ANALYTICAL REPORT ON RESULTS OF THE ASSESSMENT OF NEEDS OF SWs IN WAR AND THE IMPACT OF PROJECTS FOR SUPPORT OF SWs IN 2022-2023

INTRODUCTION

During the first three months of Russian aggression, active hostilities continued almost throughout the entire territory of Ukraine. Today, active battles are taking place in the east and south of our country, but missile attacks by Russian forces are taking place throughout Ukraine. A significant number of men left their families and joined the Armed Forces of Ukraine. Women with children are forced to survive in constant tension and fear, taking care of their young children and the elderly. As a result of shelling in many cities infrastructure facilities, residential buildings, offices of state institutions and NGOs were destroyed. In cities with the most active hostilities, residents do not have access to water, heat, food, while others may at any time lose access to these resources due to systematic bombing.

The poverty rate in Ukraine increased from 5.5% to 24.2% in 2022, pushing 8 million people below the poverty line. This is evidenced by data from a recent World Bank report. With unemployment unofficially at 36% and inflation hitting 26.6% at the end of 2022, more Ukrainians could end up below the poverty line in near future. Most problematic in this situation is the question of the employment of people. According to the UN, as a result of aggression of the Russian Federation, 17.6 million Ukrainians are in need of humanitarian assistance. More than a third of the inhabitants of Ukraine are now in extremely difficult life conditions.

Since the beginning of the war, SWs in our country have been in a difficult situation: often without work, housing, livelihood, in need of support. This war has a painful effect on psychological and physical health of SWs, which confirms their appeal to psychologists at the Hotline for SWs, negatively affects their economic and material situation, as well as the legal and social status of SWs. Due to the fact that sex work is criminalized and is not recognized as a type of work in Ukraine, SWs do not count on assistance from the state. Due to the high level of stigma and discrimination in society, SWs do not have support from civil society either. CO "Legalife-Ukraine" is the only source of stable support for many SWs in our country.

From the first days of the war, the main task of CO "Legalife-Ukraine" was to ensure the preservation of life and health of SWs and their families. To solve this problem, our organization started implementing projects to provide humanitarian assistance to SWs and to provide psychological, legal and informational support to SWs in war conditions.

In the process of forming the study protocol, on the basis of the information received from the SWs, several hypotheses were built regarding negative changes in the financial situation of the SWs and the emergence of specific, compared with peacetime, needs for services. The results of the first stage of this survey would have to confirm or refute the following assumptions:

 - SWs are in dire need of humanitarian assistance due to reduced ability to provide for themselves and families, lack of other sources of income other than sex work, lack of financial support from the state;

-  SWs need help with housing rent, transportation/reimbursement of travel expenses to move to other cities where the military situation is safer;

 - SWs need a psychological support due to the deterioration of mental health under the influence of this war;

 - SWs need a legal support due to their high vulnerability to rights violations.

Based on the results of the second round of the survey, it was planned to evaluate the effectiveness of interventions within the framework of the ACTIONAID-supported project, and develop proposals for future programs of humanitarian support to the community and to overcome barriers to services for SWs.

This report presents an analysis of the results of a survey among sex workers in Ukraine (SWs), conducted as part of the assessment of the needs of SWs in the context of war and the impact of projects to support SWs in 2022-2023. The evaluation was carried out by CO "LEGALIFE-UKRAINE" with the support of ACTIONAID.

RESEARCH BASICS

PURPOSE – to analyze the real socio-economic situation of SWs in war conditions, to analyze their psycho-emotional state, the ability of SWs to protect human rights and to study the urgent needs of SWs in humanitarian, informational, psychological and legal services in order to plan and improve the effectiveness of activities to support SWs in conditions of war.

ASSIGNMENT:

– To conduct in two stages (at the beginning of the project in April 2022 and at the end of the project in April 2023) a survey of 100 sex workers in 12 regions of Ukraine in order to determine the main needs of SWs in the context of the war for humanitarian assistance, psychological and legal support, and evaluate relevance to the project of CO "Legalife-Ukraine" for supporting SWs;

- based on the results, to prepare an analytical report and to use this results for advocacy and planning of the organization’s further activities aimed at support of SWs in war conditions.

TARGET GROUP - persons providing sex services during the war or persons who was providing sex services before the start of the war in Ukraine, regardless of their gender and sexual orientation (men, women, transgender people, etc.) aged 18 years and older, cross-groups of sex workers (SW+ LGBTIQ, SW+PLHIV, SW+PWID, etc.).

DATA COLLECTION METHODS:

• Structured interviews (137 interviews at the 1st stage and 100 interviews at the 2nd stage in 12 regions of Ukraine) using the face-to-face method. The average length of interviews in different regions varied from 25 to 45 minutes. The interviewers were the leaders of the regional initiative groups of CO "LEGALIFE-UKRAINE", who have a certain level of trust among the representatives of the target groups. The planned sample (200 people) was fully implemented mainly by the "snowball" method, through acquaintances.

INTERVIEW TOOLS:

1. Two questionnaires were developed (for the 1st and 2nd stages) for SWs, which included the following blocks of questions:

   -  Assessment of the socio-economic situation of SWs, experience in receiving humanitarian assistance for SWs, determination of their actual needs for receiving humanitarian assistance and other types of material support in times of war;

   -  Assessment of the psycho-emotional state of SWs, the need for psychological assistance in war conditions and the experience of contacting psychologists of CO "Legalife-Ukraine";

   -  Assessment of human rights capacity, SWs needs for legal assistance, experience of contacting lawyers;

   -  Assessment of SWs satisfaction with the services received from CO "Legalife-Ukraine";

   -  and recording answers based on the Google Forms created during structured interviews with SWs.

