Rachel Stuart | Brunel University (original) (raw)
Papers by Rachel Stuart
During COVID-19 lockdowns in England, ‘key workers’ including factory workers, carers and cleaner... more During COVID-19 lockdowns in England, ‘key workers’ including factory workers, carers and cleaners had to continue to travel to workplaces. Those in key worker jobs were often from more marginalised communities, including migrant workers in precarious employment. Recognising space as materially and socially produced, this qualitative study explores migrant workers’ experiences of navigating COVID-19 risks at work and its impacts on their home spaces. Migrant workers in precarious employment often described workplace COVID-19 protection measures as inadequate. They experienced work space COVID-19 risks as extending far beyond physical work boundaries. They developed their own protection measures to try to avoid infection and to keep the virus away from family members. Their protection measures included disinfecting uniforms, restricting leisure activities and physically separating themselves from their families. Inadequate workplace COVID-19 protection measures limited workers' ability to reduce risks. In future outbreaks, support for workers in precarious jobs should include free testing, paid sick leave and accommodation to allow for self-isolation to help reduce risks to workers’ families. Work environments should not be viewed as discrete risk spaces when planning response measures; responses and risk reduction approaches must also take into account impacts on workers’ lives beyond the workplace.
Scientific reports, Apr 8, 2024
Street-based sex workers experience considerable homelessness, drug use and police enforcement, m... more Street-based sex workers experience considerable homelessness, drug use and police enforcement, making them vulnerable to violence from clients and other perpetrators. We used a deterministic compartmental model of street-based sex workers in London to estimate whether displacement by police and unstable housing/homelessness increases client violence. The model was parameterized and calibrated using data from a cohort study of sex workers, to the baseline percentage homeless (64%), experiencing recent client violence (72%), or recent displacement (78%), and the odds ratios of experiencing violence if homeless (1.97, 95% confidence interval 0.88-4.43) or displaced (4.79, 1.99-12.11), or of experiencing displacement if homeless (3.60, 1.59-8.17). Ending homelessness and police displacement reduces violence by 67% (95% credible interval 53-81%). The effects are nonlinear; halving the rate of policing or becoming homeless reduces violence by 5.7% (3.5-10.3%) or 6.7% (3.7-10.2%), respectively. Modelled interventions have small impact with violence reducing by: 5.1% (2.1-11.4%) if the rate of becoming housed increases from 1.4 to 3.2 per person-year (Housing First initiative); 3.9% (2.4-6.9%) if the rate of policing reduces by 39% (level if recent increases had not occurred); and 10.2% (5.9-19.6%) in combination. Violence reduces by 26.5% (22.6-28.2%) if half of housed sex workers transition to indoor sex work. If homelessness decreased and policing increased as occurred during the COVID-19 pandemic in 2020, the impact on violence is negligible, decreasing by 0.7% (8.7% decrease-4.1% increase). Increasing housing and reducing policing among street-based sex workers could substantially reduce violence, but large changes are needed.
Critical Public Health, Oct 18, 2022
While extensive literature documents how criminalisation harms sex workers' health and ri... more While extensive literature documents how criminalisation harms sex workers' health and rights, limited research has critically examined how interactions between criminal-justice, health, and other systems shape support and justice for and by people who sell sex. We attend to this question by drawing on participatory, qualitative research with a diverse group of sex workers and other stakeholders in East London, UK. In addition to directly and structurally-violent enforcement practices, we identified wider, necropolitical assemblages and practices-across police, local and immigration authorities, health and social services-that disciplined sex workers' lives, responsibilised them for their health, and defunded specialist services grounded in lived realities, amid tensions over sex-work governance. These effects-grounded in notions of community and vulnerability that often privileged residents' concerns over threats to sex workers' safety and health-impacted marginalised and minoritised cis and trans women the most. Those who worked on the street and used drugs, were migrants, and/or women of colour were particularly targeted for enforcement, discounted when reporting violence and impacted by service cuts. Yet participants' appeals for redirection of funds from enforcement towards respectful, peer-led services reflected claims to social justice on their own terms. We recommend (re)commissioning health and support services that respond to sex workers' diverse realities, with and by them, alongside concerted efforts to end policies and practices that criminalise, punish, and blame. This would help to alleviate the health and social harms that we document, in support of inclusive participation in health and broader social justice goals.
