growing number of male sex workers, and women who buy sex from male sex workers; although we do frequently talk just about women selling sex.

For those readers who are interested in contributing to the consultation, you can find the documentation here, and details of how to respond at the end. The closing date for submissions is the 1st of December 2015.

Web-App Review: Petals

12 Oct, 15 | by shaworth

Ground breaking-anonymity features, and well-presented information, but needs to follow through.

Petals is an online web application, developed by Coventry University, which aims to provide information and assistance to those who wish to know more about, or who are at risk of, FGM.

Using the site is fairly straightforward. Accessed through the Petals homepage, it contains a home screen which demonstrates the subsections relating to advice, a quiz on the user’s knowledge of the subject, how to take action, and the details of organisations which support those who have undergone and those at risk of FGM. It also has examples of the views of different people and organisations about FGM, collecting together material already produced elsewhere.

One striking aspect of the application are the baked-in anonymity features. The website has a feature which allows the window, or tab, to be closed and the details of the page removed from the browsing history, without further intervention needed by the user. It also contains some easy-to-follow instructions for those who to remove the browsing history manually. Part of the reason behind the app’s name is that it is not directly connected with the practice of FGM, meaning that the user can hide within obscurity if they cannot anonymise their browsing. The webpage also does not use any images of FGM, presumably for the same reason.

The information in the website is presented in a clear and easy-to-understand manner. It does not rely on gimmicks, or attempt to appropriate youth cultures or speech, which means that it retains a mantle of respectability, and appears authoritative. At the same time, the ideas are presented in a way which is accessible.

The app’s slant towards persons who may not themselves be in danger of FGM, friends or male relatives, is a useful inclusion. These groups may not agree with the practice, but may feel powerless to bring about change, yet their inclusion is key to the eradication of the practice: if FGM is seen as undesirable in a female partner, market forces should prevail.

Criticism of the app is that it does not include information for those who have been victims of FGM themselves, and by emphasising the harm of the practice, without any information as to whether or not it can be reversed, or solutions to the health problems it lists, it may risk instilling a sense of powerlessness and shame in victims. Also, whilst it may have noble intentions by providing information as to what happens to adults who perform or are complicit with FGM, it provides little reassurance to those who wish to report that they can do so anonymously, or how to go about this, bar contacting the NSPCC helpline. Whilst young people may be synonymous with rebellion in the eyes of some, informing the authorities about goings-on within your family, is something that may have long term impacts on family relationships. Some information about how to mitigate or avoid this possibility may encourage reporting.

Overall, Petals has taken a really groundbreaking stance with its efforts to present information to young people in a straightforward manner, and offering vital protections with user anonymity, but needs further refinement to support those taking action.

Peer Reviewers Wanted

21 Sep, 15 | by shaworth

The Journal is seeking new peer reviewers.

This would involve occasional work reviewing submitted papers for acceptance and advising on any final fine-tuning which needs to take place. This is done online, and reviewers can claim CPD using this work.

If you would like further information, please contact

Data Use In Sexual Health

14 Sep, 15 | by shaworth

Last week, a London HIV clinic hit the headlines: in emailing service users en-masse with a newsletter, the service inadvertently emailed all clients, with names and email addresses visible to all recipients.

Like the majority of information security breaches, this was not the result of a clever hack. Many media outlets have reported this breach as being the result of “human error” as the email addresses were entered entering into the CC (Carbon Copy) rather the BCC (Blind Carbon Copy) field. By viewing the incident from this angle alone, copying and pasting into the wrong field is human error, but fails to understand that doing so is bad practice, and one which occurs due to lack of knowledge and understanding about information security.

Email can be a powerful tool for communication, and computerised databases allow us to handle information easily and effectively, but both can be crippled as a result of human users failing to understand the significance of information security, and designing systems and processes which rely on human involvement where there should be none.

Blind Carbon Copy, the function relied on by the clinic can be implemented in several ways, but the most common one is that where the BCC recipient sees only their own email address in this field. In certain situations, it is possible for users to see other BCC recipients. The security of the function depends on the implementation. A good security feature would be to use mail software that flags the use of the carbon copy field as potentially inappropriate for disseminating emails to many people, but this might not prevent leakage altogether.

It also wouldn’t address the fact that modern data management should avoid copying and pasting email addresses into emails meant for multiple recipients altogether. Plenty of off-the-peg systems exist that will automate the sending of emails to multiple clients as individuals. The concept of in-built mail merge is not a new one, but the function needs to exist within well-designed, working software. How many of us know who to ask to purchase secure software, or how long the approval process takes? If a user is faced with the option of copying-and-pasting, or waiting several weeks for an approved process to be arranged, corners will start to be cut.

All staff working within the NHS need to have, at least, a rudimentary understanding of the principles of information security, and the NHS needs to be able to provide training for them to do so, in addition to make the processes for keeping information security easily available. With increasing fragmentation of the NHS in England, and the cheapest provider chosen for service provision, this could become an increasingly common problem as users and support services diverge further.

Review of Glow: A Reproductive Health App

25 Aug, 15 | by shaworth

Glow is a reproductive health app for Android and iOS, developed and released this year. It forms part of a triad of apps including Glow Nurture, which allows logging of pregnancy data, and Ruby (currently only available for iOS) which logs and advises on contraceptive use.

The purpose of Glow is to centralise fertility awareness measures for either optimisation of fertility, or for use as part of family planning through fertility awareness methods. Users can log their cycle length, body temperature and cervical mucus consistency to determine ovulation periods. After logging data, the app generates “insights” based on the data supplied i.e. short snippets of advice for improving fertility, or managing symptoms. In addition, Glow collects data on weight, stress levels, alcohol intake and exercise. Users are advised to enter a daily health log, and set reminders about user dependent contraceptive methods and pre-natal supplementation.