GEOGRAPHICAL COVERAGE: SWs representatives from the following regions of Ukraine were involved in the study:

• South of Ukraine (Mykolaiv region - Mykolaiv);
• North of Ukraine (Zhytomyr region - Zhytomyr);
• Central Ukraine (Vinnitsa region - Vinnitsa; Cherkasy region - Cherkasy, Kirovohrad region - Kropyvnytskyi; Poltava region - Poltava);
• South-East of Ukraine (Dnipropetrovsk region - Dnepr, Kryvyj Rih);
• North-East of Ukraine (Kharkiv region - Kharkiv, Sumy region - Sumy);
• North-Western part of Ukraine (Rivne region - Rivne);
• Western Ukraine (Volyn region - Lutsk);
• Kyiv City.

FIELD STAGE TIME FRAMES: Stage 1 - April 2022; Stage 2 - April 2023.

ETHICAL FOUNDATIONS OF THE STUDY

The collection, storage and analysis of the empirical data of the study were based on adhering to ethical standards and protecting the research participants’ rights to free will, anonymity and confidentiality. All project consultants involved in implementation of this study, including all interviewers, were warned of the responsibility for disclosing and transferring to third parties any information about the respondents.

Voluntary participation

Before the start of the survey, all participants were informed about the goals and objectives, as well as guarantees of anonymity and confidentiality for respondents, their right to voluntary participation, as well as termination of participation in the survey at any time.

Protection of personal secrets

During the study, only a limited number of people had access to the data. Once the survey was completed, all recordings were stored securely: password protected and not accessible through public networks. After data analysis, all original materials were destroyed.

LIMITATIONS OF THE STUDY

•  The lack of complete objectivity and reliability of the conclusions: the respondents themselves chose what to say and expressed their subjective opinion on certain issues. However, in the course of data collection, respondents were guaranteed anonymity and confidentiality, comfortable conditions, work with trained interviewers, who had a certain degree of confidence in SW, which could positively affect the degree of frankness of their answers.
•  Compliance with the deadlines for the completion of work: given the wartime conditions and active hostilities in many regions of Ukraine, as well as the closeness of the target audience, the deadline for completing the work was slightly extended.
•  Geographical representation: given the wartime conditions and active hostilities in many regions of Ukraine, not all geographical areas were covered by the study (in particular the Eastern region of Ukraine).

CHAPTER 1. SOCIAL PORTRAIT OF SURVEY PARTICIPANTS

GEOGRAPHY OF THE RESEARCH

A total of 237 SWs took part in the M&E (Monitoring and Evaluation) surveys in 2022-2023. During the 1st field stage a survey was conducted among 137 sex workers in Ukraine (SWs) in 12 cities of Ukraine: Kyiv, Kryvyj Rih, Kropyvnytskyi, Mykolaiv, Poltava, Rivne, Sumy, Kharkiv, Cherkasy. During the 2nd stage, a survey was conducted among 100 SWs in 12 cities of Ukraine: Vinnitsa, Dnipro, Zhytomyr, Kryvyj Rih, Kropyvnytskyi, Lutsk, Mykolaiv, Poltava, Rivne, Sumy, Kharkiv, Cherkasy (the overall distribution of survey participants by region is shown in Fig. 1)

Fig.1 Number of SW survey participants by region (n=237)

GENDER AND AGE OF RESPONDENTS

Vast majority of survey participants are females 92%, 8% are transgender people. The minimum age of respondents is 21, the maximum is 58, and the average is 38 years old.

Fig. 2 Age distribution of respondents

ASSESSMENT OF THE IMPACT OF THE WAR ON SEX WORK CONDITIONS AND ECONOMIC SITUATION OF SWs

After the outbreak of the war (April 2022, n=137), 71.5% of SWs reported that they continued to provide sex services for remuneration, but the majority (62%) noted that providing sex services has become more dangerous, risks have increased, curfews reduced working hours, fewer clients have become difficult to find, etc.

19% of SWs decided to leave sex work in the first months of the war due to new risks/deterioration of working conditions.

Another 9.5% of respondents said that before the war they did not provide sex services, but now they have to do it because of the difficult financial situation - lack of work and livelihood.

April 2023 (n=100) - 93% of respondents noted that they provided sex services at the moment, of which: 12% are SWs who temporarily did not work due to the war, but have already returned to work, 11% of SWs  had not provided sex services before the war, the rest have not left sex work since peacetime.

The average age of women who are forced to go to earn money by sex work precisely because of the war is 34 years old.

Despite increasing risks and deteriorating conditions in sex work, the percentage of women earning money through sex work is increasing. This is due to increase in the number of SWs who did not provided sex services before the war, but are forced today due to a sharp deterioration in their financial situation, and an increase in the number of SWs adapted to war conditions and returning to sex work (distribution of answers to the question “ How did this war affect your employment and the conditions of sex work?” in Figure 3)

Figure 3 Distribution of SWs responses to the question "How did this war affect your employment and conditions of sex work?"

Answers to the question “Did your material and economic situation worsened with the start of the war?” prove that the majority of respondents, both at the beginning of the war (95% of SWs) and after a year of the war (98% of SWs), did experienced a sharp deterioration in their financial situation.