International journal of gender, sexuality and law, Jul 6, 2022
Sociology of health and illness, 2023
During COVID-19 lockdowns in England, ‘key workers’ including factory workers, carers and cleaner... more During COVID-19 lockdowns in England, ‘key workers’ including factory workers, carers and cleaners had to continue to travel to workplaces. Those in key worker jobs were often from more marginalised communities, including migrant workers in precarious employment. Recognising space as materially and socially produced, this qualitative study explores migrant workers’ experiences of navigating COVID-19 risks at work and its impacts on their home spaces. Migrant workers in precarious employment often described workplace COVID-19 protection measures as inadequate. They experienced work space COVID-19 risks as extending far beyond physical work boundaries. They developed their own protection measures to try to avoid infection and to keep the virus away from family members. Their protection measures included disinfecting uniforms, restricting leisure activities and physically separating themselves from their families. Inadequate workplace COVID-19 protection measures limited workers' ability to reduce risks. In future outbreaks, support for workers in precarious jobs should include free testing, paid sick leave and accommodation to allow for self-isolation to help reduce risks to workers’ families. Work environments should not be viewed as discrete risk spaces when planning response measures; responses and risk reduction approaches must also take into account impacts on workers’ lives beyond the workplace.
SSM - Qualitative Research in Health
Individuals were asked to play an active role in infection control during the COVID-19 pandemic. ... more Individuals were asked to play an active role in infection control during the COVID-19 pandemic. Yet while government messages emphasised taking responsibility for the public good (e.g. to protect the National Health Service), they appeared to overlook social, economic, and political factors affecting the ways that people were able to respond. We co-produced participatory qualitative research with members of Gypsy and Traveller communities in England between October 2021 and February 2022 to explore how they had responded to COVID-19, its containment (test, trace, isolate) and the contextual factors affecting COVID-19 risks and responses within the communities. Gypsies and Travellers reported experiencing poor treatment from health services, police harassment, surveillance, and constrained living conditions. For these communities, claiming the right to health in an emergency required them to rely on community networks and resources. They organised collective actions to contain COVID-19 in the face of this ongoing marginalisation, such as using free government COVID-19 tests to support self-designed protective measures including community-facilitated testing and community-led contact tracing. This helped keep families and others safe while minimising engagement with formal institutions.
SSM - Qualitative Research in Health, 2023
Individuals were asked to play an active role in infection control in the COVID-19 pandemic. Yet ... more Individuals were asked to play an active role in infection control in the COVID-19 pandemic. Yet while government messages emphasised taking responsibility for the public good (e.g. to protect the National Health Service), they appeared to overlook social, economic and political factors affecting the ways that people were able to respond. We co-produced participatory qualitative research with members of Gypsy and Traveller communities in England between October 2021 and February 2022 to explore how they had responded to COVID-19, its containment (test, trace, isolate) and the contextual factors affecting COVID-19 risks and responses within the communities. Gypsies and Travellers reported experiencing poor treatment from health services, police harassment, surveillance, and constrained living conditions. For these communities, claiming the right to health in an emergency required them to rely on community networks and resources. They organised collective actions to contain COVID-19 in the face of this ongoing marginalisation, such as using free government COVID-19 tests to support self-designed protective measures including community-facilitated testing and community-led contact tracing. This helped keep families and others safe while minimising engagement with formal institutions. In future emergencies, communities must be given better material, political and technical support to help them to design and implement effective community-led solutions, particularly where government institutions are untrusted or untrustworthy.
Vaccine, 2023
Background Many people refuse vaccination and it is important to understand why. Here we explore ... more Background
Many people refuse vaccination and it is important to understand why. Here we explore the experiences of individuals from Gypsy, Roma, and Traveller groups in England to understand how and why they decided to take up or to avoid COVID-19 vaccinations.
Methods
We used a participatory, qualitative design, including wide consultations, in-depth interviews with 45 individuals from Gypsy, Roma, and Traveller, communities (32 female, 13 male), dialogue sessions, and observations, in five locations across England between October 2021 and February 2022.
Findings
Vaccination decisions overall were affected by distrust of health services and government, which stemmed from prior discrimination and barriers to healthcare which persisted or worsened during the pandemic. We found the situation was not adequately characterised by the standard concept of “vaccine hesitancy”. Most participants had received at least one COVID-19 vaccine dose, usually motivated by concerns for their own and others’ health. However, many participants felt coerced into vaccination by medical professionals, employers, and government messaging. Some worried about vaccine safety, for example possible impacts on fertility. Their concerns were inadequately addressed or even dismissed by healthcare staff.
Interpretation
A standard "vaccine hesitancy" model is of limited use in understanding vaccine uptake in these populations, where authorities and health services have been experienced as untrustworthy in the past (with little improvement during the pandemic). Providing more information may improve vaccine uptake somewhat; however, improved trustworthiness of health services for GRT communities is essential to increase vaccine coverage.
Keywords
Vaccination; COVID-19; Gypsy; Roma; Traveller; Discrimination; Qualitative; England; Vaccine hesitancy; Trust; Trustworthiness; Inequality; Inequity
Vaccine, 2023
Abstract Background Many people refuse vaccination and it is important to understand why. Here we... more Abstract
Background
Many people refuse vaccination and it is important to understand why. Here we explore the experiences of individuals from Gypsy, Roma, and Traveller groups in England to understand how and why they decided to take up or to avoid COVID-19 vaccinations.
