Inger had not seen Alex* for several months. Begging for money, she was happy to see a familiar face and armed with two coffees, the two had a little catch up. No longer on any anti-psychotic medication (“No time to pick them up”), and under the influence of alcohol and often sleeping rough in graveyards at night, Alex looked unwell. Yet the biggest shock to Inger was when Alex introduced her boyfriend. Previously, Alex had always proudly identified as a lesbian woman. It was then, Inger suspected Alex was using her body to buy protection. A Homeless and Inclusion Health Nurse, Inger shares her knowledge of women’s homelessness and the importance of understanding the systemic gender inequalities that mean for women sleeping rough, their behaviours are not always a choice.
Women’s homelessness is often closely associated with childhood trauma, domestic violence and (sexual) abuse. Whilst these can be the causes of homelessness, sleeping on the street itself brings significant risks to women and the danger of being re-traumatised. Women have reported being stigmatised, verbally and physically assaulted, sexually assaulted and raped whilst sleeping rough. Homeless women are outnumbered by men and are more likely to be aged 25 years or younger. Homeless women, particularly in combination with mental health illness and substance use, are more likely to have unprotected sex and are more at risk to develop an STI or bloodbourne virus like HIV.
To survive, rough sleeping women take different measures to keep safe (Bretherton, 2017) than men. Women tend to hide or keep moving during the night, and are more likely to sleep during the day. Concealing their identity as female by adapting a more masculine look is another measure that women take to protect themselves from abuse and violence. Some women will use their bodies as capital. Women offer sex to buy material support (this can include feeding an addiction or a place to stay) physical protection, safety and social status. This is also known as survival sex, or the use of vicarious physical capital; the value that is given to male bodies that is transferred to female bodies symbolically through intimate relationships (Watson, 2016).
The lack of economic and social capital and with little prospect of obtaining this means that young women on the street need to create their own opportunities to survive. Neo-liberalism in Western capitalistic societies like the UK have shaped a focus on individualism and the idea that homelessness is something that individuals are to blame for and have to solve themselves.
To understand women’s homelessness and survival sex, we also need to understand structural gender inequalities and acknowledge that masculinities and gender norms influence their survival strategies.
Though survival sex might be seen as an individual’s choice, women reported feeling they had little or no choice in the matter because of the hetero-normative suggestion that men are entitled to transactional sex. Coercion also contributes to a woman’s likelihood to engage in survival sex. Interviewed young homeless women described a huge sense of expectation that they had to use their body as capital, not just for their own survival, but also for others or as a preventative measure against rape (Watson, 2016). Homeless women involved in survival sex have an increased suicide risk and experience high rates of victimisation and feelings of shame and regret.
As healthcare providers, it is essential that we explore the circumstances and relationships that lead to survival sex without judgement or stigma. We need to move to a holistic approach to health, and ask ‘what has happened to you’ instead of ‘what is wrong with you’. We must attempt, with compassion, and with a trauma informed approach to understand the prior traumas and extreme living conditions affecting this group. Relational care provides a better foundation for approaching (mental) ill-health and the very specific needs of women sleeping rough and the “choices” they feel they have to make.
*not her real name
Betherton, Joanne (2017) Reconsidering Homelessness and Gender, European Journal of Homelessness, pp. 1-22, White Rose, York
Watson, Juliet (2016) The Sociological Review, Vol 64, 256-273 (2016), John Wiley&Sons Ltd, Oxford