Also, the well-being of SWs and their families is directly related to work in sex industry. 76% of SWs today have no other sources of income other than sex work and non-systemic charitable/humanitarian aid. Only 5 SWs at the beginning of the war and 3 SWs after a year of the war indicated that they had additional work besides sex work. 21% of SWs received assistance from the state (as IDPs, for child care, as low-income, etc.), but they are claiming that this assistance is not enough not only for a decent life, but sometimes for the survival of SWs and their families (Figure 4 shows the distribution of SWs answers about presence of additional sources of income other than sex work as of April 2023).

Figure 4 Distribution of SWs answers to the question about additional sources of income other than sex work, %

SECTION 2. RATING OF SOCIAL PROBLEMS OF SWs AND EVALUATION OF THE EXPERIENCE OF RECEIVING HUMANITARIAN AID FROM CO "LEGALIFE-UKRAINE"

HUMANITARIAN AID

99% of respondents in April 2022 and 100% in April 2023 admitted that they were in dire need of humanitarian assistance in the form of food, medicine, hygiene products, warm clothing and other means necessary to survive in difficult conditions, as well as other types of support (informational, psychological, legal) .

At the time of the first stage of the survey, 13.1% of SWs had no experience of receiving humanitarian assistance from CO "Legalife-Ukraine", the rest of the respondents received food and/or hygiene kits, medicines, etc. at least once.

On a scale of the quality and relevance of this assistance (on a scale of 1 to 4, where 1 is “Very dissatisfied with the quality of products/funds” and “Not at all relevant in a war, not on time, not useful”, and 4 is “Very satisfied with the high quality of products/funds" and "Very relevant in a war and necessary for survival"), SWs rated the assistance from the organization as "very high"/"high" quality of products/funds and "very relevant and necessary for survival assistance”.

But SWs did noted an additional list of products/materials that they did not received and which they lack, including: water purification products, detergents, condoms, specific medical supplies, including those used in the event of a chemical/nuclear weapon intervention, sleeping bags, warm clothes, flashlights, power banks, instant food, canned food, etc. SWs also noted that it would be more convenient for them to receive assistance in the form of money or certificates for the purchase of products/funds, rather than in kind. In addition, SWs needed food and hygiene kits on a regular basis, at least once a month.

As part of the projects of CO "Legalife-Ukraine" to support the SW community, after the 1st stage of the survey, this list of products and funds was taken into account and purchased for distribution among SWs, and conditions were created for receiving humanitarian kits on a monthly basis. Since the outbreak of hostilities in 12 regions and Kyiv: more than 1,000 SWs have received 1,250 food and 1,250 hygiene kits, 450 baby food and hygiene kits, 840 medicine kits and 260 travel kits. During this time, we conducted several surveys among sex workers in the regions in order to identify needs in wartime to update them. These surveys have confirmed that basic needs remain relevant.

In addition, on the eve of winter, SWs was in dire need of various means that can help them to survive in the absence of heat, light, clean drinking water, etc. In response to these needs in 12 regions and Kyiv, SWs additionally received: 130 power banks, 130 sets of thermal underwear, 130 pairs of socks, 130 flashlights, 130 packs of water disinfection tablets, 130 sleeping bags. Also, in order to maintain health and prevent HIV/STIs among SWs, 130 packs of lubricant gel, 260 pregnancy tests, 700 packs of condoms were given to community representatives.

After a year of implementing projects aimed at supporting the community, during the 2nd stage of the survey, 100% of respondents noted that during the year they received various types of humanitarian products from the organization. On the scale of quality and relevance of this assistance, SWs rated it as “very high”/“high” quality of products/funds and “very relevant and necessary for survival” assistance (Figure 5 shows the distribution of humanitarian aid among SWs).

Figure 5 Number of SWs that received humanitarian assistance

In addition to the fact that SWs are in need of continuation of humanitarian programs, several needs remained unresolved at the end of the humanitarian assistance project in SW community, namely: due to concern for their health and for the prevention of HIV/STIs, 8% of SWs indicate the need for condoms of various/larger sizes, another 8% say that there is no permanent community space where SWs can receive assistance, 3% still note the convenience of obtaining certificates/money to buy necessary products/funds, and another 2% need assistance more often and regularly.

HOUSING AND TRANSPORTATION

After beginning of the war, 35% of the SWs were forced to change their address of residence/move to another, safer city to live in.

At the moment 30.7% of SWs did not have adequate housing, 60.6% are living in rented housing. For this period, 12 SWs (8.7%) already received assistance in the form of temporary housing from the CO "Legalife-Ukraine" (rent of an apartment, payment of utilities, etc.), 8 SWs (5.8%), which were forced to change their place of residence due to the war received assistance in transportation/evacuation.

After the analysis of the results of the 1st stage of survey, we understood that meeting the needs for temporary housing and transportation became one of the main priorities for SWs. Compensation for housing rent, utility bills, etc., transportation were taken into account as an intervention in the main project proposals of the organization. Since September 2022, more than 60 SWs who were forced to change their place of residence due to the war have been provided with temporary housing and transport for moving, as part of CO “Legalife-Ukraine”’s projects to support SWs.