Methods
We used a participatory, qualitative design, including wide consultations, in-depth interviews with 45 individuals from Gypsy, Roma, and Traveller, communities (32 female, 13 male), dialogue sessions, and observations, in five locations across England between October 2021 and February 2022.
Findings
Vaccination decisions overall were affected by distrust of health services and government, which stemmed from prior discrimination and barriers to healthcare which persisted or worsened during the pandemic. We found the situation was not adequately characterised by the standard concept of “vaccine hesitancy”. Most participants had received at least one COVID-19 vaccine dose, usually motivated by concerns for their own and others’ health. However, many participants felt coerced into vaccination by medical professionals, employers, and government messaging. Some worried about vaccine safety, for example possible impacts on fertility. Their concerns were inadequately addressed or even dismissed by healthcare staff.
Interpretation
A standard "vaccine hesitancy" model is of limited use in understanding vaccine uptake in these populations, where authorities and health services have been experienced as untrustworthy in the past (with little improvement during the pandemic). Providing more information may improve vaccine uptake somewhat; however, improved trustworthiness of health services for GRT communities is essential to increase vaccine coverage.
Funding
This paper reports on independent research commissioned and funded by the National Institute for Health Research (NIHR) Policy Research Programme. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the NIHR, the Department of Health and Social Care or its arm's length bodies, and other Government Departments.
SSM – Qualitative Research in Health, 2023
Individuals were asked to play an active role in infection control during the COVID-19 pandemic. ... more Individuals were asked to play an active role in infection control during the COVID-19 pandemic. Yet while government messages emphasised taking responsibility for the public good (e.g. to protect the National Health Service), they appeared to overlook social, economic, and political factors affecting the ways that people were able to respond. We co-produced participatory qualitative research with members of Gypsy and Traveller communities in England between October 2021 and February 2022 to explore how they had responded to COVID-19, its containment (test, trace, isolate) and the contextual factors affecting COVID-19 risks and responses within the communities. Gypsies and Travellers reported experiencing poor treatment from health services, police harassment, surveillance, and constrained living conditions. For these communities, claiming the right to health in an emergency required them to rely on community networks and resources. They organised collective actions to contain COVID-19 in the face of this ongoing marginalisation, such as using free government COVID-19 tests to support self-designed protective measures including community-facilitated testing and community-led contact tracing. This helped keep families and others safe while minimising engagement with formal institutions.
In mid-2021 NHS Test and Trace/Department of Health and Social Care commissioned the Dialogue, ... more In mid-2021 NHS Test and Trace/Department of Health and Social Care
commissioned the Dialogue, Evidence, Participation, and Translation for Health (DEPTH) research group to explore the impact of COVID-19 in Gypsy, Roma and Traveller communities, and among migrant workers. We undertook participatory qualitative research with members of these communities to co-produce insights into COVID-19 and public health responses, particularly focusing on testing, contact tracing, and vaccination.
Digital poverty in Margate a study of two hyperlocal communities, 2022
This report presents the findings of an in-depth, qualitative study of digital poverty from the p... more This report presents the findings of an in-depth, qualitative study of digital poverty from the perspectives of two hyperlocal communities in the UK seaside town of Margate. Specifically, the study examined members of the Roma and Creative Diaspora. We interviewed individuals in their milieu, using semi-structured questions that enabled the research team to segue into issues raised by the interviews to better understand their lived experiences of digital poverty.
Critical Public Health
While extensive literature documents how criminalisation harms sex workers' health and ri... more While extensive literature documents how criminalisation harms sex workers' health and rights, limited research has critically examined how interactions between criminal-justice, health, and other systems shape support and justice for and by people who sell sex. We attend to this question by drawing on participatory, qualitative research with a diverse group of sex workers and other stakeholders in East London, UK. In addition to directly and structurally-violent enforcement practices, we identified wider, necropolitical assemblages and practices-across police, local and immigration authorities, health and social services-that disciplined sex workers' lives, responsibilised them for their health, and defunded specialist services grounded in lived realities, amid tensions over sex-work governance. These effects-grounded in notions of community and vulnerability that often privileged residents' concerns over threats to sex workers' safety and health-impacted marginalised and minoritised cis and trans women the most. Those who worked on the street and used drugs, were migrants, and/or women of colour were particularly targeted for enforcement, discounted when reporting violence and impacted by service cuts. Yet participants' appeals for redirection of funds from enforcement towards respectful, peer-led services reflected claims to social justice on their own terms. We recommend (re)commissioning health and support services that respond to sex workers' diverse realities, with and by them, alongside concerted efforts to end policies and practices that criminalise, punish, and blame. This would help to alleviate the health and social harms that we document, in support of inclusive participation in health and broader social justice goals.
