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.

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Available from: Alexandra Lutnick, Feb 24, 2014
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    • "This setting may be a venue for identifying and engaging this hard-to-reach population for clinical and social services. To date, physicians report feeling inadequate in responding to the needs of those in sex trade [23], and those involved are often reluctant to initiate disclosure [24]. Prior research with women in street-based prostitution indicates that sensitive acknowledgment of sex trade seems to be both acceptable and welcomed [14], and stigma and fear of judgment can pose barriers to accessing needed services and obtaining follow-up care [14] [16]. "
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    • "The majority of staff are former or current sex workers and services encompass comprehensive biological, psychological and social care (Cohan et al. 2006). A study looking at the characteristics of sex workers accessing care at SJI found that the majority of participants had never previously disclosed their sex work involvement to health professionals (Cohan et al. 2006). In lieu of experiential staff, sensitivity training of health care professionals could also improve the acceptability of sex work and sex workers health care needs, resulting in a more welcoming environment and a higher uptake of services (Rekart 2005). "
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