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Premium member Presentation Transcript Sex Worker Health, San Francisco Style: The St. James Infirmary: Sex Worker Health, San Francisco Style: The St. James Infirmary Deborah Cohan, MD¹, Charles Cloniger, FNP², Johanna Breyer, MSW³, Cynthia Cobaugh³, Jeff Klausner, MD, MPH² ¹UCSF Department of Obstetrics andamp; Gynecology ² San Francisco Department of Public Health ³St. James Infirmary What Is Sex Work?: What Is Sex Work? 'Provision of sexual services or performances by one person (prostitute or sex worker) for which a second person (client or observer) provides money or other markers of economic value' Priscilla Alexander, Sex Work and Health: A Question of Safety in the Workplace in JAMWA vol 53, no. 2. St. James Infirmary History: St. James Infirmary History Call Off Your Old Tired Ethics 'COYOTE' Exotic Dancers Alliance San Francisco DPH STD Unit University of California, San Francisco Clinic goals: Clinic goals Non-judgmental, peer-based health care Comprehensive health care HIV, STI, Hepatitis counseling and testing Primary Care Integration of medical and social services Health education to sex workers Community education about sex workers Community building Job training Research Services: Services Primary and urgent care HIV/Hepatitis/STI/TB counseling and screening STI treatment Immunizations Acupuncture Massage, Reiki therapy Peer Counseling Support Groups Art Therapy and Creative Writing workshop Other Services and Activities: Other Services and Activities Clothing Food Bank Career counseling and training Lifeprint Career Services HIV counseling andamp; testing training for sex workers Outreach to strip clubs, massage parlors, stroll districts, hotels Community speakers bureau Medical student elective Funding: Funding San Francisco Department of Public Health, STD Prevention and Control Unit UCSF Dept of Obstetrics/Gynecology The California Endowment The San Francisco Foundation The Ford Foundation UCSF AIDS Research Institute American College of Traditional Chinese Medicine Patient Recruitment: Patient Recruitment Word of mouth 37% Outreach 29% Referrals 16% Pre-trial diversion 8% Media/advertising 8% Psychosocial Intake : Psychosocial Intake 1059 total encounters June 1999-June 2001 Intake started Sept 1999 231 current or former sex workers Peer Intake Counselors Demographics Work history Prior health-care access Drug Use History Domestic and Occupational Violence Demographics: Demographics Gender 62% female, 25% male, 11% MTF TG, 2% FTM TG Age Median 31 years (range 17-76) Ethnicity 63% Caucasian, 13% Asian/Pacific Islander, 11% Latino, 7% African-American, 6% Mixed/Other Education 62% some college or more 28% some high school or degree 10% grade school Other Characteristics: Other Characteristics Housing 70% stable housing 30% unstable housing/homeless Social Network 53% with family contact; 47% without 36% with children 60% not living with children 33% with no social network Legal History 24% arrested 63% solicitation Sexual Identification: Sexual Identification Work History: Work History Health Care Access: Health Care Access Last visit to provider 79% within 1 year 9% 3+ years ago Disclosure to provider 60% never, 25% sometimes, 15% always Reasons for not disclosing 36% afraid of disapproval, 54% didn’t think relevant, 10% both reasons Provider’s reaction 57% 'fine' 43% 'mixed' or 'negative' 29% requesting mental health care Drug Use: Drug Use Overall illegal drug use 59% 20% amphetamines 19% cocaine/crack 15% hallucinogens 10% heroin 16% IDU 27% of IDU share needles/works 10% current IDU partner 36% past IDU partner 40% tobacco use Violence: Violence 35% past/current Domestic Violence 53% past/current Occupational Violence Customer 32% Employer 20% Police 15% 3% reported cases to police Medical Intake : Medical Intake June 1999-June 2001 699 clinical encounters Mean visits per client = 2.5 (range 1-34) Sexual history HIV and STI results Sexual HistoryMean # Partners in Past Year: Sexual History Mean # Partners in Past Year Condom Use: Condom Use % Patients Reporting Pattern of use 