According to results of the 2nd phase of the survey in April 2023 - 71% of SWs had satisfactory housing, but more than half of them were worrying about lack of possibility for paying for the rent of the premises. According to the survey results, between May 2022 and March 2023, another 17 SWs (17%) received compensation from our organization for paying temporary housing, 14 SWs (14%) received compensation for transportation costs.

Although the dynamics of the provision of these services has been positive (+8.2% housing, +8.2% transport compensation), limitation in financing does not allow covering the needs of the majority of SWs. As of April 2023, the need for SWs housing remains very relevant - at least 29% of SWs surveyed do not have satisfactory housing, and 65% of them have to pay rent.

Fig. 6 General distribution among SW services of CO "Legalife-Ukraine"

Comparing the results of the survey of the 1st stage and 2nd stage, we saw an increase in the number of services that satisfy the basic needs of SWs most necessary for survival and, accordingly, an increase in the number of SWs, who received such services through the projects of CO "Legalife-Ukraine" to support the community. Fig. 6 Services received by SWs from CO "Legalife-Ukraine" and dynamics of these services.

On a scale of quality and relevance (on a scale from 1 to 4, where 1 is "Very dissatisfied with the quality of services" and "Completely not relevant in war conditions, not needed and not timely", and 4 - "Very satisfied with the high quality of services and consultations ” and “Very relevant in a war, timely and necessary for survival”), respondents rated these types of services/consultations as “very high”/“high” quality of services and “very relevant”/“relevant and necessary for survival” assistance.

SWs also noted that they need additional types of services: access to doctors - a gynecologist, dermatologist, phlebologist, infectious disease specialist, etc., access to lawyers in areas remote from large cities, offline consultations of psychologists and psychological trainings.

CHAPTER 3. PSYCHO-EMOTIONAL STATE OF SWs IN WAR CONDITIONS AND PSYCHOLOGICAL AID

Note: The evaluation was carried out during the first stage of the survey in order to determine the relevance of psychological assistance for SWs in war conditions.  The conclusions about SW’s state of health in this study are not a medical diagnosis/professional opinion of psychologists/psychotherapists, but our guess only based on SWs responses about their psycho-emotional state. To assess the state of mental health, we first asked SWs if they felt the negative impact of the war on their psycho-emotional state/on the state of their children. Then we used three specific questions in which SWs were asked to choose from a list of feelings that they sometimes/frequently experienced that correspond to their emotional state of late. The answers to these questions included main signs of common psycho-emotional states and protective reactions of the body to external stimuli: stress, panic attacks, postponed life syndrome and emotional burnout. Our assumptions were based only on the presence of half or more of the proposed signs of psycho-emotional imbalance in SWs and on the analysis of their subjective assessments/responses.

The negative impact of war on their own psycho-emotional state/state of children is felt by 91% of SWs, 2% of SWs deny the impact of the war, 7% of the respondents could not give an answer.

To the question "Do you have panic attacks?" 41% of SWs answered “Yes”, of which more than half of SWs did not seek psychological help due to distrust of psychologists (10 people), lack of funds (9 people) or low motivation and lack of understanding of the need. 34% of SWs find difficult to answer to the question of whether they have panic attacks, 25% - was sure that they did not experienced panic attacks.

To further assess the psycho-emotional state of SWs and the impact of war on their mental health, respondents were asked to answer three specific questions.

The first question from this group “Choose which of these feelings do you sometimes/often experience?” contained answers, which are signaling about main signs of stress:

1. headache, difficulty falling asleep, frequent awakening and reading the news;
2. decreased performance, motivation, increased fatigue;
3. fussiness or lethargy;
4. constant feeling of fear, racing thoughts, feeling of helplessness;
5. digestive disorders (diarrhea, constipation), dry mouth;
6. lack of appetite or constant overeating;
7. chest pains, palpitations, cold extremities, a feeling of heat in the body;
8. cravings for sweet, fatty, salty, alcohol, cigarettes, and the like.

The distribution of SWs answers to this question is shown in fig. 7

Fig.7 Distribution of SWs responses to questions about whether they have the main signs of stress

Analyzing SWs responses, we can assume that this war had a painful impact on their psycho-emotional state. Thus, only one SW answered that she did not experienced any of the 8 signs of stress, another 12 SWs selected only one of the signs from the list. 8 SWs are confident that they experienced all eight signs of stress. 36 SWs found from 5 to 7 signs inclusive, of which 16 SWs did not turn to psychologists due to distrust (6 people), lack of funds (6 people), low motivation (4 people).

It can be assumed, that, as a result of a war (an emergency situation), every third SW is in constant stress, which negatively affects their emotions, mood and behavior, and, which is a more serious consequence, has a devastating effect on the entire human body.

The second question from the specific group is “Does anything on this list happen to you?” – it contained in the answers the main signs of the delayed life syndrome:

1. you live with thoughts of a cloudless future;
2. you are constantly waiting for the right moment to do something;
3. you put off or even forbid yourself to enjoy pleasant moments, flowers, sunset, books, manicure, coffee, etc;
4. you feel like an observer of your own life.

Note: Postponed life syndrome is a condition of a person waiting for a favorable time for a happy life. In the conditions of war, many feels that life seems to have stopped, do not realize themselves in reality, in today’s day. But more often they plan their tomorrow, sometimes allowing themselves to dream about the future and enjoy these sensations, but without imagining a specific date for the onset of this future. People, who are waiting for the end of this horror, so that only after the war they can begin to live, have a syndrome of delayed life. They constantly worry, either because of the past or because of the future, and cannot live here and now. This condition often leads to depression.