Journal of Urban Health
There is extensive qualitative evidence of violence and enforcement impacting sex workers who are... more There is extensive qualitative evidence of violence and enforcement impacting sex workers who are ethnically or racially minoritized, and gender or sexual minority sex workers, but there is little quantitative evidence. Baseline and follow-up data were collected among 288 sex workers of diverse genders (cis/transgender women and men and non-binary people) in London (2018–2019). Interviewer-administered and self-completed questionnaires included reports of rape, emotional violence, and (un)lawful police encounters. We used generalized estimating equation models (Stata vs 16.1) to measure associations between (i) ethnic/racial identity (Black, Asian, mixed or multiple vs White) and recent (6 months) or past police enforcement and (ii) ethnic/racial and sexual identity (lesbian, gay or bisexual (LGB) vs. heterosexual) with recent rape and emotional violence (there was insufficient data to examine the association with transgender/non-binary identities). Ethnically/racially minoritized ...
Critical Public Health, 2022
While extensive literature documents how criminalisation harms sex workers' health and rights, li... more While extensive literature documents how criminalisation harms sex workers' health and rights, limited research has critically examined how interactions between criminal-justice, health, and other systems shape support and justice for and by people who sell sex. We attend to this question by drawing on participatory, qualitative research with a diverse group of sex workers and other stakeholders in East London, UK. In addition to directly and structurally-violent enforcement practices, we identified wider, necropolitical assemblages and practices-across police, local and immigration authorities, health and social services-that disciplined sex workers' lives, responsibilised them for their health, and defunded specialist services grounded in lived realities, amid tensions over sex-work governance. These effects-grounded in notions of community and vulnerability that often privileged residents' concerns over threats to sex workers' safety and health-impacted marginalised and minoritised cis and trans women the most. Those who worked on the street and used drugs, were migrants, and/or women of colour were particularly targeted for enforcement, discounted when reporting violence and impacted by service cuts. Yet participants' appeals for redirection of funds from enforcement towards respectful, peer-led services reflected claims to social justice on their own terms. We recommend (re)commissioning health and support services that respond to sex workers' diverse realities, with and by them, alongside concerted efforts to end policies and practices that criminalise, punish, and blame. This would help to alleviate the health and social harms that we document, in support of inclusive participation in health and broader social justice goals.
Journal of Urban Health, 2022
There is extensive qualitative evidence of violence and enforcement impacting sex workers who are... more There is extensive qualitative evidence of
violence and enforcement impacting sex workers who
are ethnically or racially minoritized, and gender or
sexual minority sex workers, but there is little quantitative evidence. Baseline and follow-up data were
collected among 288 sex workers of diverse genders
(cis/transgender women and men and non-binary
people) in London (2018–2019). Interviewer-administered and self-completed questionnaires included
reports of rape, emotional violence, and (un)lawful
police encounters
International Journal of Gender, Sexuality and Law
This article will bring together Deleuze and Guattari’s theory of Smooth Space and zemiological d... more This article will bring together Deleuze and Guattari’s theory of Smooth Space and zemiological debates of social harms to respond to the question set by Jane Scoular (2015): does the law matter in sex work? The regulation and policing of performers by hosting sites allow sites to avoid state-level legislation. However, site regulations cause performers to experience harm that traditional concepts of the law cannot address because the law is powerless against the intrinsic injuries done by neo-liberalism. The damages experienced by female performers were not generally criminal but nonetheless harmful to those experiencing them, even though generally no laws were transgressed. When performers did experience crime, the non-territorial nature of the internet prevented action from being taken. This article will explore the irrelevance of the law in the context of webcamming and the potential harms caused by academia’s fixed gaze on the customer, preventing consideration of the damages d...
International Journal of Gender,Sexuality and Law, 2022
This article will bring together Deleuze and Guattari’s theory of Smooth Space and zemiological d... more This article will bring together Deleuze and Guattari’s theory of Smooth Space and zemiological debates of social harms to respond to the question set by Jane Scoular (2015): does the law matter in sex work? The regulation and policing of performers by hosting sites allow sites to avoid state-level legislation. However, site regulations cause performers to experience harm that traditional concepts of the law cannot address because the law is powerless against the intrinsic injuries done by neo-liberalism. The damages experienced by female performers were not generally criminal but nonetheless harmful to those experiencing them, even though generally no laws were transgressed. When performers did experience crime, the non-territorial nature of the internet prevented action from being taken. This article will explore the irrelevance of the law in the context of webcamming and the potential harms caused by academia’s fixed gaze on the customer, preventing consideration of the damages done to webcam performers by other social actors.