49 37 14 48 31 21 44 37 19 15 27 58 Condom Use during Last Sex: Condom Use during Last Sex Main partner (n=84) 68% no condom 30% condom Non-intimate partner (n=24) 29% no condom 67% condom Sexually Transmitted Infections: Sexually Transmitted Infections HIV 0.2% (1/90) Chlamydia 0.8% (2/259) Jail Chlamydia Study, n=604 women 11% sex workers vs. 9% non-sex workers (pandgt;0.05) Gonorrhea 1.6% (5/320) NGU 10% (11/108) Abnormal pap smear ASCUS 2% (2/98) LGSIL 1% (1/98) LCR/culture negative PID 0.4% (2/507) Syphilis 0% (0/199) Challenges and Limitations: Challenges and Limitations Municipal STI clinic Limited staff/volunteer ethnic diversity Near Hall of Justice Medical intake not sex worker-specific Not generalizable Attrition of sex worker volunteers Stigma of sex work and funding options Conclusions: Conclusions Diversity in sex worker community High prevalence of workplace violence High prevalence of drug and tobacco use Risky behavior with intimate partners Health problems broader than just STI/HIV Importance of community involvement www.stjamesinfirmary.org Future Goals: Future Goals HIV testing service run by sex workers Mobile, van-based health care Massage parlor licensing run by DPH STI/HIV testing in strip clubs, porn sets, massage parlors, street corners and hotels Independent location Increase service hours Conduct ethical, collaborative research on sex workers Remaining Questions: Remaining Questions Political ramifications of scientific research? Does criminalization discourage safe sex practices or facilitate violence? Role of public health community in addressing these issues? Acknowledgements: Acknowledgements St. James Infirmary staff and volunteers Johanna Breyer, Exotic Dancer’s Alliance Jeff Klausner Lyn Fischer Margo St. James, COYOTE Priscilla Alexander, FROST’D Bob Kohn STD Prevention and Control Division City Clinic staff You do not have the permission to view this presentation. In order to view it, please contact the author of the presentation.
SW Health SF Style GenX Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 419 Category: Entertainment License: All Rights Reserved Like it (0) Dislike it (0) Added: August 11, 2007 This Presentation is Public Favorites: 0 Presentation Description No description available. Comments Posting comment... Premium member Presentation Transcript Sex Worker Health, San Francisco Style: The St. James Infirmary: Sex Worker Health, San Francisco Style: The St. James Infirmary Deborah Cohan, MD¹, Charles Cloniger, FNP², Johanna Breyer, MSW³, Cynthia Cobaugh³, Jeff Klausner, MD, MPH² ¹UCSF Department of Obstetrics andamp; Gynecology ² San Francisco Department of Public Health ³St. James Infirmary What Is Sex Work?: What Is Sex Work? 'Provision of sexual services or performances by one person (prostitute or sex worker) for which a second person (client or observer) provides money or other markers of economic value' Priscilla Alexander, Sex Work and Health: A Question of Safety in the Workplace in JAMWA vol 53, no. 2. St. James Infirmary History: St. James Infirmary History Call Off Your Old Tired Ethics 'COYOTE' Exotic Dancers Alliance San Francisco DPH STD Unit University of California, San Francisco Clinic goals: Clinic goals Non-judgmental, peer-based health care Comprehensive health care HIV, STI, Hepatitis counseling and testing Primary Care Integration of medical and social services Health education to sex workers Community education about sex workers Community building Job training Research Services: Services Primary and urgent care HIV/Hepatitis/STI/TB counseling and screening STI treatment Immunizations Acupuncture Massage, Reiki therapy Peer Counseling Support Groups Art Therapy and Creative Writing workshop Other Services and Activities: Other Services and Activities Clothing Food Bank Career counseling and training Lifeprint Career Services HIV counseling andamp; testing training for sex workers Outreach to strip clubs, massage parlors, stroll districts, hotels Community speakers bureau Medical student elective Funding: Funding San Francisco Department of Public Health, STD Prevention and