Fig.8 Distribution of SWs responses to question about whether they have main signs of the postponed life syndrome

To this question, 30 SWs (22%) answered that they did not experienced anything similar to the proposed sensations, 70 SWs (51%) chose only one of the signs from the list. It can be assumed that 7 SWs (5%), who chose three and four of the proposed feelings, have signs of the syndrome.

The third question: “Choose which of these feelings about your own life or work you are currently experiencing?” The answers contained indication of emotional burnout:

1. You are convinced that you are doing everything right, so you rejoice at any challenge and grab every opportunity to help your neighbor.
2. You feel emotionally exhausted, but you force yourself to work even harder, ignoring your own needs.
3. You take it out on others, accuse them of being overworked, that they can’t cope, that they are weak in spirit.
4. You don’t believe in yourself, you don’t understandwhy you are doing anything in your life, and you only dream that this condition is over as soon as possible.
5. You feel inner emptiness, do not understand what is wrong with you, and lose control over your own life.

Fig. 9 Distribution of SWs answers to questions about whether they have the main signs of emotional burnout

Usually, burnout appears gradually, but in conditions of such significant tension and stress as now, it develops much faster. In our conditions, instead of several years, a person can burn out in a few months or even weeks - depending on the environment, the availability of support, living conditions, etc. and on what "front" he is involved and how much he loads himself.

Only 7 SWs (5%) did not experienced any of the suggested features. 16 SWs (12%) chose the first answer and are convinced that they do everything right in their life and work, they rejoice at any challenge and grab any opportunity to help their neighbor. Such a response may indicate that they are not burned out, or that they are in the first stage, sometimes called "Honeymoon". This is the stage of over-enthusiasm for one’s work, which over time often leads to exhaustion and, finally, to emotional burnout.

Answers of 48 SWs (35%) may indicate that they are in a state of emotional exhaustion or at its last stage. This is the stage when burnout becomes so familiar that it becomes a new reality. A person ceases to notice anything, feels an inner emptiness, does not understand what is happening, and loses control over his/her own life. At the same time, only 26 SWs from this group addressed psychologists.

Answers of other SWs indicate that they are in different transitional stages of burnout: they experience exhaustion, they begin to “break down” – they are conflicting with others, their productivity decreases, and together with it - they gradually lose their sense of their own effectiveness and worth.

In addition, it was noted, that 22 SWs (16%) have obvious signs of stress (from 5 to 8 signs for each SW), according to their choice of answers to questions, or have signs of the first stage of burnout (3 SWs) or its final stages (19 SWs).

EXPERIENCE OF RECEIVING PSYCHOLOGICAL ASSISTANCE

During the first stage of the survey (April 2022, n=137), 46% of SWs had already received the help of a psychologist from the CO "Legalife-Ukraine”, 123 SWs (90%) knew about the opportunity to receive free psychological assistance from the CO "Legalife-Ukraine”. 60 SWs (44%) planned to apply to a psychologist at the CO "Legalife-Ukraine" within next year, 21 SWs (15%) answered that they had no such plans, 56 SWs (41%) found it difficult to answer whether they would apply for psychological support during next year.

Fig. 10 Distribution of answers to the question “In what format would you be comfortable to receive assistance from psychologists of CO "Legalife-Ukraine?”, (April 2022, n=137)

At the first stage of the survey, we suggested choosing a format in which it would be convenient for SWs to contact and receive help from psychologists. Most of the respondents chose several formats, including phone consultations and face-to-face meetings. Online consultations were chosen by 33 SWs, another 20 SWs were interested in a group psycho-therapeutic meetings.

In order to create comfortable conditions for receiving psychological assistance, CO "Legalife-Ukraine” decided to provide opportunities for SWs to receive consultations from psychologists online, by phone, in person or during group psychological and therapeutic groups.

At the second stage of the survey (April 2023, n=100) - 58% of SWs turned to psychologists at the Hotline of CO "Legalife-Ukraine". At the same time number of applications increased by 12%. Of those who did not applyed: 5 SWs were thinking about such a possibility, 7 SWs said that there was a lack of time, 4 SWs - about a lack of funds, 6 SWs confessed that they do not have confidence in psychologists, 3 SWs have contacted other psychologists, the rest of SWs had no motivation or saw no reason for requests.

CHAPTER 4. VIOLATION OF THE RIGHTS OF SWs AND RIGHTS PROTECTION OF SWs IN CONDITIONS OF WAR

VIOLATION OF THE RIGHTS OF SEX WORKERS

During the course of this survey, SWs were first asked to independently assess whether their rights had been violated in the last 6 months.

Fig.11 Distribution of SWs answers to the question “Had your rights been violated during last 6 months?”

In the next question, SWs were asked to select from a list of events that happened to them during last 6 months. The list contained types of rights violations most often faced by SWs in everyday life: denial of medical and social services; Refusal or delay in the process of obtaining social benefits and allowances; Refusal to take a police report; Blackmailing by the police and coercion to cooperate; Refusal to accept a complaint in medical or other government institutions; Dismissal from work due to HIV status or employment in sex work; Requirement of charitable contributions for the possibility of obtaining medical services; Deprivation of a place in social housing (dormitories, centers, shelters) due to HIV status or employment in sex work, etc.