During COVID-19 lockdowns in England, ‘key workers’ including factory workers, carers and cleaner... more During COVID-19 lockdowns in England, ‘key workers’ including factory workers, carers and cleaners had to continue to travel to workplaces. Those in key worker jobs were often from more marginalised communities, including migrant workers in precarious employment. Recognising space as materially and socially produced, this qualitative study explores migrant workers’ experiences of navigating COVID-19 risks at work and its impacts on their home spaces. Migrant workers in precarious employment often described workplace COVID-19 protection measures as inadequate. They experienced work space COVID-19 risks as extending far beyond physical work boundaries. They developed their own protection measures to try to avoid infection and to keep the virus away from family members. Their protection measures included disinfecting uniforms, restricting leisure activities and physically separating themselves from their families. Inadequate workplace COVID-19 protection measures limited workers' ability to reduce risks. In future outbreaks, support for workers in precarious jobs should include free testing, paid sick leave and accommodation to allow for self-isolation to help reduce risks to workers’ families. Work environments should not be viewed as discrete risk spaces when planning response measures; responses and risk reduction approaches must also take into account impacts on workers’ lives beyond the workplace.
Scientific reports, Apr 8, 2024
Street-based sex workers experience considerable homelessness, drug use and police enforcement, m... more Street-based sex workers experience considerable homelessness, drug use and police enforcement, making them vulnerable to violence from clients and other perpetrators. We used a deterministic compartmental model of street-based sex workers in London to estimate whether displacement by police and unstable housing/homelessness increases client violence. The model was parameterized and calibrated using data from a cohort study of sex workers, to the baseline percentage homeless (64%), experiencing recent client violence (72%), or recent displacement (78%), and the odds ratios of experiencing violence if homeless (1.97, 95% confidence interval 0.88-4.43) or displaced (4.79, 1.99-12.11), or of experiencing displacement if homeless (3.60, 1.59-8.17). Ending homelessness and police displacement reduces violence by 67% (95% credible interval 53-81%). The effects are nonlinear; halving the rate of policing or becoming homeless reduces violence by 5.7% (3.5-10.3%) or 6.7% (3.7-10.2%), respectively. Modelled interventions have small impact with violence reducing by: 5.1% (2.1-11.4%) if the rate of becoming housed increases from 1.4 to 3.2 per person-year (Housing First initiative); 3.9% (2.4-6.9%) if the rate of policing reduces by 39% (level if recent increases had not occurred); and 10.2% (5.9-19.6%) in combination. Violence reduces by 26.5% (22.6-28.2%) if half of housed sex workers transition to indoor sex work. If homelessness decreased and policing increased as occurred during the COVID-19 pandemic in 2020, the impact on violence is negligible, decreasing by 0.7% (8.7% decrease-4.1% increase). Increasing housing and reducing policing among street-based sex workers could substantially reduce violence, but large changes are needed.
Critical Public Health, Oct 18, 2022
While extensive literature documents how criminalisation harms sex workers' health and ri... more While extensive literature documents how criminalisation harms sex workers' health and rights, limited research has critically examined how interactions between criminal-justice, health, and other systems shape support and justice for and by people who sell sex. We attend to this question by drawing on participatory, qualitative research with a diverse group of sex workers and other stakeholders in East London, UK. In addition to directly and structurally-violent enforcement practices, we identified wider, necropolitical assemblages and practices-across police, local and immigration authorities, health and social services-that disciplined sex workers' lives, responsibilised them for their health, and defunded specialist services grounded in lived realities, amid tensions over sex-work governance. These effects-grounded in notions of community and vulnerability that often privileged residents' concerns over threats to sex workers' safety and health-impacted marginalised and minoritised cis and trans women the most. Those who worked on the street and used drugs, were migrants, and/or women of colour were particularly targeted for enforcement, discounted when reporting violence and impacted by service cuts. Yet participants' appeals for redirection of funds from enforcement towards respectful, peer-led services reflected claims to social justice on their own terms. We recommend (re)commissioning health and support services that respond to sex workers' diverse realities, with and by them, alongside concerted efforts to end policies and practices that criminalise, punish, and blame. This would help to alleviate the health and social harms that we document, in support of inclusive participation in health and broader social justice goals.
