Sex worker health: San Francisco style

UCSF, 1001 Potrero Avenue, Ward 6D San Francisco General Hospital Department of Obstetrics/Gynecology San Francisco, CA 94110 USA.
Sexually Transmitted Infections (Impact Factor: 3.4). 11/2006; 82(5):418-22. DOI: 10.1136/sti.2006.020628
Source: PubMed


To describe the characteristics of sex workers accessing care at a peer based clinic in San Francisco and to evaluate predictors of sexually transmitted infections (STI).
We conducted an observational study of sex workers at St James Infirmary. Individuals underwent an initial questionnaire, and we offered screening for STI at each clinic visit. We performed univariate, bivariate, and multivariable analyses to assess for predictors of STI in this population.
We saw 783 sex workers identifying as female (53.6%), male (23.9%), male to female transgender (16.1%), and other (6.5%). 70% had never disclosed their sex work to a medical provider. Participants represented a wide range of ethnicities, educational backgrounds, and types of sex work. The most common substance used was tobacco (45.8%). Nearly 40% reported current illicit drug use. Over half reported domestic violence, and 36.0% reported sex work related violence. Those screened had gonorrhoea (12.4%), chlamydia (6.8%), syphilis (1.8%), or herpes simplex virus 2 (34.3%). Predictors of STI included African-American race (odds ratio (OR) 3.3), male gender (OR 1.9), and sex work related violence (OR 1.9). In contrast, participants who had only ever engaged in collective sex work were less likely to have an STI (OR 0.4).
The majority of sex workers have never discussed their work with a medical provider. Domestic violence is extremely prevalent as is work related violence. Working with other sex workers appears to be protective of STIs. STI prevention interventions should target African-American and male sex workers. Addressing violence in the workplace and encouraging sex workers to work collectively may be effective prevention strategies.

    • "Researchers studying FSWs have documented numerous barriers to seeking care, including: not knowing where to obtain services, lack of transportation, inconvenient locations, long wait times, costs of care, and poor treatment by care providers (Kurtz et al., 2005; Lazarus et al., 2012; Phrasisombath, Thomsen, Sychareun, & Faxelid, 2012). Moreover, even when identified, FSWs often avoid utilizing healthcare services due to fear of care providers, the occupational stigma associated with sex work, and drug use ( Cohan et al., 2006; Kurtz et al., 2005; Lazarus et al., 2012). The numerous individual and structural level challenges associated with sex work can affect women's willingness and ability to participate in research interventions or communitybased care (Blanchard et al., 2013; Shannon et al., 2014). "
    [Show abstract] [Hide abstract] ABSTRACT: Female sex workers (FSWs) encounter numerous challenges in accessing health and social services. In this study of drug using, African American FSWs, the authors examines specific factors associated with health or social service linkage among participants in a randomized intervention trial. Respondent linkage was significantly associated with individual factors (living alone, severe internal mental distress and traumatic victimization) and project related variables (attending five case management sessions and client engagement rating). In the multivariate model, higher client engagement and session attendance remained significant. The researchers conclude by discussing the importance of intervention attendance and engagement as key contributors to health and social service linkage among FSWs.
    No preview · Article · Mar 2016 · Health Care For Women International
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    • "They may also trade sex while under the influence and receive less money when selling sex [20]. Structural risk factors for HIV infection include work environment, poverty, stigma, discrimination, and criminalization of sex work which increase the risk for HIV infection among sex workers by creating barriers to accessing HIV care and prevention services [5, 18,2122232425. The settings where sex work occurs have a large impact on vulnerability by making it harder to negotiate condom use, find protection from violence, and have access to HIV prevention, treatment and sexual health services, including STI treatment, condoms and contraception [26]. "
    [Show abstract] [Hide abstract] ABSTRACT: Although female sex workers are known to be vulnerable to HIV infection, little is known about the epidemiology of HIV infection among this high-risk population in the United States. We systematically identified and critically assessed published studies reporting HIV prevalence among female sex workers in the United States. We searched for and included original English-language articles reporting data on the prevalence of HIV as determined by testing at least 50 females who exchanged sexual practices for money or drugs. We did not apply any restrictions on date of publication. We included 14 studies from 1987 to 2013 that reported HIV prevalence for a total of 3975 adult female sex workers. Only two of the 14 studies were conducted in the last 10 years. The pooled estimate of HIV prevalence was 17.3 % (95 % CI 13.5-21.9 %); however, the prevalence of HIV across individual studies varied considerably (ranging from 0.3 to 32 %) and statistical heterogeneity was substantial (I(2) = 0.89, Q = 123; p < 0.001). Although the variance across the 14 studies was high, prevalence was generally high (10 % or greater in 11 of the 14 included studies). Very few studies have documented the prevalence of HIV among female sex workers in the United States; however, the available evidence does suggest that HIV prevalence among this vulnerable population is high.
    Full-text · Article · Feb 2016 · AIDS and Behavior
    • "Few differences were found regarding dietary habits and no differences regarding physical activity. Other studies have confirmed a relatively high prevalence of smoking among women sex workers (Cohan et al. 2006; Móró, Simon, and Sárosi 2013; Romans et al. 2001). Interestingly, and distinctive for this study's results, it was found that the prevalence of wanting to quit smoking was lower among brothel workers who smoked compared to Danish women who smoked. "
    [Show abstract] [Hide abstract] ABSTRACT: Previous research on behavioral risk factors for illness among sex workers has been limited and based on mixed, poorly defined groups of sex workers. Our aim was to compare the health behaviors and weight of women brothel workers with women in the general population in Denmark. We used logistic regression analyses to compare data from 88 women working in brothels in 2010 with data from 3,225 women of similar age from the nationally representative Danish Health Survey 2010. Compared to Danish women, the prevalence of daily and heavy smoking was higher among brothel workers, but the prevalence of wanting to quit smoking was lower. The prevalence rates of exceeding the Danish high-risk level of alcohol consumption, binge drinking, and illicit drug use were higher among women brothel workers compared to Danish women. The prevalence of underweight was higher and overweight and obesity lower among brothel workers compared to Danish women. These differences were significant when adjusted for age and educational level. We noted few differences regarding dietary habits and no differences regarding physical activity. Our findings suggest the need for health promotion initiatives, particularly for smoking, alcohol consumption and drug use, targeted at women brothel workers.
    No preview · Article · Oct 2015 · Women & Health
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