At the 1st stage of the survey (April 2022) - 39 SWs (28%) did noted minimum one case when their rights were violated. 19 SWs (14%) received two violations of their rights during this time, 19 SWs (14%) experienced three or more (up to 6 violations) during last 6 months. 60 SWs chose the answer "Nothing happened from what is listed".

5 SWs out of those 39 SWs (28%) who responded to the first question “Have your rights been violated during last 6 months?” answered in the negative, but already answering for next question they noted that they had encountered one or more of such cases as: Blackmail by the police and coercion to cooperate, Requirement of charitable contributions for the opportunity to receive medical services; Refusal or delay in the process of obtaining social and state benefits.

Another 45 SWs could not determine on their own whether their rights were violated, but in the next question, 19 SWs of them noted that they had experienced one or more of such cases as: Refusal to provide medical, social services; Refusal or delay in the process of obtaining social benefits and state benefits; Requirement of charitable contributions for the opportunity to receive medical services; Refusal to accept a complaint in medical or other government institutions; Deprivation of a place in social housing (dormitories, centers, shelters) due to HIV status or employment in sex work; Being fired from a job due to HIV status or being involved in sex work, etc.

At the 2nd stage of the survey (April 2023) - 31 SWs (31%) noted one case when their rights were violated. 16 SWs (16%) received two cases of violation of their rights during this time, 15 SWs (15%) faced three or more (up to 6 violations) during last 6 months.

24 SWs (24%) answered the first question that their rights had not been violated during last 6 months, but in the next question 3 of them noted, that they had experienced cases such as Blackmail by the police and coercion to cooperate; Contributions for the opportunity to receive medical services; Denial of medical, social services.

31 SWs (31%) were unable to determine if their rights had been violated, but of these, 14 SWs indicated in the next question that they had experienced most of the proposed offenses.

That is, about 18% of SWs did not understand what constitutes a violation of human rights and in what cases they have the right to protection. In this case, facts of abuse of power by officials (police, medical and social workers) and employers that these SWs faced are gross violations of human rights.

Therefore, it is necessary to continue educational activities among SWs on human rights and their protection, the activities of paralegals to detect and respond to violations of the rights of SWs, as well as advocacy activities to overcome barriers to accessing legal services for SWs.

Fig. 12 Distribution of SWs responses to question about cases of violation of rights that they faced during last 6 months

EXPERIENCE IN OBTAINING LEGAL ASSISTANCE

At the first stage of the survey, 128 SWs (93%) knew about the possibility of receiving free legal assistance  from CO "Legallife-Ukraine", 68 SWs (50%) answered that they had experience of contacting lawyers since the beginning of the war, another 9 SWs who did not applied to lawyers since the beginning of the war - had such plans in the near future.

Of the 53 SWs who reported that their rights have been violated during past 6 months, 30 SWs (57%) believed that they do not need legal assistance: 22 SWs (73%) have already received legal advice and the rest (8 people, 27%) do not plan to seek help due to distrust of lawyers or lack of funds.

Fig. 13 Distribution of answers to question “In what format would be comfortable for you to receive legal assistance from CO “Legalife-Ukraine”?” (April 2022, n=137)

Among the formats in which it would be comfortable for the respondents to communicate with the lawyers of CO "Legalife-Ukraine", the majority of SWs chose consultations by phone and/or personal meetings.

In 2023 55% of the respondents had experience of applying for legal assistance. But of the 45 SWs, who said that their rights had been violated, 11 SWs (24%) never sought legal advice due to lack of trust in lawyers or lack of funds.

Nearly half of the respondents acknowledged that this war and its aftermath had a negative impact on the ability of community members to defend their rights.

Fig. 14 Distribution of SWs responses regarding the impact of war on SW’s ability to defend its rights.

CONCLUSIONS 

Even before the COVID-19 pandemic and before the start of the war in Ukraine, sex workers were disproportionately vulnerable to the risk of violence, as well as sexual and emotional harm, and this harm is associated with the criminalization of sex work. Primary or direct stigma associated with sex work, sometimes disparagingly referred to as “prostitution” or “slut” stigma, is another source of social inequality for sex workers (according to research: “Detecting barriers to access and assessing the quality of services for sex-workers, studying their needs in order to increase the effectiveness of harm reduction programs, prevention and treatment of HIV/AIDS in Ukraine", which was held in 2017-2018 by the All-Ukrainian charitable organization "Legalife-Ukraine", the Analytical Center "Socioconsulting", with the support of AFEW International).

The 2020-2021 global COVID-19 pandemic caused widespread negative economic, social and health damage to SWs. For people who sell sex, the consequences have been severe: their already precarious working conditions and access to health and social services have worsened. Surveys among SWs of Ukraine as part of the study of the availability and quality of services for SWs (done in August-October 2020, with support of SWAN) confirmed this impact and demonstrated that most SWs are quite vulnerable physically, psychologically and economically. For SWs, such problems as loneliness, lack of support from partners, relatives, in particular material support in the process of raising children, are topical. Well-being of the most of SWs has always depended on their work in the field of sex services. In response to the pandemic, CO “Legalife-Ukraine” responded quickly and tried in many ways to reduce the impact of the pandemic on community. Given the social and economic disadvantages of sex workers, structural barriers and widespread stigma preventing their inclusion in society, it is not surprising that for many sex workers organizing sex workers was the only way to meet their basic needs, receive medical care and social support.

Most of the hypotheses of this study regarding the deterioration of the socio-economic situation of SWs, the existence of an acute need for SWs in humanitarian, psychological and legal assistance were confirmed by the results of the survey.