International journal of gender, sexuality and law, Jul 6, 2022
Sociology of health and illness, 2023
During COVID-19 lockdowns in England, ‘key workers’ including factory workers, carers and cleaner... more During COVID-19 lockdowns in England, ‘key workers’ including factory workers, carers and cleaners had to continue to travel to workplaces. Those in key worker jobs were often from more marginalised communities, including migrant workers in precarious employment. Recognising space as materially and socially produced, this qualitative study explores migrant workers’ experiences of navigating COVID-19 risks at work and its impacts on their home spaces. Migrant workers in precarious employment often described workplace COVID-19 protection measures as inadequate. They experienced work space COVID-19 risks as extending far beyond physical work boundaries. They developed their own protection measures to try to avoid infection and to keep the virus away from family members. Their protection measures included disinfecting uniforms, restricting leisure activities and physically separating themselves from their families. Inadequate workplace COVID-19 protection measures limited workers' ability to reduce risks. In future outbreaks, support for workers in precarious jobs should include free testing, paid sick leave and accommodation to allow for self-isolation to help reduce risks to workers’ families. Work environments should not be viewed as discrete risk spaces when planning response measures; responses and risk reduction approaches must also take into account impacts on workers’ lives beyond the workplace.
SSM - Qualitative Research in Health
Individuals were asked to play an active role in infection control during the COVID-19 pandemic. ... more Individuals were asked to play an active role in infection control during the COVID-19 pandemic. Yet while government messages emphasised taking responsibility for the public good (e.g. to protect the National Health Service), they appeared to overlook social, economic, and political factors affecting the ways that people were able to respond. We co-produced participatory qualitative research with members of Gypsy and Traveller communities in England between October 2021 and February 2022 to explore how they had responded to COVID-19, its containment (test, trace, isolate) and the contextual factors affecting COVID-19 risks and responses within the communities. Gypsies and Travellers reported experiencing poor treatment from health services, police harassment, surveillance, and constrained living conditions. For these communities, claiming the right to health in an emergency required them to rely on community networks and resources. They organised collective actions to contain COVID-19 in the face of this ongoing marginalisation, such as using free government COVID-19 tests to support self-designed protective measures including community-facilitated testing and community-led contact tracing. This helped keep families and others safe while minimising engagement with formal institutions.
SSM - Qualitative Research in Health, 2023
Individuals were asked to play an active role in infection control in the COVID-19 pandemic. Yet ... more Individuals were asked to play an active role in infection control in the COVID-19 pandemic. Yet while government messages emphasised taking responsibility for the public good (e.g. to protect the National Health Service), they appeared to overlook social, economic and political factors affecting the ways that people were able to respond. We co-produced participatory qualitative research with members of Gypsy and Traveller communities in England between October 2021 and February 2022 to explore how they had responded to COVID-19, its containment (test, trace, isolate) and the contextual factors affecting COVID-19 risks and responses within the communities. Gypsies and Travellers reported experiencing poor treatment from health services, police harassment, surveillance, and constrained living conditions. For these communities, claiming the right to health in an emergency required them to rely on community networks and resources. They organised collective actions to contain COVID-19 in the face of this ongoing marginalisation, such as using free government COVID-19 tests to support self-designed protective measures including community-facilitated testing and community-led contact tracing. This helped keep families and others safe while minimising engagement with formal institutions. In future emergencies, communities must be given better material, political and technical support to help them to design and implement effective community-led solutions, particularly where government institutions are untrusted or untrustworthy.
Vaccine, 2023
Background Many people refuse vaccination and it is important to understand why. Here we explore ... more Background
Many people refuse vaccination and it is important to understand why. Here we explore the experiences of individuals from Gypsy, Roma, and Traveller groups in England to understand how and why they decided to take up or to avoid COVID-19 vaccinations.
Methods
We used a participatory, qualitative design, including wide consultations, in-depth interviews with 45 individuals from Gypsy, Roma, and Traveller, communities (32 female, 13 male), dialogue sessions, and observations, in five locations across England between October 2021 and February 2022.
Findings
Vaccination decisions overall were affected by distrust of health services and government, which stemmed from prior discrimination and barriers to healthcare which persisted or worsened during the pandemic. We found the situation was not adequately characterised by the standard concept of “vaccine hesitancy”. Most participants had received at least one COVID-19 vaccine dose, usually motivated by concerns for their own and others’ health. However, many participants felt coerced into vaccination by medical professionals, employers, and government messaging. Some worried about vaccine safety, for example possible impacts on fertility. Their concerns were inadequately addressed or even dismissed by healthcare staff.
Interpretation
A standard "vaccine hesitancy" model is of limited use in understanding vaccine uptake in these populations, where authorities and health services have been experienced as untrustworthy in the past (with little improvement during the pandemic). Providing more information may improve vaccine uptake somewhat; however, improved trustworthiness of health services for GRT communities is essential to increase vaccine coverage.
Keywords
Vaccination; COVID-19; Gypsy; Roma; Traveller; Discrimination; Qualitative; England; Vaccine hesitancy; Trust; Trustworthiness; Inequality; Inequity
Vaccine, 2023
Abstract Background Many people refuse vaccination and it is important to understand why. Here we... more Abstract
Background
Many people refuse vaccination and it is important to understand why. Here we explore the experiences of individuals from Gypsy, Roma, and Traveller groups in England to understand how and why they decided to take up or to avoid COVID-19 vaccinations.