Control Unit UCSF Dept of Obstetrics/Gynecology The California Endowment The San Francisco Foundation The Ford Foundation UCSF AIDS Research Institute American College of Traditional Chinese Medicine Patient Recruitment: Patient Recruitment Word of mouth 37% Outreach 29% Referrals 16% Pre-trial diversion 8% Media/advertising 8% Psychosocial Intake : Psychosocial Intake 1059 total encounters June 1999-June 2001 Intake started Sept 1999 231 current or former sex workers Peer Intake Counselors Demographics Work history Prior health-care access Drug Use History Domestic and Occupational Violence Demographics: Demographics Gender 62% female, 25% male, 11% MTF TG, 2% FTM TG Age Median 31 years (range 17-76) Ethnicity 63% Caucasian, 13% Asian/Pacific Islander, 11% Latino, 7% African-American, 6% Mixed/Other Education 62% some college or more 28% some high school or degree 10% grade school Other Characteristics: Other Characteristics Housing 70% stable housing 30% unstable housing/homeless Social Network 53% with family contact; 47% without 36% with children 60% not living with children 33% with no social network Legal History 24% arrested 63% solicitation Sexual Identification: Sexual Identification Work History: Work History Health Care Access: Health Care Access Last visit to provider 79% within 1 year 9% 3+ years ago Disclosure to provider 60% never, 25% sometimes, 15% always Reasons for not disclosing 36% afraid of disapproval, 54% didn’t think relevant, 10% both reasons Provider’s reaction 57% 'fine' 43% 'mixed' or 'negative' 29% requesting mental health care Drug Use: Drug Use Overall illegal drug use 59% 20% amphetamines 19% cocaine/crack 15% hallucinogens 10% heroin 16% IDU 27% of IDU share needles/works 10% current IDU partner 36% past IDU partner 40% tobacco use Violence: Violence 35% past/current Domestic Violence 53% past/current Occupational Violence Customer 32% Employer 20% Police 15% 3% reported cases to police Medical Intake : Medical Intake June 1999-June 2001 699 clinical encounters Mean visits per client = 2.5 (range 1-34) Sexual history HIV and STI results Sexual HistoryMean # Partners in Past Year: Sexual History Mean # Partners in Past Year Condom Use: Condom Use % Patients Reporting Pattern of use 49 37 14 48 31 21 44 37 19 15 27 58 Condom Use during Last Sex: Condom Use during Last Sex Main partner (n=84) 68% no condom 30% condom Non-intimate partner (n=24) 29% no condom 67% condom Sexually Transmitted Infections: Sexually Transmitted Infections HIV 0.2% (1/90) Chlamydia 0.8% (2/259) Jail Chlamydia Study, n=604 women 11% sex workers vs. 9% non-sex workers (pandgt;0.05) Gonorrhea 1.6% (5/320) NGU 10% (11/108) Abnormal pap smear ASCUS 2% (2/98) LGSIL 1% (1/98) LCR/culture negative PID 0.4% (2/507) Syphilis 0% (0/199) Challenges and Limitations: Challenges and Limitations Municipal STI clinic Limited staff/volunteer ethnic diversity Near Hall of Justice Medical intake not sex worker-specific Not generalizable Attrition of sex worker volunteers Stigma of sex work and funding options Conclusions: Conclusions Diversity in sex worker community High prevalence of workplace violence High prevalence of drug and tobacco use Risky behavior with intimate partners Health problems broader than just STI/HIV Importance of community involvement www.stjamesinfirmary.org Future Goals: Future Goals HIV testing service run by sex workers Mobile, van-based health care Massage parlor licensing run by DPH STI/HIV testing in strip clubs, porn sets, massage parlors, street corners and hotels Independent location Increase service hours Conduct ethical, collaborative research on sex workers Remaining Questions: Remaining Questions Political ramifications of scientific research? Does criminalization discourage safe sex practices or facilitate violence? Role of public health community in addressing these issues? Acknowledgements: Acknowledgements St. James Infirmary staff and volunteers Johanna Breyer, Exotic Dancer’s Alliance Jeff Klausner Lyn Fischer Margo St. James, COYOTE Priscilla Alexander, FROST’D Bob Kohn STD Prevention and Control Division City Clinic staff