Since the beginning of the war, the vulnerability of SWs in Ukraine only worsened. The vast majority of SWs (98% of SWs) experienced a sharp deterioration in their financial situation.

As before the war, the well-being of SWs and their families directly depends on their work in the field of sex services. 76% of SWs today have no other sources of income other than sex work and non-systemic charitable/humanitarian assistance. Although 21% of SWs receive assistance from the state (as IDPs (internally displaced persons), via child care programs, as low-income people, etc.), they lack this assistance not only for a decent life, but sometimes even for survival.

Despite the increasing risks and worsening conditions in sex work (as evidenced by 63% of SWs), the number of women earning money through sex work is increasing. This is due to an increase in number of SWs, who does not provided sex services before the war, but was forced to provide them today due to a sharp deterioration in their financial situation (11% of SWs), and an increase in number of SWs, who were able to adapt to the conditions of the war and are returning to sex work right now (12% SWs).

Note that the average age of women, who was forced to go to earn money by sex labor precisely because of the war, is 34 years.

Humanitarian needs

The results of the study showed that sex workers have a number of needs that are becoming increasingly important since the beginning of the war and are not fully met by both government agencies and NGOs. These needs include: humanitarian assistance, including an expanded list of funds necessary to ensure the survival of SWs in the absence of electricity, heat, water supply, etc., as well as temporary housing, transportation, psychological and legal support.

All survey participants did recognized urgent need for humanitarian assistance, because they have no ability to fully provide themselves and their families with food, medicine, hygiene products, warm clothing and other means necessary to survive in difficult conditions.

At the time of the first stage of the survey, 13% of SWs had no experience of receiving humanitarian aid from the CO "Legalife-Ukraine". The rest of the respondents received food and/or hygiene kits, medicines, etc. at least once. On a scale of the quality and relevance of this assistance (on a scale of 1 to 4, where 1 is “Very dissatisfied with the quality of products/funds” and “Not at all relevant in a war, not on time, not useful”, and 4 is “Very satisfied with the high the quality of products/funds” and “Very relevant in a war and necessary for survival”) SWs rated the assistance from our organization as "very high"/"high" quality of products/funds and "very relevant and necessary for survival" assistance.

After the 1st stage of the survey, the wishes of SWs regarding the list of products and funds they needed were taken into account, and conditions were created for receiving humanitarian kits on a monthly basis.

After a year of implementation of projects of CO "Legalife-Ukraine" aimed at supporting the community, during the 2nd stage of the survey - 100% of respondents noted that they repeatedly received various types of humanitarian products from the organization during the year. On the scale of quality and relevance of this assistance, SWs rated it as “very high”/“high” quality of products/funds and “very relevant and necessary for survival” assistance.

Within the framework of the projects of CO "Legalife-Ukraine" to support the community of SWs, after the 1st stage of the survey, this list of products and funds was taken into account and purchased for distribution among SWs, and conditions were created for receiving humanitarian kits on a monthly basis. Since the beginning of hostilities in 12 regions and in Kyiv: more than 1,000 SWs have received 1,250 food and 1,250 hygiene kits, 450 baby food and hygiene kits, 840 medicine kits, and 260 travel kits. During this time, we conducted several surveys among sex workers in the regions in order to identify needs in wartime and update them. These surveys have confirmed that basic needs remain relevant.

In addition, on the eve of winter, the SWs was in dire need of various means that can help to survive in the absence of heat, light, clean drinking water, etc. In response to these needs, in 12 regions and in Kyiv, the SWs received additionally: 130 power banks, 130 sets of thermal underwear, 130 pairs of socks, 130 flashlights, 130 packs of tablets for water disinfection, 130 sleeping bags. Also, in order to maintain health and prevent HIV/STIs among SWs, community representatives were given 130 packs of gel-lubricant, 260 pregnancy tests, 700 packs of condoms.

Housing and transportation

After the start of the war, 35% of SWs were forced to change their address of residence/move to another, safer city to live in. 30.7% of SWs did not have adequate housing, 60.6% lived in rented housing.

After analyzing the results of the 1st phase of the survey, meeting the need for temporary housing and transportation for SWs became next to the main priorities for the SWs community. Compensation for housing rent, utility bills, transportation were included as interventions in the main project proposals of the organization.

At the end of the community support project - 71% of SWs, although they have satisfactory housing, but more than half of them still need to worry about paying rent for the premises. From May 2022 to March 2023, 17% of those surveyed received compensation for temporary housing from the organization, 14% received compensation for travel expenses. On a scale of quality and relevance (on a scale from 1 to 4, where 1 is "Very dissatisfied with the quality of services" and "Completely not relevant in war conditions, not needed and not timely", and 4 - "Very satisfied with the high quality of services and consultations ” and “Very relevant in a war, timely and necessary for survival”), respondents rated these types of services/consultations as “very high” /“high” quality of services and “very relevant”/“relevant and necessary for survival” assistance.

During the year of implementation of community support projects, the number of services that meet the basic needs of SWs for survival has increased, respectively, the number of SWs receiving such services through the projects of CO "Legalife-Ukraine" has increased. But, despite the positive dynamics of services and coverage (+8.2% housing, +8.2% transport compensation, + 13% humanitarian assistance), resource constraints, including financial ones, do not cover the needs of most SWs. As of April 2023, the need of SWs for housing remains very relevant – at least 29% of the interviewed SWs do not have satisfactory housing, and 65% have to pay for housing rent.

