CNWL

Sexual Health Services
in London and Surrey

CLASH and SHOC

CLASH and SHOC provide a free and confidential walk in clinic for people working in the sex industry to obtain free STI screening, PEP, contraception, abortion referral and cervical cytology. They also offer screening and health promotion in outreach settings for sex workers, those who are homeless or in hostels, people with drug and alcohol dependance, Black Asian and Minority Ethnic (BAME), as well as men who have sex with men (MSM) across Camden, Islington and Haringey.

Covid-19 update: Important please read

This page is reviewed and updated regularly based on the latest government and scientific advice.

CLASH & SHOC Clinics are still open as usual to those who work in the sex industry. See clinic information further down on this page for more information. If you come with friends, they may be asked to wait outside or elsewhere to maintain social distancing.

Please do not come to the clinic if you or anyone you live with have had any of the following symptoms in the last 14 days:

  • A high temperature – this means you feel hot to touch on your chest or back (you do not need to measure your temperature) ​​
  • A new, continuous cough – this means coughing a lot for more than an hour, or 3 or more coughing episodes in 24 hours (if you usually have a cough, it may be worse than usual)
  • A loss or change to your sense of smell or taste – this means you've noticed you cannot smell or taste anything, or things smell or taste different to normal​
  • You or anyone in your household who have been to Denmark in the last 14 days

If you do have the above symptoms, please contact NHS 111 to arrange for a test for COVID-19. If you need sexual health care but are not able to attend the clinic due to isolation please call the health promotion team who will arrange a phone consultation with a doctor or nurse.

Outreach Screening and Health Promotion

Our Health Promotion Team provides sexual health “Clinic in a Box” outreach services across Camden, Islington and Haringey. If you are interested in us visiting your service please contact one of the Health Promotion Specialists below.

We can often offer the following on outreach (subject to environmental restrictions);

  • 1-1 advice and health promotion
  • Referral to sexual health and other agencies
  • Chlamydia and gonorrhoea testing
  • HIV
  • Syphilis
  • Hepatitis C and B screening
  • Pregnancy testing
  • Condoms

Training for Professionals and Voluntary Organisation Staff

The CLASH team are currently developing e-training which includes the following topics: 

  • Sexual wellness, sexually transmitted infections and contraception awareness
  • Drug and alcohol use and chemsex
  • Healthy Relationships
  • Condom/Lubes use and demonstrations
  • Sex work

NAZ Partnership

CLASH work with NAZ who are a leading provider of outreach to vulnerable groups with established networks with peer-led/faith/national prevention campaigns and MSM programmes that are evaluated by PHE.

Health Promotion Team

  • Office: 020 3317 2555
  • Kaylee: 07702 106 350
  • Nadine: 07852 383 438
  • Chantel: 07702 106 365
  • Tanya: 07957 494 625
  • Del: 07702 106 363
  • Simone: 07702 106 363
Clinic Information and Services Offered for Sex Workers

CLASH at Mortimer Market Centre, Capper St, Bloomsbury, London WC1E 6JB                               

Monday (all genders) and Friday (female-identifying only) 9am to 1pm, walk-in on a first come first serve. We have two Mandarin Interpreters present in person on a Friday every week. Telephone interpreters available on both days.

SHOC at Archway Centre, 681-689 Holloway Rd, Upper Holloway, London N19 5SE

Thursday (all genders) 12pm to 4pm. Walk-in on a first come first serve. Telephone interpreters available.

Both clinics offer the following to individuals who work in the sex industry.

  • Chlamydia and gonorrhoea triple site swabs
  • HIV
  • Syphilis
  • Hepatitis C and B screening
  • Hepatitis A & B vaccination
  • PEP
  • PrEP Monitoring for those who privately purchase elsewhere
  • Cervical cytology when due, regardless of GP registration
  • Pregnancy testing
  • Abortion Referral
  • Contraception pills, patches, vaginal ring, injection (clinician or self-administered)
  • Contraceptive Implant fitting and removals
  • Contraceptive IUD/IUS consultation, removals and fitting arrangement (please note that fittings are normally booked on another day)
  • Condoms
  • Emergency contraception including pill and post coital IUD (PCIUD)
  • Help registering with a GP
  • 1-1 support with a Health Promotion Specialist
  • Ugly Mugs or Police Reporting

The following services are not done routinely and only offered in special circumstances

  • Trichomonas Vaginalis
  • Mycoplasma Genitalium
  • Bacterial Vaginosis
  • Candida
  • Herpes (HSV) Swab
  • HPV Vaccination – Men who have sex with men only
Safety Information for Sex Workers and Support Links

National Ugly Mugs

Sign up to NUM for free to report incidents and receive warnings about dangerous individuals. If you report to National Ugly Mugs they will use the information to warn other workers and potentially save their lives. Information can be left anonymously. Visit Ugly Mugs.