For all the data entry that is required, Glow is remarkably streamlined. It took very little time to enter a daily log, largely because the user interface to do so is excellent. Once the data is logged, the app returns to its home screen where the day of the cycle is demonstrated, alternating with the risk of conception (unless you’re using LARC, where it does not show this and is a nice touch). From here, it’s possible to navigate to all other areas of the app.

Glow’s user interface is exceptionally well designed, and using it feels intuitive. There are no flashy trimmings: the interface is streamlined, which is is probably why it comes in at around 24MB on your device. It can also synch with some fitness accounts with other providers.

Glow is free to download and use, and during my short time using it, I did not notice the presence of intrusive ads; although Glow’s ToCs do stipulate that advertised content is provided. Glow’s privacy statement says that personally identifiably data is not shared with third parties; although aggregate data is, which might explain where some of the profit comes from.

The main drawback to using Glow is that it is US-centric, and as such, its advice is based on US healthcare advice and guidelines. This said, the app can be used by people in other countries without feeling disconnected from the user’s personal experience.

Overall verdict: a powerful tool which can give women the tools to optimise fertility without taking up valuable baby-making time.

New Society for Abortion Care Providers

14 Aug, 15 | by shellraine, e-Media Editor


The British Society of Abortion Care Providers (BSACP) has been formed to promote best practice, education, training and research in abortion care. The BSACP is open to those involved in the provision of abortion care including doctors, nurses, midwives, counsellors, clinical support workers and managers. The BSACP will serve its members by providing a forum for professional development and networking, as well as by raising the profile of the specialty and improving understanding amongst those responsible for abortion-related policy, guidance, commissioning, regulation and training.

See the BSACP website for details of the Society, how to become a member and the Inaugural meeting to be held at the RCOG on 29th October 2015

Hues and Cries: Colour Changing Condoms and Chlamydia Vaccines

16 Jul, 15 | by shaworth

Journal readers may be interested in the paper by Stary et al in last month’s edition of Science magazine, which reports on early trials of a mucosal, killed vaccine against Chlamydia.

 Chlamydia remains one of the most common sexually transmitted infections in the UK, and creates a significant disease burden with the associated risk of pelvic inflammatory disease and infertility. Recent surveillance reports suggest that the worst affected area in the UK for chlamydia is Hackney, in London. Previous efforts to produce a vaccine in the 1960s were halted after the treatment arm was found to be more susceptible to the disease.

 For the time being, the prospect of a vaccine appears remote, given that the current trials have only been performed on mice, and it remains to be seen whether this route produces useful immunity in humans.

Meanwhile, much consternation has resulted from the colour-changing condoms presented at the TeenTech awards, which were reported in the lay press as being a real thing which have actually been invented. Those working in sexual health can breathe a sigh of relief that the product is not available to buy, and then idea is merely a hypothetical use of ELISA technology to detect mucosal antibodies to common sexually transmitted infections. It remains to be seen whether this is even a feasible use of the technology suggested; however credit is due to the students for bringing the topic of sexually transmitted infections and the use of condoms to prevent them to the attention of consumers.

Good Vibes: The FPA’s Novel Funding Strategy

3 Jul, 15 | by shaworth

The UK Sexual Health charity The Family Planning Association (FPA) is eighty-five years old this year, but its decision to broaden its funding opportunities by opening up an online shop specialising in sex toys proves that age is no barrier to experimentation.

Set up in 1930, the FPA originally provided clinical services to the people of Britain when the NHS did not, but over time it has broadened its range to include the provision of education materials, lobbying for abortion and contraception rights, and leading campaigns to improve equality in sexual health for marginalised groups.

In these more recent and austere years, the charity has been forced to close some of its services: the sexual health advice line (excluding Northern Ireland) closed in 2014, and has remained so due to funding deficits. Nevertheless, the charity has decided to embark on a bold and ambitious venture, entering into the world of on-line shopping. In partnership with Rolesar Limited, it has opened FPA Pleasures.

In the broader sense, charities supplementing their donation income through the sale of new goods is not new, and usually these are themed around the charity’s mission, such as the plethora of boat-related gifts in the Lifeboats’ launch stations-cum-gift shops, or supportive of their ideals, so the the idea of the FPA branching into sex toys is at least following a well-trodden path.

Whether the venture is successful or not remains to be seen. To pardon the expression, there is stiff competition in this market from LoveHoney, and high-street purveyor of cut-price perversion Anne Summers to name but too. What makes the FPAPleasures shop stand out however, is its visible commitment to inclusiveness, a reflection of its values as a charity. There are images of older models and models demonstrating same sex relationships, which gives the store-front a welcoming feel for all. A short stroll through the menus reveals a advice for those who have disabilities, including non-physical ones.

How much income from the site will be generated remains to be seen, but if you’re interested in helping the FPA make it through the next eighty-five years, a treat for yourself via FPAPleasures might be a helpful move.

ESC 14th Congress in Basel

25 Jun, 15 | by shellraine, e-Media Editor

BaselThe 14th Congress and 2nd Global Conference of the European Society of  Contraception and Reproductive Health will be held in Basel from 4th – 7th May 2016.

The First announcement invites abstracts to be submitted by 15th November for presentations, free communications and posters

The UK has many members and always has a significant presence with many contributions in all sessions. There is a significant reduction for members so consider joining, if not already, and book a place before 15th January 2016 for an even greater reduction – €520 compared to €850

For more information visit the website at

Latest from JFPRHC

Latest from JFPRHC