Psychological help

Note: The conclusions about the health status of SWs in this study are not a medical diagnosis/professional opinion of psychologists/psychotherapists, but only our assumption based on the answers of SWs about their psycho-emotional state. To assess the state of mental health, we first asked SWs whether they felt the negative impact of the war on their psycho-emotional state/on the state of their children. Then we used three specific questions in which SWs were asked to choose from a list of feelings that they sometimes/frequently experience and correspond to their emotional state of late. The answers to these questions included the main signs of common psycho-emotional states and protective reactions of the body to external stimuli: stress, panic attacks, postponed life syndrome and emotional burnout. Our assumptions were based on the presence of half or more of the proposed signs of psycho-emotional imbalance in SWs and the analysis of their subjective assessments/answers.

The negative impact of the war on their own psycho-emotional state/state of children is felt by 91% of SWs, 2% of SWs deny the impact of the war, the rest could not assess such an impact.

Analyzing the responses of SWs, we can assume that the war really had a painful impact on their psycho-emotional state: every third SW is under constant stress, which negatively affects their emotions, mood and behavior, and can also have more serious consequences for the entire human body. 41% of SWs reported that they sometimes/often experienced panic attacks. In 5% of respondents, there are signs of delayed-life syndrome. In addition, 16% of SWs, while having clear signs of stress (from 5 to 8 signs for each SW), additionally have signs of emotional burnout.

During the first stage of the survey (April 2022), 46% of SWs had already received help of a psychologist from CO "Legalife-Ukraine", 90% knew about the opportunity to receive free psychological assistance from CO "Legalife-Ukraine". 44% planned to apply to a psychologist at the CO "Legalife-Ukraine" within the next year, 15% answered that they had no such plans. To create comfortable conditions for receiving psychological assistance, CO "Legalife-Ukraine"" provided opportunities for SWs to receive consultations from psychologists online, by phone, personally or during group psychological and therapeutic groups.

According to the results of the community support project - 58% of SWs from the respondents turned to psychologists at the Hotline of CO "Legalife-Ukraine"". The number of applications increased by 12%.

Of those SWs, who did not turn to psychologists: 5% think about such an opportunity, 7% talk about lack of time, 4% talk about lack of funds, 6% do not have confidence in psychologists, 3% turned to other psychologists, and the rest are not motivated or see no reason to apply.

Violation of SWs’ rights

The percentage of SWs who faced violations of their rights during war increased from 56% at the beginning of the war to 62% during second year of the war.

The most common types of violations of rights are: blackmail/coercion to cooperate by the police, denial of services in public institutions, delaying the process of obtaining social benefits and extorting charitable contributions for the opportunity to receive medical services.

It should be noted, that about 18% of SWs do not correctly assess a violation of human rights and in what cases they have the right to protection. In this survey, these are SWs who noted that they did not experienced violations of their rights, but in answers to the following questions they talked about the facts of abuse of power by officials (police, medical and social workers) or employers and other gross violations of human rights that occurred in relation to them.

Almost half of respondents acknowledged that the war and its aftermath had negatively affected the ability of community members to defend their rights.

At the beginning of the war, 93% of SWs were aware of the possibility of receiving free legal assistance from CO “Legalife-Ukraine”.

50% of SWs had experience of applying to lawyers on various issues since the beginning of the war, another  9% of SWs of those who did not contacted lawyers since the beginning of the war had such plans in the near future.

In the second year of the war, 55% of the respondents had experience of applying for legal assistance. The number of applications on various issues of legal assistance increased by 5% over the year.

But one in four of the SWs who admit they have experienced violations of their rights do not seek help, because they do not believe in a positive outcome of the case or because of distrust to lawyers or lack of funds.

Therefore, it is important to continue educational activities among SWs on human rights and their protection, to strengthen the activities of paralegals in fixing and responding to violations of the rights of SWs, as well as advocacy activities to overcome barriers in access to legal services for SWs.

Additional Needs of SWs in War and Reconstruction Periods

In addition to the basic needs already listed, at the end of the project SWs reported several more needs unresolved, namely:

through taking care of their health and for the purpose of preventing HIV/STIs, 8% of sex workers reported a need for condoms of various sizes;

another 8% of SWs confirmed that the community does not have permanent premises, where SWs can receive assistance;

3% of SWs noted the convenience of obtaining certificates/money instead of natural products for the purchase of necessary products/funds;

another 2% of SWs reported that they need help more frequently and regularly.

SWs also noted that they need additional types of services: access to doctors - a gynecologist, dermatologist, phlebologist, infectious disease specialist, etc., access to lawyers in areas remote from large cities, offline consultations of psychologists and psychological trainings.

Needs for self-organization of SWs

Community support projects are critical to ensure survival of sex workers during war in Ukraine and beyond. Given the criminalization, social and economic disadvantage of sex workers, structural barriers and stigmatization for many sex workers, self-organization of sex workers remains the only way to satisfy their basic needs, receive medical care, psychological and legal support. But, the limited possibilities of self-organization and insufficient funding for interventions do not allow to fully meet the needs of SWs in Ukraine. Self-organization needs increase of resources and support for programs for sex workers, that are aimed at changes in society and legislation, community development and advocacy, there are need of funding to overcome stigma and barriers, meeting the needs of sex workers.