If in danger, call 999 and say “Help”. If unable to speak, once the operator has answered then dial 55

Below is some basic safety tip however, this list is not exhausted and please follow the below links for further information.

  • Always have a working phone on you
  • Carry an alarm or whistle
  • Be aware of your surroundings and know your exits
  • Try to see clients in neutral locations where help can be found quickly.
  • Never lock doors or windows
  • Never leave with or accept anyone in who you feel uncomfortable with
  • Ideally tell someone where you are going and when to expect you back
  • Ideally no drug or alcohol use as this can impact on your ability to recognise and escape danger
  • Try not to accept any clients who are too intoxicated.
  • Be friendly but assertive and strong. Make clear your limits and negotiate services before accepting clients.
  • Always pour your own drinks and never leave them unattended. Do not accept food that is not sealed or prepared by you.
  • Keep money out of sight and locked away but keep some cash on you in case you need to escape.
  • Don’t wear a scarf or place anything around the neck.
  • Make sure earrings or other jewellery cannot be pulled off you.
  • Don’t use real names or personal details with clients or on any work related websites or social media

Trust your instincts, safety comes first! 

More information

Testing information for Sex Workers

What syphilis test is used?

Syphilis is a subspecies of a bacterium called Treponema pallidum. There are no available tests that can tell the difference between the three subspecies of Treponema pallidum which include; syphilis, yaws and bejel. CLASH & SHOC use Syphilis chemiluminescent microparticle immunoassay (CMIA) which detects both IgG and IgM antibodies.  If it is positive two further tests are performed which include; T pallidum particle agglutination (TPPA) which is used in the detection and confirmation of T pallidum antibodies (IgG and IgM).

The non-treponemal rapid plasma reagin (RPR) detects antibodies to cardiolipin-lecithin-cholesterol.  The RPR titre decreases with treatment and/or time, and is most useful for assessing acute disease, monitoring treatment and identifying reinfection.  Once the CMIA and TPPA are positive they normally remain positive for life even after successful treatment. RPR then becomes the only available test we have to pick up reinfections. RPR is not specific to syphilis and so can give a false positive reading which is why it is not used as the first line test in those who have never had the infection before. 

What is the difference between the different HIV tests?

To test for HIV, our lab uses the 4th generation HIV Antibodies 1 & 2 and p24 antigen test. No test is 100% accurate and there are always a small number of individuals who could take longer to show antibodies.  Both the 4th generation and 5th generation tests look for the same thing and are equally as good. However, 5th generation tests will differentiate between HIV 1 and 2, whereas the 4th generation do not.  Whenever someone has a positive HIV result you always repeat it to confirm the result and they will then do further testing to differentiate between HIV 1 & 2.  

HIV RNA quantitative assays (viral load) are normally used in those who have high-risk exposure and are exhibiting symptoms of sero-conversion. This is because the viral load is likely to be high. However, the majority of people do not have symptoms and the viral load may not be high enough in every individual to be picked up early, leading to false negatives. It is more often used in babies who are born to positive mothers. RNA tests can also give false positive results which again is why they are not routinely used as a 1st line screening test.

HIV Positive Individuals:  RNA (viral load) test is used in HIV care to monitor treatment effectiveness. It also indicates those who have an undetectable viral load.  Undetectable = Untransmissible (U=U) means that there is no onward transmission of HIV by sexual contact when someone has an undetectable viral load AND is on antiviral viral treatment (ART). A small number of HIV positive people can be undetectable when not on treatment but U=U does not apply in these circumstances.  As per national guidance, if undetectable and treatment is being adhered to daily, viral load does not need to be checked more often than every 6 months.  Please discuss this with you HIV care provider if any concerns.

What are the testing window periods for each infection?

A window period is the length of time it takes for the majority of infections to be detected in a test. Please note that no test is 100% accurate and there is always a chance of false positives or false negative. Additionally, some people take longer so show up.

  • Chlamydia and Gonorrhoea = two weeks
  • Syphilis = six weeks
  •  Hepatitis B & C = 12-24 weeks.
  • HIV 4/5th generation antibody/antigen tests = 45 days
  • HIV 3rd generation test including saliva and blood point of care tests = 90 days.
  • Different companies providing home testing will use either 3rd or 4th generation tests and you will need to contact that provider to understand which window period is applicable.
  • HSV Antibody serology = 12-24 weeks.