Methods
We used a participatory, qualitative design, including wide consultations, in-depth interviews with 45 individuals from Gypsy, Roma, and Traveller, communities (32 female, 13 male), dialogue sessions, and observations, in five locations across England between October 2021 and February 2022.
Findings
Vaccination decisions overall were affected by distrust of health services and government, which stemmed from prior discrimination and barriers to healthcare which persisted or worsened during the pandemic. We found the situation was not adequately characterised by the standard concept of “vaccine hesitancy”. Most participants had received at least one COVID-19 vaccine dose, usually motivated by concerns for their own and others’ health. However, many participants felt coerced into vaccination by medical professionals, employers, and government messaging. Some worried about vaccine safety, for example possible impacts on fertility. Their concerns were inadequately addressed or even dismissed by healthcare staff.
Interpretation
A standard "vaccine hesitancy" model is of limited use in understanding vaccine uptake in these populations, where authorities and health services have been experienced as untrustworthy in the past (with little improvement during the pandemic). Providing more information may improve vaccine uptake somewhat; however, improved trustworthiness of health services for GRT communities is essential to increase vaccine coverage.
Funding
This paper reports on independent research commissioned and funded by the National Institute for Health Research (NIHR) Policy Research Programme. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the NIHR, the Department of Health and Social Care or its arm's length bodies, and other Government Departments.
SSM – Qualitative Research in Health, 2023
Individuals were asked to play an active role in infection control during the COVID-19 pandemic. ... more Individuals were asked to play an active role in infection control during the COVID-19 pandemic. Yet while government messages emphasised taking responsibility for the public good (e.g. to protect the National Health Service), they appeared to overlook social, economic, and political factors affecting the ways that people were able to respond. We co-produced participatory qualitative research with members of Gypsy and Traveller communities in England between October 2021 and February 2022 to explore how they had responded to COVID-19, its containment (test, trace, isolate) and the contextual factors affecting COVID-19 risks and responses within the communities. Gypsies and Travellers reported experiencing poor treatment from health services, police harassment, surveillance, and constrained living conditions. For these communities, claiming the right to health in an emergency required them to rely on community networks and resources. They organised collective actions to contain COVID-19 in the face of this ongoing marginalisation, such as using free government COVID-19 tests to support self-designed protective measures including community-facilitated testing and community-led contact tracing. This helped keep families and others safe while minimising engagement with formal institutions.
In mid-2021 NHS Test and Trace/Department of Health and Social Care commissioned the Dialogue, ... more In mid-2021 NHS Test and Trace/Department of Health and Social Care
commissioned the Dialogue, Evidence, Participation, and Translation for Health (DEPTH) research group to explore the impact of COVID-19 in Gypsy, Roma and Traveller communities, and among migrant workers. We undertook participatory qualitative research with members of these communities to co-produce insights into COVID-19 and public health responses, particularly focusing on testing, contact tracing, and vaccination.
Digital poverty in Margate a study of two hyperlocal communities, 2022
This report presents the findings of an in-depth, qualitative study of digital poverty from the p... more This report presents the findings of an in-depth, qualitative study of digital poverty from the perspectives of two hyperlocal communities in the UK seaside town of Margate. Specifically, the study examined members of the Roma and Creative Diaspora. We interviewed individuals in their milieu, using semi-structured questions that enabled the research team to segue into issues raised by the interviews to better understand their lived experiences of digital poverty.
Critical Public Health
While extensive literature documents how criminalisation harms sex workers' health and ri... more While extensive literature documents how criminalisation harms sex workers' health and rights, limited research has critically examined how interactions between criminal-justice, health, and other systems shape support and justice for and by people who sell sex. We attend to this question by drawing on participatory, qualitative research with a diverse group of sex workers and other stakeholders in East London, UK. In addition to directly and structurally-violent enforcement practices, we identified wider, necropolitical assemblages and practices-across police, local and immigration authorities, health and social services-that disciplined sex workers' lives, responsibilised them for their health, and defunded specialist services grounded in lived realities, amid tensions over sex-work governance. These effects-grounded in notions of community and vulnerability that often privileged residents' concerns over threats to sex workers' safety and health-impacted marginalised and minoritised cis and trans women the most. Those who worked on the street and used drugs, were migrants, and/or women of colour were particularly targeted for enforcement, discounted when reporting violence and impacted by service cuts. Yet participants' appeals for redirection of funds from enforcement towards respectful, peer-led services reflected claims to social justice on their own terms. We recommend (re)commissioning health and support services that respond to sex workers' diverse realities, with and by them, alongside concerted efforts to end policies and practices that criminalise, punish, and blame. This would help to alleviate the health and social harms that we document, in support of inclusive participation in health and broader social justice goals.