​When are people tested for Trichomonas Vaginalis?

Due to the low prevalence in the local community and minimal complications of trichomonas vaginalis in asymptomatic patients, this infection is only tested in those who are contacts of the infection or have symptoms e.g discharge, pain and/or pregnant.

When are people tested for Mycoplasma Genitalium?

Due to the low prevalence in the local community and minimal complications of Mycoplasma Genitalium in asymptotic patients, this infection is only tested in those who have been diagnosed with Pelvic Inflammatory Disease (PID) or Non-Specific Urethritis (NSU).

When is Herpes Simplex tested for?

Genital herpes is most commonly diagnosed visually and confirmed through a PCR swab of an ulcer/blister on the genitals. Therefore, we can only use this test if there is something present for us to swab. There are blood tests available that normally show up after 6 months of infection but these tests are not routinely available through the NHS. At present these tests cannot tell you where on the body the herpes is, for example, oral vs genital

How is HPV diagnosed?

HPV is a virus that has hundreds of different strains ranging from completely harmless such as warts, to some potentially increasing the risk of certain cancers in the future. Warts are diagnosed through visual examination. There is no blood test or swab available to accurately test for HPV on the NHS as they can have a high rate of false negatives. Those with a cervix are screened for HPV every 3 years once they have turned 25 in England. This test takes a sample of cervical cells to test for strains most commonly linked to cancer.

How should I interpret my Hepatitis B result?

There are several different tests that can look for Hepatitis B and each combination of results will help the clinician to interpret your result.

  • Natural Immunity - You have had the infection in the past but you have now cleared it and have immunity.
  • Vaccinated immunity - You are immune through vaccination
  • Weak Immunity - You may need further vaccinations
  • Not immune – You have not been infected in the past or vaccination has not worked.

Everyone is tested for Hepatitis B at their initial visit. Once someone is immune, either through natural immunity or vaccination, no further hepatitis B screening will be performed as it is no longer needed.

When are people tested for Hepatitis A?

We only test for hepatitis A in those who currently have hepatitis B or C, HIV or suspected acute hepatitis A infection.  Hepatitis A is an infection transmitted via the faecal-oral route (anus to mouth), which is usually short lived and self-limiting.  Regular screening therefore is of little value. However, we do offer vaccination against hepatitis A to anyone who practices oral-anal sex.

When are people tested for Hepatitis C?

Hepatitis C is a virus transmitted by exposure to blood products (for example a blood transfusion before 1991), sharing needles when injecting drugs, condom less sex, and from mother to baby during pregnancy.  The test we use is Hepatitis C Antigen, which detects the virus within 3 months of exposure. Although there is no vaccination against Hepatitis C, there are excellent treatments. 

PEP, PrEP and Vaccinations for Sex Workers

Can I Get PEP?

Post-Exposure Prophylaxis (PEP) can be given within 72hrs after exposure to HIV to prevent it from establishing in the body. It will involve taking two different antiretrovirals for 28days. You can walk-in and request PEP from CLASH & SHOC, as well as at any of our general clinics at Mortimer Market Centre and Archway Centre during clinic opening times. You will be assessed to establish your risk for HIV and if you meet the eligibility criteria. As with all our treatments and vaccinations we offer, PEP is free from our service.

Can I Get PrEP?

Certain individuals at increased risk of HIV can now obtained PrEP for free if they meet the eligibility criteria listed below. If you do not meet the criteria but would like further information, this can be discussed with the CLASH & SHOC clinic Nurse/Doctor. 

  • Men who have sex with men and trans women who have had condom less sex anal sex in the last 6 months
  • People whose partner is HIV positive and is having condom less sex, unless their partner has been on HIV treatment for 6 months and their viral load is <200
  • Anyone who was registered on the Impact PrEP trial.

Who is offered the HPV vaccination?

Currently in England, all children are offered the HPV vaccination in school or if missed, from participating GP surgeries if under 25. The vaccine is available from some sexual health clinics in England to men who has sex with men or/and transgender individuals. Those who are over 25 and were born and identify as female can obtain the vaccine privately if not previously had. 

Which Hepatitis Vaccinations can I have?

We offer both Hepatitis B and A vaccination to all those who are not already immune. Unfortunately, there is no vaccine for hepatitis C.

Useful Links Regarding Sexually Transmitted Infections, Contraception and Health