Journal of Urban Health
There is extensive qualitative evidence of violence and enforcement impacting sex workers who are... more There is extensive qualitative evidence of violence and enforcement impacting sex workers who are ethnically or racially minoritized, and gender or sexual minority sex workers, but there is little quantitative evidence. Baseline and follow-up data were collected among 288 sex workers of diverse genders (cis/transgender women and men and non-binary people) in London (2018–2019). Interviewer-administered and self-completed questionnaires included reports of rape, emotional violence, and (un)lawful police encounters. We used generalized estimating equation models (Stata vs 16.1) to measure associations between (i) ethnic/racial identity (Black, Asian, mixed or multiple vs White) and recent (6 months) or past police enforcement and (ii) ethnic/racial and sexual identity (lesbian, gay or bisexual (LGB) vs. heterosexual) with recent rape and emotional violence (there was insufficient data to examine the association with transgender/non-binary identities). Ethnically/racially minoritized ...
Critical Public Health, 2022
While extensive literature documents how criminalisation harms sex workers' health and rights, li... more While extensive literature documents how criminalisation harms sex workers' health and rights, limited research has critically examined how interactions between criminal-justice, health, and other systems shape support and justice for and by people who sell sex. We attend to this question by drawing on participatory, qualitative research with a diverse group of sex workers and other stakeholders in East London, UK. In addition to directly and structurally-violent enforcement practices, we identified wider, necropolitical assemblages and practices-across police, local and immigration authorities, health and social services-that disciplined sex workers' lives, responsibilised them for their health, and defunded specialist services grounded in lived realities, amid tensions over sex-work governance. These effects-grounded in notions of community and vulnerability that often privileged residents' concerns over threats to sex workers' safety and health-impacted marginalised and minoritised cis and trans women the most. Those who worked on the street and used drugs, were migrants, and/or women of colour were particularly targeted for enforcement, discounted when reporting violence and impacted by service cuts. Yet participants' appeals for redirection of funds from enforcement towards respectful, peer-led services reflected claims to social justice on their own terms. We recommend (re)commissioning health and support services that respond to sex workers' diverse realities, with and by them, alongside concerted efforts to end policies and practices that criminalise, punish, and blame. This would help to alleviate the health and social harms that we document, in support of inclusive participation in health and broader social justice goals.
Journal of Urban Health, 2022
There is extensive qualitative evidence of violence and enforcement impacting sex workers who are... more There is extensive qualitative evidence of
violence and enforcement impacting sex workers who
are ethnically or racially minoritized, and gender or
sexual minority sex workers, but there is little quantitative evidence. Baseline and follow-up data were
collected among 288 sex workers of diverse genders
(cis/transgender women and men and non-binary
people) in London (2018–2019). Interviewer-administered and self-completed questionnaires included
reports of rape, emotional violence, and (un)lawful
police encounters
International Journal of Gender, Sexuality and Law
This article will bring together Deleuze and Guattari’s theory of Smooth Space and zemiological d... more This article will bring together Deleuze and Guattari’s theory of Smooth Space and zemiological debates of social harms to respond to the question set by Jane Scoular (2015): does the law matter in sex work? The regulation and policing of performers by hosting sites allow sites to avoid state-level legislation. However, site regulations cause performers to experience harm that traditional concepts of the law cannot address because the law is powerless against the intrinsic injuries done by neo-liberalism. The damages experienced by female performers were not generally criminal but nonetheless harmful to those experiencing them, even though generally no laws were transgressed. When performers did experience crime, the non-territorial nature of the internet prevented action from being taken. This article will explore the irrelevance of the law in the context of webcamming and the potential harms caused by academia’s fixed gaze on the customer, preventing consideration of the damages d...
International Journal of Gender,Sexuality and Law, 2022
This article will bring together Deleuze and Guattari’s theory of Smooth Space and zemiological d... more This article will bring together Deleuze and Guattari’s theory of Smooth Space and zemiological debates of social harms to respond to the question set by Jane Scoular (2015): does the law matter in sex work? The regulation and policing of performers by hosting sites allow sites to avoid state-level legislation. However, site regulations cause performers to experience harm that traditional concepts of the law cannot address because the law is powerless against the intrinsic injuries done by neo-liberalism. The damages experienced by female performers were not generally criminal but nonetheless harmful to those experiencing them, even though generally no laws were transgressed. When performers did experience crime, the non-territorial nature of the internet prevented action from being taken. This article will explore the irrelevance of the law in the context of webcamming and the potential harms caused by academia’s fixed gaze on the customer, preventing consideration of the damages done to webcam performers by other social actors.